Random thoughts on pharmacy, among other things

I spent a few hours on a plane today. I do all kinds of things when I’m stuck on a plane. I used to work, but that got old after a while. Now I play games, read for pleasure, listen to music, or simply think. Today was a thinking day. I tried playing a game, but my mind was fixated on other things. It’s quite irritating when that happens as I’d rather play games. Anyway, today my mind was focused on pharmacy, which is nothing unusual. I think about pharmacy a lot. Here are some of the things that are floating around my mind:

– I’ve been masquerading as a product manager for almost two years now. Two years ago, almost to the day, I left the confines of hospital pharmacy and decided to try my hand at something else. I’ve been reflecting on what I’ve accomplished in those two years. And? Well, from what I can recall I haven’t done dick. I can’t recall a two year span in my career where I’ve done less.

– I’ve been in many pharmacies during the past two years. The pharmacies I see today are the same as the first ones I saw two years ago. In other words I haven’t seen a change. That’s bad, really bad.

– Pharmacy practice remains a big pile of silos. An acute care silo, an ambulatory silo, a long-term care silo, and so on. Until we shatter those silos things will fail to improve.

– What ever happened to the PPMI from ASHP? I know that some hospitals made changes based on the recommendations, but I haven’t heard anything in a long time. Did the movement come to a halt? I could be that I’m just out of touch. I let my ASHP membership lapse this year, which means I don’t receive AJHP anymore.

– Why isn’t the government asking pharmacists and technicians how to fix things? I suppose people in suits that have never worked in a pharmacy know better. It’s the only explanation. Meaningful use is about everything, but the pharmacy. Yeah, yeah, I know, there are a few things in there that have to do with pharmacy, but in the overall scheme of things pharmacy is an afterthought.

– If you’re waiting for some company that makes pharmacy products to fix your problems, or for a consultant to tell you how to fix them, don’t bother. It’s not their responsibility, it’s yours. Companies that make products for your pharmacy are doing it to make money, not improve your circumstances. They’re like prostitutes. They give you what you want, and are willing to pay for, not what you need to improve your life. The things pharmacies need to provide better healthcare for patients will come from the trenches. Not to say that you don’t need their products, because you do. But let’s face it, a lot of the pharmacy automation and technology out there is crap. It’s ok to say it. I’ve worked with a lot of it during my career, and I can’t recall a time when someone said, “Wow, this is perfect”. Compare that to consumer technology today. I can do more with my Chrome browser than I could with my old Pharmacy Information System. No joke. Know what the kicker is? The browser is free.

– Companies that make products for pharmacies need to hire pharmacist and pharmacy technicians; lots of them. Why? Because they know what’s needed. How many products do you know of that started out in the pharmacy of some hospital before it was purchased by some company for mass production? I can think of several. We need more of that.

– Pharmacy departments should give personnel time to work on projects to improve operations, patient care models, etc. Call it the Google employment model if you will. One month a year? Research time with a University? Internship with a technology company?

– For the first time in history the people working in pharmacies are as tech savvy as those building the technology. The current generation of pharmacists and technicians have been raised with technology as part of their lives. Cell phones, computers, tablets, streaming video and music, cloud storage, fitness trackers, and so on. This means they know when you’re lying to them about how something works.

– Why aren’t pharmacy directors, operations managers, etc worried about providing better pharmaceutical care? Because they’re all worried about money and regulatory requirements. I’ve talked to a lot of pharmacist in the last few months and topics of conversation are centered on how to leverage the gray areas of pharmacy to make money (340b, contract pharmacies, etc), and how to cover their butts in case there’s a site survey of some kind. None have mentioned improved clinical services, increased pharmacy presence among medical teams, or better patient care. Odd, don’t you think? I have this strange notion that if we, as a profession, provide great patient care then the rest will work itself out. Naïve? Maybe.

– I find it interesting that the most dangerous place in the pharmacy is the IV room, and it is the most overlooked. Think NECC would like to go back in time and change their process a bit? Probably. It boggles my mind that hospital pharmacies aren’t screaming for better technology in the IV room. But then again, people aren’t worried about that. See thought above.

– Retail pharmacies shouldn’t exist. Think about it. Is there a worse place to provide a patient with proper consultation and medication education? No, not likely. “Thanks for the information on Jonny’s amoxicillin, now shut up and ring up my milk. I need to get home.” I’ve worked retail pharmacy. People hate you because it takes longer than 30 seconds to fill their script, you’re the face of the insurance company, and they missed the sale on canned tuna. There has to be a better way.

– While we’re on the topic of retail pharmacies, why do pharmacists work in that environment? I’ve tried it. In fact I’ve tried it three times in 15 years. Never lasted more than a few months. Retail pharmacies have absolutely nothing to do with patient care.

– I’ve read a lot about medication adherence lately. It’s a hot topic. Non-adherence costs the United States healthcare system billions of dollars each year. Yes, billions with a ‘b’. Why haven’t we fixed it? Every pharmacist with more than 5 years in the trenches can tell you how. Really. It’s easy, but no one wants to do it because it’s expensive and labor intensive. Crud, my credit card company does a better job of letting me know how I spend my money then healthcare does letting people know how well their managing their medication regimen. Which is more important? That’s actually debatable, but you know what I mean.

– Speaking of medication adherence, who should be held accountable? Honestly, if everything is done correctly by the healthcare system, i.e. med reconciliation, education, consultation, procurement assistance, etc., then the patient should be held accountable. You can’t force someone to take a medication if they choose not to.

– Why don’t pharmacists follow patients like physicians? In regards to continuity of care it makes sense. A pharmacist should review a patients medications at every step. Common sense, people. Common sense.

– The profession of pharmacy needs some zealots. You know what I mean, evangelists that hype the profession even though people know they’re completely full of crap. If you say something loud enough and long enough people will start to believe it. I think business people call it marketing.

– The profession of pharmacy needs pharmacy directors that are willing to take chances with their practice environment. Willing to thumb their nose at “regulatory requirements” and simply build a system of better patient care. It’s never going to happen because everyone is afraid of the potential consequences.

– Why don’t hospitals and vendors partner with Colleges and/or Universities to improve healthcare? I’ve been thinking about this a lot lately. I live in Fresno. There’s nothing glamorous about that, but we do have a couple of Universities here: California State University Fresno and Fresno Pacific University. We also have several hospitals here in Fresno: Kaiser, Children’s Hospital Central California, St. Agnes Medical Center, Veterans Administration, and Community Regional Medical Center – Fresno. There are several more within a 50 mile radius of Fresno. Not to mention the ambulatory clinics, dialysis centers, urgent care centers, and so on. There should be some type of collaboration for research. There’s a tremendous opportunity here, and we’re ignoring it. I’ve been trying to figure out how to jump start something for several months, but can’t quite get my crap together.

– Is it possible to completely automate a pharmacy? Yes, it is possible. The technology is available in the world, but unfortunately not available for pharmacy. Automatically assemble a car? Yes. Automatically pull a med and deliver it to a patient without human assistance? No. Until we get to that point we’re stuck in neutral.

– Why do pharmacists still work in operations? To the best of my knowledge I don’t think you need a Pharm.D. to pull a med from a shelf or make sure the name on the drug label matches the name of the drug on the patient label, i.e. acetaminophen and acetaminophen.

– Boards of Pharmacy are obsolete in their current state. They create more chaos than orderly practice. It’s mostly bureaucratic red tape these days.

There’s more, but I’m starting to ramble. That’s when I know it’s time to stop.