New Environment
Not long after I got my results, I moved on to Lake Regional Health System. Outside of my pharmacy rotations, it was the best place I ever practiced pharmacy. The providers were much more accepting of pharmacist recommendations there and I generally felt more useful. However, much of that same problem still arose. Oftentimes, I was comforted by the fact that on rounds, my physician colleagues did seem to truly consider and weigh my recommendations, even though they had a higher rejection rate then I would have preferred. But, at Lake Regional, the disagreements were far less often fundamental or likely to result in patient harm. It usually in situations in which it was truly more of a matter of opinion or preference rather than an objective truth.
At Lake Regional I was in a supervisory capacity, which I enjoyed. I like troubleshooting issues and being Mr. Fix It. It’s not that order verification or dispensing isn’t important, it absolutely is, but I never felt like I was really doing what I was good at when I worked those stations. I started to find myself saying to my subordinate pharmacists, “I know it’s not right. Just make the recommendation and document it. You tried, that’s all we can do.”
“Try” is all we can do.
No one has to listen to a pharmacist. Or, maybe no one listens because pharmacists don’t exercise their authority to deny filling a prescription often enough. Pharmacists have too often been focused on keeping their job or keeping the peace to ever risk alienating a prescriber by flatly denying to fill a prescription. During the hydroxychloroquine hysteria of 2020, pharmacists across the country denied prescriptions for the drug when it was prescribed off label and without evidence to treat or prevent COVID-19. Physicians and even medical associations across the country decried this as pharmacists “practicing medicine without a license” and threatening to sue, even as pharmacists stood with their Boards of Pharmacy at their backs supporting them. HCQ was a no brainer. It did not work, it still doesn’t work, and there was real evidence of serious potential harm with the treatment. Pharmacists who denied prescriptions for it were performing one of the most basic duties of a pharmacist; to do no harm.
Fast forward to a year later and ivermectin is the new craze. There is no evidence of efficacy for this drug either, and so prescribers and patients desperate for a treatment that isn’t a vaccine rushed to prescribe it. Some pharmacists denied prescriptions, but most are going through. Why? Neither treatment was effective!
The difference is this: ivermectin is safe, at least relative to HCQ. It goes back to the rule about what recommendations are worth making when you’re a pharmacist. Only the most egregious mistakes are worth correcting. HCQ could certainly kill people, and most pharmacists will not allow a physician to cross that line. Ivermectin, though it doesn’t work, is unlikely to result in death, at least if used within somewhat normal parameters. Because of that, it doesn’t rise to the level of an egregious mistake, and so it passes.
This leads to a world as a pharmacist where the warning lights are going off constantly, but the plane keeps flying. It’s only when the pilot dips the nose down or stalls the plane that the warnings are finally heeded, at which point the mistakes are so obvious or egregious that it’s almost insulting that it needs to be pointed out.
“Of course the plane is going to crash if you fly into the side of the mountain… why do you need me to tell you that? And why are you still arguing with me about it? Pull up!”
The thing is, medicine is a complicated and nuanced science, and despite my diatribe it is possible to have legitimate disagreements on the proper course of treatment between two or more professionals. I think, after 7 years in the profession, I finally realized that my desire for more control over the situation and my narcissistic impulse of thinking I know best DOES indeed make me a bad pharmacist. You simply can’t have those thoughts and work in the field. It’s not how it’s designed. Pharmacists are NOT the Air Traffic Controllers of the Medical Field. The are the overeducated backstops saving you from disaster and preventing disease with immunizations. They are the most poorly utilized health professional. They train for a job that does not exist, in a healthcare system that would rather see them go away or at least be quiet. If CVS gets their way, there won’t even be a pharmacist in your local pharmacy, just some robots and a cashier. Oh, by the way, #pizzaisnotworking.
Our communities need to rally around these brave #pharmacists. As many businesses are working short-handed during the pandemic, retail pharmacists were shorthanded many years before this pandemic. #IWantMyPharmacistToHaveMoreThanPizza #pizzaisnotworking https://t.co/mupHiHtMnX
— Loretta Boesing (@BoesingLoretta) August 30, 2021
This all leads back to why my job today is perfect for me. I have a reasonable degree of autonomy. I get to continue doing my most favorite thing about pharmacy (vaccines and disease prevention). I get to work on marketing and public relations. I give presentations. I negotiate. I lead. I mediate. I make scientific and informed decisions. I share medical information. I feel like I make a difference. I feel like I matter.
I feel like what I do matters every day. When I was a pharmacist, I was lucky if I had one of those days per month.
I don’t necessarily think that pharmacy was a bad career choice for me. But pharmacy in the early 21st century was. I thought I was happy at Lake Regional, and I was, to an extent, but my disillusionment with the pharmacy profession was more deeply entrenched than I realized. And it only took leaving the profession to finally understand that.
