On further searching I came upon another site, this one ranking the top 50 pharmacy blogs in the blogosphere. If you take a glance at this list you will notice one interesting pattern in the blog titles. I already alluded to this above, but to clarify many of these blogs have the word Pharmacy or Pharmacist in the title combined with some colorful adjectives. Some examples include angry, angriest, frantic, slave, pissed, soul-sucking, and politically incorrect. I wish many of my naive peers in pharmacy school would take a look of some of these blogs to get an idea of what they are potentially getting into as pharmacists. In all seriousness, these bloggers make pharmacy seem like a profession heading downhill hell.

I work in retail pharmacy so I can at least empathize with these bloggers’ experiences, but at the same time what are they (we?) contributing to the profession by being cathartic? I presume they are professional on the job so why don’t they reserve that same professionalism for the Internet? After all, their postings aren’t private by any means and they should be well aware of this if they aren’t already.

As I’ve suggested before, community pharmacy often seems like a rat race for pharmacists, so my concern really isn’t with pharmacy bloggers ranting and raving, but that they do it so often. If your work environment is that oppressive, most of the time it’s perfectly within your ability (as a competent graduate of a professional school) to change your situation, change your employer, or adapt and shut-up. It’s not good for your health to miserably endure said circumstances (ironically we’re supposed to be healthcare practitioners).

At some point you have to stop whining about stupid patients/customers. Yes, they are a fact of life when you interact with the public. But what did you expect getting into a profession involving sick people and their pursuit of anything that might bring normalcy and health back into their lives? To make things worse, community pharmacists basically police the distribution of controlled substances to the public. Then again, the real problem is much bigger than pharmacists.

If anything, we need to stop reciprocating aggression we may receive from patients and address the underlying causes of unhappiness in the pharmacy workplace. When the company model is based on a fast-food franchise, emphasizing the convenience of drive-thru windows and drugs priced cheaper than value meals, people start treating the pharmacy staff like their highschool-age McDonald’s counterparts. When you offer medication counseling as the equivalent to a packet-of-ketchup (in other words, for free), you’re selling yourself short and people start treating you as such.

As my high school history teacher used to say: move, adapt, or die. I would add: use your education and experience to make your professional life more hospitable.

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That privilege usually goes to non-pharmacy managerial types with little understanding of the work process in community pharmacy and with even less sympathy for pharmacists’ methods. Of course, there are exceptions to this generalization and there are also pharmacists who know how to negotiate with their employers in order to receive basic amenities (such as restroom breaks, lunch periods, etc). Regardless, community pharmacists haven’t had a unified voice in these matters for a long time.

The story of the modern era is largely about accomplishing goals by getting people together to enact change. In the case of pharmacy there are several professional organizations who identify themselves with precisely this task: being the voice of pharmacists. At least a few people are taking the APhA to task for their lack of attention on the workplace dilemmas that plague the average pharmacist. Instead the APhA is working on the future of pharmacy. Are they to blame? No, the APhA is redefining what it means to be a pharmacist. However, their tunnel vision is preventing them from addressing today’s problems, so maybe they should pass on the mantle for being the premier association for pharmacy professionals.

There are other organizations that pick up where the APhA has dropped the ball. Some are well-established and others are grass-roots ventures striving towards a better reality.

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A pharmacist is not required to notify the patient of the change (from brand name to generic), although some choose to do so.

Technically, the statement is correct. At the same time, it is implying that pharmacists are at least partially to blame for the confusion regarding generics because they are not legally required to counsel on generic substitution. Consider the following scenario though: Your doctor writes you a prescription for an antibiotic. You want to get over this infection quickly, so you head to the nearest drugstore and get your prescription filled. As the cashier gives you your receipt, he also asks if you have any questions for the pharmacist. You think about this for a quick second. You think that you remember enough of what your physician told you to take the medication correctly. Plus, the medication comes with a safety guide which has the directions printed on it in case you forget. You opt out of the free counseling session and head home. If you had spoken to the pharmacist you would have been notified that you were receiving a generic drug.

Obviously the situation is more complicated than, “oh the pharmacist is too lazy to counsel.” In fact, there are lazy pharmacists out there, I myself (like all technicians) having worked with some before. The vast majority; however, make an earnest effort to counsel, but may be genuinely predisposed, or the patient might decline being counseled as in the above scenario.

On the other hand, why would a patient decline free medication counseling? Where else can you find an expert in medication therapy providing free advice? You might argue that pharmacist counseling isn’t actually free and that the fee is covered by the cost of the prescription. What about when a patient asks for a recommendation on an over-the-counter medication? Counseling is virtually a pro bono affair compared to getting advice from other professionals (lawyers for example).

There are two issues at play here. Can generic medications be dispensed in place of brand name medications? If so, what is the responsibility of the pharmacist in alerting the patient to this switchover?

Based on my pharmacy technician experience, I used to think that generic substitution was a straightforward affair. When patients asked me why they should buy generic pseudo-ephedrine (Sudafed) versus the brand name stuff, I would answer that they were chemically identical. They would protest that that couldn’t be all there was to it, and I would continue explaining that the tablet would appear different because of different inactive ingredients which comprise the “fillers.” For a complete answer though I defer to the Food and Drug Administration.

It might help to better appreciate counseling from pharmacist perspective if you actually see how pharmacists counsel. This is actually something I learned in the very first semester of pharmacy school because counseling is central to the pharmacy profession. Counseling consists of three major questions. All three questions are open-ended and phrased to determine what you, as the patient, remember from talking to your physician:

1. What did the doctor tell you this medication is for? Translation: Let me tell you the name of the medication, its strength, whether it’s brand or generic, and explain exactly what the drug is used for.
2. How did the doctor tell you take the medication? Translation: Let me tell you about the drug dose such as how much of the medication you will be taking and how often.
3. What did your doctor tell you to expect? Translation: Let’s go over side effects, drug interactions, and any drug allergies you might have.

The format of these questions is not cut and dry and will differ from one pharmacist to another. Knowing the questions will be helpful as a patient (which we all are at some point) because they allow us to anticipate when to voice our concerns so the pharmacist can tell us what we want to know and more importantly what we need to know.

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