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Who wants to vote that the Drive-Through is a Professional Disaster?

June 13th, 2012 by Jim Plagakis

Whoops, I typed PHARMACY Drive Through

I do not like the drive-through. I hate it when the customer (I hesitate to say ‘Patient’) is driving a 1995 Cadillac and refuses to turn off the engine. Noxious fumes come wafting into the pharmacy and I have to breathe that crap. I am so damned prejudiced against slovenly, obese people wearing sweaty wife-beaters and eating a triple burger from Whataburger that I want to puke. When I look at the woman in the passenger seat and see hefty left arm with multiple tattoos, I think bad thoughts that are hardly generous and loving. That hefty arm is usually attached to an obese example of lost and forgotten feminine pulchritude. The children in the back are fighting and the best example of parenting comes from the driver. ”Shut the !**@! up or I will break your !**@!’ head.” He looks to the woman. ”It’s your !**@!’ fault. You refused to get abortions.” The prescriptions are for Norco-10 and carisoprodol 350.

This essay is not about that. I hate it when anyone uses the drive through when they do not have to. I commend the company I work for. It is okay to tell a pissed-off-because-she-has-to-wait-5-minutes well dressed, fit woman. ”Ma’am, the drive through is NOT an Express Lane. It is a convenience. There are people in the store who have been waiting for 20 minutes. I am going to get them first.” This happens usually on Friday evenings when is just me and the technician.

I hate it when there is a car that refuses to “drive around” and waits for the order to be ready. Actually, I do not hate that. I really hate it when car number three finally makes it to the window and the !**@! blames me because she had to sit and wait. I have never said this, but my 60 year old, tall, imposing male tech has, “This is not McDonald’s. The pharmacist gives every prescription his full attention. It takes a little time.”

I will not serve anyone who walks up to the drive through window. They could get run frikkin’ over, standing there. ”Get out of here. You could get frikkin’ run over by some idiot on a cell phone. Come in the store.” If they argue. ”The company’s insurance does not cover you getting run over.” Back to work. If I hear horns honking, the idiot is still standing there. The drama of the drive through.

I gave my male tech trouble a few weeks ago when he went out front for an OTC item for a drive through customer. Company training stipulates that we DO NOT get OTC items. It takes too long. I watched him return with a bottle of APAP 500mg. After he sold it, I jumped him. As usual, the way I do things, I forged ahead. Will I ever learn? ”Come on, Jim. Have a heart. She is a good customer and she is on crutches.” What could I say? ”Oh, sorry for jumping you, Tom.”

None of that is my purpose in writing this. My real purpose is to start a discussion about how the drive through puts the patient in danger because pharmacists cannot live up to our duty to warn adequately using a intercom system that may be decades old, compromised by moisture. There is a barrier. We are removed from the patient or the caregiver. We cannot show them the pills. We cannot demonstrate how an albuterol MDI is used. If the patient is a child and it is the first ever MDI, how can you do your job? If the Rx is for a tapered dose of prednisolone 15mg/ 5ml. How can you explain dosing when the young mother is on the frikkin’ phone.

The drive through is a death trap, potentially.

I have no problem having the technician tell the patient or caregiver that I want them to come into the store, to the consultation window. The technician knows that when I want them inside, we will ring the Rx up inside. The interesting aspect of this is that almost 100%, they take the counseling seriously. I can see the wheels turning: This must be really serious if he is making me come inside.

Suck it up. You are the pharmacist. It is always your call.

If the non-pharmacist store manager gets pissed, do what Pharmacisst Steve has been recommending for over a year. Write a letter to the store manager asking for clarification. Send a copy to the Pharmacy District Manager and (most important) to the Chief Compliance Officer. The COO is the company’s cop. It is his ass if laws are broken. No one wants the COO in the loop. Write something like this.

During our conversation last week, you demanded that I do not ask for a prescription patient to leave the drive through and come into the store so I can adequately counsel. I make the request to have the patient (or caregiver) come into the store when the counseling is sufficiently complicated that I am not confident that counseling over the intercom is adequate. Please confirm your orders to me in writing. I want to remind you that there is a legal mandate that pharmacists counsel. If you presume that you can tell me not to counsel or how to counsel, I will take exception. I have always been an effective and loyal employee of 3 P X. When I am the pharmacist on duty, I am the only authority in the pharmacy. My call will stand. You might want to discuss this matter with the company’s Chief Compliance Officer. In the meantime, mind your own business and stay out of the pharmacy.

If you really want to stir the crap, send copies to the Board of Pharmacy in your state and also to the Attorney General.

After sending this letter Certified/Return Receipt, you will probably be protected by the company’s (also legal) non-retaliation policy. Goooo Fooor It.

Once again, I believe that the Oregon Board of Pharmacy is on a roll. When they look at the intrinsic dangers of failing to warn simply because of the physical barrier, the Oregon BOP will be the first to ban the drive through.

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