“Oh, you’re just being difficult!” As a pharmacy manager, I got that a lot. I always felt my pharmacy department was treated like second-class citizens. We were the ones that always had to compromise. We had to change the way we did things to make others happy. The pharmacy always had to give in.
Sometimes giving in puts us in violation of the rules— either federal, state or internal (so in these instances, we didn’t do it). But most times, my pharmacy was expected to bend the rules in order to accommodate others.
Often, when we objected, the pharmacy was seen as the bad guy. We were not team players. We’d hear comments like, “Oh, you’re just being difficult!” Why couldn’t we be helpful, and do just this one little thing that somebody wanted?
I’ll admit, it was hard to say “no.” but sometimes, we had no choice. Here are some of those times:
“Can I have some free medication?” I’d never go to the central supply and ask for an elastic bandage for my sore leg. I’d never go to the speech and audiology department and ask for free batteries for my hearing aids. But I have had hospital employees who came to the Pharmacy and asked for [free] antacid liquid or [free] acetaminophen tablets. What’s more, these employees had a preconceived notion that they were entitled to these items. especially since they worked in the hospital.
“I’m sorry,” I often said. “ We’re not that kind of Pharmacy. I cannot sell you these items.”
A look of confusion usually appeared on the face of the employee upon hearing my remarks. These people were expecting that I would simply give them these medications. They were even more horrified that I was expecting payment for them.
Quite often, the employee said, “I don’t know what the big deal is! Why can’t you just give me these meds? And why should I have to pay for them?!”
I did not give the employee these items— free or not free. They always stormed away— quite upset.
I knew why this occurred. Most times, the employee went up to their boss. The employee told their boss that they were not feeling well. Rather than sending the employee to employee health (and possibly having them sent home), their boss sent the employee to the pharmacy. Hopefully, the pharmacy could give them “free” medication, and then they could return to work! The pharmacy did not give out “free” or “not free” medications to employees.
“I forgot to take [or bring] my prescription medications this morning. Can you give me some?” This situation is similar to the previous section, but with a slight twist.
In this case, the employee came to the Pharmacy asking, “Could I have a couple of Amoxicillin 500 mg capsules (a prescription medication)? “
In addition to the usual comments as to why the Pharmacy couldn’t supply the employee’s medication, free or otherwise, there were other issues with this request. There were problems, such as the fact that our pharmacy had no prescription on file for this person’s medication. Also, the pharmacy had no medication profile for this employee. Thus, my pharmacy couldn’t determine any possible allergies or drug interactions that might occur.
However, I always found the proposal that my pharmacy gives out “free” medication to be quite distasteful. Yet the majority of employees were annoyed and quite offended that I couldn’t give them a couple of pills.
What if I went into the employee cafeteria and claimed that I had forgotten to bring my can of soda on that particular day? Now imagine if I requested a free soda. Would I get one? Of course not.
What if I went into the gift shop and said that I had forgotten to bring in my newspaper that day? But I expected to get one for free. Would I receive a free newspaper? No.
But many employees felt that it was their right to obtain free medications (prescription and over-the-counter) from my pharmacy. And many were irritated that I had the audacity to even suggest charging them for these medications.
“ I need you to fill a prescription for a patient who’s going home.” I was called to the office of my vice president. My vice-president was a medical doctor. A college student was a patient in our hospital. He had gotten ill while he was in school and was rushed to our hospital. He spent several days recovering. My hospital wanted to discharge him early, before the weekend. He was flying back to Atlanta on Friday afternoon.
They wanted to give him a controlled substance for pain upon discharge. They wanted my pharmacy to fill the prescription. I said nothing as I stared at my vice president. I could think of several things that were wrong with this request.
- My pharmacy was a hospital pharmacy. We filled prescriptions for inpatients. Were we allowed to fill prescriptions for outpatients? I don’t know. What laws (federal and state) were we in violation of if we filled discharged patients’ prescriptions?
- My hospital had a policy that stated that “patients are not permitted to take home any medication (except their own), supplies, or equipment (that is not purchased and charged specifically to the patient).” Were we in violation of this policy since our hospital was providing medication to be given to the patient to take home?
- Who was writing the prescription for this controlled substance? Was it the vice president, who was not listed as a consulting physician for this patient? Was it one of the residents? Was it the patient’s (in-house) attending physician?
- Did the physician writing the prescription have a valid DEA number? In order to write a prescription for controlled substances for a discharged patient, a physician must have a DEA number.
- How was this prescription to be packaged? Anything that was viewed to be less than a genuine final product might capture the attention of the TSA workers. They might alert the local authorities and possibly contact the DEA, especially since this involved a controlled substance.
I said “no” to my vice president’s request. I suggested that the patient obtain some extra-strength pain medication. Furthermore, the physician, who treated the patient in the hospital, should write a non-controlled substance prescription for pain. The patient should be given this prescription and fill it out when he gets home if he needs it. The patient should also follow up with his general practitioner in his hometown.
Can’t you change the way you do things? (What’s the big deal?) My morning pharmacy technicians worked an eight-hour shift. They began their morning at 6:30am. It took each pharmacy technician 45 minutes to update their respective medication carts. Afterward, the carts were delivered to the nursing units by 7:30am.
Because the morning pharmacy technicians started at 6:30am, they worked until 3:00pm in the afternoon. This constituted an eight shift with a half-hour lunch. My afternoon pharmacy technicians began their shift at 2:30pm and worked until 11:00pm. The morning and afternoon shifts overlapped for a half hour from 2:30pm to 3:00pm.
Nursing wanted to implement a twelve-hour shift in my hospital. Nursing wanted to work from either 8:00am to 8:00pm or from 8:00pm to 8:00 am. They would work three days a week (36 hours). They would get paid 40 hours a week.
The nurses felt that by having the medication carts arrive at 7:30am, they (the nurses) would not have enough time to administer their medications before leaving at 8:00 am. They requested that the pharmacy technicians should change their shift hours from 6:00am to 2:30pm. That way, the medication carts would be delivered by 7:00am.
This change would have impacted my pharmacy operations. If I had my morning pharmacy technicians change their shift hours from 6:30am – 3:00pm to 6:00am – 2:30pm, it would have eliminated the half-hour overlap. This was not an acceptable option. We could not accommodate the nurses’ request.
The nurses were not happy with our response.
Quite often, I was perplexed by some of the things that my pharmacy was asked by others to endure. Many times, others have these preconceived notions about my pharmacy and my staff. They presumed that my pharmacy would do anything that they wanted my Pharmacy to do.
They expected that my pharmacy would concede to these ideas. They hoped we’d change our routines and just do what they wanted. If we didn’t… Well, we were just being difficult.
In retrospect, my pharmacy often changed our routines to satisfy others. Why did we do that? I’m truly baffled.
Daniel Shifrin, R.P., M.S. is a recently retired pharmacist who enjoys sharing his insights about hospital pharmacy. He is proud to own one of the largest collections of Pharmacy Stamp First Day Covers.