Who wants to vote that the Drive-Through is a Professional Disaster?
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 shit. 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 fuck up or I will break your fuckin’ head.” He looks to the woman. ”It’s your fuckin’ 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 bitch 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 shit, 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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JP.. everything that you have said is correct… but to add to what has been said… I think that a drive thru window is a HIPAA violation/lawsuit/fine… waiting to happen..
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I also think that we need to insist on 100% Otic-cellphone-ectomy when we are trying to counsel a patient.
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depending on my mood and the initial response from the pt… after getting no response from a signal from me to “cut the phone”.. I will tell them.. I am obligated my state law to counsel you on your meds and HIPAA mandates that it be done “in private”…
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I need you to get off the phone .. so that I can do my job and not break any laws.. if I still don’t get a positive response.. I tell them.. when you finish your phone conversation.. let the tech know, and I will do my job…put their meds back on the shelf and go back to work… and when they finish their conversation.. which usually happens rather quickly.. I do not break my ass to get back to the register.. the pt gets a polite .. as soon as I get a moment I will be with you.
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In regards to those who can’t tell the difference between a fast food drive thru and that of a drug store… I would calmly tell them.. that their Rx is never going to even be looked at until they move away from the window.. if they remain resolute .. I would offer them a friendly warning.. that last year… someone did the same thing and one of the people behind the person sitting at the window… got out of their car.. came up to the person refusing to move… dragged them out of their car and opened a big can of “whop-ass” on them… just thought that you should know .. that sitting there may have some consequences from others.. who considers their actions/in actions inconsiderate and rude… and take it upon themselves to rectify the situation. HAVE A NICE DAY !
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You have to train pts/customers as to what to expect and what is expected of them. If you don’t.. they come up with their own expectation of what is going to happen… and typically their expectations – like wait time – gets shorter. At some point… a untrained pt/customer is going to get pissed.. because YOU have failed to meet/exceed their expectations.
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When I had my own store.. the company’s motto was on the wall near where each employee normally worked…
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“NEVER promise more than you can do.. ALWAYS do more than you promised..”
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If you tell them 30 minutes and you do it in 20 .. GREAT…
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If you tell them 20 minutes and it takes you 30 minutes.. you have a pissed off patient…
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However.. if you tell them 20 minutes and within the first 5 minutes you find that it is going to take 30 .. clarify Rx with doctor… something beyond your control.. COMMUNICATE with the pt that the time needed is going to be longer than first anticipated .. because… don’t wait until you are 10 minutes late to explain to the pt/customer why you didn’t meet what you promised… they are already upset/mad and you may not be able to back things up.
The pharmacy is not a bank or a fast food joint. There shouldn’t be a drive up/drive through window. Period.
what I don’t understand is that historically … 50% of the front end sales have been impulse.. if you put drive thru windows in the bldg.. every car going thru the drive thru is one less opportunity for a impulse sale.. with the margins on Rxs continuing to drop.. you have got the person to come to your front door and then you give them a reason not to come into the store.
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It is my understanding that Walmart is taking out all their existing drive thru’s when a store in remodeled and no new store has a drive thru in the plans…. and the local Walmart moved the Rx dept to a more center place in the store… maybe to increase chances of impulse sales???
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Does anyone believe that the world’s largest retailer might have financial stats to justify not putting a drive thru’s in their stores?
I recently attended a district wide pharmacy meeting for my workplace. They tell us “We are the first to implement the drive-thru in pharmacy. You should be proud of that.”. No one in these corporations seems to know what they are talking about. Proud? It’s quite the opposite. I rarely understand anyone on the first try. It’s extra time wasted. And multiple lanes, so now you waste extra time waiting for a tube to go back and forth.
The “call” buttons. It causes the phones to ring constantly. Its like working with another patient in the store, and then someone coming up to the counter screaming “EXCUSE ME!”
We have a smoking ban in my city. No smoking anywhere near a place of employment. People seem to think drive thru is excluded. If I have to open a window to the outside, it is NOT going to be letting in a puff of smoke. In fact, that’s dangerous.
I am a canadian wal-mart pharmacist, and while my store does not have a drive through window, they have posted an article about how “wonderful” a drive through window would be for the customers….how much of a convenience it would be….yikes! they will lose alot of pharms if they even consider this action up here..
I need a gallon of milk and a 1/2 gallon of ice cream too!
Thanks again for the post
I never could understand the rationale of the drive-thru for a retail pharmacy. Besides being annoying and dangerous, it actually hurts the business. I spoke with a front-end manager recently about the drive-thru. She told me that her previous store’s drive-thru was broken for a week and, during that week, they had a noticeable increase in front end sales and she had the numbers to prove it. In a business so dependent on foot traffic and “impulse” buys, WHY would you make it easier for people to stay out of the store? This isn’t rocket science.
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My biggest complaint with the drive-thru is that people refuse to come into the store to solve a problem with their prescription. I’ve gone so far as to threaten to call the police on a woman who would not move from the window while she called her doctor’s office to discuss her Percocet rx. I picture myself in the scenario described by Pharmaciststeve, beatintg the shit out of these clowns who refuse to deal with problems inside the store instead of causing a jam-up at the drive-thru. Just another issue to cause undue stress and anxiety during the workday.
I remember something in the last year that WAGS was going to have a “test market” using “carhops”… I have not seen anything since the original announcement…
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As I remember.. person had to call ahead and spend $25 to get the “free service”..
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I see several problems with this service…
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getting people to read/understand the requirements
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Getting people to understand that “calling ahead” does not mean calling in the order while you are sitting at the stop light < one block from the store…
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$25 means $25 in each transaction.. not your total transactions for the year..
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@slave… why not call the police.. isn't this type of person disturbing the peace? Doesn't your P&P state that they do not tolerate a hostile work environment?
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By calling the police.. you would just be following the company's P&P.
@Pharmaciststeve, IMO I believe you hit the nail on the head. If drive thru is eliminated, perhaps profits would go up due to impulse buying. I hate the drive thru!! It is unprofessional & dangerous. It gives the impression that RXs are no more important than a burger & fries.
Doesn’t this same theory of “failure of Duty to warn” apply to EVERY mail order prescription as well? Last time I checked, USPS, UPS, DHL and FED EX don’t employ licensed RPhs……….
Nor do those delivery agents have any responsibility for adequate temp storage in transit. unlike the manufacturer, wholesaler and pharmacy… once the pharmacy hands the package off to the delivery agents.. all bets are off.. in regards to temperature management.
I have only seen one study on temperatures in routine and potency and one was on a nasal or respiratory inhaled drug and it lost ONLY 50% OF ITS LABELED POTENCY… but the patient got a 90 days supply cheaper than he/she would have paid at the local pharmacy.
The drive through sucks for the pharmacist but to the Mom or Dad who has three sick pukeing kids in the car its a life saver. Just what a parent wants to do is get all three kids out of the car and drag them inside the pharmacy to pick up thier prescriptions. Its like anything in this world. Used properly it is a wonderful thing to have. I never realized it until I had three sick pukeing kids in the car and all I had to do was drive up to the window and pick thier scripts.
Broncofan7 ever got a script from mail order? They put enough drug information sheets in there they would save a 100 trees if they left it out. They provide a phone number to call if you have questions as well. Hell you get more infomation that you are more likely to pay attention to from a mail order script.
@AJ… before the invention of the drive-thru windows.. each area had numerous pharmacies that would DELIVER the medication to the pt’s home… so that the Mom/Dad could go directly from the doc’s office to their home to take care of their kids…
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In the small town that I opened my pharmacy in 1976 there were 13-14 indys.. most of whom deliver… today in that same town. only one remain that was there in 1976.. but we have chain/grocery pharmacies and drive thru’s out the wazoo.
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In the next town over.. until a year or so ago.. we had five Rx depts at ONE INTERSECTION… two chains.. two big box stores and a grocery store chain. One of the big box stores has since closed.. (name starts with a K).. I know that at least three had drive-thru windows.
AJ, you are right about all those information sheets. It has gotten to the point of being ridiculous. My father gets his meds via VA mail order and the amount of paper in the bags are ridiculous. Look at all the trees being wasted! A study should be done to determine the ‘adverse effects’ of those information sheets. How many people don’t take their meds after reading those sheets??? Is the overall impact on patient care better or worse after giving people all this information??? The mft’s should be forced to put percentages by each side effect. Instead, most just list everything under the sun to cover themselves from lawsuits.
I practice in Whitehorse, Canada, the territorial capital of Yukon, with population about 28K. None of the 5 community pharmacies here have drive-throughs. All but Wal-Mart and Superstore offer delivery.
I was surprised to see a small, independent community pharmacy in Fort St John, BC, had opened a drive through, and as I was in town, I stopped in to talk to the pharmacist about it. The pharmacist who owned the store (and worked in it) was very happy with it and didn’t see any drawbacks to it. Now in a little city like FSJ (pop about 18K), there really was no “need” for a drive-through, but his patients appreciated it and he staffed appropriately. When it’s a bitter -40 outside, his patients appreciated not having to park and come inside.
I don’t know if I’d like it in our pharmacy though, where we normally do about 300 scripts daily, not including compliance packs and packing meds for the local Corrections (jail). I for sure would want to be able to shut it down in favour of people in the store if it got really busy.
@ AJ—not a single piece of paper or 1 million pages worth of patient information sheets adequately replaces the counsel of a Pharmacist. Retail Pharmacies every month are served notice form their respective state boards of Pharmacy for not at least offering patient counseling despite the fact that they ALSO provide a patient information sheet with Rx’s and obviously have the phone number to reach the Pharmacy imprinted on the bottle and the receipt. So your post was as misguided as the latest edict that comes down from the bean counters currently ruining our profession.
Coming to a pharmacy drive-thru window near you?
http://boston.barstoolsports.com/around-barstool/man-calls-911-because-deli-made-his-sandwich-wrong/
Broncofan7 you are either a student, new grad or not in the profession at all. What fantasy world do you live in where the pharmacist gets to adequately cousel patients? You are a dreamer and a fool if you think the most valuable service a pharmacist provides is patient counseling. It should be but it isn’t. Keeping your face glued to the computer pushing that verification button is the only value ypu have to the company. Keep the mill running and thoses merics in check or you are out of a job. You are stiil the one pushing the button beacuse a law says you have to. A stroe of a pen and the profession is gone. Look for it to happen soon.
As a patient, I would be curious what pharmacists consider to be adequate counseling. I would consider myself an informed patient and I don’t value counseling by retail pharmacists (clinic or hospital pharmacists on the other hand…). Is it information beyond dose, purpose, time of day, and basic side effects (basically reciting the information on the label and found on the worthless handouts )?
Because if that is all, then I understand why no one bothers or cares. I’ve read the PDR for the meds I’m on or are going to take (yes, I’m not a typical patient). So I know when the pharmacist provides me with incorrect info (it happens) or the handout is misleading (not unusual). They don’t even always catch potential side effects (not in the computer, so apparently it doesn’t exist).
While retail pharmacists are highly trained and knowledgeable, they have apparently been trained by their patients (and companies) to appear anything but. Put simply, while I’ve enjoyed my interaction with retail pharmacists, I wouldn’t trust them for medical advise based on my history (over decades) of counseling. I’m not convinced that most can do anything besides fill accurately. And I don’t see how you need advanced training and a degree for that.
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If you have never jumped out of an airplane, don’t think you know about sky-diving just because you read the book. You are not receptive, so I would not waste my time. If you look at your fingernails or check your cell phone, I walk away. If you have a minor STD such as trichomonal vaginosis, there is nothing in the handout that explains that your sex partner most likely infected you. I would tell you that. When you scream, “The bastard cheated on me?” I have to explain that… That’s enough. You are cheating yourself if you are not receptive to drug store pharmacist counseling.”
AJ- your posts reflect a petulance and incoherent quality upon which one could rightfully conclude that you are more than likely familiar with the profession of retail pharmacy through your experience as a pharmacy school dropout whose sole purpose in life is to rectify the guilt and shame that you have for not being able to follow in your parents footsteps as pharmacists so you look to tear down the profession to your pathetic level. 180 Rxs 3 techs and 1 rph 5 days a week… It can happen, it is profitable and yes, counseling DOES in fact take place and patients are consulted on OTC remedies as well. I run MY. Pharmacy the way it used to be; the way it should be. Now go make me a sandwich…. And hold the bologna for all of our sakes….