The Three Idiots: See No, Speak No and Hear No.

Jp Enlarged

Ignorance is Bliss.  Or… is it just Ignorance.  The modern pharmacy schools are robo-dispenser Mills that put out the metrics-minding, speed-burner 14 hour shift factory piece-work dispensers that believe that what they do is practicing pharmacy.   Goose and Peon and Steve and Pharmacy Gal have had their feet in this mud puddle for a long time and they know what it is to be a “Druggist”.

There was a time when “Druggist” was a derisive label.  It was not as professional as pharmacist.  It painted a picture of a balding guy wearing a bow-tie who always had time for the patients.  Before Durham-Humphrey, a Druggist was an alternative to the Doctor.  After the early 1950s, people still came to the drug store expecting the druggist to help them.  We did too.  The OTC shelves were choking with really good drugs.  Merrill made an OTC antacid with 5 mg of dicyclomine per 15 ml.  Diarrhea was a significant problem back then.  We bought Lomotil by the thousands.  A patient could bypass the doctor and get paregoric in 60 ml bottles from the Druggist.  Sign the “Exempt Narcotic” register and wait the prescribed length of time before coming back.  Cough-Cheracol, ETH & Codeine and Robitussin AC.

It was a different world.  I liked it a lot.  It was fun and I perceived that I was making a difference.   At Wentlings, there was a lunch counter.  We gave prescription patients a coupon for a cup of coffee while they waited.  And, they had to wait.  I’d estimate that 30% of all prescriptions were compounded.  I’d often go over to the counter and have a cup of Joe with them before or after I completed their order.  As I said, a different world, one that was fun.

The other evening I was remembering Charles Larwood.  He was the Dean of The College of Pharmacy.  He was also a Pharmacognocist.  What the?? That is what some of you newbies just asked.  Pharmacognosy.  That probably is not offered at 95% of the schools.  I would bet that the dean of Touro University, one of what I have termed the boutique pharmacy schools, does not even know what pharmacognosy is.  No shit, I am serious.

Anyway, I was imagining having a Friday night vodka martini with Dean Larwood.  I took a sip, too much vermouth and only one olive.  My ideal martini has a drop or two of dry vermouth and three olives.  I explained the 14 hour work day to the dean.  He tapped the table with his right forefinger.  His eyes widened and he pursed his lips tightly. “You can’t go to the bathroom?”  After 5 minutes, he raised his right hand, palm toward me, the universal signal to stop.

“It shouldn’t be this way,” he says.

“The pharmacy schools are the pimps for the drug store companies,” I said.  ”They are gluttons for the donations.”

“It shouldn’t be this way,” the dean repeated.

I do not see how we can fix it.  Guys like me, Peon and Steve are done other than the shouting.  Shouting is all we can do.  Goose will be around for awhile as will be Pharmacy Gal.  Most of the new kids do not know anything.  I visited Toledo for homecoming 10 years ago.  My room-mate “The Fabes” shared this experience.  A little girl (about 5 feet tall), but a budding rock star, gave us a tour.  She took us to a lab and proudly showed us what they did.  Suppositories, creams, emulsions, suspensions, etc.  ”Official” products.  For you who did not get or will not get a real pharmacist education:  ”Official” are those found in the U.S.P. and N.F.  That’s MY school and I was proud.  50 years later and the kids are getting what I got.

Is pharmacist education producing two levels of practitioner?  Pharmacists and Robo-Dispensers?

The quintessential pharmacist’s art is compounding and these new schools do not even teach it.  No one other than the pharmacist can legally compound and they don’t teach it.  Give me a break.  Compounding is ours.  We need to covet it and charge plenty for it.  New pharmacists do not know how to do it.

They have not been taught the art of being a “Druggist”.  If they lose this, they are losing it all.  Pharmacies become dispensaries.  I have no problem with dispensaries like CVS or like the mail orders run, by the way.  Just do not call them pharmacies.

I spent lots of time with a brand new pharmacist before I left Galveston.  She knows what a Druggist is now.  She knows that Druggists are the elite pharmacists.  It is more so a ground of being.  We spent a decent amount of time compounding.  She knows that using an over-sized bottle and making a “Shake” lotion is much simpler than using a mortar and pestle.  You also get a more elegant product.

I did my part, you guys.  Just one 20 something girl who now thinks and acts like a “Druggist”.  What about you?  Fuck this preceptor shit.  Be a mentor.

Goose was fortunate to be “taught” by Varro Tyler at Purdue.  I really love and depend on “Tyler’s Honest Herbal”.  Varro cut the crap.  He gets right to the gold.  Most monographs are less than two pages.  The “Summary Chart”  at the end of the book is priceless.  Each Herb (In alphabetical order) has six points.  Common name, Source name, Part Used, Principal Uses, Apparent Efficacy, Probable Safety.  “Honest Herbal” is a terrific resource for any Druggist.

 

15 Comments

15 Comments

  1. Cindy  •  May 20, 2013 @9:22 am

    Oh Jim! You are right! I just checked my college and they no longer offer pharmacognosy. I loved that class! Its a shame its not offered anymore. I think there is an herbal medicine elective now but I like the term pharmacognosy. Its sad that a whole generation of students won’t know the term.

  2. Pharmaciststeve  •  May 20, 2013 @1:48 pm

    Pharmacognosy.. at Butler it was referred to “weeds & seeds and roots and rhizomes” – the good old days :-)

    If you notice.. the word “Pharmacy” is no longer part of the landscape…I temp at a very large LTCP and the person in charge of the techs – of course a non-pharmacist – title is “head of production” and the “Pharmacy” is referred to as a “distribution center”.. all the compounding is done by techs.. including the IV’s.

    We have WALGREENS”, RITE AID, CVS.. when the word “pharmacy” is used.. it is in very small font.

    If you look at the typical store inventory.. it is more like a large convenient store.. small grocery stores.. in fact.. when I was a kid.. I worked in a Krogers that was only 12,000 sq ft.. smaller than most chain stores today.

    When I had my own store .. my name was not in the name ..although PHARMACY was.. but .. docs would tell pts to go to “Steve’s Pharmacy”.. when they were referring someone.

    I believe that RPH’s are continually moved around is so that a individual RPH does not come too familiar with the pts.. so that when the RPH leaves… they will not be missed. Since they were no more important to the pt than any other fixture in the store.

    In fact.. I bet the typical pt would be more pissed off if the store’s plan-o-gram was dramatically redone.. than having a staff RPH leave.

  3. goose  •  May 20, 2013 @2:21 pm

    JayPee,
    I too remember the days of Pharmacognosy. My professor at Purdue was Varro Tyler who many considered yhe “dean” of the practice.
    I only kept 3 textbooks/references from Pharnmacy school. Remmington’s, Pharmaceutical Calculations and my Pharmacognosy Textbook that Dr Tyler wrote. I also have “The Honest Herbal”, which I think was a best-seller in the 80′s.
    I also remember his lectures on native Indiana plants that had medicinal values, many used by the local Indian healers. One was “Jack-in-the pulpit”, the roots were ground up and used as a poltice by Indians. I have one growning in my yard, I think of Dr.Tyler whenever I see it.
    Dr. Tyler was a pharmacist first though and he promoted the traditional pharmacy tasks of compounding, drug information and consulting. He is gone now, but I am sure he would be less than happy with the state of affairs in Pharmacy and at Purdue University. He also would not be taking checks from companies that are running the profeesion into the ground. (CVS, Wags, etc)
    You are right, the pharmacy schools are the pimps and the students are the whores, no other way to look at it.
    By the way, one of our current residents with 6 years of pharmacy school and a 1 year residency currently has no job offers.
    Wake up students and don’t fall for the residency bullshit!

  4. Norm Pelissier  •  May 20, 2013 @3:11 pm

    I had P-Cog (Pharmcognosy for you young ones) taught by the best. Dean Heber Youngken who wrote the book used by most of the Phcy schools in the country back then (actually his father wrote the book while at MCP (Mass College of Pharmacy) was the first dean at URI. Our prof was Dr. Daniel Tsao who was a protege of Yougken when he was out in Washington State. We had Foxglove plants growing outside the school (Digitalis Purpurea?). Later on, I heard all about the great drug Lanoxin was from my older RPh brother Charlie who worked for none other than Burrows and Wellcome, the mfr. of Lanoxin.

  5. boilerrph87  •  May 20, 2013 @3:49 pm

    Goose….I also am a Purdue grad. I remember Dr Tyler, in fact Pharmacognosy was one of my favorite classes. Wonder if they even still teach that class these days. I was a student when Dr Sperandio was Dean. Compounding class was my favorite. When I graduated, where I worked we didn’t do a great deal, but most common was the gentian violet solutions, variations of Mary’s Magic Mouthwash, Philadelphia solution, a 2lb order of Triamcinolone/coal tar and Aquaphor for a psoriasis patient and occasional Ritalin capsules for a local vet for a small dog. Yeah, I’m now one of the old timers I used to always look up to as my mentors. Unfortunately, these new kids coming out have absolutely no clue on traditional pharmacy, I’ve seen a lot of grads who have terrible customer service skills in consulting if they even do consulting….now a days it’s the tech asking the customer ‘do you have any questions for the pharmacist’ which I know is not following the consulting law, IF you can even get the customer to listen to the information. It’s sad for me to see how it’s gone from true pharmacy to ‘pill mills’ and ‘fast food mentality’

  6. goose  •  May 20, 2013 @8:51 pm

    Pharmacy students don’t have time for practical courses anymore, they’re writing drug monographs, learning statistics so they can evaluate all the articles they read about worthless biased drug trials and talking about what residency they are going to do. I currently have a student that will graduate $300,000 in debt. Where is the outrage about longer and longer bullshit educational requirements, students deeper and deeper in debt and schools asking alums for more and more money all the time.
    If you are a grad of a pharmacy school and you send them one dime, I think you are a fool. You are not saving these kids any money, only a small percentage goes to a select few. When Purdue calls me for money I hang up.
    One of these days the shit is going to hit the fan and all this shit will be out in the open. Nothing we do as pharmacist will mean a thing if we do not help the kids now get out of this debt load.
    Step 1: No more donations to pharmacy schools.

  7. goose  •  May 20, 2013 @9:08 pm

    Steve brings up an interesting point about the pharmacist being a fixture in the store. I’ll bet most people cannot tell you the first name of the last person that filled their prescription. I know I can’t when I go to a big chain.
    My insurance makes me go to CVS so I got all my scripts changed to generic equivalents and pay cash at one of the last two independents in town.
    They just need a pharmacist there for the license. Soon everything will be outsourced and the pharmacist will be a glorified cashier.
    I have a student I just started teaching today tell me that she works as a tech at Wags and has since 2005. She says she enters new RXs for customers who drop them off but want to wait. She says she is told not to do this but does it anyway. She also said that she thinks the fact that she worked retail hurt her for her pharmacy interviews.
    It’s all such bullshit and there is no end in sight.

  8. boilerrph87  •  May 20, 2013 @10:52 pm

    I quit giving to Purdue pharmacy years ago. I also hear they want to add yet another year of Pre Pharm…WTH…by that time, one would technically be a junior and then what does one do when they get rejected…wasted 3 years of school to now have to find another major and imagine the debt they have already by then. I worked a short time at CVS, what an absolute nightmare. I spent 10 yrs in LTC, this new ‘MTM’ model to me isn’t any different than what I did every month in my LTC facilities…I believe I could run circles around some of these new kids based on my experience since graduation and yet I’m looked down upon because I’m ‘only a BS RPh’
    Unless somehow we all can get on the same page and tell corporates, PBMs, insurances and these pharmacy schools enough is enough, things aren’t going to change and our profession will disappear forever because I forsee the day when the rules will be changed to the point a pharmacist will no longer be needed…(a good starting example is Pfizer being allowed to sell Viagra on the internet directly to the consumer).

  9. anonymous  •  May 21, 2013 @7:23 am

    MTM in a busy retail store is almost impossible nowadays. There are some ideas that should not be introduced to retail and that is one of them. I know of several doctors who use duplicate therapy on patients and when we did MTM with them they refused to cut out even one drug. Example, two or three anti-inflammatories, five BP drugs (no organ failure) etc. I had one customer on 20 drugs in a month. Her health is horrible. Yes, hospital or LTC or nursing home facility where the doctor is more responsive b/c he or she has so many patients they’ll sign off. As for retail..it will hit the fan sooner than later. Until the chanins realize that cutting hours in pharmacy (I saw a slide show from CVS that quoted that 70% of their revenue comes from the pharmacy), is just detrimental to everyone. Bring the hours back, bring the raises back (billions in profits) and fix up your company’s computer system.

  10. pharmacyslave2000  •  May 23, 2013 @9:58 am

    I always enjoy hearing about the “good ol’ days” of pharmacy. I can only imagine the changes that have occurred in the last 30+ years. I agree that certain parts of pharmacy have been lost and/or destroyed by the corporations. Try compounding anything but the simplest of ingredients in a busy retail store today and see what a mess of the metrics that creates. I must admit, I’m as guilty as anyone of being a “robo-dispenser”. That’s what the company wants, that’s what they get. I think we can all agree that the current state of the profession does not allow for much rocking of the boat.
    ***
    I also agree with “anonymous” in regards to MTM. There is absolutely no way that proper MTM can be done in the retail environment. That is a desk job/office job. It can not be adequately accomplished while on the “front-lines”. It may be the future of pharmacy in some capacity, but not for those of us at store level.
    ***
    The profession is rapidly changing, and not necessarily for the better. We can pine for the old days or try to adapt and keep our jobs relevant. Check out the stock reports on the big 3. There are BILLIONS of dollars being made. The chains aren’t changing their business model anytime soon.

  11. anonymous  •  May 23, 2013 @5:29 pm

    I agree with Goose about learning how to write monographs. I love my alma mater but I felt the curriculum was focused on hospital pharmacy rather than retail. Looking at my classmates, the majority chose retail for the money. Hospital was a distant second tied with pharma companies. A few communications classes do not prepare you for the onslaught of phone calls, questions, interruptions and daily quotas retail rphs face. We had one compounding class. We learned lotions, suppositories and creams. It’s a shame they don’t teach what I had to make routinely, oral solutions. If it wasn’t for one of my former coworkers, I would not know how to make these since the hospital pharmacy would never share their recipes.

  12. unhappy pharmacist  •  May 23, 2013 @8:35 pm

    Very interesting thread! I also remember the good ole days!! They were something special. New pharmacist today have no idea what a great profession we had. The new kids are to hung up on the #’s. They don’t even have the ability to talk to a patient in laymen’s terms.
    After selling my practice, I went to work for one of the big three. I was amazed at the lack of concern for the patient. The goal was fill & fill fast! I nearly had an MI. I work 14 hours & get no breaks! I never have time to eat.
    After a particularly bad day, I said screw it! I am biding my time. I refuse to compound (there is a specialty pharmacy nearby that does)! Want something special go see them!! I don’t have time! If I can’t take a break why should I make more work for myself???
    Do I sound bitter? Maybe, Angry??? YES!!! When will the BOP realize they were once just like us?????? They need to realize work conditions affect patient care & in my state that is their jurisdication!!!

    Hope I can survive another 5 years, although cashier @ Big lots looks better everyday.

    I no longer mentor, I tell students to run as fast as they can from a pharmacy degree!!

  13. bcmigal  •  May 24, 2013 @11:16 pm

    I,too, tell students to run as fast as they can from pharmacy. If I have to fax one more report or follow one more check list, I think I will explode and take that stupid WSAB with me!

  14. anonymous  •  May 27, 2013 @9:27 am

    The students know what’s in store bcmigal. I worked with several who wanted to goto pharmacy school and worked in retail. I said what you see is nothing compared to when you get your license. Your liability, the lack of breaks, the constant standing, making critical decisions about drug interactions. They only see you look at pills and type and counsel patients. I totally believe that pharmacy in the US needs to be strictly regulated. No more 4 year degrees from foreign countries. No more english as a second language. We need an hour break esp. for 14 hour shifts. You want to work, get a pharmD (I am not bashing 4 or 5 year degree holders just making a point that new workers should not be just a 4 year degree that cost 8000 overseas). You want to be manager, prove yourself. I believe that almost a third of the rphs in my district are subpar, including the US ones. If we had a good staff, then these reports and tasks would not be so cumbersome. But, until there are stricter guidelines, like not hiring a person who has no clue how to use a computer or who has had 10 jobs in 3 years, we are doomed to fail.

  15. Peon  •  Jun 4, 2013 @10:53 pm

    JP made a good point about otc products of the past. When I got out of pharmacy school, I loved helping customers with otc products. Someone have a cold? Get them a box of Triaminicin.
    Today, it is a veritable maze trying to get a customer products for a cold. I know…there is nothing out there to cure the cold. But, I can tell you from first hand experience that Triaminician was a great product for a cold. It made you feel better.
    -
    Well, no! The FDA in their great stupidity has destroyed pharmacists ability to actually pick a good product to treat the most simple thing: a cold. As JP said, in the past, we had something to give people for their ailment. For diarrhea, we had Paregoric. The only thing left is Imodium and it is not recommended for young children. And, the FDA does not think we are capable of recommending an otc product for a kid under the age of 3.
    -
    The years to make a pharmacist has expanded, but the ability of pharmacists in retail has contracted. Have you ever thought about it? While nurse practitioners roles have expanded, and I suppose they will be doing ‘brain surgery’ next, our roles have contracted. Nurse practitioners are under educated for what they do, and pharmacists are over educated for what they do. It makes you wonder why more and more years of education is being tacked on to becoming a pharmacist. Is it the educational leaders in pharmacy that are pushing this? Is it the greed of the colleges?
    -
    Providing good healthcare is a coordinated effort. Pharmacists have always been left out of the loop. We have always lacked information that could have helped us provide better care. Instead of tacking more and more years to becoming a pharmacist, the colleges should be pushing to bring pharmacists into the healthcare loop. I know that so many of you have encountered so many times when knowing something about the patients diagnosis would have helped greatly. But, we are ‘blind’ when it comes to counseling patients. So many times we don’t know why a drug is being given to a patient. Todays technology should be providing us with patient information. We need to be brought into the healthcare loop.

Leave a Reply

Allowed tags: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>