The Stockholm Syndrome at your local Drug Store

Jp Enlarged

You are going to have to explain to me what is going on?  I have never before seen a bunch of specialists acting like they are factory floor, piece work workers.  You are treated like shit and I do not see outrage.   I see effete whining.  This behavior has developed over the last few decades until it is now expected.  It this some variant of the Stockholm Syndrome?

Why don’t pharmacists stand up for themselves? 

 

Stockholm Syndrome:

 

A condition experienced by some people who have been held as hostages for an extended time in which they begin to identify with and feel sympathetic toward their captors.

 

Sounds good to me.  What is wrong with you people.  Really, where is the outrage?  There is nothing wrong with anger, if you use it rather than letting your emotions use you.  The following is from “The Prisoners of Comfort”:

 

Recovery is regaining Your Power

            Essentially, the miserable pharmacist is wretched because they choose to be unhappy.  There is a choice every single day to be proud of what they do or to blame the job because they are not happy.  They don’t even use the best tool available to them.  That tool is anger!

Anger is fuel.  It is not the bad thing that your parents said to suppress as mine did.  “Jimmy, nobody needs to know you are angry.  You should control yourself.”  We feel anger and we become frustrated when we hide it because we want to do something about it.  This goes against the image of the calm, in-control professional.  Instead of showing the anger, we stuff it and chug Maalox and take two 20mg omeprazole every day.

How would it look if we showed that we were angry?  At work, you don’t hit that someone or break that something or throw that fit.  If you smash that fist against the wall, do it in the bathroom where no one can see that you are out of control.

What we do with our anger is deny it.  We stuff it so far down that we forget what makes us angry.  We are institutionalized and we believe that we should not get angry.  We lie about being angry at the store manager.  We hide our anger at the lack of technician help.  We do not express our outrage to the district manager.  Doesn’t he know that it is his precious customer service that pays the price?

Some of us hide it so well that we medicate the anger and filch the occasional lorazepam to hide it even better.  We are professionals and professionals are nice people.  We bury our anger.  We block it and we hide it.

What we do best with our anger is lie about it.  Unfortunately for our spouses, we lie so well that we often take our misery out on the people we love (or are supposed to love) the most.  We do everything but listen to our anger.

Listen to your anger.  That is what it is meant for.  Anger is not a polite request.  Anger is a scream.  It is a command.  It is a slam of the fists down on the table demanding your attention.  Anger has a right to be heard.  Anger should be appreciated and valued.  Anger must be listened to if you are to regain your professional balance and power.  Why?  Because anger is an atlas or a chart or a diagram back to living the ideals you had when you were in pharmacy school.

Anger reminds you of your boundaries and limits, the areas where no one was allowed to tread without your permission.  If you can set up the periphery of your professionalism in just one area, more will follow.  If you list only ten serious drugs that you will counsel on no matter what, your list will be twenty in little time.  If you let the store manager know in writing that his touching you at anytime, in any manner, is unwanted, you will regain enormous power and control over your own life on the job.   You can gain power simply by refusing to get wet underpants because you neglect going to the bathroom when you have to go.  Documenting anything at work that makes you uncomfortable will give you surprising control.

Anger shows us where we want to go.  We may not know exactly what we do want on the job, but our anger tells us, without ambiguity, what we sure as hell do not want.  That is a really good place to start because anger shows us where we have been and sets us on the course of recovery.  Anger is not a sign of disease.  It is a sign of health.  If you no longer get angry at being institutionalized, stop, take a deep breath, and examine how you will find your way back.  I contend that you will find that the first sign of recovering your health, well-being and pride will be anger.  Welcome it.  Savor it.

It is not very healthy to act out from anger.  That is childish and not productive.  I quit a job once out of anger.  It was a good job.  I was well respected in the community.  The problem was that the store manager tried to micro-manage my department.  I have never bent to management from a non-pharmacist.  This guy was out to bring me to my knees.  I fell right into the trap.  I became so angry that I brought the problem to a head with some stupid brinksmanship.  My district manager did not back me as fully as I wanted, so I quit.  My one-way commute for that job was less than ten minutes.  The one-way commute for the next job was ninety minutes.  I was like a teenager having a meltdown.  I turned my anger into indignation without any examination of the circumstances.  I was an idiot.

Anger is there to be acted upon.  Anger points the direction.  Anger is the wind for our sails as our sailing ship tacks as we move on the appropriate bearing where our anger guides us.  Had I used my head and had the presence to translate what the anger was telling me, I would have made better choices.

“Damn it, I could run a better pharmacy than that!”  This anger says that you want to have your own pharmacy, you just need to put all of the pieces together.

“I can’t believe it.  Mildred told me that she was going to demand a transfer to the suburbs and she got it.  That’s what I wanted.”  This anger says: Stop keeping your goals and dreams hidden.  You need to express your wants and believe that you deserve your dreams to come true.

“That was my idea.  This is unbelievable.  I mentioned it only once and that son of a bitch took my plan and put it to work.  He gets all of the credit and I get none.”  This anger says that it is time to take yourself seriously and show yourself some respect.  Your ideas are good enough to do something about.

Anger is the tornado that blows away all of the restrictions and hesitations and lack of self confidence of our old lives.  Anger is a valuable instrument to be used productively.  Anger cannot be the master, only the servant.  Anger is a deep well of power, if used properly.

Apathy, laziness, misery and gloom are the enemies.  Anger is not a good buddy, but anger is a friend.  Not a mild-mannered friend, but a very loyal and steadfast friend.  Anger will always remind us when we have been cheated or cheated upon.  It will always tell us when we have been deceived or when we have betrayed ourselves.  Anger will tell us that it is time, finally, to act in our own best interests.  Anger is not the action itself.  It is the action’s invitation.

………………………………………………………………………………………….

You guys spend too much of your work days with unbridled anger stuffed down inside.  You smile.  You acquiesce.  At first, you feel like crap about it, but after awhile you don’t even feel the anger.  Stockholm Syndrome?

Is that why you tolerate shabby treatment?  My college roommate is a pharmacist.  He has worked as a hospital administrator for decades.  He is the Compliance Officer at a Chicago hospital.  I will ask him what would happen if an administrator ordered a young doctor to violate the current ethical standards in his/her profession.  I will ask him what would happen if doctors were expected to break the law every day, all day long.  I will report back to you.

4 Comments

4 Comments

  1. Pharmaciststeve  •  Sep 23, 2013 @3:40 pm

    Anger should be the fuel of revenge.. With the current surplus .. The only revenge is documenting the breaking of laws..
    Some RPh’s have resorted to using video pens .. Which are fulling functioning pens
    http://www.pharmaciststeve.com/?p=2838
    Recent example of Rph being berated by pic and company so far is unwilling to provide video of the incident and all co-workers developed amnesia
    Just wait until whistle blower takes a chunk out of cvs’s bottom line with his lawsuit and other follows in his foot steps..
    We are going to end up in nothing short of a Rph civil war.. Unless you document issues on your own everyone within the corporation will cya themselves. .. And you have the choice of bending over or standing up with proof you have accumlated about all the wrong doings
    We no longer have a shortage to back us up..but there is the media and the attorneys.. Pt will only speak up when they get hurt.. Unhappiness can be dealt with a 25 dollar gift certificate.
    Whistle blower’s case will have.a court date in the next week or so. It is gaining traction… It will not be long before it will be gaining speed.. It could have verdict before end of the year.
    The system will work against unless you work the system.

  2. YoungGun  •  Sep 25, 2013 @4:07 pm

    Hey Jay-Pee, thank you for this wonderfully insightful article. It’s almost as if you’re reading my mind! I too have become a master at suppressing my own anger. I’ve held it in for so long that the volcano finally erupted two nights ago, unfortunately as I’m sure is all too often true, my family was standing directly in the blast zone. I must have been completely unconscious of how much the stress has taken its toll on my health. I’ve been taking two 20mg famotidine tablets daily to quell persistent “sour stomach” which I now realize to be my own anxiety and stress taking physical form. I won’t share all the details with you, but the essence of the conversation went something like, “you don’t know what it’s like to work yourself to death day in and day out.” “I can’t do this job for another 3 years, let alone another 30.” “I hate my techs for getting an hour worth of breaks during their 8 hour shifts while I am pretty much constantly hypoglycemic at work.” “I’m tired of corporate constantly telling us how important we are but then treating us worse than slaves, even slave owners saw the value of regular meal breaks.”
    It felt good to get some of this off my chest but then I realized that I was trashing one of the only good things left in my life. I have a wonderful wife and children who have been very supportive recently through this difficult time in my life. I don’t know where I would be without them.
    After some self reflection I have resolved to never bring my work problems home with me again. As I alluded to in one of Jay-Pee’s previous posts I have gotten my foot in the door with the one big retailer that seems to know how to do business the right way (starts with a C, sells items in bulk). The Rph market is really tight here on the east coast though so it may take some time. Jay-Pee is right though, we can’t take this garbage home with us every night. Go outside and scream, punch the wall, call a friend and air it out; whatever you do, don’t let this shit JOB destroy the things that are actually important in your life like health and family. Once those things are broken then can’t be fully repaired. I’ve resolved to push back harder than ever against my current employer as well, no more extra effort from me anymore. I’m also not catering to any ridiculous patient demands anymore. Going the extra mile for your patients unfortunately grows into future EXPECTATIONS that you will always go the extra mile and that they don’t have to carry their own water anymore. Let’s face it, most patients didn’t get on 6+ daily meds by being overly responsible or proactive with their lives. Not my problem anymore!
    It’s sad that it has come to this point but how much longer can we continue to get shit on from every possible direction and come out in one piece on the other end? Has anybody else noticed that every technology advancement that was supposed to free us up to do more important things has been an absolute boondoggle? Remember how E-Scripts were supposed to be a great improvement over poor M.D. penmanship? How many of you have seen just utter chaos come though the computer? Every day I get 7-10 scripts that make absolutely no sense. I received a Rx yesterday for Amoxicillin that said dispense zero capsules. Most are much more dangerous though. Metoprolol Tartrate once daily when it should be twice daily or Succinate twice daily when it should be once daily. I saw prednisolone eye drops come from a dermatologist the other day. Oops! should have been oral prednisone! When a M.A. gets ahold of a physician’s PDA watch out! I’ve seen some really incredible mistakes. Great way to cut costs by outsourcing the digital Rx entry to someone who usually has less drug knowledge than the patient. That is if they can even get their wrong script to the right pharmacy. I could go on forever!
    Remember when automatic refills were going to revolutionize pharmacy and increase patient compliance? Don’t make me due laughing! At its best it’s borderline insurance fraud and a huge waste or our time and resources. At its worst it’s incredibly dangerous! Somebody a while ago pointed out that their patient had 4 different strengths of Lisinopril on auto-refill! Most of the time patients say then don’t want/need that yet only to come in 24 hours after you have voided it, demanding it RIGHT NOW! My all time favorite though is the patient who just shows up saying “my meds are ready” when they have nothing there, then they demand to have “everything” filled but then only want 3 of the 12 meds you filled STAT. Of course then you go into the patient profile and realize they were all voided 11 days ago because the patient couldn’t walk across the street after they received their 5 reminder calls. Ok now I’m done. Sorry for the rant guys/gals!

  3. pharmacyslave2000  •  Sep 25, 2013 @6:01 pm

    I wonder how many lives/marriages/friendships/etc. have been destroyed because of the crushing stress of retail pharmacy? No one, except our peers in the industry, can understand what we go through. Retail pharmacy can be a lonely career.
    ***
    Speaking of “advancements” in the profession, I read on another blog that California is on the verge of giving pharmacists limited prescribing authority for medications such as birth control and smoking cessation. VERY BAD IDEA! You think quotas, excuse me, “metrics” are bad now, add in this debacle and we will be pushed over the edge. This is not professional advancement, this is another money grab to go along with vaccinations, MTM, etc. We will get absolutely nothing in return for this other than more work and more numbers for management to hold over our heads. I stated before that the ability to vaccinate is the worst thing to happen to pharmacy since the $4 rx, now we can look forward to this.
    ***
    YoungGun, I think you’ve got it figured out. I’ve told anyone who would listen that the best way to deal with this job is to do the best you can then go home. Leave the shit behind you. F the corporation, F the “patients”, F your co-workers. Worry about yourself and your own sanity. The corporation, “patients” and co-workers don’t give a shit about you, why should you care about them? At the end of the day, your family and those you care about are what matters most. Life’s too short to be miserable.

  4. Peon  •  Sep 25, 2013 @11:26 pm

    YoungGun, please do not be sorry for your rant! You did a very good job of ‘telling it like it is’. Our jobs require us to suppress our anger. But, anger suppressed will come out somewhere and sometime. Instead of expressing my anger, I will often ‘get even’. Rude customer….well, their wait time suddenly increases….any additional help they might have received suddenly vanishes. I think this is one method of expressing your anger that is less destructive to the people around you. You might want to try this method and see if it helps.
    -
    You are so right about slave owners knowing it was valuable to give regular meal breaks. These corporations have not realized that a tired pharmacist, a hungry pharmacist, a pharmacist that has been working 10 hours without a break is an increased liability to the company because he/she is more likely to make a filling error. It seems the companies think they can just throw money at pharmacists and then expect them to work under conditions worse than slaves. Steve has been talking about rx errors for a long time. I cannot help but believe that rx errors will increase under such working conditions. The corporations will likely stay in denial for a long time and impose metrics to the point that there is a rapid turnover of pharmacists. Instead of solving the problem, I expect them to simply replace the pharmacist that made the mistake with another pharmacist.
    -
    It is best to not take your work home with you. I have tended to never mention my work when at home. If asked how my day went, I would just say fine.
    -
    One thing that you have come to realize is that extra work or going the extra mile, while working for these big corporations, is foolish. Corporations are not individuals. Your DM may note that you are a good worker and it might help to a small degree. But, for the most part, any added work will not be recognized nor rewarded. The same will often apply to customers. I don’t want to give everyone advice on how to deal with customers because we are all different. Some people find it very rewarding to help customers. My views maybe a bit different from others. For myself, I have found it better for me to do my job and not spend a lot of time with any individual customer. I have also found that it is better to not go too much out of the way to help the customer. If an insurance company is requiring a PA, I tell the patient the insurance will not pay until they contact their physician and get him to call the insurance company. Out of refills…our computer system will automatically fax the doc. I will not phone the doc for the patient. If they are in a hurry for their medication, they can phone the docs office. And, there is one thing, YoungGun, that you mentioned which struck a sympathetic chord with me: all the patients being on all these meds and how they got to that point. I live in the most obese state in the US. The people in my area are killing themselves by eating. They have all these ailments that are directly attributable to their eating habits. And, they are taking all these meds, and we, the taxpayer, are usually paying for these meds. Over the past few years, I have become less and less sympathetic toward these people. And, on the subject of helping customers, I have found that if you are very helpful, you create a ‘dependent’. That customer will always expect you to bend over backwards for them and the first time you don’t, they get mad and go somewhere else. You created a dependent and they always take up your time when they come to the pharmacy. Lets face it, most of us don’t have the time, in a busy pharmacy, to give much attention to any one customer. There are two possible solutions: 1) don’t give any one customer much time or 2) take all the time you want and fill less rx’s in a day. I have not seen many, if any, pharmacists that are willing to fill less rx’s. The way you do it is to take all the time you want with each customer no matter how long the lines get. At some point, people will get the message to not come to your pharmacy because of the long wait times and you will fill less rx’s. If I were a pharmacy manager, I would have to take a close look at this last option. Most pharmacists, with the mistaken notion, think they must fill each rx that is brought to the pharmacy and try to fill them as quickly as possible. This is an erroneous idea. Sure, the pharmacy manager might not get a bonus. If rx volume drops, then the pharmacy manager might be replaced. The key is to start with a newly built pharmacy and then do as I said. The volume will naturally increase, but you will not be killing yourself trying to fill each rx as quickly as possible. And, if I were to take a pharmacy manager position at a new store I would take the position of not rushing at my job.
    -
    Yes, I have noticed that technological advancements have not really been advancements and in many cases they present more problems than they solve. E-scripts is prime example of this. The problems with E-scripts is two fold: 1) full of errors 2) docs send rx’s for everything patient is taking. The whole concept of E-scripts was to get away from poor physician handwriting. But, now we have E-scripts where there is probably errors on 15 to 25% of them. It is unbelievable the number of errors I receive each day with E-scripts. Then, there is the extra work involved when a patient sees a physician and asks for a refill on his bp med and the doc e-scribes all his meds to the pharmacy. We fill a sack full of meds for the patient, then the patient comes into the pharmacy and says, “I only needed my bp med.” This has become a very real problem where I work. I certainly don’t like wasting my work and we really don’t have the time for all this waste. YoungGun, we frequently get rx’s from the local hospital emergency room where the quantity is zero.
    -
    Auto refill is something we discourage at the pharmacy where I work. We tell the patient it does not work right, and it doesn’t. This is another big time waster.
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    The metrics are the equivalent of a soldier standing over his slaves with a whip. And, those metrics are so ridiculous, sometimes to the point of almost being laughable. Don’t know about other chains, but with mine, those metric numbers can be juggled if you want to take the time to do it. There is a store in my area that has a 97% on-time rate. There is no way this is possible without juggling some things. I know how to get our stores rate up there too, but it takes time and I just don’t want to waste my time doing it. Now, if they start telling me my job is on the line, then I will juggle those numbers. There is the phoning of customers to tell them they need to come pick up their meds. How does the company know that we called? So, a lot of it is just silly and I know my chain has gone nuts over these metrics and are measuring everything down to the smallest detail. I would try to tell them, if it would do any good, that the REAL WORLD pharmacy cannot operate by measuring everything, because everything cannot be measured. There is the time that I prevented a customer from suing my chain because a pharmacist misunderstood what the customer wanted. How do you measure this? There are so many qualitative aspects to pharmacy practice that can never be measured. The chains live under the illusion that everything can be broken down into numbers. This is a very bad and dangerous idea.
    -
    YoungGun, it is nice to see someone your age that really understands retail pharmacy in the corporate world.

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