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Yesterday, we reported on a new study from the American Pharmacists Association (APA) suggesting that there is a clear correlation between the strength of the relationship between the consumer and his or her pharmacist and that consumer's being properly informed so as to use medications with lower risk of adverse effects and better health outcomes.

We commented that we’re of two minds about this survey:

On the one hand, it sounds like it makes sense both for the consumer and the retailer. After all, in an increasingly technological store environment, the pharmacist can be a valuable touch-point through which a relationship with the consumer can be forged.

That said, we’ve been getting prescriptions at the same CVS for more than a decade…and we haven’t the foggiest idea who the pharmacist is, nor do we care. We just want the stuff to be ready when we need it, and for the right pills to be in the right bottle – and in neither case do we need a personal relationship.

Hate to sound cranky, but there it is…

Got lots of reaction to this commentary…

MNB user Verne L. Mounts, R.Ph., wrote:

Dear Cranky,

I am a pharmacist, since 1985, and I have been credited with saving more than one person’s life by my “relationship” with nearly perfect strangers due to my counseling expertise. I will share two experiences with you related to over-the-counter counseling opportunities in my career; not to mention my numerous interventions when it relates to prescription medications…

Several years ago a grandmother was observed attempting to make some bandage and first-aid purchases in a pharmacy I worked at. A clerk asked if she needed assistance and the grandmother acknowledged she could use some help. The clerk informed the grandmother that I was good at making self-care recommendations and that she would notify me.

I proceeded to step out of the pharmacy and found the grandmother in the first-aid section. I asked what I might assist her with and she informed me the doctor sent her to the pharmacy to pickup bandages for her granddaughter’s hands. I asked what type of wound needed to be dressed. She informed me that her four-year-old granddaughter had blisters on her hands that nearly covered her entire palm. Since this was the late eighties, I assumed the child had burnt herself on a space heater, which was a very popular supplemental heating source at that time, as I was thinking to myself. But…I asked the grandmother, “What was the source of the blisters?” The grandmother stated that these were the same blisters that were on the child’s bottom and that we had filled numerous prescriptions for her bottom rash/blisters over the past few weeks. The doctor felt that these were due to a yeast infection.

I then asked the grandmother if her granddaughter had been on any oral antibiotics lately. She stated she believed she had been over a month ago but assured me that all the medications prescribed were filled at our pharmacy.

I proceeded to return to the pharmacy and reviewed the computer profile and identified a suspected antibiotic capable of an adverse drug interaction known as Erythema Multiforme or a severe form known as Steven’s Johnson syndrome. Erythema Multiforme is an exfolliative dermatitis that can result in the skin blistering and shedding from the body and be potentially life threatening.

At this point I asked the grandmother to wait while I contacted the doctor’s office. When I contacted the doctor’s partner I asked that the yeast diagnosis be reconsidered as a potential adverse drug interaction, due to a sulfa antibiotic prescribed approximately a month ago, and consider a possible diagnosis of Erythema Multiforme or Stevens Johnson syndrome vs. yeast infection.

The physician I spoke with was elated for my intervention and contacted his partner, the prescribing physician. The child was sent to a local Childrens Hospital evaluated and hospitalized for treatment and observation.

I was credited by the physician, grandmother, and mother as potentially saving the child’s life by my intervention “relationship”.

Also, I write a weekly pharmacy column for a local newspaper, which has a number of readers within our county. Approximately seven months ago, a wife came to the pharmacy counter, on a Saturday that I was working, with three different OTC stomach remedies. She stated, “Verne, I am glad you are working, my husband is in the car, he does not feel well, but he wanted your advice as to what he should take for his stomach.” “He will not see a doctor, but he told me he would purchase or do whatever Verne recommends.”

I proceeded to ask her a number of questions:

_ What are the symptoms he is experiencing?
_ How long has he had the symptoms?
_ Has he ever experienced these symptoms before?
_ Has he been hospitalized for these symptoms?
_ Is there any sign of blood in his stool?
_ Is he vomiting?

With each of these questions the wife had a response that led to my next statement or recommendation.

I will not recommend any of these products, but only that you go out to the car and tell your husband that I recommend that he must be seen at the emergency room now!

The wife left the pharmacy, presented my recommendation, and they proceeded to the hospital. He was admitted to the hospital for 3 days with a bleeding ulcer, given several units of blood and upon discharge proceeded back to my pharmacy to fill his discharge prescriptions. I happened to not be working that weekend but he asked my partner to pass along a message to me. “Please tell Verne that the doctors said he saved my life and my wife and I am very thankful !” Later he returned to tell me in person.

Cranky, I am sorry you have never experienced that level of pharmaceutical care, which I consider a standard of care. Consumers make choices about where to shop, based upon various criteria or are attracted to a certain type of pharmacy establishment. If you were going to a physician who showed neither passion for his profession nor interest or compassion for you as a patient, would you continue to maintain him/her as your healthcare provider?

Maybe it is time to look around for a new pharmacist. Look for a pharmacist who can provide you what you need even if you are not aware you need or have missed it. Maybe you just need to elevate you pharmacist expectations.

MNB user Denise Remark-Lundell wrote:

I believe as you that I want my prescription to be the correct drug/dosage in the right bottle. That said, for many older people, a relationship between customer & pharmacist could mean the difference between taking conflicting drugs from multiple doctors or not. Many elderly take many prescriptions from several doctors who may not know of each other's existence and what they've prescribed. If that customer funnels all scripts through one pharmacist who knows the patient, then the pharmacist is more likely to be cognizant of potential problems.

Another MNB user wrote:

Your opposing view on this subject is obviously slanted towards being a well-informed consumer who is pressed for time. I suspect you also fit the category of consumers that fill less than 6 prescriptions per year. If you have questions about the prescription or the disease state, you simply look it up on the internet.

A relationship with the pharmacist has proven to be very important to the consumer who is likely a senior, is on multi-drug maintenance therapy, and has no or limited access to disease state and drug information outside of their pharmacist.

MNB user Joyce Mann wrote:

My family is moving across town this month. One of the relationships we don't wish to sever is the one with our pharmacist. We rely on his staff for over-the counter meds - my husband has heart disease, so we must be careful. We are fortunate to have good health insurance paid by my (grocery-distributor) employer, so have never been tempted to price-shop or use the internet for our prescriptions.

We have always gone to the pharmacy attached to our grocery store.

MNB user Bob Sgarlata wrote:

While I have a similar relationship as you, or lack of, with my pharmacist, we are in the minority. The Patient-Pharmacist relationship is critical -- and grows significantly with age and the use of prescriptions.

As former VP of Retail Marketing for Walgreens, I saw this dynamic up close & personal. I recall being near the Pharmacy Counter in one of our stores when an elderly gentleman brought his prescription to the counter only to learn that the regular pharmacist had a day off. His response? "That's okay, I'll come back tomorrow."

There are many similar examples of this meaningful Patient-Pharmacist relationship that serve to remind us of the importance of properly managing and leveraging this potent relationship. There are also examples of the opposite.

Recently I was in a rather new combo store, which I will not name. They had a separate, small room at the end of the Rx counter with this sign overhead: "Pharmacist Consulting Area". Unfortunately, the room was completely filled with unused wire displays and shelving.

Brick & mortar pharmacies are using the importance of consultation in their fight against online pharmacies and drug importation competition; however, if pharmacy wants to 'talk the talk' they better learn to 'walk the walk.'

MNB user Rosemary Fifield wrote:

For years I had the luxury of going to a small, pharmacist-owned drugstore, and I always used the pharmacist as a resource. She knew more about the drugs, their side effects, their interactions, and their contraindications than my very busy, somewhat impersonal doctor. I trusted my pharmacist for her specialized knowledge, and it was a sad day for me when she retired and no one else would pick up her business. What you describe at the CVS is now my experience, but I do lament the absence of that personal relationship. I felt safer then.

MNB user Gretchen Murdock wrote:

First off – I want to congratulate you on your headlines today. Very entertaining.

Secondly, I want to comment on your article about knowing your pharmacist. We live in a medium-sized cosmopolitan area where the suburbs have been expanded into the small surrounding towns. This allows us to take advantage of some of the small town businesses that have been there for a long time and have roots in the community. Our pharmacy could have appeared in a 1950s movie and the three old timers that run the place are a study in character actors. The wonderful thing about it is that they do care about their customers, and they do take an interest in your family. If you need prescription or cough medicine and the store is closing, they will stay open until you arrive. If you need something for your child and you can describe the symptoms, they will recommend something that is most appropriate. And the wonderful thing about it is that you are not just a number. This allows for more information to be passed along during the “how’s your mama” talks. I have come to realize that customer service, which is so important in other shopping arenas, is even more important in the pharmacy.

Service is the foundation of some of the most successful supermarkets, and it certainly goes a long way with me when it comes to the pharmaceuticals that I provide my family.

Sorry, Kevin – I’m on the other side of this one.

MNB user Suzie Bowen wrote:

If all you care about is having your prescription correct and ready on time, that's great! That is something every pharmacy customer should expect and receive. However, it is always good to have a friendly face you know when you do have a question about the new drug you've been prescribed and the possible side effects or interactions it may have with other medicines you take (even over the counter medications). As many of us baby boomers age we find ourselves with more and more vials in our medicine cabinets. I, for one, want to make sure I know what I'm taking and what I can expect. Heaven knows, anyone who's ever tried to read the insert with your medication (from the manufacturer) can tell you they either can't understand it or are so frightened by the list of side effects they don't want to take it. Yes, know thy pharmacist!

And finally, another member of the MNB community chimed in:

I wonder how many people you will stir up with your comments about the pharmacist. Wow, Kevin, an enlightened man such as yourself suggesting that it is unimportant to know your pharmacist. I guess it shows that we can't all be smart at all things.

Having worked in the pharmacy education for ten years, I can tell you that, for many people, knowing their pharmacist saved their lives. Blindly stopping at your pharmacy, grabbing your meds and trusting that all is well is a recipe for disaster. Conversely, taking advantage of the counseling services your pharmacist WILL provide (they are mandated by law to do so,) can greatly improve your knowledge of your medications and may provide added knowledge to help you get healthy enough to potentially get off the medications...which should be your goal.

Having candidly quizzed both physicians and pharmacists for years about side effects, dangers of interaction, disease management, diet and health tips, I can tell you that I feel much safer getting my answers from the person behind the pharmacy counter than at the doctor's office. Statistics prove why: When pharmacists accompany docs on their rounds, medication errors drop by 66%! Less than half the population talks to their pharmacist (or their doctor) about their personal potential for medication errors! And to weave this together for impact...medication errors are in the top 5 reasons for death in this country every year.

Consider this, Kevin. 20% of our population takes more than five drugs, often prescribed by three of more doctors. These prescriptions may be filled at more than one pharmacy, which means your CVS pharmacy may not know about the prescription you filled at the little pharmacy by your other doctor across town. NOW...if you didn't talk to your pharmacist= about all your medications, how do you think he could warn you of the dangers or interaction potential for all five meds?

Pharmacists will take the time to talk to you and, if they don't, go to another pharmacy. It is too important to not take advantage of their knowledge, their disease management computer programs and their personal service to your health. Many pharmacists are trained in nutrition, nutritional supplements and specialized (made-to-order) medication compounds that are becoming more popular...because they are made specifically for the individual and are considered safer. A talk with your pharmacist may be able to help you with non-medical concerns, such as lack of energy or lack of sleep, things the doctor doesn't have time or knowledge to help you get through. In most cases, the pharmacist get make recommendations to your doctor if he/she thinks your medications pose a concern. Using them both as a team will keep you is proven.

Pharmaceutical medications are so expensive, partly to pay for the sales people to wine and dine the doctor, so they will sell the medication. Presents a bias, doesn't it? Pharmacists are not coerced by this, so they can offer unbiased opinions...if you ask.

Health care is too expensive not to take advantage of all its services. A pharmacist will talk to you...without charge...about your medications and their impact on your health. They see the problems with medications and can give you answers about the interaction between them. Kevin, don't know how many prescriptions you take - I pray not many and that your health is good. Get past the mindset that the pharmacy is just a place to pick up and pay for drugs. It is much more than that, if you use it properly.

Okay, okay. We give up.

We know when we’re outnumbered, out-argued…and in this case, maybe out of touch.
KC's View: