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Pharmacy Exposed: 1,000 Things That Can Go Deadly Wrong At the Drugstore, by Dennis Miller
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Weighing in at over 750 pages, Pharmacy Exposed is a massive indictment of a profession in crisis.
--This is the most explosive book ever written about pharmacy and chain drugstores.
--This is the first-ever expose' of pharmacy written by a pharmacist.
--This is the book that will change the way America views pharmacy and chain drugstores.
--This is the book that the big drugstore chains do NOT want you to read.
Most people view the pharmacist's job as fairly straightforward, uneventful, and even boring. Doctors write prescriptions and pharmacists fill those prescriptions. What could be simpler? Too often, the reality is quite different. Due to competitive pressures in the marketplace, pharmacy has been transformed into a high-speed, high-stress, high-stakes enterprise in which powerful prescription drugs are just a blur on a hamburger assembly line. The big drugstore chains have embraced the McDonald's fast food model with disastrous consequences.
I quit pharmacy after twenty-five years because I was so fed up with slinging out prescriptions as fast as my hands and feet would allow. I am trying to expose the fact that mistakes are far more common in drugstores than patients and physicians realize. Powerful prescription drugs are dispensed across America in a system that is guaranteed to produce errors. The big chain drugstores don't want you to know that pharmacies are purposely understaffed to increase productivity and profitability.
A huge number of pharmacists are disillusioned with the profession and are not recommending pharmacy as a career for their children. A huge number of pharmacists say that they would never have chosen pharmacy as a career if they had known what conditions are like in what we sarcastically refer to as "McPharmacy." This is a reckless system that treats powerful and potentially deadly prescription drugs as if they were no different from any other consumer product in America. The big drugstore chains run their operations as if pharmacists were dispensing nothing more hazardous than a Big Mac at McDonald's or a Slurpee at 7-Eleven.
Many pharmacists feel that the chains have made the cold calculation that it is more profitable to sling out prescriptions at lighting speed and pay customers harmed by mistakes than it is to provide adequate staffing so that mistakes are a rarity rather than a predictable occurrence. Understaffing sometimes forces pharmacists to take educated guesses rather than call doctors to clarify illegible prescriptions. Understaffing sometimes causes pharmacists to override potentially significant drug interactions rather than phone the doctor who prescribed the drugs.
Pharmacists are under tremendous pressure to fill prescriptions at unsafe speeds. Drive-thru windows increase mistakes by creating the expectation among customers that prescriptions should be filled as quickly as McDonald's fills burger orders. It is a fact that the speed with which pharmacists fill prescriptions is one of the primary criteria used by chain management in determining whether pharmacists are doing a satisfactory job.
Pharmacists go home at night crossing their fingers and wondering whether all the prescriptions they filled (and supervised techs in filling) that day were filled properly. They say to themselves something like, "Mrs. Jones was in today but I don't even remember checking her prescriptions."
Pharmacists desperately hope that the public will be so enraged by the common occurrence of pharmacy mistakes that they (the public) demand that the chains provide adequate staffing for the safe filling of prescriptions. Pharmacists desperately hope that the public will demand that safe staffing levels be given priority over the bottom line. Don't allow yourself to become a pharmacy statistic. Let chain management know that the current system is entirely unacceptable. I can state with certainty that the public has no idea how common pharmacy mistakes are today.
- Sales Rank: #850135 in eBooks
- Published on: 2012-09-04
- Released on: 2012-09-04
- Format: Kindle eBook
Review
As important as Upton Sinclair's The Jungle--California pharmacist
From the Author
I advocate a major overhaul in pharmacy toward one that serves patients' needs rather than corporate interests, and toward one that places the health and well-being of pharmacy customers ahead of corporate profits.� I have attempted to say what many pharmacists passionately believe but are afraid to verbalize out of fear of jeopardizing their employment.� Too many pharmacists today feel that the chain drugstore model has been disastrous for the public safety and for the profession of pharmacy.� So it is not surprising that many pharmacists are not recommending pharmacy as a career for their children.
The pharmacy of today that I describe is one controlled by the bottom line, in which cost-cutting is the core guiding principle.� This singular obsession with profits causes the big chains to cut pharmacy staffing to levels that are a threat to the public safety.� The chains have embraced the fast food model with disastrous consequences in a system that rewards quantity over quality.� This is a system where pharmacists are forced to fill prescriptions as if they were working at McDonald's, Burger King, or Wendy's.� It is a system where pharmacists too often don't have enough staffing to adequately answer questions from customers.� It is a system that cuts costs by hiring more technicians to do tasks formerly done by pharmacists.� It is a system in which insurance companies erect an ever-increasing number of obstacles to dampen utilization while at the same time making policyholders' and pharmacists' lives more complicated.� It is a system in which pharmacy mistakes are a horrific yet predictable and inevitable consequence of the chains' obsession with the bottom line. �
The pharmacist's daily reality too often consists of arrogant doctors with some or all of the following traits: 1) notoriously illegible handwriting, 2) inadequate knowledge of drug interactions and a rude or dismissive attitude toward pharmacists who call about those potential drugs interactions or questionable doses, and 3) receptionists who too often have a very poor understanding of drug names yet routinely phone prescription orders to the pharmacy.� The pharmacist's daily reality also consists of corporate bean counters who only care about numbers, and about how fast pharmacists can fill prescriptions.� Pharmacists feel that their speed in filling prescriptions is much more highly valued by the chains than the pharmacist's knowledge of drugs.� The pharmacist's daily reality consists of impatient customers who only care about how long they will have to wait for their prescriptions to be filled, and who seem to have no understanding of the potential hazards in the pharmacy and how common pharmacy mistakes are.
�� �
Ours is a nakedly profit-driven health care system in a culture that demands a quick-fix pill for every ill. It is a culture that prefers pills instead of prevention.� It is a culture in which the public has been well-conditioned by Pharma advertising to salivate for the latest wonder drug.� It is a culture of fast food in which pharmacy drive-thru windows are a threat to the public safety by creating an expectation for service that is as speedy as McDonald's.
From the Inside Flap
This is the most explosive book ever written about pharmacy.
The American public has no idea how common pharmacy mistakes are.� A few years ago, ABC's 20/20 did an undercover investigation of pharmacy mistakes. The segment was titled "Pharmacy Errors: Unreported Epidemic?" In my opinion that is an accurate description of the problem except that the question mark should have been replaced with an exclamation point. Search Google for "pharmacy mistakes" if you have any doubt about how serious this problem is.
I have included in Pharmacy Exposed a description of fifty major court settlements from pharmacy mistakes.� In thirty-four of these cases, the mistake resulted in a jury award of at least a million dollars and/or resulted in the death of a patient. �
Here are the top four awards that I am aware of in pharmacy mistake cases.
1. $31.3 million award in Illinois--Walgreens pharmacist dispensed diabetes drug glipizide instead of gout drug allopurinol, leading to renal failure, stroke, and death
2. $30.6 million award in California--Thrifty-Payless pharmacist dispensed 100 mg of phenobarbital to girl instead of 15 mg prescribed, causing brain damage
3. $25.8 million award in Florida--Walgreens pharmacist dispensed blood thinner warfarin in 10 times the dose prescribed, causing cerebral hemorrhage
4. $21 million award in Illinois--Walgreens pharmacist dispensed adult diabetes drug glipizide to infant girl instead of anti-seizure drug phenobarbital
Not surprisingly many pharmacists privately welcome multi-million-dollar awards.� I've heard several pharmacists say things like, "I hope the media coverage embarrasses the chains into providing adequate staffing so that pharmacy mistakes aren't inevitable."
Several years ago, my own stepfather was given the type-2 diabetes medicine Glucophage at a Wal-Mart pharmacy in Florida, instead of the anti-hypertensive Toprol XL. My stepfather has never had any type of diabetes. Luckily I was visiting my mother and stepfather when my stepfather asked me why the pills in his refill bottle looked different from the Toprol XL he was expecting.
Pharmacists have been eagerly waiting for a book to give to their spouses, parents, friends, and customers that describes the absurdity of operating pharmacies based on the McDonald's fast food model.� Under this model, pharmacists have little choice but to sling out potentially deadly medications at a speed that makes mistakes inevitable.�� �
Despite investing an incredible amount of time daily or weekly on this project, it has taken me nearly thirty years to finish Pharmacy Exposed:� 1,000 Things That Can Go Deadly Wrong at the Drugstore.� Weighing in at over 750 pages, this book represents a massive indictment of the McDonald's-ization of pharmacy.� This is the book that the big chains do not want pharmacy customers to read. �
It is my hope that Pharmacy Exposed becomes a paradigm-shifting book.� This very controversial book will upset a lot of people in positions of power in the world of pharmacy, particularly those at the highest levels at the big chain drugstores, but also those at state boards of pharmacy and at this nation's many pharmacy schools.� I hope to make a very compelling case that the status quo in pharmacy today is completely unacceptable and is, in fact, a prescription for disaster. �
A huge number of pharmacists are disillusioned with the profession and are not recommending pharmacy as a career for their children. These pharmacists say that they would never have chosen pharmacy as a career if they had known what conditions are like in what we sarcastically refer to as "McPharmacy."�� �
This is a reckless system that treats powerful prescription drugs as if they were no different from any other consumer product in America.� The big drugstore chains run their operations as if pharmacists were dispensing nothing more hazardous than a Big Mac at McDonald's or a Whopper at Burger King.� Somehow McDonald's and Burger King are able to provide adequate staffing for the dispensing of hamburgers but the big pharmacy chains are unable or unwilling to provide adequate staffing for the dispensing of a far more serious--and potentially dangerous--product. �
Pharmacy Exposed discusses the issues chain pharmacists have been afraid to speak out about because of fear of jeopardizing their jobs.� Too many pharmacists today feel that the chain drugstore model based on McDonald's has been disastrous for the public safety and for the profession of pharmacy.� Pharmacists are disgusted with what they see as the unconscionable way in which the big chains jeopardize the safety of our customers.� Pharmacists are furious that the current system cavalierly jeopardizes our license with every prescription we dispense. �
Many pharmacists feel they are rolling the dice every day they go to work.� Our constant companion is the fear that our next mistake results in the death or serious injury of a customer.� Pharmacists go home at night crossing their fingers and wondering whether all the prescriptions they filled that day were done so properly.� Pharmacists say to themselves something like, "Mrs. Smith was in today but I don't even remember checking her prescriptions." �
A huge number of pharmacists are deeply disgusted with state boards of pharmacy for being too intimidated by the legal and political clout of the chains, and for being too timid to at least try to pass regulations that address the understaffing that is endemic to chain pharmacies.� Pharmacists feel that understaffing is at the heart of the epidemic of pharmacy mistakes in America.� Pharmacists believe that state boards of pharmacy are doing a breathtakingly poor job in protecting the public safety by failing to mandate staffing levels that are adequate for the safe filling of prescriptions. �
Many pharmacists feel that pharmacy schools have grossly misrepresented what conditions are like in the real world.� Many pharmacists say they would like to bring a class action lawsuit against the schools of pharmacy for promoting a sugar-coated view of pharmacy, and for promoting a professional model for which the big chains have complete and utter disdain.� Pharmacy schools promote a model of the pharmacist as drug expert, but the big chains want nothing to do with that model.� The big chains expect pharmacists to fill an ever-increasing number of prescriptions with the same or even decreasing levels of staffing. The big chains seem to have a huge preference for fast pharmacists over knowledgeable or helpful pharmacists.
Pharmacists feel that their speed in filling prescriptions is much more highly valued by the chains than their knowledge of drugs.� Many pharmacists believe that the chains have made the cold calculation that it is more profitable to sling out prescriptions at lightning speed and pay customers harmed by mistakes than it is to provide adequate staffing so that mistakes are a rarity.� Understaffing increases pharmacy profitability but it also increases the frequency of serious errors. �
Pharmacy mistakes are a horrific yet predictable consequence of the chains' obsession with the bottom line.� It appears that cost-cutting--not patient safety--is the core guiding principle.� It is my hope that Pharmacy Exposed causes the public to be enraged at the inherent danger in this fast food model of pharmacy.� It is my hope that Pharmacy Exposed serves as an urgently-needed antidote to this madness, showing readers how they can protect themselves and avoid becoming a casualty of a system that is in crisis.� It is my hope that the public tells chain executives in no uncertain terms that the current system is entirely unacceptable.
Most helpful customer reviews
10 of 10 people found the following review helpful.
A Consultant Pharmacist's Review
By "DrJohn" BSPhD
As a 30 year professional Pharmacist who has practiced Long Term Care (geriatric) Pharmacy as well as Home Health Care, Hospital, Oncology, and Retail Pharmacy, I can attest to Dr Miller's expertise in this book. I refer to him as Dr Miller as he has definitely earned his doctorate in the School of Pharmacy Hard Knocks.
Dr Miller's insight into the practice of retail Pharmacy is exquisite. His insights are of one who has paid attention to his surroundings as he has practiced the most rigorous of this profession. While the uninformed public can easily assume that a Pharmacist has an easy profession, Dr Miller shows what a Pharmacist really goes through on a daily basis.
Dr Miller points out the many things that can cause medication problems with the unsuspecting patient, to the true fact that most mega conglomerate pharmacy corporations would rather concentrate on the number of prescriptions filled rather than their patient's need of the right medication at the right dose to the right patient.
This book is a must read for health professionals as well as pharmacy patrons. Many patients will wait hours past their appointment time at a doctor's office than wait more than 5 minutes at their pharmacy for their prescriptions to be filled. Dr Miller correctly points out the many checks, regulations, and insurance preauthorizations hoops that a pharmacist must jump through to fill a prescription. Then his employer wants this pharmacist to fill prescriptions as fast as McDonalds shoves hamburgers out of a drive through window.(which drug stores also have. How would you like to have someone tell you what your medication is and how to take it over a loudspeaker so the whole neighborhood could hear? Yet that is what a drive through window forces a pharmacist to do in order to comply with counselling laws on the FDA books)
Read this book and get educated.
7 of 7 people found the following review helpful.
Great Topic, Extremely Poor Editing
By T-Rex 5
My giving of this book 3 stars is being extremely generous. I do so based on the important topic of this book, and the sincerity of the author and that its obvious he has poured his heart & soul (as well as 20 years writing it). The author has expressed elsewhere that he is very disappointed with the negative reviews his book has received. It is obvious he has ignored the helpful constructive criticism he has received, but even so I will repeat it. Since he obviously appreciates repetition, I am hopeful he will appreciate this. 1) the book needed an editor more than any other book I've read. The author is a pharmacist, not an editor. I strongly encourage him to pay for some professional editing services. He mentions in the book that some of his family members who had previewed the book told him he was being too repetitive, but that he ignored this advice because he "didn't want to leave anything out." Many family members would be like the subjects in "The Emperor's New Clothes" and not want to state the obvious. I felt nothing but sadness that he would be so oblivious to his families gentle criticism that he would actually put it in the book. Because it is true, the book is EXTREMELY repetitive, even at times repeating the same thought nearly word for word in the same paragraph. The same stories are related in different chapters repeatedly. The author expressed in the book his hope that it would change pharmacy and the way people relate to it. But by refusing to use an editor and make his book readable, he ensured that most people would never be able to get through the book and see the points he was making.
2) the first 50+ pages of the book features full page covers of 50+ other books that the author apparently enjoyed. Or perhaps he thought putting the covers of the books into his own book would make people who liked those books like his. Why he did this wasn't explained, but it seemed very gimmicky and detracts from his book. My feeling is that if an author has to spend the first 50 pages of his book promoting other authors, then he doesn't have any confidence in his own book. It would have been much more professional to delete all the full-page book covers, and just put a list of other "suggested references" at the BACK of his own book.
3) the book is actually more of a memoir than an expose. People expecting an expose on pharmacy will undoubtedly be disappointed to find the book is a memoir of the author. And people who enjoy memoirs, may never read this book expecting it to be a technical expose. This is another example where a good editor could have made sure the cover advertised the actual contents of the book and reached the appropriate audience.
4) I was put off by the author's repetitive complaining of how he was sick of hearing the petty complaints of people that he felt were caused by lifestyle issues that they refused to address. I would expect a medical professional to know that constipation, insomnia, cough, etc. can all detract from the quality of life of a person, and are not petty complaints to the person suffering from them. I would also expect a medical professional to understand that there are often deep psychological issues or physical circumstances beyond a person's control that cause a person to live unhealthy lifestyles. An empathetic medical professional would seek to try to understand why the person is making unhealthy lifestyle choices and then help them come up with solutions that would actually be workable in their own life. If the author had understood this, it could have made a great point in his book, that the fast-food pharmacy practice leaves no time for pharmacists to actually help people figure out better lifestyle choices.....instead the author just laments & expresses disgust repeatedly that people don't care and that they only want a "quick" solution to their problem. He seems completely oblivious to the real lives of people--people who often work long hours or multiple jobs while simultaneously caring for children and/or elderly parents or people who grew up in abusive households who have never had a good example to follow--these people are looking for a "quick" solution, because they honestly don't know what else to do, and they need empathy, not disgust.
Still, the author makes very good points about the dangers of drugs and the devastation that can result from drug errors, about how common & easy it is to make drug errors, and the set-up of pharmacies that are conducive to these errors. I enjoy memoirs, so I enjoyed the stories the author told about his experiences in pharmacies (I just didn't enjoy reading them more than once in the same book.) I appreciate the passion the author has for pharmacy & for healthful living to avoid unnecessary drugs. This book could have been so much better than it was, and hopefully the author will get a professional editor for future books he writes.
10 of 12 people found the following review helpful.
Lots of repetition
By M. Scott
I bought this book for my husband (we are both pharmacists) This book is fairly accurate in that it tells the consumer why medication errors are so prevalent in chain drugstores. I should know; I've been a pharmacist as long as the author has. However, the author repeats chunks of the book at fairly regular intervals-it is horribly edited. The book is 753 pages long, for goodness sake! Realistically, the book should only be about 400 pages if repetitive filler is taken out.
As far as the content goes, most of it is the author's opinion about the state of health care; he goes on a significant tangential rant about how people want to get "a pill for every ill" and if they just eat a healthy diet and exercise they wouldn't need so much medication. Seriously?? Some advice-stick to the original theme of the book about why medication errors happen.
One more trivial aggravation I had-the author quotes the PDR for God's sake. What a joke! Pharmacists scoff when customers come up to the counter and say " I read this in the PDR..." because all the PDR is is a bunch of manufacturer drug package inserts bound together to make a book (Big Pharma propaganda). To the author- if you want to sound knowledgable about medications, how about quoting from a real reference such as Facts and Comparisons or the Drug Information Handbook?.
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