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    Goal of improved health may fall short despite increased pharmacy workload


    David Stanley
    Working in a retail pharmacy can be incredibly frustrating at times. Throughout my years behind the counter though, while battling the ups and downs of modern drugstore workaday life of delays, interruptions, constant struggles with payers and other professionals, and, more recently, metrics, quotas, and multi-colored clocks that measure our speed, there was one thing I never questioned. That the ultimate goal was to improve the lives of our patients.

    We may differ in our opinions of how it should be done, but the whole reason we are here is to help people live longer, healthier lives. That is the whole point of a healthcare system, and that much we should all agree on. Right?

    Unfortunately, there are signs that we are starting to fail.

    No one could argue that tremendous gains in health care haven't been made in the postwar era. We wouldn't want to go back to a time before penicillin or MRIs after all, but a closer look at more recent data reveals some disturbing trends. A study published in 2008 in the online journal PLOS showed that, from 1961 to 1983, there wasn't a single county in the United States in which life expectancy declined. From 1983 to 1999 however, 11 counties had lower life expectancies for men, and 180 for women. This was followed in August of this year by an even more troubling report in the journal Health Affairs. From 1990 to 2008, white women without a high school diploma in the United States lost 5 years of life expectancy, and their male counterparts are living on average 3 fewer years than a generation ago.

    Let that sink in. I'll be willing to bet that your job is harder now than it was 20 years ago. That your stress level is higher, that more is expected of you, and that no matter how much pressure you felt you were under if you were working at the end of the first Bush administration, it is nothing compared to what you feel now.

    And the payoff for all this? A significant number of your customers aren't living as long as they were before you even had a fax machine in your pharmacy. Something is very wrong here. When experts are quoted in The New York Times saying things like "The five-year decline for white women rivals the catastrophic seven-year drop for Russian men in the years after the collapse of the Soviet Union," it's not something the health professions can be proud of.

    The Times article goes on to say that this dramatic decline was caused by "a slowing or halt of reductions in cardiovascular disease, combined with increases in lung cancer and diabetes," which should come as a slap across the face to a profession that claims its value in the modern healthcare system is an ability to educate patients about the basics of smoking cessation, blood pressure treatment, and diabetes care. If only we could muster the same urgency to address this problem that some chains give to making sure you are wearing your name tag.

    So, what have gut-wrenching changes in pharmacy been for if not to improve the health of those we serve? At the risk of sounding cynical, perhaps the answer lies in a different set of numbers. The combined 2011 profits of the two largest drugstore chains and pharmacy benefit managers were just shy of $9 billion dollars, which tells me some people are doing just fine under the current healthcare system. Not, however, pharmacy employees who are under a large and ever-growing amount of stress in their working lives, or the patients who are ending up in an early grave. I started my career never questioning that our ultimate goal was to improve the lives of our patients. Today, however, I am desperate to be proven right.

    David Stanley is a pharmacist, blogger, and professional writer in northern California. He can be reached at
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    David Stanley, RPh
    David Stanley is a pharmacy owner, blogger, and professional writer in northern California. Contact him at [email protected]