Hey everyone, Dr. Z.
Okay, first of all I wanna say
I'm not gonna curse in this piece,
so you can and should share it.
This is crucially important, okay?
There was a New York Times article about CVS
and the other large pharmacy chains
pushing performance metrics, understaffing and overworking
and asking pharmacists to do more and more
with less and less, leading to potentially errors.
Now again, correlation doesn't mean causation,
but let's really dig into this
because I think it gets to the heart of performance metrics,
medicine as a business, and the fact that in this country
we do not reward safety and quality, we reward volume.
Still, even in this brave new world of Health 2.0
and it is killing patients
and, believe it or not, it's killing caregivers.
We have, like, double the suicide rate
of the rest of the world,
we're suffering moral injury every day
trying to do the best thing for our patients
while making a living, while supporting our families,
while understanding that we were idealistic
and went into this for a reason,
and our frontline pharmacists
are like canaries in the coal mine for this.
Let's talk about this.
And I'll link to the article
and I want you guys to share this.
So, imagine you have a job
where you have to fill prescriptions,
give flu shots, tend a drive-through, counsel patients,
catch potential mistakes that maybe physicians
or other entities have made somewhere in the system,
educate both the patients and the doctors,
and deal with insurance companies, all right?
All while being under the constant threat
of these performance metrics which say
you have to make sure that patients
are asking or getting refills,
that you're calling doctor's office, pushing for refills,
that you're pushing for 90 day supplies of medicines
because that's more money,
and making sure you do a prescription every minute
because time is money and volume is money in these systems.
Now, you have these big chains,
which dispense 70% of the prescriptions in America,
pretty much running the show.
The CVSs, Rite Aid, Walgreens, etc.
Now, CVS was really singled out here
because they are the most aggressive, apparently,
in terms of these performance metrics.
Now, remember this.
Pharmacists on the front lines who are understaffed
and are going crazy trying to fit these metrics
are now making mistakes that were documented in the article.
So people are dying, they're getting methotrexate
instead of some other benign drug.
Children are getting steroids
instead of another benign drug.
I mean, these are, they can cause injuries,
they can cause fatalities,
they can cause suffering and they are entirely preventable.
Humans make mistakes, but we can design systems
that are incentivized to decrease mistakes.
However, we don't have that.
Instead, our financial incentives are all around
squeezing as much out of an individual pharmacist
as we possibly can knowing,
the system knowing that that pharmacist,
and by the way, substitute nurse or a doctor
or a respiratory therapist or a dietician
or whatever, housekeeper,
knowing full well that those people
who dedicated their lives to caring for other human beings,
to applying science to the problem of humanness,
knowing full well that they are expendable.
That in a second, you could pull another one
and put it in their place.
So if they open their mouth and say, "You know what,
"I'm not comfortable with this."
"Okay, go be not uncomfortable with this
"in the unemployment line."
And so pharmacists and others are terrified of retribution
for speaking up.
So what do they do?
They anonymously hit up their pharmacy boards in the states.
The majority of which do not have any ability
to look at errors on scale
and measure how many errors we even have that are happening
due to all this understaffing and overmetricizing,
or whatever else is going on
that's causing these errors, right?
And the pharmacy boards of which lawyers and representatives
of the major pharmacy chains often sit on these boards,
so that's gonna be adjudicated fairly.
And knowing that if their name is associated
with any complaint, these pharmacists
are going to potentially lose their job.
Right?
And so here you have a system
that is designed by its very nature,
remembering that reimbursements for these drugs are dropping
'cause of insurance pressures,
and so the companies have to make money
and they do that by squeezing more and more
out of less and less.
At whose expense?
The patient's.
Why?
Because these companies don't suffer
when a patient is injured.
You know, maybe they'll get sued,
and that's a rare thing.
But do they get paid to provide quality?
No.
And who intersperses themselves in the middle of this?
The pharmacy benefit managers,
the biggest parasites in all of medicine.
Started with good intentions,
let's keep pharmacy costs under control,
medication costs under control, let's represent employers,
and now they are simply a rebate providing,
money game shifting parasite.
Which, by the way, several of which are owned
by the big pharmacy chains.
You don't think this is a money game?
You don't think Optum is making tons of money from OptumRx?
Come on, guys.
In this country, this is a money game
at the expense of patients, at the expense of caregivers,
at the expense of our front line pharmacists.
So, imagine, all right, that you interview
a thousand pharmacists, which they did in this article,
or as part of the article reporting.
60% of the pharmacists said they feel undue intimidation
and pressure to fulfill performance metrics,
of which their salary or bonus
or other things may be dependent,
at the expense of patient safety.
And of that 60%,
60% of those pharmacists work in the large retail chains
as opposed to a community independent pharmacy
or a hospital pharmacy or something like that.
Let that sink in.
It is the big companies, that again,
are just behaving according to incentives.
I know people in the highest echelons of these companies;
they're good people in a bad incentivized system
that is causing harm.
So, 60%, it's unconscionable
that we're allowing this to occur.
There should be riots in the street with the number.
And by the way, the deaths and the injuries are,
you don't think they're underreported?
They have no mechanism to be reported.
The state boards have very little power.
This has been a struggle, all right?
So it's a huge problem.
Now, here's another part.
The horrible incentive structure
in the retail pharmacy business trickles out
to cause suffering and pain in the rest of healthcare.
How?
You're a doctor's office.
You're now deluged with requests for refills
on medications that don't need refills
because some algorithm told a pharmacist
that they have to call the doctor's office
to ask for a refill on a one-time steroid pulse.
Now this doctor's office
that's already drowning in effing paperwork
is now having to say,
"Oh crap, now there's a legal request for a refill.
"I have to deal with that.
"My inbox is already killing me."
This is dumb.
Why are they incentivized to ask for refills?
'Cause it's more money, people.
It's about cash.
It's not about patient care, it's about cash money.
Period.
And imagine this, hmm, huh.
You're a psychiatrist's office.
You write a prescription for lithium
for someone with bipolar.
You write on the prescription, "One month supply only."
The algorithm, or whatever it is,
either mistakenly or intentionally
overrides that and pushes for a 90 day refill,
90 day amount because it's covered by insurance
and the company is incentivized
to be paid as much as possible
by dispensing as many pills as possible.
And what happens now?
This patient potentially has the ability
to seriously overdose on this medication
or take it for longer than necessary or whatever it is.
And the American Psychiatric Association
has weighed in on this.
It's a huge problem.
Now, is the answer destroy these corporations,
go back to independent pharmacy?
Maybe, maybe it is.
If we could pull that off, I'd love to see it happen.
Because when we had an independent pharmacy,
the doctor knew the pharmacist,
the pharmacist knew the doctor, they had systems in place.
Sure, errors still get made
and we need bigger systems and technology
to help with that systems design, yes,
but there was a personal relationship.
So maybe that's the answer.
It's never gonna happen,
so let's check that off as not gonna happen.
So, what can happen?
Number one, we can actually change incentives,
whether it's legislative or whatever,
'cause right now pharmacy boards,
they focus on individual pharmacists when there's an error.
"Oh, you bad pharmacist, you should be punished."
Is that how it should frickin' work?
No, it should be this.
"Oh, you made a mistake as part of a company
"which now we're gonna look
"at those company work environment practices, systems,
"look at a root cause, do a just culture kind of analysis
"and go, 'Hm, looks like CVS done effed this up.'
"They're understaffing you, making you work a drive-through,
"give flu shots, counsel patients,
"do all this stuff at once.
"And not enough technicians,
"or technicians aren't allowed to do enough, whatever it is,
"figure it out and start to incentivize that.
"Ooh, now that's company's gonna have to pay for that.
"There's gonna have to be an incentive
"to do the right thing for patients."
And so we have to start pushing our legislators
and our state boards and our governance to actually lead
and accomplish that.
And you know what, I think the big corporations
actually are gonna be okay eventually
with focusing on quality if they're paid to do it.
'Cause they will go where the money is, period.
That's what corporations do, for better or for worse.
I like America.
I think ultimately it's for better that we have capitalism,
but let's make it work right, okay?
'Cause right now it's a crony oligopoly
that isn't incentivized right, especially in healthcare.
All right, so the call to action is this.
We need to focus on holding these corporations
responsible for quality,
we need to support our brothers and sisters
on the front line in pharmacy and the pharmacy technicians
and everyone working in these big retail chains,
trying to take care of our patients safely,
and we often blame them for driving us crazy.
It's not their fault, you guys, okay?
It's incentives, incentives, incentives.
And we need to make sure, again,
that we're all in this together,
that everyone in healthcare stands up together
with one voice when these problems meet us.
I want you to read that New York Times article,
I want you to share all of this.
I want you to become a part of this movement.
If you're a pharmacist, and you're not gonna lose your job,
leave a comment.
If you're a pharmacy, and you are gonna lose your job,
leave an anonymous comment
using a YouTube account on the YouTube clip, all right?
'Cause we need to hear your voice
and the public needs to see when they're watching this video
that you have weighed in.
Because you're the ones there, touching the patients,
experiencing this effect, all right?
So have your voice heard,
that's what this platform is about.
All right, guys.
I love you and we out.
Peace.