A friend sent me a text the other day.  He went to his local pharmacy and was dispensed a drug he has never had before.  His text said, “Siri gave me better info than the pharmacist”

When I asked him to elaborate, he said the pharmacist never asked him anything about what he was taking the drug for, he simply read the directions off the label for him (which he could do himself) and mentioned a few possible side effects.  Ultimately, he felt the interaction was rushed and of no use to him.

I always find these situations rather embarrassing as a pharmacist, and they happen quite often.    Many of my friends and family across the country contact me for information regarding their health and their medications because they have had poor experiences and/or have no relationship with their local pharmacists.

Consider this typical pharmacy scenario.  A patient presents with a prescription for a repeat of their high blood pressure medication.  The technician at intake enters the prescription, sees nothing has changed and processes it.  On the back end, an assistant prepares the product, the pharmacist checks it and out it goes.  At the till the assistant asks, “Do you have any questions for the pharmacist today?”  The patient says no, thanks them and leaves.

This scenario happens over, and over again in our pharmacies every day.  For the majority of patients presenting to a pharmacy, they have minimal to no interaction with a pharmacist.

When do patients interact with a pharmacist?  Typically, when they get a new prescription.  What do patients usually receive in this interaction?  They are almost always provided with information, or what I call the “Top Five Points”.  What the drug is, how to take it, what side effects they could expect, when it might work and call if they have any questions.   Basically, patients see us as the providers of information. (Which I guess is marginally better than being seen as only a drug dispenser.)

The problem with this is that pharmacists simply spit out information that is easily found elsewhere.  This holds little value to patients.

Approximately 92 per cent of adults aged 18-39 now carry a computer in their pocket. Information is at our patients’ fingertips, it’s everywhere.  We are no longer the only source of drug information like we were 20 years ago.  People can look up the drugs on their prescription before they even get to you to fill it.  If our only interaction with a patient is to provide information (i.e. counselling), we will shortly be regarded as irrelevant.

If a patient takes a prescription to either your pharmacy or one of the four or five other pharmacies in your area and leaves with the exact same product and outcome, what is differentiating you from any other pharmacy?  This generation of young adults is favouring speed and convenience.  What’s more convenient than drive through, or a kiosk you can feed your Rx into and out comes a product, or an APP that will organize delivery of your drugs?  To the patient, there is no difference except increased convenience.  In both scenarios they do not have a meaningful interaction with a pharmacist.

In a time when pharmacists are pushing to advance forward on being reimbursed for services from third party payers and government, we must remember that these payers are ultimately patients too.  If they feel that a computer algorithm or robotic dispensing is cheaper and more convenient, and they have never seen the value of a pharmacist being involved in their care, then we may as well hang up our lab coats.

There are very few pharmacies that engage patients in shared decision making, chronic disease management and work to develop relationships with patients by following up with them on their drug therapy.  Yet, this is where pharmacists need to be.  This is what is irreplaceable.

Oh, but wait a second….  What about checking all those prescriptions?  We spend the majority of our time signing our name on the final check of prescriptions. Pharmacists are needed for that, right?  Nope. Registered technicians are much cheaper than pharmacists, so don’t count on being able to continue to sign your name for many hours a day and still be relevant.
“If we don’t like change, we will like irrelevance even less.” -General Eric Shinsek

I recently hired another registered pharmacy technician into my practice.  It didn’t take long before she became an essential part of the team, and with her amazing communication skills, she’s become sought after by our patients.  When I asked her why she left her previous job in a community pharmacy, she disclosed that it was because the pharmacists there did not allow her to practice to her full scope. She could not do final check on prescriptions, could not counsel on devices nor perform many other tasks she was licensed to take responsibility for.  When she gave her notice, the pharmacy manager told her she understood why she was leaving and supported her in pursuing a job where she could practice to her full scope.

This was stunning to me.  It was hard to believe that rather than change their practice, the pharmacy manager chose to let a valuable employee leave.

This certainly isn’t an isolated incident.   I’ve presented continuing education sessions to registered technicians and have heard very similar reports about pharmacists not allowing them to practice at the “top” of their license.  Meaning, they were not allowed to do final check on prescriptions or unit dose packaging, they were not allowed to counsel on devices and some not even allowed to count out narcotic medications.

This seems entirely contrary to the goals of pharmacists who typically state they do not have enough time for clinical work and engaging patients in expanded scope services.

Pharmacists cannot possibly evolve into providing expanded scope services without accepting registered technicians for the full professionals they have now become.

Working to the fullest potential of their license is empowering for any profession. Technicians and pharmacists alike tend to have more job satisfaction when they are doing what they are trained to do, and job satisfaction is key to a successful pharmacy team.

Here are three key areas where pharmacy technicians are often under-utilized:

• Final Check. There is no reason for pharmacists to do the final check on prescriptions.  The cognitive check and counseling of the patient can be done along with the initial assessment at intake.  Technicians carry their own malpractice insurance to take responsibility for the final sign off and dispense to the patient.  Pharmacists should also not be spending their time checking unit dose packaging or blister packs.  A cognitive assessment should be done by the pharmacist at regular intervals, such as quarterly, or when there is a change in therapy. This does not include having to check the final product or packaging.

• Identifying expanded scope and billable services. My technicians really shine in this area.  They are continually identifying patients requiring pharmacist services, including those requiring injections, medication reviews, follow up and prescribing services.  They triage patients, set up appointments, and market these services to patients.

• Teaching devices. Teaching a patient how to use a device such as an aerochamber or a blood glucose meter can be time consuming.  Utilizing the skills and expertise of registered technicians in device training is efficient but often underutilized in pharmacy practice.

Allowing all staff to work to their full potential, increases efficiency and job satisfaction as well as providing an excellence in patient care.