Monday, July 25, 2005

Pharmacy Practice in Florida

I worked in a retail pharmacy in Orlando, Florida for five years, and came across many problems due to the vast influx of immigrants into the state. Communication with immigrants who do not speak English is an increasing problem in border states like Florida, Texas, and California. The new emphasis on patient care in the field of pharmacy means that communication is quickly becoming the most important aspect of a pharmacist’s responsibilities. When confronted by a language barrier, matters drastically become complicated, and can impede a pharmacist from being as effective as they otherwise would be.

How do you properly counsel a patient on their medications when they cannot understand a word you are saying? This is a problem I had to face all day long in the pharmacy that I worked. We implemented a few strategies to combat this. One thing we did was to have a sheet of Spanish phrases that we would commonly use in our pharmacy. For instance, at our fingertips we had the Spanish equivalents for “Take once a day”, “Call your doctor if you have any problems”, “How do you feel?”, “Where does it hurt?”, etc. We were unable to carry out a complete conversation, but this did help in the patient’s understanding of how to properly take their medications and what to do if there were any problems, and it helped in our understanding of their specific problems as well.

Another tactic employed by our company was to hire Spanish-speaking pharmacists and technicians. Communication, of course, became much easier; however, I have personal reservations concerning this. First, this does not provide any incentive for Hispanics to learn how to speak English. Secondly, these patients would only come to get their prescriptions filled if the “Spanish pharmacist” was working. Thirdly, once word got out, then droves of Hispanic patients would come into our pharmacy and overload our Hispanic pharmacist whenever he was working. Many people came just to socialize. This prevented the pharmacist from focusing attention on more important matters. Lastly, we non-Spanish speaking people were left out of all conversations, and had no idea what exactly was being said; we were unable to help and felt useless. It seemed awfully rude to us as well, but we did our best to understand.

Our company would also post bilingual signs, and all of our OTC
and HBA products were printed in Spanish and English. Once again, I have personal problems with this. In my opinion, English ought to be the official language of America, and anyone coming here ought to be courteous enough to learn the language. Catering to them only eliminates their incentive to learn English. I do not want to see us become like Canada where all signs are bilingual (French & English) because it removes a sense of national unity and identity. Being forced to speak Spanish, in my opinion, defeats the purpose of being born American.

There are also programs and classes set up specifically for pharmacists who desire to learn Spanish in order to better communicate with their consumer base. The Hispanic population is growing exponentially in this country, and the influx is beginning to spread further and further north affecting many states besides just the border states. These classes may not be a bad idea for pharmacists who work in heavily populated Hispanic communities.

My personal favorite method of communicating with Hispanic customers is through their family or friends who speak English, and can translate for them. Talking through an interpreter is a slow process, but at least it shows that they are willing to make an effort to help not only the pharmacy staff, but themselves as well. I get particularly perturbed when Hispanic customers actually get angry because we do not speak their language. It takes some nerve to come to a foreign country and demand that they speak your language, and then become upset when they don’t! This is where the entitlement mentality has brought us in this country. These immigrants are not here for a month before they begin to feel as though they are owed something, and are entitled to it, whatever it may be.

I periodically worked in a retail pharmacy very close to Disney World in Orlando. We would have foreigners from all over the world in our store. All of them spoke English. It seems, for some reason, that only the Hispanics refuse to learn how to speak English. I am not sure why that is, but it is an issue present in many pharmacies today. Once again, it is because we cater to them and remove the incentive to learn our language. There are no signs in French, German, Chinese, Japanese, or any other language. It is because of their sheer numbers that businesses cater to them. Greed is good in many ways, but this is one example where principle ought to supercede the need to make a buck.

Once their children assimilate, then things will get better. Most Hispanic children can speak English. Also, their last names will change as they marry into our culture. This will be a huge benefit for pharmacies because Spanish last names are also a big issue. First of all, they do not really have last names in their culture. It is hard to explain, but they do not designate last names like we do here in the U.S. Trying to find a prescription for a Spanish person is very difficult if you have to ask them what their last name is. Another problem is that even if they have designated a “last” name for themselves, they all pick from an extremely limited list of choices. When 75% of your customers all have the last name “Rodriguez” or “Martinez”, then it makes it hard to find the proper prescription. Also, their first names are not varied much either. Most women are “Maria” and most men are “Jose”. It is amazing how many different customers are named Jose Rodriguez, or Maria Martinez. They make John Smith and Sally Jones look like Keir Van Damme and Natasha Lipinski.

Reflexively irate and overly sensitive politically correct, knee-jerk people may consider these to be racist comments, but they are merely an accurate interpretation made from completely honest, first-hand experience. Opinions vary, but the facts are undeniable. No one should ever treat any foreigner poorly just because they are foreign. It is our duty to do everything we can to help our patients get the best care possible. The onus lies mainly with the pharmacist, but there are limits. One example is being required to learn a completely new language. This rant is moot, however, because the problem is too out of control right now for hopes of a short-term cure. In time, as assimilation occurs, things will improve and become easier not just for pharmacists, but for Hispanic patients as well.

There are many issues pharmacists must deal with when working in border states where the foreign population is so high. It can be very trying, but there are things one can do to make it easier. The most important is to be aware of these potentially complex situations ahead of time in order to prevent them from becoming too complicating and unnerving.

Sunday, July 10, 2005

Where Should the Onus Be?

Who has not heard the expression, “the customer is always right”? This seems like a great idea for the business world where it is imperative to coddle consumers so as to make them repeat customers. For those of you who have worked retail before, particularly a retail pharmacy, you know how this principle can be abused by certain customers/patients who try to take it to the nth degree. For those of you who have yet to work in a retail pharmacy, then you better pay attention because this issue will feel very real to you before long.

We all know, or should by now, that being a pharmacist involves a great deal of responsibility. I’m not just talking about the obvious responsibilities of checking for drug interactions, watching for contraindications, or resolving third party conflicts. One issue becoming more prevalent all the time is the process of communicating with patients and making sure they understand everything about their medications that they need to in order to provide them the best patient care possible. What happens, as is becoming more prevalent nowadays, when your customer base consists of patients from diverse backgrounds? How can you, as a pharmacist, best serve your patients when they come from so many different cultures, speak various languages, and hold many different beliefs and values from your own? Is it better to try to treat each and every patient as a separate individual and account for all of their idiosyncrasies, or would it be more efficient to treat all of your patients in basically the same manner and let them adapt to you?

The knee-jerk response of compassion, very prevalent in America today, may lead one to immediately say that the pharmacist should do his or her best to deal with each patient on an individual basis. The argument is that in order to provide the best patient care the pharmacist must try to be aware of different ideologies and beliefs held by people of different backgrounds so as to avoid offending them. In some cultures, for example, it is rude to look someone in the eye that is older than yourself. Some cultures have very strong beliefs about medicine and healing that may be very different from anything a student would learn in an American pharmacy school. This would mean that the pharmacist, in addition to what he or she learned in school, would have to also learn what people of different ethnicities think about medicine and healing. Some cultures, for example, put a lot more faith in herbal medications than we do here in America. This reasoning would result in the pharmacist having to be aware of these differences in case anyone from a particular culture should happen to bring a prescription in to be filled.

The other side of the argument states that perhaps it would be better if the pharmacist or technician just stay constant, and treat patients in the same manner. If special circumstances are required for someone who does not speak the language, for example, they can take the initiative and bring in someone, a friend or family member, who speaks English and can translate for them. Advocates of this point of view may argue that there is just too much variety out there and it is ludicrous to expect a pharmacist, or anyone working retail, to cater to everyone who walks into their store. Perhaps foreigners coming into the pharmacy who are from another culture could try to realize on their own that any offense by a pharmacist or technician is purely accidental, not intentional. Maybe they could use a little foresight and realize that there are many different ethnicities to account for in this country and that misunderstandings are inevitable.

It is interesting how the responsibility is always placed on the server and not the one being served. Pharmacy, which is basically the only health profession that exists in a retail environment, is especially interesting because one would think that, when it comes to health, the one being served would do their best to makes things as easy for the pharmacist as possible. The opposite seems to be true, however. Not only is the pharmacist expected to perform his or her normal responsibilities as quickly as possible and with no errors, but now it seems as though he or she is also expected to know every subtle nuance that exists in the world and be an international translator as well. This is just one example of how attitudes are changing around the world and especially in this country. Everyone is so paranoid about offending someone else and those who get offended seem to do so over the most inane things. Touchiness has reached a new plateau and it has resulted in making life much more difficult than it needs to be. God forbid anyone should say or do something that offends someone else. Unless we all start to relax a little and quit taking trivial things so seriously, matters are going to get a lot worse. Of course, that’s another article entirely.

The Perks Associated with America

“No people who have ever lived on this earth have fought harder, paid a higher price for freedom, or done more to advance the dignity of man than Americans.”-Ronald Reagan

We are mired in an age of moral relativism where most everything is acceptable, personal responsibility is a diminishing principle, whiners over-engage in victimhood, standards are being dissolved, the value base is in decline, and feelings rule over logic in forming opinions. America bashing has also become fashionable thanks to the “blame-America-first” crowd. Admittedly, this is not a perfect nation by any means, but it is the greatest one ever created in the history of humankind. Therefore, a reminder is in order as to how lucky we are, and that things could be much worse.

Regardless of all of the unsubstantiated, hysterical, and frantic fear mongering doomsday fanaticism spewed forth by environmentalists in this country, America is still one of the least polluted nations in the world. We have the most sophisticated industrial technology and environmental regulations, which allow us to be so clean, of any country. Totalitarian nations like Russia and many of those in Eastern Europe have dead forests and three-eyed fish because there is no incentive for them to keep the land free of hazardous pollutants since private ownership does not exist. These countries also do not allow any environmental reporting. Capitalism makes the world a better place in more ways than one.

In Russia, China, and Cuba, just to name a few, the government controls the media. The citizens only hear and see what is intended for them (e.g., government propaganda). Presently China is referring to their pilot that died as a ‘revolutionary martyr’. In this country they are called ‘showboats’ and ‘hotdogs’, and should not be portrayed as national heroes. This guy saw Top Gun one too many times and tragically thought it was a cool idea to imitate what he saw. Sadly, the media in the U.S. is becoming more and more biased, and selective about what they cover. The Jesse Dirkhising case is a prime example. If you have never heard of it, then that is not surprising since most of the media choose not to cover it. Nonetheless, due to the still barely breathing first amendment, the freedom of speech and of the press almost guarantee that any and all viewpoints on a subject can be heard by the masses of people- theoretically anyway. All that needs to be done is to straighten the ‘slanted’ minds of those in the media so that all stories have an equal chance of being covered fairly and justly.

Despite our perpetually poor performance on international academic tests, we still have the best technology available to students than anywhere else. America spends more on education than most nations. Yet presently two-thirds of our fourth-graders lack proficiency in reading, and many graduate high school still unable to read! It just goes to show that Internet access cannot replace hard work, and the desire to learn. What we need to do is find a way to instill the value of education and the desire for knowledge in our young people; this is where good parenting is needed, not more government intervention.

Human rights in this country greatly exceed those of anywhere else, ever. This is why immigrants are risking their lives on a daily basis and coming over in droves from all over world. America is still a beacon to the oppressed, the dispossessed, and the poor because our standard of living is the highest it has ever been anywhere at anytime. They also realize what too many of us have forgotten; dreams can be fulfilled and anything can be had with hard work and determination. Too many of us believe that we are entitled to things, and play the victim role when we should be thankful for being here instead.

Slavery still exists in many places around the world. The ship with 250 slave children has been in the news just recently, but this sort of thing has gone on continuously for millennia. Africa has a plethora of other problems as well, too numerous to mention here. Many African nations have a smaller economy than most any city in the industrialized world. One in five households there have electricity, only two-thirds have access to adequate water, and three-fourths have no access to adequate sanitation. There are constant reports of such things as child killings, large-scale massacres, rioting, and rising domestic violence. South America is not much better.

The treatment of women is horrid all over the globe. Most male-dominated societies treat women like second-class citizens, or worse. The status of women has never been higher in the history of humankind than it is right now in the U.S.

Look at the leaders of the world. Zimbabwe’s justice minister, President Robert Mugabe, threatened Supreme Court judges there, who are not of his political persuasion, with violence unless they resigned. Recently the Namibian President Sam Nujoma ordered his police to “arrest, deport, and imprison” homosexuals and, thus, initiated state-sanctioned gay bashing. China also has similar policies toward gays, and, in fact, anyone who dies of AIDS is cremated on the spot.

Talks concerning getting our plane back have become futile because Chinese officials refuse to discuss it until they get more apologies. Their manic need to ‘save face’ verges on the absurd and may lead to serious problems between the two countries. Mexico’s president, Vicente Fox, admitted in March that torture has been a tool used in Mexico for centuries as part of the justice system and politicians there often get into fistfights! Fighting in the Middle East has been going on incessantly for centuries and no seems to be able to stop it.

Let’s examine our health care system. The U.S. has the best medical knowledge and technology, the most funding, and the least amount of disease than any other country. The FDA provides us with the best food quality, and our sanitation is unparalleled. Socialistic health care systems, like that which exists in Canada, are going broke. Reports now show that 25 million people in Africa have AIDS, and the rate of infection is 25%. All sorts of varied diseases run rampant all over the world on a much more drastic scale than here. How many people have you met with malaria or scurvy? It is said that ‘the plague’ still exits in some parts of the world!

Here in America we have the most personal freedom, an outstanding economy, the most comfortable lifestyle, the best opportunities, the greatest form of government, and I could go on and on. Sadly, our prosperity has spawned a spoiled leisure class. Values such as hard work, self-reliance, respect for the law, and love for country are being replaced with entitlement, laziness, disrespect, and contempt for America. We must maintain those values that have made us the greatest nation in the history of the world, and take measure not to lose them. Also, we all have ancestry from other parts of the world, and we are all proud of our heritage; however, we are here now so let’s be proud of being American too, shall we?

Up To Our Eyeballs In Litigation

One of the liberties granted in this country is our right to sue anyone we wish for anything we like. While this is a cherished and much needed venue for the personal pursuit of justice, one has to wonder if the system is being misused. Following are some examples of litigation that have made the news in recent years; see if you can pick out the fictional example: 1. A woman sues McDonalds and wins $50 million because she spilt hot coffee on herself, 2. An illegal alien derelict sues the city because he gets drunk, falls onto train tracks, and loses his legs when run over, 3. A woman sues the Pop Tart Co. because one caught fire in her toaster, 4. Two teenage girls sue their school for $40 million because they did not make the cheerleading squad, 5. A burglar sues the man who’s home he broke into because he hurt himself during the robbery, 6. A woman in California sues the tobacco company and wins $54 billion because she claims to have been unaware that smoking was harmful, 7. A man sues four different fast food chains for causing his obesity, several heart attacks, and other health problems, 8. An illegal Mexican alien sues Texas and is awarded millions after becoming disabled from diving into a body of water below a dam because the numerous warning signs there were in English, not Spanish, 9. A Dominican Republican native who said his boss badgered him with racial slurs every day gets a $4 million ruling from a federal jury, 10. A Muslim woman sues Florida for taking her driver’s license after she refused to remove her veil for the picture, 11. Another Muslim woman sues an airport for making her remove her turban in the security line, 12. A college student sues his school after he gets drunk and falls off of his balcony injuring himself, 13. In a product-liability suit the Hershey Co. is ordered to pay $135 billion in restitution fees to 900,000 obese Americans, 14. Prisoners in a federal penitentiary, claiming their First Amendment rights were violated, bring a class-action lawsuit because they were banned from watching R-rated movies, 15. A man wins over $11 million in New Jersey after falling off of another man’s porch.

Okay, ready for which of these frivolous lawsuits is counterfeit? The answer is none! Sadly and unbelievably, all of the aforementioned examples are actual cases of litigation. “Undoubtedly”, you say, “the judges involved in these cases surely must throw them out”; that statement would say much about your naiveté. “Well then”, you jest, “juries must be able to sieve through the bologna and come to a sensible and respectable verdict!” All right, now you are embarrassing the both of us.

Lawyers and judges are the fiends behind this insanity. They are the culprits of this debacle that is corrupting the inner-workings and very fiber of our society. Now, it pains me to have to say this, but I am required to do so- I am generalizing, of course. Not all lawyers and judges are swine. There are many cases of legitimate litigation out there. Now that I have gotten that sorrowfully necessary statement out of the way, we can continue. Imagine all of the warning labels you see sprayed everywhere mottling the landscape. Have you ever wondered why they are there? It is because someone, after hurting themselves by doing something incredibly imbecilic, sues an organization, wins, and now (thanks to their lawyer who gets about 40% of the settlement), the establishment that got swindled has to implement warning labels forevermore. Here are some examples: Sears hairdryer- “do not use while sleeping”, Rowenta iron- “do not iron clothes on body”, Boot’s Children’s Cough Medicine- “do not drive a car or operate machinery after taking this medication”, Nytol Sleep Aid- “WARNING, may cause drowsiness”, Superman costume- “wearing of this garment does not enable you to fly”, Swedish chainsaw- “do not attempt to stop chain with your hands or genitals”, baby strollers- “remove child before folding”, on trash compacters a picture of a person placing their head inside with a line through it indicating “do not do this”…and the list goes on. Judges are another problem altogether. They can reverse court decisions, many are appointed for life, and they are not required to have their opinions printed in official court publications. Bad judges are harder to remove than Charles Manson’s psychosis, and just as difficult to contact. Those judges who have their own daytime TV shows seem more like standup comedians than demur and intelligent interpreters of the law.

The current state of litigation in this country is entering the land of the absurd and is downright dangerous. Health services are declining and prices are skyrocketing due to the current malpractice insurance crisis involving doctors in this country. When will we wake up and incorporate common sense into our justice system? Why do the American people allow this insanity to continue? When will they demand reform? Serious contemplation of the answers to these questions can cause one to tremble uncontrollably. Too many of us seem content to live in the world as we wish it were rather than how it actually is. We must learn to face reality and deal with things as they are before we can change them for the better. The cost of this ludicrousness in money, health, lives, and individual liberty is chilling. Something must be done now before it is too late. The clock is ticking.