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.

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