Major:

Hey, guys. My name’s Major. I’m with Darshan. We are with the Gavel & Pestle podcast. Today, we’re talking about the pharmacist and patient centricity. This is a good episode. This is episode 206, right? 205 was marketer fraud. As a pharmacist, that’s pretty … Actually, that was a really interesting one. We had a series of four, plus a bonus tip on what to look for in a marketer to avoid fraud, right?

Darshan:

Yeah. We were laughing, ’cause Major pointed out that I never know how to count. I always have a bonus, so why don’t we just announce the bonus from the get-go? But I never … The last one comes out of nowhere, so –

Major:

It’s … Sometimes, we do kind of come up with one at the end. It’s like, “Oh. There’s actually … We totally forgot this. Let’s dump it all together.” So.

But today, episode 206, we’re talking about pharmacist and patient centricity. Darshan, what is patient centricity?

Darshan:

So, you know what? Patient centricity is this new hot topic that everyone’s talking about, whether it’s pharmaceutical companies, whether it’s doctor’s offices, whether it’s healthcare in general. Everyone’s saying, “Patients should be the focus.”

Here’s the funny thing: Why weren’t patients always the focus? It’s … In the end, all of us are just trying to help patients do better. Why does it take a new sort of wave of interest to go, “You know what? The … It’s all about patient centricity.” Well, it should have been in the place. It’s all about making sure that the patient’s needs are met.

But when you think about it, when you think about the paternalistic doctor who’s telling you, “This is what you need to do,” that’s what we always lived with. When you think about the pharmacy … sorry, the pharmaceutical company, saying, “These are the medications. Suck it up.” Well, that world is changing.

So patient centricity, what does that mean for the pharmacist?

Let’s start with what it doesn’t mean. It does not mean, when the patient comes in, they drop off the prescription, you’ve got that … You’ve got the technician who’s probably overworked, who’s really unhappy, who takes the prescription, has this foul mouth, who’s really upset, who’s really tired, and goes, “Come back in 45 minutes.” “But I need it right now.” “Well, come back in 45 minutes. Lots of people here right now.” That’s not patient centricity.

Patient centricity’s about putting patient first, understanding what the patient’s needs are, and if you are an independent pharmacist, it’s important to understand in the context of patient centricity, what are your patients actually looking for, talking to your patients, understanding what they want.

So, patient centricity is this movement of focusing care, with the interest of your specific patient in mind. Not patients as a whole, not patients as a group, not patients in general, but the patient in front of you. So that’s what patient centricity is.

Major:

So I’ve got a question about what you just gave an example of.

Darshan:

Yeah.

Major:

You said, “If the pharmacy is busy, you’re filling your prescription, and the pharmacist says, ‘Come back 30, 45 minutes, there’s a lot of people here. I can’t get to you.'” What … We’ve all experienced that. That’s just a fact of life, and there’s nothing you can do about that, that’s on the patient side. You’re like, “Well, guess I’ll be back in 30, 45 minutes.”

Darshan:

Right.

Major:

What is an example of the alternative for that? The pharmacist is busy. You can’t deny that. There’s no alternative for that. But what should the patient experience, instead of rejection?

Darshan:

So the ideal is, really, the pharmacist is the one who takes the prescription. The pharmacist is the one who goes, “Why don’t you come to this other corner? Let’s talk a little bit about what you’re looking for? So this doctor gave you this. Why did your doctor give you this? Do you understand why you’re taking the medication?”

“Oh, you know what? My blood pressure’s going higher.”

“Oh, okay. And what did the doctor say that you should be having?”

“Well, he said that my blood pressure’s higher, and he said that I should take a water pill.”

“Have you taken water pills before?”

“Well, I have, and they make me pee a lot, so I really don’t like taking them.”

“Oh, you’ve taken these before, then?”

“Yeah. I’ll probably just fill the prescription and I won’t sort of take them, because I know I don’t like [feeling 00:04:10] them.”

Well, if this is the conversation you’re having, and your patient just told you that they probably aren’t gonna take the medication, all it took for you was a three to five minute conversation to find out that this patient’s not gonna get better with this medication, because this patient does not like the pills that were just prescribed.

Major:

That’s well and all, that’s a great direction, but that wasn’t my question.

Darshan:

Okay.

Major:

My question was, “What should the patient experience?”

Because … In the case that it’s a busy day. It’s like ten o’clock on a Monday. They’re filling prescriptions for the weekend. They’re trying to get this through. If you walk in with your prescription on a Monday, Monday in the morning on opening. Boom. You’re there when they open the doors. What should you as a pharmacist do, or what should your pharmacy do, to convey, “Look, you’re busy. Come back later.” Should they put that patient first? I mean, granted, this is all … you’re gonna need to understand context. Maybe there’s a different situation. This is not one-size-fits-all, obviously. But –

Darshan:

Correct.

Major:

What’s the ideal scenario?

Darshan:

It’s not one-size-fits-all.

Major:

Because they can’t sit down.

Darshan:

And that’s exactly what we’re discussing.

Major:

They can’t. The pharmacist can’t sit down with everybody and talk to them and go over every … that’s not realistic.

Darshan:

So that’s a great point, and what you’re talking about is this difference between the ideal world of a pharmacy, and what realistically happens. And I’ve worked as a pharmacist in retail. I’ve been at that ten a.m. on Monday morning, when everyone’s dropping off prescriptions, and you’re just drowning in prescriptions, and the last thing you want to do is talk to people, because you just want to get people out of the door.

Here’s the question: If people are trying to get out of the door, are they satisfied?

What the ideal situation is, is number one, better staffing. This becomes more complicated in the context of large retail chains, ’cause they’re working off of metrics. But in the smaller, independent pharmacies, you’d be surprised how often the pharmacist says, “You know what? I know I’m busy, but I know that it’s more important that I talk to you.” When you’re the smaller retail pharmacy, you build those relationships a patient at a time, and that’s the key difference.

So, if you are a large chain, and you want to build a relationship the same way as an independent pharmacy does, staff your pharmacies better, and that’s gonna be the key difference.

The second piece is, as a pharmacist, you know what? I’ve also been that same pharmacist, where it’s a slightly slower day, and you say, “You know what? [Is 00:06:46] the patient coming to the counter, why don’t you, technician, take the prescription, ’cause I’m busy reading a magazine?” And everyone’s seen that pharmacist who’s sitting in the back, reading a magazine, bored, and is really not looking to engage with the patient. Well, you went to pharmacy school not to read that magazine. You went to pharmacy school so that you can talk to patients, and you can make their lives a little bit better.

I know one of the thoughts that goes through a pharmacist’s head when you’re standing in that position is, “What the patient only cares about is getting their prescription so that they can get through the day.” And you see yourself almost as a barrier –

Major:

A gatekeeper, of sorts.

Darshan:

Exactly. A gatekeeper, of sorts.

And that’s not your job. Your job is not to be a gatekeeper. Your job is to help in their own healthcare, and having that conversation, talking to patients, is critical to get there.

So you’re … It’s a great question, Major. You’d be surprised how excellent a question it is.

Major:

You know, one solution I would say, and this is a very small thing. This … Mileage may vary, right? If … Use their name.

Darshan:

Great point.

Major:

Just … If you recognize them, use their name. The name is … that itself is a small piece that would save so much stress and anxiety. Just that, “Okay. You used my name. We’re at that level. It’s a personal thing. This isn’t something that … You’re not out to get me. You’re not trying to keep me from my medication. This is … You’re busy, and you understand my plight, and I need to understand yours, and I do, because you used my name.”

And I know that’s … that might be a stretch for some, but in the heat of the moment, I can see how that’s just impossible to do, but if you have the right pharmacy staff, the right pharmacy techs, if you’ve got people behind the counter that take the time to, “Brenda. Barbara. Sandy. Tom.” If you just use their name, then that would solve a lot of headaches. I would assume. This isn’t something [I’m 00:08:53] tested, but …

Darshan:

It [will 00:08:55] definitely help.

Major:

I’d imagine.

Darshan:

No. It will definitely help for patients to know that they’re not just a number. It’ll definitely help patients to know that you took the moment to find out more about them, and that’s the key piece we’re both talking about. We’re saying it in two different ways.

Major:

Patient centricity.

Darshan:

We’re saying, “Stop treating patients as a number.”

Major:

There you go.

Darshan:

“Stop treating patients as the thing you have to endure, so that you can get through your day.” And don’t get me wrong –

Major:

And I think something that we’re –

Darshan:

… we’ve all had those days where we just need to get through it.

Major:

Right.

Darshan:

But remember why you’re there. You didn’t go through six years of pharmacy school, or eight years of pharmacy school, so that you can just get through your day.

Major:

I think part of what we’re trying to convey is patient centricity doesn’t have to be this overhauling of your pharmacy. It doesn’t have to be this obscenely involved process, where you change things out and revamp everything. This is just small, subtle changes. Just baby steps.

Darshan:

Yeah. Baby steps. You still have to get to the goal of not looking at it as a … seeing patients in a different light. But you’re right. It starts with saying someone’s name. It starts with asking, “How are you doing?” And meaning it.

Major:

Mm-hmm (affirmative)

Darshan:

And it starts with actually engaging with patients. So absolutely. And that’s really part of that conversation, which is, you go from saying their name, saying, “What brings you here?” And they’ll say, “I have a prescription.” And talk to them about the prescriptions. Find out what they want out of it.

So, for example, if it’s blood pressure, and if they go, “You know what? I don’t really care.” Well, they should.

“Do you understand what blood pressure is? Do you know why the doctor gave you this? ‘Cause if you don’t understand why, you’re unlikely to keep taking something that may have side effects, that may have adverse effects.” So if they don’t understand the importance, and if they’re not a participant in their own care, then their compliance suffers, and they’re gonna keep coming to you, and you haven’t achieved your goal of helping patients get better.

So I think those are the key components of patient centricity, which is that conversation, that engagement, and putting the patients in the middle of their own care, as opposed to being on the sidelines, and just getting a product from it.

Major:

There you go.

Darshan:

But it’s important … Yeah. But it’s important to recognize that patient centricity does have both a positive side and a negative side. To quote Star Wars, “There’s a dark side.”

So what is the dark side of patient centricity? And it’s happened to me before, where patients see themselves as the core of that model, and pharmacists say, “You know what? I need to make sure the patient’s satisfied, and physicians say that I need to make sure the patient’s satisfied.” But if you don’t have that conversation, if you don’t have the hard conversations, what you start having is things like the opioid crisis, where you just essentially become a legalized drug dealer, and that’s problematic as well.

If you’re not … You think that you’re just getting the patient what they want, what you’re really doing is enabling a patient to get more than they need to get. That they’re pain’s gone, but now they’re feeding an addiction. What you need to do is have that conversation. You need to say, “You know what? I know you’ve gotten these … this prescription from three other doctors, and I filled them for you. I’m gonna be reaching out to your doctor. But John, Joan, Joanne, we need to sit down. Let’s talk a little bit about what’s going on. Is your back still hurting? ‘Cause it’s been six months since you had the surgery. What changed?”

“Oh, you know what? My back is still hurting.”

“Okay. Are you going to a back doctor yet? A [musculoskeletal 00:12:50] specialist, if you will. What have they said?”

These are the hard conversations you need to have, and if they … and they might say, “You know what? It’s none of your business.” Actually, it is. It’s part of your responsibility as a pharmacist to ask those questions, to make sure that the medication’s being used appropriately, and that’s a core piece of patient centricity, it’s not just to become a conduit to give drugs. It’s to understand what is in the best interest of patients, and helping them get there.

But it’s also important to balance this idea of patient centricity and this dark side, against the positive side, and what can happen if you don’t take patients seriously.

So, we spoke about opioids, and we spoke about how patients can abuse the system, but then you’ll every so often, get pharmacists who proudly declare, “You know what? If you call in to see if I have Oxycontin, I don’t have Oxycontin.” And you’ll see these pharmacists who will routinely say that. What if that patient really needs that Oxycontin? What if that patient is truly in pain? And you know what? You’ve just prevented them from getting it, because you think, as a pharmacist, you got to sit on that high horse, and you got to judge someone, and say, “You know what? You don’t need the medication, and I think you’re fraudulent.”

No. They may actually be in chronic pain. Instead of just sort of pushing them away, you get to have that conversation. Say, “You know what? I know this is what’s going on.” Have you had that conversation? Or, “You know what? I know you’re in pain. Maybe this is not working for you. Maybe we need to look at something different. Maybe, for your trigeminal pain, you should be talking about Gabapentin, and not about Oxycontin.”

And those conversations need to be had, as well.

Major:

You know –

Darshan:

So, patient centricity … Go ahead.

Major:

Patient centricity, that is today’s episode, 205. I’m actually concerned that we’ve kind of given off this air of holier-than-thou with it.

Darshan:

Yeah.

Major:

That’s not the intention. That’s not … People are human. That’s what they are. Human beings.

Darshan:

Exactly.

Major:

You are gonna have those patients that it doesn’t matter what you do. You’re always gonna be wrong.

Darshan:

Right. Absolutely.

Major:

You’re gonna have the patient that sits there, under the counter, and waits, and stares you down as you’re filling prescriptions. Those are case-by-case basis.

Darshan:

Sure.

Major:

We’re talking about the guy coming in for his diabetes medication. We’re talking about just things that you … The repeat customers who you know, you know their name. We’re not talking about the single guy that comes in once every six months, that you have no clue who he is. Like the far out left field, the outliers. But, in any case –

Darshan:

Let me be clear about who I’m talking about.

Major:

Yeah.

Darshan:

And why I’m talking about patient centricity. And it’s a valid point, and I don’t want this to come across as a holier-than-thou, the guy sitting in the ivory tower telling you how to run your pharmacy. The truth is, I’ve sat in your pharmacy. I’ve run that pharmacy, and I know how hard it is.

What I want to point out is, in a world where Amazon’s looking to come into your business, and is trying to deliver. In a world where PBMs are saying, “You know what? We’re gonna decide what medication you can give.” In a world where mail orders are starting to control, it’s important that you, as a pharmacist, be able to make a living, and what I’m sort of suggesting is, patient centricity is gonna be a advantage that someone sitting somewhere else simply doesn’t have. It’s your golden ticket to the patient. It’s your golden ticket to help patients achieve their goals. And that’s really what I’m trying to point out.

I’m telling you about a trend that’s out there, that may be useful for you in connecting with patients in a new way, and therefore, getting them to say, “You know what? I could get this prescription from Doctor Smith and go to the … get the PBM to have it mail order delivered for me. All that stuff’s great, but I really like going to my neighborhood pharmacist and getting him to fill my medication, ’cause he talks to me. He understands what my goals are, and he helps me prevent adverse events that I hadn’t thought of, and that everyone else would have missed.” And that’s really what I’m trying to point out.

Major:

There you go.

So this is episode 205. You know, Darshan, the first episode of the season, episode 201, we discussed Amazon’s acquisition of PillPack, and how that can affect your pharmacy. In our next episode, 206, we’re actually gonna unpack how the acquisition of PillPack will affect pharmaceutical companies. So that’s a whole other side of the coin. So stick around, guys, and we’ll talk to you then. This is Gavel & Pestle. My name’s Major –

Darshan:

This is great.

Major:

… and this is Darshan.