One evening a couple of weeks ago while at a movie I felt my cell phone vibrate. This was unusual, since virtually all my patients correspond via my often-checked e-mail. The caller ID was unknown to me, and was not that of my answering service. I would have waited 15 minutes until the movie ended, but there it was, vibrating again. And so, muttering to my wife “Tell me how this ends,” I headed for the lobby.
The caller was a pharmacist from Walgreens. She inquired if I knew a certain Ms X, naming one of my longtime patients. I told her I did and asked what the problem was.
“Did you write her a prescription on (a date two days earlier) for (a common pain medication)?”
I thought to myself, “What a question! I write anywhere up to 50 prescriptions a day and she thinks I’m going to remember the specifics of one from two days ago.” However, I knew the patient well, and knew her meds, so I confirmed the prescription as mine. “Thank you,” she said, “Just checking.”
But after I hung up, I went into a slow boil. The call was totally unnecessary and wasted everyone’s time, especially the patient’s, who was waiting for her prescription to be filled. What is it with some pharmacists making a criminal of every customer who hands them a prescription for a controlled drug? An experienced pharmacist can spot prescription fraud a mile away. And if she’s in doubt, she can simply hand back the prescription with a “Sorry, I can’t fill this.”
The pharmacist who had me paged apparently needed a character reference on her customer before filling the prescription. Had she bothered to check her records, she would have discovered the woman was indeed a regular customer and that this was an ongoing medication for her. If the pharmacist was suspicious, the State of Illinois maintains a helpful prescription monitoring website for health professionals that keeps tabs on the use of controlled medication (opioids, amphetamines, anti-anxiety meds, sleeping pills) by everyone in Illinois. In about ten seconds, by clicking through the website, the pharmacist could have discovered that her customer used this medication regularly, had just one prescribing physician (me), and refilled her meds at appropriate intervals.
Disturbing fax from Walgreens
I would have chalked up this phone call to a newbie pharmacist had I not received a most disturbing fax from Walgreens a couple of weeks later. Just a few quotes and comments will give you the gist. Remember, this letter is being addressed to prescribing physicians (emphasis mine):
“Many of you have raised concerns about the confidential or private nature of your patients’ health information. By law, pharmacists are granted access to private health information necessary for them to perform their responsibilities.” (My comment: this is a VERY loose interpretation of the existing laws.)
“Under Federal regulation, pharmacists have a responsibility to ensure that each prescription for a controlled substance is ‘issued for a legitimate medical purpose.’ To make that determination, pharmacists may need to gather additional information, including the patient diagnosis and expected length of therapy. We understand this diligence takes extra time, for our patients, and for you, our partnering physicians. We want to thank you for taking this time…”
Your initial response might be: Well, there are some bad characters out there. Dope dealers and such. I can see why a pharmacist might want to call my doctor and check on this before he hands over a bottle of OxyContin.
To which I answer: If you agree with Walgreens, kiss your privacy adieu. Believe me, no one in health care–not WholeHealth Chicago, not Rush, not Northwestern–runs a caller ID on every incoming call. I’m not at all suggesting you try this, but were you to have a friend call your doctor’s office and say, “Hi, this is William Jones from Walgreens. We’re just checking on your patient (insert your name). Did the doctor prescribe (name a med you take)?” you’ll be horrified how quickly your privacy barrier is transcended.
In actual fact, given the vast numbers of controlled medications in use, the percentage of prescription drug abuse is extremely small. One study on opioid analgesics–OxyContin and the like–pegged “inappropriate use” (addiction, re-selling drugs) at less than 1%. It’s also true that abuse of prescription narcotics is epidemic, but when a pharmacist knows her customer base and uses the prescription monitoring website described above, there is virtually no justification for calling a physician or manipulating HIPAA (privacy) health care laws to probe into a customer’s personal medical records.
Walgreens’ master plan?
So I had to ask myself: what could be the real reason for instituting a policy that is guaranteed to get pushback from both customers and their physicians? I think there are two factors at play.
First, the economics. It always boils down to economics. Having been raised in a drugstore myself, I know controlled drugs are a real pain (pun intended). They require meticulous record-keeping by both physician office and pharmacy and are the first targets of burglaries and employee theft. Also, since most of the better pain medications are still brand-name, maintaining inventory is quite expensive and the profit margin is very low.
When a store fails to maintain proper surveillance on its controlled drugs, the fines are substantial. All in all, with lots of work and little profit to show for it, Walgreens probably wishes controlled drugs would just go away. Let CVS have the business. A steady decline in controlled drug use is distinctly possible with Walgreen’s new approach. If physicians are badgered at all hours by “concerned” pharmacists, they’ll just write as few controlled prescriptions as possible.
Second, Walgreens’ ambitions to enter all aspects of health care make privacy irrelevant. Once the Affordable Care Act is in place, Walgreens will enter the fray and start selling health insurance. They already operate hundreds of Take Care Clinics, which are poised to convert to primary care offices. Last week, it was announced these clinics will start treating chronic illnesses (blood pressure, diabetes, etc). With all the pieces in place—insurance, primary care offices, and pharmacy services–Walgreens becomes your total health care provider, fully entitled to access all your medical records.
Now envision that nice young person totaling up your purchases at Walgreens, first asking “paper or plastic?” for your cigarettes, Altoids, Tampax, Jack Daniel’s, and Reese’s Pieces. Then, with a smile and a quick flick on her screen, she cheerily asks if your herpes flare-up has cleared while printing a quick discount coupon for your overdue Pap smear. Behind you in line, a curious seven-year-old asks his brother in a too-loud voice, “WHAT’S A PAP SMEAR?”
But seriously, Walgreens’ aggressive invasion of your privacy is not at all amusing. Let me end this with a most disturbing clip from the 1999 film Magnolia. By way of background, Julianne Moore plays a young wife caring for her much older husband who’s at home dying of cancer. She is utterly exhausted and on the verge of a meltdown. The clip picks up as she stops at the pharmacy to get her husband’s pain meds and her own antidepressants.
Based on the fax I received, the only thing this scene lacks is the Walgreens sign in the window. Watch carefully as the senior pharmacist dials his phone—that’s the call Walgreens wants doctors to expect. That’s the future. And I warn you, the next three minutes are deeply unsettling.
If you’d like to share a pharmacy experience with other readers, please do so in comments below. Meanwhile, Walgreens management may want to go back to the drawing board on their motto “At the Corner of Happy & Healthy.” It’s one of those res ipsa loquitur moments.
Be well,
David Edelberg, MD