Dan: 0:00

In your local hospital there's likely a heavily protected cabinet with fingerprint only access that stores drugs that might be abused. Some of the drugs in that cabinet you'd probably expect. Some, you might not.

Rose: 0:16

Actually, cocaine specifically, we use in our surgery areas quite extensively.

Dan: 0:20

If a surgeon's got like a twelve hour thing going on, just like a little nip just to get through.

Rose: 0:25

Gosh. Could you imagine? Oh, please. No. Thank you.

Dan: 0:30

That's Rose Davin. She's been a pharmacy technician for twenty plus years. She's worked in both a retail setting, like in a pharmacy at CVS or Walgreens, and a clinical setting, like a pharmacy in the hospital. So about that cocaine.

Rose: 0:48

No. We actually use it in a compounding facility to make cocaine eye drops and cocaine nasal packing for when people are getting plastic surgery. We will put it in their nose so that when they are laying on the bed afterwards, they're not getting blood clots going down the back of their throat. So we'll use it to, like, stop bleeding.

Dan: 1:08

This is so incredibly interesting. Yeah. Cocaine is routinely used. Huh.

Rose: 1:14

I mean, we're not mainlining the hard stuff, but yes, we are certainly using it for medical purposes under a very tight regulation, of course.

Dan: 1:34

I'm Dan Heath, and this is What It's Like To Be... In every episode, we walk in the shoes of someone from a different profession. A mystery novelist, a stand up comedian, a summer camp director. We wanna know what they do all day at work. Today, we'll ask Rose Davin what it's like to be a pharmacy technician. We'll talk about what happens after a patient dies from a potential pharmacy error, how pharmacies make sure employees don't make off with the opioids, and what happens if a pharmacist drops a pill on the floor? Stay with us. So I know you've worked both the retail and the the clinical side. Like, what what are the biggest differences in your life, you know, as a pharmacy tech in those two settings?

Rose: 2:25

I think probably the biggest difference is that they're actually nothing alike.

Dan: 2:30

Nothing alike because at retail stores, patients are coming in to fill a thirty or sixty day supply of drugs to take home with them, while in the clinical setting patients might be getting one dose at a time of many different drugs from their nurses while they lay there in bed. Rose said in some hospitals the pharmacy team might fill 10 to 20 thousand doses in a day. In the clinical setting, are you interacting with nurses and doctors? Who are you working with most closely in a given shift?

Rose: 3:02

It depends on which type of clinical setting you're working in. We're gonna go into the weeds here. In some larger clinical settings, you can have 10 or 11 different kinds of pharmacies. So all in one..

Dan: 3:16

10 or 11... Why why would you need 10 different pharmacies?

Rose: 3:20

Yeah. So you can have an investigational pharmacy. If you have a research component, you can have a pediatric pharmacy. You can have an oncology pharmacy. You can have an operating room pharmacy because when people are doing their surgery and they're in a sterile field and they need a drug, they're obviously not gonna walk out of the room to go and get it. We have to supply the drug and bring it to them. You can have an employee pharmacy for prescriptions for employees. You can have an outpatient pharmacy, a discharge pharmacy so that the patients don't have to stop somewhere on their way home. You can have a specialty pharmacy for drugs that are highly restrictive. There's a lot of different types.

Dan: 3:57

So I think that we've all had the experience of getting medications, and and they're different colors and different shapes and different sizes. I'm just curious, after the experience you've had, like, how many different medications do you think you would recognize just by looking at them at this point?

Rose: 4:18

Oh, that is a great question.

Dan: 4:20

Do you think it's like a couple or dozens? Or...

Rose: 4:23

Oh, no. I would say probably hundreds.

Dan: 4:26

Woah. Really?

Rose: 4:28

Yeah. Especially when you add in my clinical experience, you're probably thinking of, like, pills in a bottle. But I'm thinking larger scope pharmacy, injections, vials

Dan: 4:38

Oh, yeah.

Rose: 4:39

Liquids, creams, ointments, inhalers.

Dan: 4:42

Right.

Rose: 4:43

If I was doing just tablets, I'd probably say it'll probably be close to a 100. It's in the useless knowledge file in my brain.

Dan: 4:51

No. It's totally fascinating. I'm just imagining like a a blind test where there's like 50 pills on a table, and you're like, that's that. That's that.

Rose: 5:00

To give the pharmaceutical industry a little bit of credit, some manufacturers actually specifically color code and shape code their drugs. So it's not exclusively my awesomeness.

Dan: 5:10

Oh, so there's a logic to... what is some of that logic?

Rose: 5:14

Some drugs like Depakote, which is used for, like, seizure activity and stuff like that, that's its primary focus, they have different scents and different colors and different shapes so that if they get something that

Dan: 5:26

They have scents?

Rose: 5:26

Like Some of them are specifically, like, vanilla scented and stuff like that. Now part of that is to make it more palatable for our pediatric populace.

Dan: 5:36

Okay.

Rose: 5:37

But other parts are to make it easy to identify, especially from a pharmacist standpoint. When somebody calls in and says, I found this white pill that's in my kid's room. Can you tell me what it is? We can ask some more leading questions like, does it have a scent? Is it round or is it oval? Does it have a score line down the middle? Does it have any letters? So those kind of things are a little bit like a cheat code for us.

Dan: 6:05

Wow.

Rose: 6:06

Not all drugs do it, but some do.

Dan: 6:08

Is there any logic to why one pill is circular and one is oval or one's yellow and one's green or whatever?

Rose: 6:17

Across the entire industry, I would say no.

Dan: 6:19

Okay.

Rose: 6:20

But there is some logic to is something a capsule versus a tablet? Does something have a coating versus no coating? It gives the drug a chance to get down into the GI tract and be delayed release versus starting to work immediately.

Dan: 6:36

I imagine, you know, part of just dealing with tiny pills is, like, sometimes they're gonna fall on the floor. Like, what what is the protocol when they... Can you pick them up and, like, dust them off, or do you have to throw them away? And then if so, do you have to account for that? Like, how does that work?

Rose: 6:52

There is no five second rule when it comes to medication. So you are required to dispose of them.

Dan: 7:00

Okay.

Rose: 7:01

Most companies, whether it's clinical or retail, will have their own internal company policy for how to do so. The exception to that would be if it's now we're gonna get into the real weeds. There's different schedules of drugs based on their propensity to be abused or diverted. So for things that are run of the mill drugs, we call them nonschedule drugs... over the counters or blood pressure pills, cholesterol pills, that kind of stuff that don't have a high propensity to be abused, stolen, or diverted. Those you can, in general, just chuck in the trash and just document it in your inventory. Things that are controlled substances, which are C1 through C5s, those have to be documented and logged and reported to the state and the federal government.

Dan: 7:47

Really? So if you drop a Vicodin pill or something like that...

Rose: 7:51

Yeah. Dan: Really? So if you drop a Vicodin pill or something like that... Yeah.

Dan: 7:52

Wow.

Rose: 7:53

For obvious reasons, we don't want somebody digging through a trash to try to get something that they saw us throw out.

Dan: 7:58

Right. You figure out that there's one pharmacy tech who's dropped seven hundred Vicodin pills in the last month.

Rose: 8:05

Yes. Yes. Exactly so.

Dan: 8:09

While we're on this topic, one thing I wanted to ask you about is just, like, if you had a colleague that was, you know, a nefarious character that was determined to abscond with some opioids for their own use or to sell or whatever, like, what are the protections that would be in the way of making that possible?

Rose: 8:30

I've actually unfortunately had this happen in both settings, so...

Dan: 8:32

Oh, really?

Rose: 8:33

Yeah. Unfortunately. Which is which is why we have these safety protocols in place. It's very tempting for some people to do that.

Dan: 8:42

Mhmm.

Rose: 8:42

In a retail setting, in probably a clinical setting, I would say, every time you touch a controlled substance, it has to be logged in a system. In most retail settings, most of them have, like, a locked cabinet or a safe, and there's a a book that you have to log every time you open it. Usually, only one...

Dan: 9:03

A physical book or like a... Okay. Dan: A physical book or like a... A physical book or like a...

Rose: 9:04

No. Like an actual paper book. And usually, only a one pharmacist on duty has a a set of keys or the passcode to get into that special area.

Dan: 9:13

Oh, wow, okay. Yeah.

Rose: 9:14

Some larger chains have even gone so far as to put a delay on their safe, especially down south, because they unfortunately experience a higher level of diversion than up north, where if you go in and you need to access the safe when the pharmacist tries to access it, there's like a ten or fifteen minute delay before the safe will open or come up from the floor. And that's specifically so that if somebody comes in and tries to rob you, it will give your your facility time for law enforcement to get there before they actually have access to the drugs.

Dan: 9:47

Holy cow.

Rose: 9:48

Yeah.

Dan: 9:49

Wow. I I don't think I was anticipating this level of, like, safeguarding. That's that's wild.

Rose: 9:55

Yeah. And again, that's not universal for all retail settings, but it is not unheard of, and it is becoming the new standard.

Dan: 10:03

Mhmm. And and you said you you had you had encountered colleagues who had tried this. Tell tell us about what happened.

Rose: 10:11

Yeah. In my retail situation, we noticed what's called a countback. So whenever a technician accesses the the pharmacist will access the controlled substance cabinet and look in the book and say, I'm supposed to have 300 of this tablet. I'm visually confirming that I have 300 of these tablets, and I'm taking out what this order is specifically called for and putting it in this bin for the technician to fill it. And then the technician fills it and then counts back what's left in the bottle.

Dan: 10:40

Wait. But how could you count? I mean, you you don't have time to count, like, three hundred pills, do you?

Rose: 10:45

So if it's an open sealed bottle, we would never take it out of the cabinet because there's no reason for us to look at it.

Dan: 10:51

Okay. If

Rose: 10:51

it's an open bottle, say the bottle comes with a hundred tablets in it originally, and you need 30 of them. The pharmacist will leave the two full count bottles in the cabinet so that they're not touched for any reason. And then they'll take the one bottle out. You'll count out the 30 tablets, count it a second time, and then count back what's left in the bottle, seal it, and send it to the pharmacist. Then the pharmacist will double count again what's in the bottle, then they'll count back what is left in the stock bottle. They'll sign off in the book that everything was appropriate, and then they'll go and lock it back in the book.

Dan: 11:24

That is a lot of counting.

Rose: 11:27

Yes. This technician specifically, over the course of multiple different medications, started noticing that they were saying, "Oh, I dropped this pill" or "This bottle only came with 99 instead of a 100." And so we started getting a little suspicious relatively quickly within, like, a week or two. And so then they started pulling the video and watching the technician.

Dan: 11:54

Oh, man.

Rose: 11:55

They called law enforcement and the store manager, and they pulled the technician aside. And they said, we need you to empty your pockets because we just watched you do something that you should not have done.

Dan: 12:07

Man. So you guys are under surveillance.

Rose: 12:11

Yeah. I would probably say for everything. It's it's intended specifically for the controlled substance cabinet because we wanna be mindful that our staff are not feeling that we're, like, getting watched by Big Brother.

Dan: 12:23

What is the most expensive medication you've ever seen in a in a retail setting?

Rose: 12:30

In a retail setting? Probably some of our antivirals, like some of our hepatitis medication or some of our cancer center medication. Some of our our cancer drugs, our chemo drugs, our, hepatitis drugs can be $20,000 for one bottle every month.

Dan: 12:46

Woah.

Rose: 12:47

Yeah. No. That's a cash price. I'm not sure what the insurance would charge them.

Dan: 12:50

That was the cash price. So, I mean, have you ever had the experience of, like, scanning a barcode and then the the cash register says $20,000?

Rose: 12:59

I have had, I think a $6,000 transaction. Yeah. Woah. Yeah.

Dan: 13:05

And and did the person seem to be prepared for it, or were their eyes goggling?

Rose: 13:10

Most retail pharmacies, when they have something like that come through, they will call the patient beforehand and say, I don't wanna order this drug and bring it in because I'll never use it for another person without clearing with you that you're aware that this is the cost. Are you willing to pay this cost, or do you want me to talk to your doctor and see if maybe there's a different drug that might be cheaper on your formulary that we can try?

Dan: 13:32

I mean, I can't get my head around a $20,000 medication. Like, is it is it kept inside a Faberge egg in the store? Like, what what

Rose: 13:43

Good golly. No. In a clinical setting, I've had drugs that we've brought in as recently as less than thirty days ago that were over a million dollars.

Dan: 13:53

What?

Rose: 13:54

Yeah.

Dan: 13:55

I have I have no that's all I that's the only thing going on in my mind right now is just what? Do you remember what it was for?

Rose: 14:04

Yeah. It was actually a drug that's used to preserve somebody's eyesight.

Dan: 14:10

Wow. I guess if anything was worth a million dollars.

Rose: 14:14

Yeah. So when you get into highly specialized drugs like that, they're usually utilizing really new technology like gene therapy and stuff like this, and this is specifically used, I think, for retinosis. And there's only a certain amount of clinical settings that are registered to be able to handle this drug because you have to have special training and you have to be, have special surgeons that administer it and that kind of stuff.

Dan: 14:41

Hey, folks. Dan here. Happy fiftieth episode, everyone. Only 750 more to catch up with This American Life. On a different note, I was looking at some stats and 21% of you are listening from outside The USA. So first of all, thank you for that. And second of all, only two of our episodes so far have featured non Americans. That was the London Cabby and the Barman who was from Ireland. We loved making both of those shows and we wanna do more of that. So, you know, I'm seeing decent blocks of you from Australia, from Germany, The Netherlands, France. Tell us what professions would speak to your home country. You can always reach us with suggestions at jobs@whatitslike.com. Now back to the show. Can you walk me through, like I go visit my doctor, she issues me some prescription, she says, okay you're using the CVS on such and such road, I say yeah, what are the steps between her like punching in and authorizing the prescription to when I go pick it up?

Rose: 15:59

That's a great question. There's actually a lot involved that people are not aware of. So when your doctor either hands you the paper prescription, which is getting less and less, or sends it electronically, which is usually the standard, it will pop up in the intake computer, which is the person that you walk up to at the counter.

Dan: 16:19

Okay. And is the person that I that I deal with at the counter that that takes my money and, is that a pharmacy tech or is that somebody else?

Rose: 16:27

Those are all techs. Yeah.

Dan: 16:28

Okay.

Rose: 16:28

It's rare that you'll get a pharmacist unless you have to get a counselor or you have a question.

Dan: 16:32

Okay. You know, I have to confess, I didn't know that the people that are taking your your order or your prescription at the register that those were techs. I thought that maybe there were three kinds of people, there were pharmacists and techs and then, you know, retail counter people, but no, there's not.

Rose: 16:51

And not to my understanding. I've never met a pharmacy that functions that way because you have to have certain rules and regulations of what kind of people can be around medication.

Dan: 16:59

Right.

Rose: 17:00

And since you have access to it, I would assume it probably would not be beneficial for a company to employ somebody behind the counter that really shouldn't have access to any of those medications.

Dan: 17:09

So back to the journey of a prescription, it pops into the queue of a pharmacy tech and then they check to make sure it's valid.

Rose: 17:19

Does it have a signature? Does it have a total quantity? Does it have a drug name? Does it have a patient's name on it? Things that sometimes believe or not actually get forgotten.

Dan: 17:28

Once they confirmed all of that, the pharmacy tech inputs the patient's info and the prescription info into their system. And then they kick it over to a pharmacist.

Rose: 17:37

Who's gonna look to make sure that you got the right patient, you got the right doctor, you got the right drug, the right instructions, the total dispense quantity, and the refills.

Dan: 17:45

And and this happens every time, like, no matter how boring the prescription is, the the pharmacist is still gonna eyeball it.

Rose: 17:51

For the original input, yes. Absolutely.

Dan: 17:53

Okay. Yeah.

Rose: 17:54

And then after that pharmacist reviews it, then it goes over to dispense. Now a technician is gonna print the label and they're gonna go and pull the drug, or if it's in the controlled substance cabinet, they're gonna hand off that label to the pharmacist to go and pull the drug for them.

Dan: 18:07

Mhmm.

Rose: 18:08

And now they're gonna fill it. Most places now use BCMA, which is barcode management. So they're going to scan the drug label and then scan the bottle that they're gonna use to fill it to make sure that it's correct.

Dan: 18:20

Okay. And if it's not correct, what happens? Does it just beep red at you or something?

Rose: 18:23

Yes. It does not let you go forward, and you have to try and scan it again.

Dan: 18:27

And and if you're just dispensing pills, are you counting out 30 tablets from a huge container, or do machines dispense automatically or what?

Rose: 18:37

It depends on the retail setting. Some larger chains do have automated dispensing cabinets for, like, their fast movers or, like, their top 20 drugs or something like that. But not all do.

Dan: 18:49

Do you have a certain strategy for quickly counting pills? Were were you giving any training on that?

Rose: 18:56

In a retail setting, we count by fives. So you have those little trays that you see with, like, a little metal spatula, and you count by fives. You pour a quantity onto the tray and you shake it a little bit so that all your tablets are flat, And then you spatula five tablets at a time into the cylinder at the end, and then you pour that into your bottle, and then pour the remaining tablets back into your stockpile. In a clinical setting, we're usually not dispensing thirty, forty, fifty of a certain tablet because our patients are not stable enough to be able to do that. So you're only dispensing three or four of a tablet, but you may just be dispensing six different tablets.

Dan: 19:36

And after all that, the prescription is still not ready for the pickup shelf yet. There's one more check by a pharmacist.

Rose: 19:43

They will also scan it, and an image will pop up on their screen of what that pill should look like. This should be a round orange pill with the letter four in it in a line.

Dan: 19:51

Oh, wow.

Rose: 19:52

And they'll open the bottle and they'll look and make sure that it matches.

Dan: 19:57

Earlier you were talking about how in a clinical setting you might do twenty thousand doses a day and if the error rate there is one percent, which is pretty good, right, ninety nine out of a 100, you're nailing it, that's still 200 errors a day, which is just crazy to think about if one of those errors is your mom or your sister. How often do mistakes happen?

Rose: 20:22

Yeah. That's one of the really unique things about probably, honestly, any clinical setting. Any other job, any other company, if you tell them you had a ninety nine percent success rate of meeting your goal and being correct, you'd be getting bonuses and parades in your honor, and you'd have money hand over fist. You'd be doing great. All the promotions. In a clinical setting, unfortunately, that's not the case. The goal is obviously a 100% correct, but the reality is we're humans and stuff happens.

Dan: 20:56

Rose said that there are a lot of tools used by pharmacy techs that safeguard against errors, like the use of barcodes. You match medications to patients, and also in hospitals, the process of dispensing medications is increasingly automated.

Rose: 21:12

So for a lot of tablets, you have a machine that can print, you know, a label that says Patient A needs these three drugs, and that machine will go and scan that label and then scan those three drugs and then seal it together and then shoot it out so that you can send it up. So those three drugs have all been barcode checked, and we're a 100% positive that they're right.

Dan: 21:32

That's so interesting. So it it's like a lot of the process work and a lot of the technologies being added are devoted to basically getting the human element out of the system.

Rose: 21:43

Yes.

Dan: 21:44

Because humans are 99% perfect, and in this particular case, that's not good enough.

Rose: 21:49

Yes.

Dan: 21:51

So, I remember hearing a story years ago that the actor Dennis Quaid, his wife had just had twins and they were in the hospital, I think there were some complications and and the twins were being given doses of heparin, the blood thinner.

Rose: 22:09

Yes.

Dan: 22:11

And because of a mistake, they were given a thousand times the dosage that they were supposed to get. And obviously, I mean, they were on the cusp of dying. I mean, it took a miracle to kind of bring them back and it turned out eventually they were fine, but later they did a post mortem on this and it turned out like the two doses of heparin, the correct dose and the 1000x dose, were both in similar kinds of packaging, similarly labeled to the point of even the colors were similar, they were like different shades of blue if I recall. Have you ever been part of a situation like that, either a really terrifying near miss or a situation where actually the wrong dosage was administered?

Rose: 22:58

Yeah. Unfortunately, I was. I was making an IV very similar to what happened with these twins. Somebody was drawing up a heparin dose and unfortunately picked the wrong source material to draw up.

Dan: 23:10

Mhmm.

Rose: 23:11

And I was making a medication for a patient who came in, and they came in because they were low on this specific electrolyte. And so the IV bag asked for a large amount of this electrolyte. And I remember distinctly checking with my pharmacist saying, hey. I'm kind of a new technician here. This is in the very beginning of my career. I've never seen this much of this. Is this correct? And the pharmacist checked with the team, and they said, yes. Absolutely. I made the bag. We sent it up as a stat. It got hung on the patient, and the patient, unfortunately, almost immediately passed. And, understandably, the logistical question was, what was in that IV bag? Was it made correctly? Did that have something to do with this? So they immediately came down to me and said, you need to stop working in this room, and we are going to take your bag, and we are going to send it off to an independent facility to test it, to make sure that it was made correctly. And my heart absolutely dropped to the floor because I distinctly remember thinking to myself, there's nothing I can do to change this outcome. If I made that bag wrong, I'm going to have to live with that for the rest of my life, and there's nothing I'm ever gonna be able to do to undo that. And so it was several weeks later. I was not allowed to work in that room while they were doing the investigation, and it came back that my bag had been made correctly and that they needed to pursue another option as to why this patient had suddenly gone into a negative space. And I remember the pharmacist calling me and telling me we got the results back, and your bag was accurate, and we're gonna move on to other avenues. And I pulled over on the side of the road, and I just sobbed. And my sister actually found me, like, a couple of hours later still crying on the side of the road

Dan: 25:07

Oh my gosh.

Rose: 25:07

Like a blubbering mess.

Dan: 25:09

Yeah.

Rose: 25:10

Because I knew that no matter what, I couldn't change the outcome. And it completely rewired how I work as a technician in the clinical setting and in the retail setting. And I remember them telling me that I could go back into the room, and I was cleared to start making and compounding again. And I said to the person who managed the area, I I don't think I can do it. I don't know that I could handle it. And the manager said, you're the exact type of person that I want in that room because I know that you will never take what you're doing lightly, and that you will give every single drug that you are touching your full attention. And that if something gets through, it's because you genuinely made a mistake. It's not because you are being negligent, and it's not because you don't understand the importance of what you're doing.

Dan: 25:56

That is such a lot of pressure. I mean, that one just simple mistake, I mean, could kill someone. I mean, how do you how do you work under that pressure?

Rose: 26:08

Yeah. That's why I I do tell people that I don't feel that there's a a great understanding of how much responsibility a pharmacy technician has. Again, clearly, we're always working under the direct supervision of a pharmacist and within the parameters of the law, but technicians actually have a significant amount of responsibility. You still have the same level of risk in a retail setting. You could accidentally put somebody else's bottle in someone's bag, and it could not get caught. You could give them a drug that could really harm them, or, you know, there's there's a lot of risk that's involved in that. So you really for the most part, technicians are really dedicated to patient safety and getting it right. And I don't think a lot of people understand how much pressure that is.

Dan: 26:52

If you could go back and watch a videotape of yourself, like, in your first month on the job, I mean, I imagine you've gotten better at every aspect of the job in in twenty plus years. Where do you think has been your single biggest area of growth?

Rose: 27:08

Patience and grace. It's not necessarily in how I do my job, like the filling of the pills, but in understanding that everybody deserves grace and everybody deserves a little bit of space, whether it's a customer who came in who's really irate, or a patient that is yelling at a nurse, and the nurse is then yelling at us because she needs to give this med, and it's not up there. Just understanding that how I do my job is much more important than if I'm doing my job.

Dan: 27:43

Mmm. I imagine you just you have to somehow practice not taking it personally. Because ultimately, these things, I mean, I can imagine why they would flare your temper or stress you out, but but ultimately, they're not really about you.

Rose: 27:59

Mmm. Yes. And some clinical settings have recognized that there can be this push and pull when it comes to medical professionals, and they actually have almost like an exchange program where nurses and doctors will come down and and shadow and work in the pharmacy for an hour during med pass time. Oh, really? Yeah.

Rose: And pharmacy will go up to the nurses' station during med pass time, and and they can each see what it's like when nursing goes to the bin to give all five of their patients their morning meds at 08: 28:18

00, and they have forty minutes to do it, or else the computer will time them out, and none of the meds are where they think they should be.

Rose: 28:34

And then nursing can see downstairs in pharmacy. We have two people answering the phone for 800 people who are missing their meds, and we can see due to barcode administration that they were scanned and sent, and they were hand delivered, so we know they gotta be there somewhere.

Dan: 28:49

Is it common for pharmacy techs to eventually advance to become a pharmacist?

Rose: 28:55

Yeah. It's very common, especially in a clinical setting. I would say fifty percent of the techs eventually go into pharmacy school or into another medical field profession, nursing, doctor. In a retail setting, probably not as much. And if they were going to go into something, it would probably be pharmacy as a pharmacist rather than, you know, a different type of medical field.

Dan: 29:17

And is there a major difference in pay or or hours between the retail and the clinical side?

Rose: 29:24

Yeah. Unfortunately, there is. We are trying to close the gap, but, in a clinical setting, because you have the high stress and the potential to compound in some areas and stuff like that, it usually starts at a slightly higher pay than in the retail community. Unfortunately, again, in the retail community, a a lot of people unfortunately see as a pharmacy technician as a cashier, and so they're an entry level grocery store pay.

Dan: 29:51

Wait. It's not like minimum wage sort of scale, is it?

Rose: 29:54

Some retail chains, yeah, they'll offer a minimum wage.

Dan: 29:58

So Rose, we always end our episodes with a quick lightning round of questions. Here we go. What is a word or phrase that only someone from your profession would be likely to know, and what does it mean?

Rose: 30:12

Probably "prior auth". Most people do not know what a prior authorization it is, but it is the death knoll of a pharmacy technician. It's when we see that come up on the screen, we are really knowing that we're in it, and that it's a term that's simply used that says the insurance does not wanna pay for something unless the doctors fill out some additional paperwork that determines that it's really necessary. And unfortunately, sometimes the doctors can fill out that paperwork and the insurance can still say I'm not gonna pay for it. And that's a really challenging and emotionally engaging conversation to have to have with the customer.

Dan: 30:51

Because the customer thinks, I just left my doctor's office and they said they're gonna prescribe this thing. Like, isn't that, isn't that it?

Rose: 31:00

Yes. One would think that that would be it, but somehow it is not. So that can be really challenging to have to explain to a customer. And to be completely frank, doesn't really make a lot of sense to pharmacy either. But we we unfortunately are just the conduit for the message. We really don't have any choice in the matter. Because some people are like, well, can't you just put it through anyways? Like, the way that the automated inputting system works, you physically can't get around it. It won't let you go forward unless you switch it to cash and you pay cash. And then when you offer that option and people find out the cost of medication, they say, no. Thank you. I would like for you to talk to my doctor.

Dan: 31:41

Right. What's the most insulting thing you could say about a pharmacy tech's work?

Rose: 31:49

That all we do is put a label on a bottle.

Dan: 31:52

Mmm. What would you want people to know about your work who might have that misconception?

Rose: 31:59

That's a really good question. I would want them to know that there's a lot of steps involved to getting it right, and to making sure that what you're getting is safe and appropriate, and to respect that process.

Dan: 32:18

What's a tool specific to your profession that you really like using?

Rose: 32:23

Oh, 100% a barcode scanner. That makes me happy inside. It's I love it. When I hear that little beep that says you got the right drug and I can move it on along, it's great.

Dan: 32:37

I think a lot of people might think that the barcode scanner is just, you know, it it's some kind of, I don't know, vaguely bureaucratic tool, and it's like a little bit of a nuisance, and it's a little bit pointless, but it's actually like absolutely core to the safety systems, isn't it?

Rose: 32:56

Absolutely, absolutely. And to be completely honest, I empathize with them. It is kind of annoying. It is kind of cumbersome and clunky. I get it. But I always like to tell people and remind people that being safe is not always being fast. So sometimes we actually need something that will slow us down and make us look again. And that's what barcode scanning does.

Dan: 33:24

What is an aspect of your work that you consistently savor?

Rose: 33:29

Making a difference. Making a difference and learning.

Dan: 33:32

What does that look like on a on a day to day basis?

Rose: 33:36

On a day to day basis in a retail setting, it could be something as simple as having a customer come to the counter that you've established a relationship, and you recognize them, and you pull their bag, and you say name and date of birth, and you already have the bag in their hand, and you put a smile on their face.

Dan: 33:53

Mhmm.

Rose: 33:54

And they say, you know who I am. In a clinical setting, it would be seeing the patient go home.

Dan: 34:00

Yeah. And knowing that you were part of that.

Rose: 34:04

And I was part of that.

Dan: 34:11

Rose Davin is a pharmacy technician and pharmacy buyer in Rochester, New York. During part of our conversation that you didn't hear, Rose brought up a model of prevention.

Rose: 34:24

We affectionately call it the Swiss cheese model, actually.

Dan: 34:29

I learned about the Swiss cheese model when I was researching my book Upstream, which is about solving problems before they happen. And the model goes like this. So imagine a block of Swiss cheese and if you cut the block into slices, every one of those slices will have a hole. But if you put them back together, there are no holes that go all the way through the block. Why? Because the holes are not aligned. And that's a useful way of thinking about situations where you're trying to prevent a bad outcome. Because no one precaution is going to be foolproof. Just like we heard, 99% accuracy rates for medications in hospitals are really good but there's still a hole. But if you line up multiple defenses, even if all of them have their own holes, when you put them together, like little slices of cheese, there's no hole that would get all the way through the system and cause an error or a mistake or an emergency. It struck me that the Swiss cheese model might be useful for some of you in preventing problems you care about. Like, what are the steps that might stop one of your best employees or team members from leaving? A regular check-in with the boss as a time to surface problems? A culture where dissatisfactions can be aired without fear? Some proactive attempt to mold jobs to people's interests? What are the metaphorical slices of cheese you could put in the way of a bad outcome? Pharmacists and pharmacy techs are brilliant at this. The barcodes, the double checking, the visual confirmations and so on. It's worth the fuss. Because as with the story of Dennis Quaid's newborn twins, the stakes are life and death. Counting out pills in fives, compounding IV bags and creams, safeguarding the abusable drugs, dealing with insurance hurdles, all to ensure that the right medication and the right dose gets delivered in the right moment. Folks, that's what it's like to be a pharmacy tech. A shout out to one of our recent Apple podcast reviewers, Blue Man Ben one. He called the show a great podcast to binge while on a road trip, and that inspired us. If you know anyone going on a road trip this summer, we just put together a what it's like to be starter pack for new listeners. It's a hand curated playlist on Spotify with some of our favorite episodes queued up for you. We'll have a link to it in the show notes. This episode was produced by Matt Purdy. I'm Dan Heath. See you next time.