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Upon returning home from Walgreens I opened the bag to read the pages of tiny type that comes with prescriptions, but the bottle seemed light. I poured it out. It contained half the number of pills listed on its label.

I dialed the number on the label. A pharmacist answered. I explained the situation. He launched into a stern, accusative warning, "I certainly will note in your record that you claim . . . " He was not saying, "You just left the store ten minutes ago? Bring it back. Let me check the inventory to see if we have 15 more pills than we should." It is not as though someone slipped and the count was off by one or two or three. It was off by half a bottle. If honest records were being kept, the error could be found. Just as when you hand someone a twenty and they give you change for a ten. If the cash in the drawer is correct, counting it will reveal the mistake.

In what other industry would they not apologize and ask for the opportunity to make it right?

From his response I believed that I was talking to the person who shorted me. He was so good at manipulating me into going away quietly that it sounded like something he did often enough to be this good at squelching customers. This was someone capable of checking a box that would incriminate me. He could label me as a drug seeker and damage my ability to get care forever. And over a prescription for Zantac?

Zantac can be gotten over the counter in smaller doses. It is as innocuous as aspirin. It is not a pain killer someone would seek. It just reduces acid in your stomach.

Was this pharmacist making money by selling on the side what he collects from shorting patients? I don't know anything about the illicit ways a pharmacist can make money, but why would he be intimidating me like this if not running some kind of fraud?

To whom would I complain anyway? Who would believe me? How bad would he be willing to make my life in order to protect himself? My experience and observation is that nothing is beneath health care professionals who are protecting interests of their own.

I dropped it, just as he apparently wanted me to do. I didn't say anything to anybody. When people in medicine want to take advantage of patients, they have all the power. There is no one to whom patients can turn for help. In the decades since then I have never gone to any Walgreens for a prescription again, but there was nothing I could do to protect other patients from that pharmacist.

If you hear an echo in the background right now, it is the inner voices of every health care professional who reads this murmuring the incessant disbeliefs and rationalizations that roll off their tongues in response to such information. Among them I have never witnessed even awareness of such events as part of the many small acts by committed by providers that have a cumulative damage to the patient community that is enormous. I have witnessed only routine thought processes that dismiss both the importance and the reality of that which would interfere with justifying and protecting itself.

If the well being of patients were their first priority, wouldn't systems that protect patients from predators be the first thing they would establish? No matter how small or large the problem, they don't (see Majors). It is not even on their radar. They are in denial of its being a problem in the first place.

Like the backhoe operator who never tunes in to the viability of the soil for its eventual use, because careers are better off just doing one's own job without worrying about the end result for the consumer, many people in medicine do not tune in to doing what they would do to protect patients if the well being of patients actually were their first priority, or any priority at all really.

"Has anyone told you that taking this particular prescription in quantities this large could damage the lining of your digestive tract? Especially when taken for this many months? No? What are you trying to cure? Have you been tested to see if you have that? No? With the magnitude of the increases in quantity over the months you have been taking this, to cure something for which you haven't even been tested, don't you think you should get a second opinion? You appear to be severely under weight. How much? You've lost 40 pounds in two months? You haven't got anymore to lose. This isn't right. Get a second opinion."

A doctor who learns that a pharmacist said those words to a patient never will order prescriptions from that pharmacist again, and possibly could spread the word in the medical community that that pharmacist is a problem. There really isn't anyone looking out for the interests of patients in this system. They imagine that they do. They believe that they do. And sometimes take small steps that could lead in that direction, But any professional within this system will be discouraged from looking out for patients by anyone else whose self-interest or pride or power might eroded by someone protecting patients. And then "you cannot let one patient ruin your whole care" takes over.

Patients need someone outside of medicine on their side, someone whose livelihood cannot be threatened by helping patients. Patients need someone outside of medicine to whom a pharmacist can whisper concerns like the one above.

Physicians rebel against the idea of anyone other than them advising patients. There are doctors who persuade patients that patients should put their faith in one doctor and let that doctor guide all of their care. The fact that 30% of second opinions are different than first opinions, and the fact that the most common cause of patient harm is misdiagnosis and delayed diagnosis, isn't important enough to them for it to be on their radar. The feedback systems don't exist to give them perspective on what they do that is bad for patients.

A pharmacist could recognize many of the patient harm problems caused by doctors, but it is in their disinterest to become sensitive to that. Patients need someone outside of medicine whose interest is served by being sensitive to that, perhaps through something like a Community Patient Agency.

"Are you sure it wouldn't be better to live with the pain than to risk getting addicted to what you have been prescribed?" is something that a pharmacist would have a hard time saying to a patient. There should be a number the pharmacist could call with such concerns and be applauded for it rather than injured.

As it is, pharmacists are a cog in the machine that unnecessarily kills hundreds of thousands of patient each year and permanently injures many times more than that. They are as responsible as the back hoe operator who does not stop digging when recognizing that the soil being dug never will support a viable septic tank for the young family who will sink all the money they have into a house that, in the end, will ruin them when its value plummets as a result of sewage removal problems that should have been recognized by all of the people who helped to create that house, but all of whom had a conflict of interest - vested interests with no skin in the game - a situation that breeds self-serving blindnesses and rationalizations, just like in medicine.

Ever try to sell a house with green water pooling in the backyard? Ever try to get care for, or even acknowledgement of, an iatrogenic injury?