Tied to the Whippin’ Post

“Sometimes I feel, sometimes I feel,
Like I been tied to the whippin' post.
Tied to the whippin' post, tied to the whippin' post.
Good Lord, I feel like I'm dyin'.”
Allman Brothers Band

“... you don't have to wait for someone to treat you bad repeatedly. All it takes is once, and if they get away with it that once, if they know they can treat you like that, then it sets the pattern for the future.”
Jane Green, Bookends

A worn and dusty edition of “Remington’s Pharmaceutical Sciences” from the nineteen- fifties, turned up in the basement of a pharmacy I bought twenty long years ago. It still holds a treasured place in my professional library. A section covering the theory of professional pharmacy practice offers up some advice and some caveats that ring oddly sound when applied to current day circumstances.

A paraphrased thumbnail sketch of this ancient pharmacy wisdom reads as follows:

• A pharmacy professional’s primary focus and responsibility is the well being of the patient. Concerns about job security and about compensation should never be allowed to interfere with the primary duty to the patient.

• Professional compensation and job security must be closely monitored and adjusted to be kept sufficient enough to prevent these concerns from becoming issues that cloud judgment and interfere with a pharmacist’s duty to the patient.

• External commercial business concerns must be kept strictly segregated from everyday professional pharmacy practice to prevent them from interfering with the duty to the patient. The well being of the patient reigns supreme over the profit motive of the business side of the pharmacy practice.

It is tempting to dismiss these suggestions as quaint and antiquated bromides from the yellowing pages of a bygone era in professional pharmacy practice. That would be hasty. These guidelines might carry more import now than they did seventy years ago. In a nod to outspoken sports commentator, Charles Barkley, “I might be wrong, but I doubt it.”

The job market has gotten pretty tight for pharmacists recently. There are fewer independently owned pharmacies providing practice opportunities, due to a hostile and restrictive insurance billing environment. Tight reimbursement conditions for hospitals are driving cautious hiring practices and personnel reductions. There are way too many licensed pharmacists due to excessive graduation rates from a burgeoning number of schools of pharmacy. Fewer round holes… too many round pegs.

When job postings become rarer than the teeth in chickens, job openings become dearer commodities. A power advantage swings toward the employers who control the jobs. The possibility that the needs of these employers might be placed ahead of the needs of patients becomes an increasingly clear and present danger. Things only amplify when the job market looks so glum, that pharmacists are petrified by the prospect of losing a job for fear of not being able to find a suitable replacement. A job can become a precious facet of life; one not to be surrendered at any cost, or under any circumstances.

If the power balance between employers and pharmacists becomes sufficiently distorted; employers may dub themselves as proxy manipulators of the professional activities and the practice judgment of the pharmacists employed. My way or the highway! Pharmacists, who resist employer interference in professional conduct, may do so at very real risk of punishment. The threat of termination makes for a pretty effective lash. Feet to the fire! The primacy of patient welfare and safety often gets lost in the mix.

It is unlikely that most pharmacist employers are meddlers and workplace bullies; but neither is it a good idea to allow them that option. Discussions with other pharmacists and with persons working at the various professional associations might be a good way to keep tabs on the scope and the extent of the problem. Social websites offer another great forum for sharing state-of- the-profession discussions like this one.

Worsening of practice conditions can be a direct cause for professionally disenfranchised pharmacists to become too timid and too unwilling to just-say-no. The end result can be: crushing prescription dispensing burdens, reduced levels of technical support staffing, slipshod immunization efforts, ineffectual Medication Therapy Management programs, shrinking compensation, and worse.


A recent and widely publicized crackdown on the irresponsible dispensing of abuse-able controlled substances by several large pharmacy companies; provides just one cautionary example of pharmacists displaying poor practice judgment while under the gun; perhaps at the behest of their bullying and meddling employers. All this, in a social climate where demise by prescription narcotics has become a leading cause of death in the country. What was the thinking here?

All things considered, however, the threat of punishment by an employer does not excuse a pharmacist for failing to: exercise good professional judgment, exhibit ethical behavior, and perform the job in a fashion that is always in the best interests of patients. Strong personal reasons… do not good excuses make. The decision to practice under unsafe conditions, to knowingly contribute to high prescription error rates, to dispense narcotics unwisely, to rubber-stamp-and-phone-in important clinical services… those things are completely on us. We are the sworn professionals.

The notion that job mobility might be an effective shield against outside meddling with professional practice and conduct… seems sensible. The concept is worthy of mention in any era’s “theory of professional pharmacy practice.” Maintaining a healthy balance in the pharmacist labor force can be viewed from this perspective as an aliquot of responsible stewardship toward the profession, by its members. Pharmacists should be willing to work with one another and in concert with their professional associations to promote workforce mobility… as if the very well being of their patients depended upon it. Patient morbidity and mortality do indeed come into play.

Pharmacists are bound by honor and by ethics to closely guard the best interests of the patients whom they serve… above all else; our own selfish interests or the selfish interests of those who employ us notwithstanding. Promoting employment mobility to bolster professional autonomy may seem like a yellowed, dusty, and old fashioned suggestion… but it may instead be a timeless strategy. The yardstick against which we measure present pharmacist performance might be calibrated by observing how well we utilize effective practice principles like this one from the past… even while tied to the whippin’ post.

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