Lotus-eaters and hayseeds

I have had the opportunity recently to work in a pharmacy in Alberta as well as my usual gig in B.C., which has led to me pondering the differences in pharmacy culture between the provinces. “Lotus-eater” is the label often applied to those on Canada’s left coast. It is a dreamy existence on misty islands. A lifestyle of sampling fine local vineyards, the endless farmers’ market quest for the best arugula and the busy careers of life coaches and massage therapists. And of course, being able to step off a dock for an idyllic afternoon sail or putt-putt around the bay, and the ubiquitous image of surfboards permanently lashed to roof racks. Compare this to the “hayseeds” of Alberta, with their “get ’er done” hardiness. Every day you can see this sense of community in action with deeds that speak louder than words. It’s evident in the way one farmer drives his combine off his field and onto the neighbour’s to get the crop in before the winter snow sets in. Alberta is also the land of beef eaters, oil slingers, and bitter winters where they still send their children to school in up to minus -24 weather with a caution to “please dress warmly for outdoor recess.” (This sentence is incomprehensible to any Vancouver Islander on so many levels - “What does - 24 even mean! … they must have meant - 4 ). There is also a country-wide perception of widespread intolerance, which is unjustified—intolerance can live anywhere and unfortunately, does, whether you are a lotus-eater or a hayseed. Please understand, I have my feet firmly planted in both provinces, having just realized that I’ve lived half of my life in each. I love each province equally. What I can say about Alberta’s “get ’er done” with respect to pharmacy is that you need to tolerate a lot of bureaucracy to accomplish that. The number of Alberta Health Services sites and logins that I had to create to gain access to prescription, lab, and COVID immunization information is mind boggling. My usual “book of codes” that I use to float through multiple stores, is full of Alberta logins with a lot of scratch-outs over many pages. Every pharmacist I encountered other than a manager said they were currently locked out of the system and had not reset their own password. Now I understand why, as I have had to call Alberta Health a dozen times in a month. It took me 10 days to gain access to information I feel I should look at to fill every prescription. And if I am not mistaken, I am not allowed to be assigned to more than one pharmacy. There is this mysterious fob… an actual key fob, or a virtual one that I now have on my phone, without which I see nothing in the AHS universe. I asked the other pharmacist how he filled prescriptions without seeing the information on every prescription. He said he only looked up if he thought there was potential for multiple pharmacy/ multiple doctor with a patient. Compare this to B.C., where province-wide Pharmanet access has been in place since 1998. I can walk into any pharmacy, and as long as I have an active B.C. license, I can immediately work. I can see all the prescriptions the patient has had anywhere in B.C. I cannot see lab values or vaccinations, yet—this feature is just being introduced this year. I don’t have to apply for fob access at every location, I don’t require a login and password to log onto multiple user sites. If the College has me as licensed, I am able to work anywhere immediately. And yet, when I talk to my fellow pharmacists in Alberta, they say they would not work, or do business in B.C. The one said that the lack of professional services they are able to bill in B.C. is discouraging. With the prescribing privileges accreditation in Alberta, it opens windows of patient assessments annually, initiating prescribing, ordering lab values, funding for smoking cessation, and for any and all subsequent interactions with the patient. As we have seen with most governments, they have completely devalued the actual “pills” and the act of dispensing. So, you need to be aware of how to bill for these services and actively engage in them. In B.C., we have not negotiated, or been successful in gaining additional prescribing authority or minor ailment assessments, or any of these added services. We are allowed our two medication reviews annually per patient, and follow-ups for a lower fee. But in B.C. we can change the pharmacy manager in as little as seven business days! What ever happened to “get it done Alberta”? Kidding aside, a change of manager in B.C. last month took four days. Here at a store in Alberta, I am five weeks into an attempt at change of manager. The idea of two weeks’-notice in Alberta is anxiety inducing. Thus, I am a TPIC—temporary pharmacist in charge. Let’s just get rid of temporary and actually make it happen. Working with AHS reminds me of the Vogons from Vogsphere who destroy earth to make way for an overpass in the Hitchhiker’s Guide to the Galaxy. A subsequent visit to Vogon by the hitchhiker leads to a mind-numbing encounter with paperwork and lip service for distant plans of action. The immunization programs for COVID -19 are also worlds apart. B.C. has yet to allocate vaccine to pharmacies beyond the select group of chains they have seemed to favour. This despite repeated demands from independents who always participate in flu season and public vaccination in many remote communities in which big companies do not operate. Our small group handles upwards of 7,000 vaccinations annually—how can we not be engaged in this roll-out? The B.C. government is instead focusing on mass clinics at gyms and public centres. And, if indeed, they can vaccinate 100 people per hour, as I calculated in the one facility I visited, well, it’s no wonder they don’t want to ship to stores that can do 50 per day. And part of me (between the calls to the pharmacy, the booking systems, the added staff, and the hard fought $18 per shot) says it’s not worth it for pharmacies. Not just financially, but also taking into account the stress and workload put on the already COVID-burnt-out teams. On the other hand, at another public clinic I observed there were twelve public members waiting to be vaccinated and over 25 staff of immunizers, intake, first aid, and general dogsbodies directing traffic. We will be paying for this for years to come. A necessary expense, but it all could have been done with less taxpayers’ dollars if they had utilized the pharmacy immunization system that has been in place, and quite effective, since 2009. Meanwhile, Alberta pharmacies are receiving shipments weekly, doing 30-50 patients a day. Again, extra staff and the hassle of booking systems, not to mention the confusing Alberta Health Services site for ordering and receiving the vaccine. I received a call from the AHS vaccine team as we had not reconciled an order from late April. I explained that the previous manager had tried and it glitched out on him, and that I had no access because they would not grant it to me in a timely fashion. I was told it was a mandatory reporting system. Well…yes, but first let’s allow me access, and then I will “get ‘er done,” as they say. Round and round we go into the Vorgon vortex of Alberta Health Services. This hitchhiker is about to hit the road again, still not convinced it’s better in one or the other, and committed to both. One cowboy booted foot is planted in the rich dark prairie soil - the other bare foot, is stepping into my ocean kayak.

Lotus-eaters and hayseeds

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More Blog Posts in This Series

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Burning down the healthcare house

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