Co.Design

One Fix For Health Care: Dissolving The Barrier Between Patients And Pharmacists

Pharmacists can readily improve patient outcomes. So why are drugstores designed to keep patient and pharmacist apart? asks Smart Design’s Dan Formosa.

Having long been a fan of early, and dumb, comedies, I am quite familiar with the "dope slap." It was perfected by Moe Howard but employed by many before and since. A Google-searched definition describes a dope slap as the physical equivalent of "Whatta you, a moron?!" Its purpose is to slap some sense into a person quickly (or if your technique is on par with Moe’s, several people at once) who can obviously use an instant jolt of common sense.

While I haven’t thought about the dope slap in quite some time, it came to mind recently when looking at some common "what were you thinking?" practices in health care. I’m just not sure who gets the slap. Here’s what triggered the thought. Several months ago, I had the opportunity to visit Taiwan, participating in a design event in Taipei. Over the weekend, I was shown around town by one of the Taipei-based designers. Walking through a market, I stopped into a Chinese medicine shop. It was a pharmacy of sorts—if you consider various exotic herbs and powdered animal parts to be pharmaceuticals. While the ingredients were fascinating, and just a little scary, the most interesting part may have been the 45-minute conversation I had with the "pharmacist." (We conversed through translation—save for a few poorly pronounced words, my Chinese is nonexistent).

Despite the completely foreign setting, most memorable was the fact that such an extended conversation took place. The pharmacist took the time to talk, listen, and explain. The Chinese medicine shop encounter was more extensive, holistic in scope, and more informative than any conversation I have had with a pharmacist in the United States, ever.

Revelation. I’m a designer. I’ve seen Chinese medicine shops before. But look at the design of that shop, and the display of the ingredients on the shelves! Look at all those interesting things in jars in the glass cases, scary as mentioned but at least somewhat identifiable! And stools at the counter! The whole place is set up to encourage conversation. Compare that with pharmacies I have been used to all my life. Why am I just making the connection now? The first dope slap goes to me.

How obvious is it that my pharmacy in the U.S. is so different and in many ways vastly inferior to that found in many ancient traditional cultures. For one thing, stools in the Chinese medicine shop mean I’m supposed to sit! The entire place is set up with the intention that conversation and consultation are part of the norm. In contrast, my local pharmacy experience is not radically different from a dreaded visit to the Department of Motor Vehicles, where extended interaction is not in anyone’s best interest.

For reasons I cannot explain, my pharmacist is stationed behind a glass partition. I often have to stand in line till it’s my turn at the booth. I stand while talking. Usually it’s the pharmacy’s less-professional assistant who I interact with. (Actually, I’m not sure what her background is—pharmacist-in-training, salesclerk, something else?) She’s my main contact unless I have a question. Then the pharmacist will come out from behind the glass and provide a usually abbreviated answer. That, or just holler the answer back.

The setting is, to say the least, not very conducive to conversation. Quite the opposite, it gives signals to just keep moving along—its real goal is speed. Yet we know from studies into medications and compliance that a good relationship with a pharmacist can greatly increase the chances of staying on a drug regimen.

Non-compliance with prescription medications is a serious problem. Compliance has been shown to drop as much as 40% within the first six months of a patient starting a regimen. Interaction with a pharmacist has been shown to significantly reduce that drop, keeping more patients on track. This not only means healthier patients. It results in more sales for the pharmacies. And more sales for pharmaceutical companies. And more overall measurable effectiveness for that drug. At stake are the health of the country and literally billions of dollars in transactions. There is no good reason to discourage one-on-one interaction at pharmacies. But look at the design. Dope slap number two goes to whoever was in charge of designing my chain-store pharmacy.

While apparent from my visit to the Chinese medicine shop, these thoughts really started to gel after a recent discussion I had with a group of undergraduate design students from Syracuse University. In their school project, they pointed out many additional and equally unfortunate differences between pharmacies and other common, more comfortable settings. Compare a pharmacy today to a pharmacy from the 1930s. Or to an Apple store. Or to a neighborhood bar.

For one thing, today a typical pharmacy displays rows and rows of pills in similar-looking white bottles on the pharmacist’s shelves. These different drugs are then transferred to identical-looking pill bottles. With the bottles being heavily tinted in an orange or Target-pharmacy red, the pills themselves—even when they look different in actuality (many don’t)—are difficult to see. (The Target pill bottle, circa 2005, with its flat sides and color-coded ring, helps, but it’s not a silver bullet.) The generically printed bottle labels look the same and bear drug names that are hard to differentiate and difficult, sometimes impossible, to pronounce.

Why do people on medications seem so confused and fail to comply as instructed? Dope slap number three goes to anyone asking this question. Who wouldn’t be confused?

By comparison, pharmacies in the 1930s were less sterile looking and more personable. The Apple store has a Genius Bar, complete with stools. The neighborhood bar, of course, has bar stools. It also has a busy-but-often-talkative bartender, and lots of different-looking bottles on the shelves that we all (or at least many of us) can readily identify. A recent redesign of Walgreens pharmacies by a team at Ideo addresses some of these issues. It stations a health care guide-person in the center of the space and features both an "Ask Your Pharmacist" booth and a more private consultation room. The result: better communications with pharmacists.

That’s a positive step in the face of this generally ignored opportunity to improve health care. The pharmacy system may have evolved to its current state for a reason, but that reason is not design or compliance. In an apparent attempt to create pharmacies that portray an appearance of being superficially efficient, hospital-like, and sterile, we may be missing a significant opportunity to help people. Pharmacies today are by no means designed to improve compliance. With an increasing number of people on more and more medications, shocking statistics on drug confusion and non-compliance, and the fact that the pharmacy is in a position to help, it’s tragic that design is not more widely enlisted to become part of the solution. Dope slap number four—a multiple one this time.

[Images: Olga Miltsova, zhuda, and Diego Cervo via Shutterstock]

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9 Comments

  • carlamjaspers

    The structure of the modern US pharmacy clearly promotes a model of convenience, favoring the consumer that needs nothing more than a quick transaction over the one interested in a more personal relationship with their pharmacist. For the former, an online system for prescription refills or email consultation may be preferable. 

    For the latter, it would be interesting to further examine how consistency influences service, as well as compliance. More specifically, if a person chooses to retrieve their prescriptions on specific days, allowing repeated and consistent interaction with a specific pharmacist, might that lead to greater familiarity between both parties?

    Might the consistent interaction with a well known pharmacist elicit greater patient accountability, since the pharmacist is aware of the patient's regimen and thus knows when they deviate?

    Another way of approaching this could be to assign pharmacists a patient caseload, in which they're responsible for a consistent roster of consumers, allowing them to become increasingly familiarized over time with the individuals they're serving. While new consumers are continuously emerging, a consistent roster for each pharmacist paired with an automatic refill system could be one method of managing existing volumes, while also freeing pharmacists for more in-depth consultation.

    Perhaps instead of allocating another Pharmacist to the role of 'genius bar', a staff member (clerk, pharmacist in training, etc) could be enlisted to serve as triage, addressing needs of those who need further consultation versus those who don't. 

  • Barry Dwyer

    As a Pharmacist, you do offer advice whenever you can. The front counter is the genius bar so to speak. It's always been there. However, in a very busy dispensary where you've a high workload you simply don't have the time to spent 15 minutes talking to someone. People's complaints vary from the completely inane (they'll keep you an hour if you let them) to the serious. You have to prioritize. In a very busy dispensary the priority is checking medication on prescriptions, then you have to take phone calls (from patients, doctors, reps), do orders, stock control, blister packing etc... employing a second pharmacist to sit at a 'genius bar' so to speak is simply not cost effective.

  • Dan Formosa

    Hi Barry. There are various ways to rethink the system. The Walgreens project is a good example looking to solve some of these issues. In early stages of that project, the design team identified exactly that problem - a typical response from consumers (and patients) that "pharmacists are so busy” people did not want to ask them questions. In response, the design team not only rearranged the store, they also identified new roles within the Walgreens pharmacy. Another real-world issue - if in-person pharmacists (and/or knowledgable pharmacy staff) are difficult to speak with, online orders for medications (and access to online information) becomes a just-as-good or better alternative.

  • Richard Ruth

    I remember a study that was done in Australia a few years back and as far as how patients perceived health care professionals (HCPs), pharmacists outranked doctors as far as the HCP that was "most trusted."  Quite interesting given my interactions as a pharma rep were usually that the average pharmacist was businessman first, HCP second, whereas your average general practitioner was HCP first, businessman second.
    The interaction with a pharmacists in Australia is hands down better than the interactions here in the US.  The pharmacists at CVS and Walgreens are typically pill jockeys, and a handful of monkeys could do their job.  In Australia, they have far more influence and a need for a strong knowledge base and customer service skills. Several medications in Australia are "Pharmacist Only", so they are essentially over-the-counter (they even sit on the shelf), and a patient does not need a script, however, they do have to talk with the pharmacist first.  Such a practice reduces the medical burden on GPs and the entire healthcare system.  Not sure why the US is so hesitant to adopt similar practices, but maybe that is tied to some of the other comments, where there is a higher incidence of robberies at pharmacies in the US.  

  • Barry Dwyer

    Richard, A GP practice is different than running a community pharmacy. You're essentially retail and trying to provide a HCP service at the same time. GP surgeries don't have €100k+ of stock sitting in there to worry about. You also have to make sure you're not making a loss on every prescription you fill. I know plenty of Doctors to do quite the turn as business men!

  • ritasue

    I always knew I was lucky to have Frank as my pharmacist and I know that many other customers at the Duane Reade at the corner of West 57 Street and Sixth Ave will agree. Frank is always on his feet talking with customers and his staff. He knows all his customer's names and has an active friendship with many of them. My insurance company sends many promotions about the benefits of filling prescriptions on line, even offering the money saving option of ordering and receiving 3 months at a time of a prescription one takes regularly. But that would cut me off from Frank, so I am not interested. It also makes me wonder why an insurance company does not understand the importance of building a personal relationship between pharmacists and their customers. If this kind of interaction can happen in the heart of densely populated New York City neighborhood, it can happen anywhere. Frank was born caring and gregarious and built relationships in the original Duane Reade pharmacy layout and the more recent one installed after the Walgreen's acquisition. About seeing the medications on the shelves waiting to be dispensed? I personally can't understand the benefit(s). If I could look at boxes of Chinese herbs, that would be different.

  • Paddy

    The pharmacy experience is dreadful and far from its roots, removing the medically trained pharmacist from the patient.  However, I think the design has evolved partly for the reasons you note but also to minimize risk. Most Chinese herbs will not kill the patient if delivered mistakenly by a distracted practitioner, and I can't think of the last time I saw tape of an armed robber leaping the counter to grab up lingzhi mushrooms.
    That said, it seems such a waste that we keep these highly trained and valuable medical brains locked away in an industrial process.

  • Adrian Bussone

    The Walgreens re-design sounds similar to what CVS implemented in several of their stores a few years ago - Less distance between customers and pharmacists, a more private conversation area for a one-on-one focus. The trick is more about helping the customers feel that the pharmacists are actually approachable and willing to answer questions.  White coats can be quite daunting, no matter what a sign says.

  • OrionAdvertising

    Many pharmacy chains are expanding their services and encourage interaction between patients and health care providers. They are setting up "minute-clinics" in the store and setting up programs that connect pharmacists and patients to improve compliance and enhance wellness.