80

George’s Corner 

201606_CT_NovDec_2016_Web

Yesterday
was my 80th birthday. Several times I said, “Thank you for the first
80 years — they have been great. I am looking forward to the next 80.
There is still much to do.”

However,
this is also a time to look back on what has gone on since 1936. What
follows are a few of the things that have impressed me.

My dad
had high blood pressure. The drug of choice was phenobarbital. He
hated it because it made him drowsy. During one of his “vacations”
from phenobarbital he had a stroke that caused his death. Now we have
a long list of drugs to deal with blood pressure. Drowsiness is seldom
a problem. That is just one example of the huge number of advances in
drug therapy.

We had a
telephone at our suburban house. Trinidad 2-0926. Listen for the dial
tone, put your finger in the “TUV (8)” hole, turn the dial clockwise,
let it spin back, then put your finger in the “PQRS (7)” hole; then
the “2” hole, etc. If you were lucky it would work. If you needed to
call someone in another city, you dialed “0” and talked to an
operator. Now, you poke your cell phone (which you can do just about
anywhere) and tell it to “Call Jane,” who could be anywhere else in
the world.

Conventions
are still at hotels. Back then, just outside of the meeting rooms
there was always a row of telephone booths. They are all gone. Same
with airports. Same with street corners. No more telephone booths.

Automobiles.
I learned to drive in a 1936 Ford. Stick shifts were all that was
available. Now we drive cars that accelerate automatically to a
preselected speed with the flip of a button and slow down and stop
automatically if the car in front of you slows and stops. Of course
you can now make phone calls and get told when and where to turn to
get to your destination.

We all
carry little computers with huge abilities. No need to list them. You
know. You have one in your hand or within reach. I have a huge
dictionary that has been on the shelf for over 20 years.

Healthcare
is changing. M.D.s are not the gods that they used to be. They may be
team leaders, but their god image is going away. That is because the
provision of healthcare is a cooperative activity. Each specialist has
a role to play. The age of the overeducated, underused pharmacist is
finally going away.

When I
started practicing pharmacy we had manual typewriters that had little
clips to hold those little labels on the platen of the typewriter. We
had little label lickers that had to be filled with water every
morning. ALL of the prescriptions were handwritten. Oops, some were
printed by the drug manufacturers and given to the physicians, ready
to sign.

Some of
our “best” patients had charge accounts. Meaning, if we were lucky,
they paid later. The rest paid $-CASH-$. However, cash was seldom over
$5.00. Prescription drugs were sold for $0.95. Yes, 95 cents. Or
$1.95. Or $2.49. The last digit was always a 5 or a 9. Price was
generally based on the cost of the drug, plus 50%, plus a small fee.
However, all of those prices were subject to change based on what we
thought the pharmacy down the street was charging.

I marvel
at where the pharmacy computer world is now. Fast, comprehensive,
easy-to-use systems are making pharmacies the most efficient component
of the healthcare world.

People
price-shopped. So if someone asked for the price of a prescription,
the pharmacist was likely to write his (mostly male pharmacists) price
on the prescription in code. PHARMOCIST. $1.95 was written on the
prescription as PSM. The next pharmacist knew not to charge more and
sometimes charged a nickel less.

The drugs
were cheap. But they also were primitive; nowhere near the
sophisticated drugs we have today.

Third
parties did not exist. The first insurance programs of any
significance were the welfare/Medicaid programs. In the ’60s and ’70s
others started popping up. Most used the “shoebox” method. The patient
gathered receipts in a shoebox and every now and then sent in a stack
to the insurer. That was a mess, so some insurers created billing
forms. I remember one pharmacy’s collection of about 10 different
stacks of billing forms for different programs.

That was
a mess also. Voila! The National Council for Prescription Drug
Programs (NCPDP) was created. The NCPDP created the “universal claim
form.” Which was great, except it had to be filled out by hand because
the boxes where data was entered were not lined up horizontally.

Those of
us who were putting together pharmacy computer systems (early 1970s)
got that fixed so we could print out the forms with our primitive
dot-matrix printers.

Computers:
Then and Now

Which
brings up the pharmacy computer world. The first one I tried to sell
depended on a voice line going to somewhere in Pennsylvania from a
terminal in California. I carried that terminal around to do demos. We
dialed the number (often fingers in the holes), stuck the phone in the
terminal’s cradle, typed in data, and waited for Pennsylvania to
reply. Sooner or later something that looked like a label would print
out on lousy paper. I didn’t sell any (thank goodness), but I got
hooked on the idea.

My
brother Chad was (and is) an electronics genius. He built computers
before Jobs and Wozniack put together Apple 1. We got to talking and
decided we could build a pharmacy computer. We, and a couple of
others, created (created is the right word) the first stand-alone
pharmacy computer system. Lots of stories about midnight oil,
primitive programming, printer nightmares, minor victories, etc. Maybe
sometime I will write the whole story as I remember it. Too long for
here.

I marvel
at where the pharmacy computer world is now. Fast, comprehensive,
easy-to-use systems are making pharmacies the most efficient component
of the healthcare world.

I am
looking forward to observing (and participating in) the changes to
come. That’s the next 80. CT


 

George
Pennebaker, Pharm.D.,
is a consultant and past president of the California Pharmacists
Association. The author can be reached at
george.pennebaker@sbcglobal.net;
916
/501-6541;
and PO Box 25, Esparto, CA 95627

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