What patients are really saying about our pharmacy teams in British Columbia
By Aaron Sha, Max Ahluwalia, Fong Chan, and Priya Bains
This project started when Priya, who was then a pharmacy student working in my community pharmacy, got curious about what people were saying about our pharmacy on Google Reviews. We would be amazed at the kind words we received in the good reviews but also shocked by what people would comment on the bad reviews. Our curiosity piqued, we decided to go further, and make this into a formal project. Therefore, over the course of 2023, along with professors Chan and McCormack from the University of British Columbia, we analyzed over 20,000 Google Reviews of approximately 1,200 community pharmacies in British Columbia to understand the sentiments of patients towards pharmacies during the COVID pandemic. Results of our analysis showed that reviews before and after COVID were mostly positive, with approximately 7 out of 10 patients leaving a positive review; however, we did notice a pattern of negative reviews that highlighted the challenges that community pharmacies faced. Below are examples of reviews that emerged repeatedly, each one highlighting these challenges. Comments were edited for brevity and privacy.
By training an artificial intelligence model ChatGPT, we were able to quantify the number of reviews that shared similar sentiments.
“I called the pharmacy to request an emergency supply of my asthma inhalers. As a lifelong sufferer of asthma who has infrequent triggers, imagine my surprise when the pharmacist told me I cannot have my prescription without seeing my doctor. I told the pharmacist I have an appointment in 2 weeks, and I do not want to get sick by going to the emergency department. I have little faith in humanity and the pharmacy should be ashamed of themselves.”Challenge Emergency supplies are provided on a case-by-case basis and provided if the pharmacist deems supplying the medication is appropriate. Patients are often not aware of this thought process and are also not provided adequate explanation as to why the request may be denied.
Authors’ commentary Emergency supplies are always a challenge for community pharmacies, as pharmacists are often expected by patients to provide what is being requested. In the above case the pharmacist may want to explain their rationale and why it is important that the patient requires a reassessment (e.g. uncontrolled asthma).
“I ended up in an emergency department with a life-threatening infection and sent my husband to the pharmacy to pick up the antibiotics. I called the pharmacy and was told it would be ready so I sent my husband to pick it up. My husband showed up only to be told that they could not give him the antibiotics due to an interaction with one of my other medications. Then, the pharmacist went behind my back and contacted the emergency doctor and got the doctor to change it to another antibiotic, which is one that did not work for the infection before. What a waste of time, I would give this pharmacy zero stars if I could.”Challenge Lack of communication and patient’s understanding of the consequences of the drug interaction.
Authors’ commentary Often it is an agent ordering or picking up on the patient’s behalf. However, when a problem arises, the agent may lack context to relay the message properly to the patient. If the pharmacist was able to reach the patient in the above case to get the full history, a negative experience may have been prevented.
“Very impolite, arrogant, and unresponsive pharmacy department. Show some respect to customers, we are paying taxes too!” Challenge With news of nationalized pharmacare, and extended coverage of certain classes of medications (e.g. contraceptives), patients are seeing pharmacy teams as an extension to the government.
Authors’ commentary Community pharmacies are run as businesses, and although provincial and federal governments are providing coverage for certain medications, there has been no increase in terms of dispensing fees since 2014, yet businesses costs have steadily increased over the last few years. This may have resulted in cost-cutting measures leading to increased stress for pharmacy staff and poorer patient care. An increase of dispensing fees that is reflective of inflation is required to prevent further degradation of pharmaceutical care.
“Went there to get antibiotics that the doctor faxed in the day before, was told to wait for another 30 minutes. While waiting, the pharmacist commented that “it’s a cold medication, you are not going to die”. I just kept quiet as I did not want to make a scene and was late for work.” Challenge Pharmacy team working in a busy and stressful environment, which may lead to frustration and undesirable emotional responses.
Authors’ commentary As the demands on pharmacy staff continue to increase due to changes in scope and financial stressors, it is important for leadership to recognize the need for stress-relief at the workplace. A possible solution is to designate a private area for team members to vent and to include mental wellness programs as part of the benefits package.
“I arrived 1 minute early for a vaccine appointment. Store was empty then. Pharmacist had me sit while he was doing paperwork. I sat and waited and another 2 people arrived over the next 5 minutes. I didn't get my shot until 15+ mins after my appointment time. I understand that you've got things going on. Maybe tend to your customer first and then do paperwork. Especially if you know you have back-to-back appointments coming up. Expected better service from a local community pharmacy.” Challenge During the peak vaccine season, it may be difficult for vaccinators to keep up with appointments and tending to walk-in appointments and other obligations.
Authors’ commentary Due to financial stressors, pharmacy businesses may want to maximize the number of appointments in a given time. It may be helpful for regulators to set a minimum time between appointments per provider so adequate time can be provided to each patient receiving care.
“Don’t bother with the pharmacy here, they are still living in the age of fax.”Challenge Although faxes are still commonly used in health-care settings, patients are often surprised about pharmacies using this as a form of communication. Transmissions sometimes fail due to connection errors and the machine is also prone to issues.
Authors’ commentary Faxes are still commonly used for the perception of security in protecting the patient’s privacy. Even though digital alternatives exist and are more reliable, the risk-averse industry is slow to change. Pharmacists can explain to patients the reason fax is still being used, and empower patients to contact their government representatives to update regulations to facilitate technological advancement.
“Worst customer service at a pharmacy. I was asked to show ID to set up a file, since electronic records are widely used in BC, we never bring ID, even to Lifelabs, just put the care card number in the computer to match the name of the prescription. The pharmacy assistant refused to do that, and the pharmacist told me to calm down. Then I had to go to another pharmacy, in which they were able to fill the prescription right away.” Challenge Inconsistent requirement of identification across different pharmacies and health facilities, leading to patients being turned away.
Authors’ commentary Currently photo identification is required for pharmacies to set up a patient profile to ensure no errors are made at entry and to prevent fraudulent activities. However, there are many reasons why patients may be present without a valid ID, due to a number of factors, and delaying treatment is not an option. A guidance document from provincial regulators may assist in protecting the pharmacy staff who choose to dispense medications without ID when the case is in the best interest of the patient.
“Pharmacist picked her nose while handling medications. She did not wash or sanitize.” Challenge Pharmacy staff in the community are always under the watchful eye of clients and all of the actions may be scrutinized then posted for the public to review.
Authors’ commentary It is hard to imagine any pharmacy staff would be performing the commented action while knowing they are being watched. During staff orientation, it is important to advise new colleagues the importance of personal hygiene and to remain vigilant of all actions. Even a small itch on the face and subsequent scratching without handwash may be misconstrued as unsanitary action.
“After transferring from another pharmacy over to this pharmacy I cannot begin to tell you that you feel so special and are treated with such love, kindness and appreciation. The day I transferred over, one of the pharmacists called me within 25 minutes, updated me on the transfers of all my prescriptions and all changes made to my file. Guided me through and supported me in how their process works.Author’s commentary After reviewing all the challenging comments, and there were quite a few, it is our pleasure to share with you this comment from a patient in the community. Good communication, kindness, and respect to privacy goes a long way in building patient trust and providing the best care.
Conclusion
After reviewing thousands of reviews, overall our team was pleasantly surprised by the number of positive reviews. As shown from the positive comment, reviewers with similar sentiments by far outnumber all of the negative comments combined, showcasing the hard work and dedication pharmacists have given back to their communities. Although our work is only focused on community pharmacies in British Columbia, similar challenges can be heard across Canada when we presented our research in national conferences. Our hope is these comments can spark more interest in studying patient sentiments and bring to discussion the challenges and solutions for improvement. As the adage goes “once is an accident, twice is a coincidence, and three times is a pattern”, we encourage all colleagues to look at their own reviews to gather insights to help address gaps in services or care.
Citation (1) Bains, P., Chan, F., McCormack, J. P., & Sha, A. (2024). British Columbia community pharmacy during COVID-19: Describing the patient experience via Google reviews. Canadian pharmacists journal : CPJ = Revue des pharmaciens du Canada : RPC, 158(1), 24–28. https://doi.org/10.1177/17151635241281749