Consider a large, expensive machine for use in a workplace, whose defining purposes are:

1. the ability to put stamps of approval on documents, which all documents are required to have in order to pass through the workplace

and 2. The ability to be assigned responsibility for any stamps that it screws up, so that no one else in the workplace is held responsible for anything wrongly approved by those stamps.

Now imagine that the correct application of stamps is a vastly in-depth system, requiring the ability to manage a huge amount of detailed information and follow a huge number of complex rules.

And now imagine that the machines’ ability to do this is unreliable as fuck.

(loong rant below)

Just a few, the best ones, are almost autonomous. Most of them, the average pretty-good ones, can stamp things correctly most of the time, more than half, by themselves… but the rest of the time they must be painstakingly guided through the process by employees who know how it works.

And of course no employees actually know how it works, not nearly as well as the machine is supposed to know.

So they just have to give their best guess, a lot of the time. Sometimes that means hoping the machine is right. Other times it means actively putting the machine through the motions of carrying out their best guess, because the machine doesn’t even HAVE a guess of its own, or its guess is so obviously wrong that anyone can see it.

The worst ones either have to be manually operated like that ALL the time– making them less efficient than a handheld rubber stamp– or will resist being controlled and will actively reset themselves to incorrect stamping settings, again and again, no matter how much guidance they get.

Bad ones are very, very hard to replace. Even though they’re considered at fault for their own mistakes, it requires a truly disastrous screwup before replacement can even be considered.

See, they’re not easy or cheap to get or to maintain. Producing one and getting it ready to be used is a long and costly process that doesn’t happen nearly often enough, so there’s far more demand than supply, even for bad ones. And no workplace can legally function for a single day without having one, so even the worst one is better than having nothing.

And…. no one hates this arrangement enough to try to change it. Because no matter how bad your machine is, at the end of the day it’s not your problem, because the machine itself is the one deemed responsible for it all.

….Okay, this isn’t a literal machine.

….You’ve just imagined a pharmacist.

Probably many types of managers, actually. But pharmacists are what I know.

In an ideal world, this is how a good prescription fill could go:

A prescription for oxycodone from the emergency department shows up in the electronic queue. I try to process it, notice that the insurance gives me a DUR reject, set the payment to Cash, put it in the Clinical queue, and call out to the pharmacist, “New ED in Clinical, could you help me with the reject?”

(well. Actually, in an ideal world, I wouldn’t have to change the payment to cash, because the system wouldn’t have a glaring design flaw where leaving it in rejected status would make it fall off the face of the earth and be impossible for the pharmacist to find. And also I wouldn’t have to call out anything, because the pharmacist would ALSO be watching the electronic queue for new work to do, just like I am. But these are pipe dreams.)

Anyway. Then, in a mostly-ideal world, the pharmacist would check on the prescription, try to run it through insurance, see the DUR reject… notice that the reject HAS to be resolved because we are not allowed to sell oxycodone paid in cash to patients who have that type of coverage…. realize that a DUR reject NEEDS a pharmacist to override it….. and then override the DUR reject and put it back in my queue for me to fill.

Here is how, in this world, it actually went.

After I called out to the pharmacist about the ED in Clinical and the reject, I went on with the other tasks I was doing to help other patients. When I got a chance to come back to this one, I noticed the pharmacist had approved it and left it for me in my queue– but it was still set to cash.

Conversation went:

“Did you look at the DUR reject for (patient name)?”

“What?”

“The DUR reject. On the oxycodone. For the new ED, for (patient name).”

“Set it to cash so I can look at it, and put it in clinical.”

“I did that already, and you approved it. But I can do it again… There it is.”

“Which one is it?”

“the one for (patient name)…The one you just approved before.”

“And what was the problem?”

“It had a DUR reject, which has to be resolved because–”

“Okay okay, let me look at it. Where is it? Give me the patient ID number.”

“It’s the one I just put in clinical, the one you just approved for (patient name)… the ID number is–”

“Oh, okay okay I see it!”

(minutes later, DUR reject is resolved and the prescription is ready for me to fill)

And this is … I’d estimate a good thirty-five percent of the prescriptions here.

That was one of the easier ones. There are others that are worse, because of the pharmacist’s delight in having a lovely rapport with me where he can always finish my sentences… and his complete disregard for ever letting my sentences finish in the way I was intending to finish them.

(Meaning a lot of information is lost… and it takes a whole lot of convincing to get him to even accept the fact that any information was lost… and convincing is awfully hard to do when I am still not getting to choose the endings of my own sentences.)

Arrrrrgh.