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Does competition deliver choice and better services for customers or does it lead to unrealistic expectations and corners being cut?

FREE MARKETEERS gush at the thought of unregulated markets where the strong thrive and the weak are crushed.

True, competition puts customers in the driving seat €“ which sounds great until you realise that they don't know what they are doing.

A couple of weeks back, a patient came into the pharmacy with a repeat dispensing prescription for three months, including, among other items, methotrexate. €Would you like one month now, sir?€ I asked. €No,€ he replied, €I want them ALL now.€ That's not really how this system is designed to work, was my response. €Are you saying you can't give them all to me now?€, he retorted. €Well, the GP hasn't specified an interval, so I do have some discretion.€

It was clear that I was getting nowhere with the increasingly irate (and irrational) patient. €Every other pharmacy I have ever been to just gives them to me all in one go,€ came the next barb. In the end I relented and made the full supply against my own better judgement and with a clear disclaimer to the patient that he was acting against my professional advice. He stormed out of the pharmacy saying he would never return.

Taking the correct stance and not conceding to the patient's demands would have served no purpose €“ he would simply have shopped around to get the outcome he wanted.

Where pharmacies are stretched by targets or financial realities, there is always going to be a tension between making a living and playing absolutely by the book. The tighter things are financially, the more blurred the line becomes.

Out on a limb

On the same day, I had another incident with a different patient, this time involving prescription hosiery. The patient wanted a 'special order' item in time for a wedding. I rang the supplier immediately and obtained the item as quickly as I could. When it arrived a few days before the wedding, we rang the patient to let her know the item was now available for collection.

When she arrived to pick up the item the patient thanked us for obtaining it so quickly but, before she left the shop, she decided to check it €“ only to then announce that she was unhappy with the colour (none specified on the script and the patient had expressed no preference when she handed the prescription in). She demanded that I ring the supplier to try to return them.

She demanded that I ring the supplier to try to return them

So on speakerphone in the consultation room, I rang the supplier, even though I had already explained that it was non-returnable because it was a special order item which they didn't normally stock.

After hearing exactly the same response from the supplier as she already had from me, I hung up. €You could have tried harder to get them to accept the return - I've dealt with suppliers and if you make enough fuss they will give you what you want.€

A few days later we contacted a vascular nurse at a local district general hospital to ask her to change the prescription she had written for one stocking to a pair (as it is impossible to order a single stocking). €Send the patient to [she named a competitor pharmacy] - they'll give them one stocking,€ she said. Not much you can say to that, really.

There are contractors out there who are prepared to make a loss on such transactions, but it does none of us any good. If we all tried to compete with that type of lunacy, there'd be pharmacies filled with one of every variant of stocking imaginable until the end of time.

Impossible position

People are more demanding than they have ever been - leaving businesses in an impossible position of trying to keep them happy. A good example of this is where we are pressured into giving specific brands of generics, or even brands against generic prescriptions.

I am often forced to bite my tongue, pandering to patients who claim €this brand of ramipril is stronger than that one€, or these omeprazole €don't work€.

We all do it because, if we don't, we're afraid the patient would simply go elsewhere. Two patients of mine went to see two different GPs, claiming different brands of generics had lead to 'reactions'. One GP said: €Go to [he named a local pharmacy] - they are less likely to change your brands.€ The other said: €It makes no difference; they're all the same.€

Patient two is now fine with the generic; patient one says she must stick with that pharmacy because her GP told her to. You can't win.