Lessons from Difficult Conversations at CVS

Difficult conversations are happening all over the place, all day, every day. I’m so grateful I know how to have them with confidence. Otherwise, each one would be even more time-consuming and frustrating.

Too often lately, I face difficult conversations with CVS pharmacists. CVS seems to have a high turnover-rate of pharmacists in Massachusetts. And last week I read that the U.S. has a national shortage. So almost every time CVS makes an error filling one of my kid’s prescriptions (and a lot of errors have been happening), I have to begin a new relationship from scratch. Have you faced something similar?

Theoretically, picking up a med at CVS is supposed to be simple. You give them a patient’s name and date of birth, they hand you the correct amount of medication in exchange for the correct co-pay, and you go on your merry way. In practice, here’s what actually happened for me recently.

1. After waiting my turn in line, I gave the Pharmacy Tech the patient’s name. She gave me a bunch of filled prescriptions. Two were for the same drug, but the combined number of pills was less than the amount the doctor prescribed for the coming month. When I pointed this out, the Pharmacy Tech said, “You have to talk to the pharmacist.” I didn’t have time right then, so I paid for the prescriptions and left.

2. Next time I returned to CVS, I brought back the bags of pills and explained the situation to a pharmacist I’ll call “Joe”. Basically Joe responded, “It’s not my fault, there’s nothing I can do about it, call your insurance company, goodbye.” I left.

3. The next day, I called the insurance company. I explained the story again. After 20 minutes, the customer service representative said, “It turns out I don’t handle this. You will have to tell this whole story to someone in another department. I’ll transfer you.” I waited on hold and then re-explained the story. This rep said, “Oh, that’s easy. Just tell your pharmacist to call the Drug Utilization Review Board, tell them what went wrong, and request an override. Then CVS will refund the extra money you paid plus give you the missing pills you were supposed to receive for the full month’s supply.” Between waiting on hold for each rep and explaining my story twice, it took me a full hour on the phone with the insurance company to receive this magical lesson.

4. Next I called CVS. The Pharmacist Intern who answered said, “I understand. We’ll handle it right now. Come back when you have time, and we will refund you money and give you the missing pills.” Phew!

5. Back at CVS a couple days later, I again spoke with Joe, the pharmacist I’d talked to a few days prior. He recognized me. I explained what the insurance company told me. He once again said, “It’s not my fault, there’s nothing I can do about it, call the insurance company.” Clearly Joe hadn’t listened to my words. I told him again what insurance said. This time he said he would handle it and returned to his computer.

6. Minutes later, Joe handed me a refund with a curt “Goodbye.” I said, “Thank you for the money back. I still need the missing pills.” He said, “I can’t do anything about that.” Calmly (not easy for me) I said, “Joe, I know you can help me.” I repeated, “I need you to call the Drug Utilization Review board to ask for an override, please.” He sighed, made the phone call, and brought me the pills.

7. Relieved, I walked away, hoping never to have to return.

This vignette is one of countless frustrating experiences I’ve had trying to get my family’s prescriptions filled.

Pharmacists are highly educated in science, yet they have few freedoms. Physically, they are limited to a small work area. Mentally, they seem overwhelmed by corporate policies, federal regulations, supply chain problems, and variations in insurance practices. Emotionally, they constantly face stressed prescribers and concerned patients. It’s likely that their daily reality does not match the expectations they had when starting their doctoral programs.

I’ve come to realize that, even when they’re looking directly at you, pharmacists are not necessarily listening to you speak. Based on thousands of customer dialogues, many seem to run scripts. They assume they know what you will say. They wait for you to stop talking, then respond by rote. Often their script will not match your request.

As a raving fan of clear, efficient, kind, communication, these conversations could easily drive me insane.

Rant over. If you’ve read this far, you may be wondering why I shared it.

My wish is for you to benefit from what I’ve learned dealing with all these pharmacists. I hope you can apply my lessons learned to the difficult conversations you face, with pharmacists and other humans. Here they are:

Lesson 1:  Prepare to fail the first time. Difficult conversations are rarely brief. If the conversation was about a simple situation, you probably wouldn’t expect it to be difficult.  Summon your patience if you can. I’m the first to admit, this is not my strong suit.

Lesson 2:  Center yourself so that you can keep in mind that the situation probably is not personal to you.  Breathe and be kind to yourself. This messy situation probably isn’t your fault. Try not to take it to heart.

Lesson 3:  Use your power of empathy to try to understand the context the other party faces in the situation. When I turn up with a prescription question, my pharmacist has huge healthcare, regulatory, and technological factors to consider.

Lesson 4: If your difficult conversation relates to a systemic issue, communicate that you understand it’s not personal to the other party. Having noticed that pharmacists seem demoralized by all the errors getting made on their watch, I communicate with that in mind. They probably entered this profession to be a helper, not a hindrance. When I acknowledge both their desire to be helpful and the many factors beyond their control, pharmacists understand I’m not out to get them.

Lesson 5:  Prepare to fail a second time. It’s not unusual that this situation with Joe was resolved after my third attempt to communicate with him.  That time, I engaged him as a helper. I said, “I need your help to sort this out. Here’s what I learned about how you can help me. Please help me.”

Lesson 6:  When people are on the receiving end of a difficult conversation, they often listen for what the situation might say about them. A Pharmacist in this situation may be wondering what the customer thinks about them. “This person must think I’m an idiot, that I’m not helpful. But I know I’m not an idiot. I’m helpful!” If we can assuage the other party’s fear of attack, we can show them an opportunity to be the success they want to be in that moment.

Lesson 7:  You can learn something useful from every difficult conversation. You may not recognize the nugget until later, but if you can be present and centered you can hear, listen, and learn. What you learn from one difficult conversation can help you with the next one. You can learn how a system works (or doesn’t). You can learn about how a person (or a profession) tends to think. You can learn how best to approach the individual in the future. What I learned about the Drug Utilization Review Board helped me two days after my Joe encounter when a similar thing happened with my son’s insulin prescription.

Interested in learning more about navigating difficult conversations, at CVS and with others? Click here to check out my self-study course.