My guest blogger this week is author and retired CIA officer, Andre Le Gallo.

He studied the Middle East at The School of Advanced International Studies at Johns Hopkins and lived in Muslim countries. We have reviewed all three of his books on the Middle East: The Caliphate, Satan’s Spy, and The Red Cell.

Readers of this column know we don’t follow the news. However, it was hard to miss exposure to Bill Maher’s recent comment about terrorism when he referenced so many bad apples demanded an examination of the orchard(at the 3:13 point in the video). Killing in the name of religion isn’t good for anyone. Christianity and Judaism can both be

Andre Le Gallo

criticized for imposition of outdated traditions on their members today although we’re not aware that either endorse homicide or human sacrifice in the 21st Century. There is definitely a need to be selective about which of the ancient values to observe today.

Therefore, it seems relevant to hear from a man who has earned the right to speak on the topic.

Welcome, Andre!

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The discussions on Islam generally miss the point that it is not, strictly speaking, a religion any more than the iPhone is just a means to call your mother. Unlike Christian religions which focus on the individual’s belief in and relationship to God, Islam is a complete package governing every aspect of life on earth.

Islam set itself up as a new and improved version of the two previous monotheistic religions, Judaism and Christianity, whose prophets Islam folded into its own traditions. Islam acknowledged the previous two religions as foundation stones but also claimed that they had been superseded by the latest revelations. If Judaism was the 1.0 version and Christianity the 2.0 version, then Islam was supposed to be the new and improved 3.0 version. The other two were obsolete and no longer supported by God.

It is noteworthy that the Prophet was not only a religious leader; he was also a warrior, a merchant, an administrator, a judge, and a diplomat. An Islamic Republic is a state governed ultimately by “experts” who claim to represent God’s will. Governing with and through man-made laws is not part of the Islamist vision. In his book, What Went Wrong, Bernard Lewis recounts how early Muslim diplomats to Europe felt nothing but pity for countries that had to rely on their constitutions and statutes, all written by men, when they had Holy Law direct from God. Unlike Christianity’s now well-established principle separating religion from government, as in “Give to Caesar what is Caesar’s and to God what is God’s”, Islam draws no separation between the two. This is not to say that Christianity’s path was without martyrdom, usually caused by others unlike the current Muslim experience, and violence. However, it evolved through the Reformation and the Enlightenment two hundred years later. Since the Islamists’ credo is that their religion’s core value is the eternal truth of the revelations contained in the Quran, the path to changes and adjustments, other than to cut out all changes to Islam’s original values, faces an internal roadblock.

Islam’s true believers are not content with simply worshiping Allah and leaving others to worship in their own way. Their intent is to spread their beliefs to all walks of life from justice to finances to equal rights for all.

A set of values compatible with seventh century desert nomads is irreconcilable with Western democracies of the 21st century.

Le Gallo’s books are available on Amazon.

The Eight Sentences:(Well, nine, I rarely go over the limit. Maybe the moderators will be tolerant.)

“It’s a somnambulistic trance,” blurted Barger.

Dryden spoke up, “Where did that come from? First you reported  the sheriff getting murdered and then all of a sudden you hit us with one of your big-ass words.”

“Well it isn’t that big of a word. I’ve heard of it,” said White.

“And the sheriff didn’t get murdered anyway. It was the police chief and Barger said he bought it in a shootout,” said Scully.

Dryden replied, “It sure as hell sounded like one of his Tourette moments to me.”

Barger was ready to rejoin the fray, “You’re both correct. It was one of my moments but it wasn’t something out of Mrs. Byrne’s Dictionary. A somnambulistic trance is like when you’re driving down the freeway in complete control of your vehicle and aware of everything around you, but your thoughts are elsewhere–didn’t you ever drive right past your exit that you’ve taken for years?”

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The Setup:

From Chapter Twenty-two my my current serial novel, A Year Without Killing. In this scene, members of the League of Old Men are talking. Hawk Barger’s “condition” has just shown itself. This was introduced in a previous chapter and snippet. He suffers from acquired savant syndrome and often comes out with unusual words at the most inopportune times. In this case, I wrote this scene to immediately follow a scene at the end of the previous chapter in which Star Braun experiences the trance to which Barger makes reference.

NOTE: Mrs. Byrne’s Dictionary will be the subject of a future blog.

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Share your own EIGHT with us!

oin us here at Weekend Writing Warriors.The  same link will take you to the work of dozens of talented writers. For a treat, please check out their work, too.

Many of the contributors to Weekend Writing Warriors also

The Eight Sentences:

Sentence structure is a matter of style–every writer has his/her own–and no one is required to like it.

Frequency of use and the authors’ reputations don’t guarantee a pleasurable read.

If you do like a particular author’s style, it stands to reason, you’ll read more of their work.

Does annoying sentence construction take you out of the story?

Many of the examples of backward writing that I find most annoying include adverbs and “ing” verbs, both of which only serve to add to my displeasure. Some folks think this style of writing and sentence construction is fine. Apparently, it’s preferred in English class themes. My editor agrees with me in that it has no place in novels where active writing works better.

Where did that come from?

I recently wrote a blog about one of my pet peeves in writing (I only have about 5,280 pet peeves). My intention was to speak from a reader’s point of view. Every reader has her/his own preferences as do editors and authors. I claim no authority to speak from a position of wisdom on this subject, but I do know what I like and dislike as a reader. The entire article can be found HERE.

Share your own EIGHT with us!

oin us here at Weekend Writing Warriors.The  same link will take you to the work of dozens of talented writers. For a treat, please check out their work, too.

Many of the contributors to Weekend Writing Warriors also

participate in the Snippet Sunday group on Facebook.

Pharmacy student, James Herbert joins us today.

Our guest blogger this week is James Herbert, a Pharm D Student at South College School of Pharmacy, Knoxville, TN. He is a Husband, Father, Doctor Who fan, science fiction fan, philosophy-theology aficionado, and ex-IT guy with dreams of using informatics and technology to enhance pharmacy’s role in improving patients lives. He says, “I’m just a regular guy livin’ the dream because in the end aren’t we all?”

His topic addresses a situation begun decades ago and is now coming to a head. We introduced this subject last week with an article regarding the re-branding of patients to customers. Herbert believes there’s more to it than just semantics.

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James Herbert

A paradigm shift in healthcare begun years ago, speeds toward the downgrade of the patient to a statistical economic construct.
Patients are now being referred to as customers.
This is a dangerous shift that moves the focus of the patient’s medical needs towards the consumption of goods and services. Consumption of services does not require the relationship between patient and healthcare provider necessary for patient care. The purpose of healthcare is to provide appropriate care to patients. This shift away from the fundamental principle of personal attention is detrimental to the public health.
“Customer” is an economic term: A party that receives or consumes products (goods or services) and has the ability to choose between different products and suppliers.1 A patient is a person who has a medical need. In times of an emergency a patient does not have the luxury of choosing who provides their care. In cases of extreme emergency they have no say what so ever. Patients do not consume the “goods” and “services” of healthcare in the same way they would in a traditional retail environment. You will not see patients lined up at a hospital door on black Friday for example.
Dorland’s Medical Dictionary (2008) defines patient care as the services rendered by members of the health profession and non-professionals under their supervision for the benefit of the patient
Taking care of customers is commonly called customer service. “Customer service is a series of activates designed to enhance the level of customer satisfaction –that is, the feeling that a product or service has met the customer expectation.”2
Customer satisfaction is measured by the satisfaction survey. Here is where the disconnect begins
A survey, by its very nature, limits itself to the chosen parameters. That is to say that there are “buckets” that are being weighed as they are “checked off” in the survey. It is in this way that the customer is reduced to a set of statistics. In surveys, the person is irrelevant, it is the data that is important. Chosen members of management chose the parameters.
Data identifies trends and trends can be impacted by a series of scripted efforts. These efforts are called metrics. Metrics reduce customer service to a series of equations. CVS uses Triple S and KPM metrics3 in order to quantify and improve service performance. Customer expectations can be manipulated in scripted measures. Sitting down with a customer influences their perception of the amount of time spent with them4. Adding key words or phrases to encourage additional purchases is another scripted method of providing customer service (See CVS Pharmacy Business Metrics Paper)
Pharmacy may be measured by its Triple S and KPM or similar metrics but for hospitals to be reimbursed for providing care to those with Medicare/Medicaid, HCAHPS is the golden standard. Press Ganey is the leading provider of patient satisfaction surveys designed to help meet the HCAHPS requirements.

The manipulation of satisfaction scores may have nothing to do with providing safe and ethical healthcare. In one case a physician was able to achieve a 7% improvement in his satisfaction scores by prescribing an antibiotic to all his patients who complained of a cough, sore throat or sinus headache5. Managing low scores can lead physicians to prescribe powerful opiates for toothaches6. Healthcare professionals under pressure to meet metrics, forego patient care to perform customer service. The result is that most satisfied patients tend to be those who have higher healthcare cost, drug expenses, and most shockingly, have higher deaths rates than those who do not feel satisfied with their care7. The customer purchases their “good” but they may not get care for their health.
The retail pharmacy chain is the end game when customer service once and for all trumps patient care. In the retail setting, “wait times”, scripts per hour, and profit margins are king7. The pharmacist as healthcare provider is no longer part of the business model. Overwhelmed with hundreds if not thousands of script per day and skeleton staffing the pharmacist’s role is reduced to that of a dispensing machine. The result is they are not perceived as healthcare professionals. One woman demanded: “Please just do your jobs and fill what you see and stop trying to make yourself something you are not”9. In retail chain pharmacy healthcare is not important. Customer service is. Customer service quantified by metrics.
When results are all that mater then there is no “person” behind the customer or patient. They have been dehumanized. All that is left is the data. People do not get treatment. Data gets manipulated. Customers are not getting service. Data gets manipulated. When all that matters is the data, then the ends justifies the means. Metrics and surveys, by their very nature, dehumanize people.
The future of healthcare is freighting if the focus does not turn back to personal patient care. A therapeutic relationship addressing a patient’s medical need with personal and individual care, trust, and understanding. This includes a healthcare provider who has a specialized set of knowledge and skills that are not available on website, a television ad, or a talk show.
When raw, sterile numbers take precedent over warm flesh, people are no longer in the equation.

Without people there is neither health–nor care.

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References:

# http://www.businessdictionary.com/definition/customer.html
# Turban, Efraim (2002). Electronic Commerce: A Managerial Perspective. Prentice Hall. ISBN 0-13-185461-5.
# CVS Pharmacy Business Metrics: http://s3.documentcloud.org/documents/472510/250510-rx-tg.pdf
# Simple tips to improve patient satisfaction http://www.medscape.com/viewarticle/743875?src=mp&spon=25#vp_2
# Patient Satisfaction is Overrated: http://www.medscape.com/viewarticle/821288
# Why rating your doctor is bad for your health: http://www.forbes.com/sites/kaifalkenberg/2013/01/02/why-rating-your-doctor-is-bad-for-your-health/
# Patient satisfaction linked to higher health-care expenses and mortality http://www.ucdmc.ucdavis.edu/publish/news/newsroom/6223
# Pharmacists: Corporate greed putting patients at risk http://www.khou.com/story/news/investigations/2014/11/06/iteam-prescription-errors/18591573/
# LETTER: Pharmacists aren’t doctors http://www.courierpostonline.com/story/opinion/readers/2014/11/17/letter-pharmacists-doctors/19044977/

Last week a new acquaintance asked me what I do for a living. My reply, “I spend my day telling people things they don’t want to hear. I’m a pharmacist and I deliver the news that  “your co-pay is much higher than you expected,” “your insurance company requires a prior authorization,” “your prescription was out of refills and your doctor has not responded to our request for a new prescription.” The list of examples goes on and on, but these are by far the most common.  People have high expectations of me and my department to make sure they leave the store happy and on the road to recovery from the ailment that brought them into the store.

Stew Leonard owns one of the most successful grocery stores in the world. Does his policy work in every situation?

Years ago, a syndicated columnist stated in no uncertain terms “The customer is NOT always right.” The article continued with the author’s evidence to support the claim. In retail sales, the age old standard is a difficult hurdle to overcome. In pharmacy it’s almost impossible. Once a shopper complains to a member of management outside the pharmacy, it’s a sure bet the manager will side with the customer—unless it’s a patient requesting something the pharmacist is prohibited from doing either by law or regulation. The distinction of roles they play once they enter the portal of a retail pharmacy is blurred. Sometimes, the clarity of a sharp focus is never achieved.

A simultaneous reference(customer/patient) to the people who shop in stores that contain a pharmacy became noticeable back in the 1970’s.  Was this duality the precursor to changes we see in the perception of consumers today? Are these shoppers  customers or patients—or both?

This labeling of shoppers took on more prominence with the rise in popularity of chain drug stores in the late twentieth century.

When pharmacists (usually independents) began leasing space for a pharmacy inside department or discount stores (such as Walmart’s precursors like “Gibson Wholesale”) the change  in,  shopping nomenclature picked up speed as well as consumer awareness of the trend.

Pharmacies are now being paid for talking to patients.

Contemporary retail practice settings such as a prescription department in a grocery store or Walmart, continue that same tradition with shoppers being both customers and patients. I worked for Walmart for 7 years and by the time I left, we had to document counselling encounters in the computer—yet another conversion of a patient to a number.

Another significant event in the change in perception of shoppers was the influx of non-pharmacists into upper level management of both hospitals and chains. [Historical note: Eckerd Drugs (which no longer exists) had a chain of command of pharmacists supervising pharmacists from store level all the way up to the highest echelons of corporate management. The Sr. VP of Pharmacy reported directly to the CEO. Non-pharmacist management types could influence pharmacy only via him. Those days are gone with the wind. By contrast, the top pharmacy position at Walmart is a medical doctor(or was a few years ago.) ]

Retail pharmacists are now required by law to offer to counsel patients on new prescriptions. The requirement comes not from a concern for customer service, but from the government wanting patients who received government funded medication to use it correctly. Uncle Sam wants the most bang for his buck. Insurance companies now reimburse pharmacists for these same “cognitive services.”

Simply stated, insurance companies want pharmacists to talk to their beneficiaries and, just like our Uncle, get the most bang for their buck.

Many pharmacists complain that the reimbursement is not commensurate with the time involved. Many patients don’t want these extra services. They just want their prescription so they can get home, eat supper, and watch television. Perhaps they don’t mind being just another number. Such a mindset could be dangerous to their health.

Whether they consider themselves customers or patients, the shoppers I serve have one thing in common;

they’re all on drugs.