Counting Tablets

And the work no one sees

When I first qualified as a pharmacist I thought I knew it all. My freshly minted certification from the pharmacy board instilled me with confidence, I thought was going to change the world of pharmacy. 

Full of energy I thought of ways to do everything better. I collected these ideas, wrote them down, and presented them to the pharmacy owner, a well respected pharmacist of over 50 years. 

“John, all of our prescriptions come for 28 days from our local doctors surgery, but certain once daily medications come in packs of 30 tablets as standard - meaning 30 days worth. We lose two minutes every time we do a prescription for them as we have to repack them into new boxes of 28 tablets. Seeing as they only cost 6p per pack, we could save money by not repacking them and just putting the label for 28 tablets on the pack of 30 tablets. So.. Shall I start doing that?”

I was so confident of his answer I barely waited for the reply before moving on to the next point. 

“No - always give what’s on the label” he interjected, stalling me in my path. 

Baffled, I blurted.. “But we will save money?..” 

“Yes, but we risk losing patient trust.”  

“I don’t understand,” I asked, confused. 

“Attention-to-detail is the cornerstone of pharmacy and shortcuts like this risk undermining that. If the patient counts out their pills at home to transfer them to another container and realises we gave them an extra two pills at best they will think we’ve taken a shortcut, at worst they will think we’ve been sloppy and missed this. Either way the impression is sewn in their head and it’s very hard to disrupt their perspective”.

“But they probably won’t even notice?” I countered.

“True - he said. But then again they might”.

At the time I thought his approach was overly cautious and he was too stuck in his ways to appreciate this opportunity. If I could just get him to read the 4-Hour Work Week I thought at the time. 

It has taken me the proceeding 4 years to understand his reasons fully.

How the small stuff is done, the things the patients might never see or notice is everything. This kind of attention-to-detail is necessary to build a culture of excellence and trust. I can tell within seconds of being in a new pharmacy what kind of standards they have. 

Once I realised this, I saw this everywhere. From Steve Jobs to Van Halen. 

Steve Jobs notoriously insisted that every element of the Macintosh computer be beautiful, down to the circuit boards inside. Walter Isaacson quoted Paul Jobs who instilled this mindset in a young Steve while painting their fence "you got to make the back of the fence that nobody will see just as good looking as the front of the fence. Even though nobody will see it, you will know, and that will show that you're dedicated to making something perfect."

David Lee Roth and Van Halen’s contract with promoters famously contained a clause specifying that a bowl of M&M’s had to be provided backstage, but with every single brown M&Ms removed. If the band found a single brown M&M’s the venue may have to forfeit the show and fully compensate the band. Roth explained in his memoir "Crazy from the Heat”, "when I would walk backstage, if I saw a brown M&M in that bowl, we’d line-check the entire production. Guaranteed you’re going to arrive at a technical error… Guaranteed you’d run into a problem.”

There are many examples where doing the small things well repeatedly leads to greatness. This is well understood but the challenge is in the doing. Life and constraints are consistently pushing us towards shortcuts.

The day after completing the first draft of this essay I found myself in the dispensary with a queue outside the door and all four phones ringing in chorus with no chance of being answered. After completing my clinical and legal checks on the prescription in front of me, I grabbed a box of ferrous fumarate off the shelf. The box was marked as a split, meaning that tablets were already taken from it. Luckily I only needed 14 tablets, after aggressively manoeuvring the leaflet inside so I could see and count the tablets inside - I found 15 tablets.

For a second I looked up at my colleagues, none of them were watching. I glanced at the shop floor, no one was watching either. I might just give 15 I thought. 

As I walked back to my computer to bag it up, the hypocrisy was too much for me to bear. It’s the small things I thought as I counted out the tablets, and double checked them. 

Doing the small things right is tough, can take twice as long, and can feel like it doesn’t matter.

It’s taken me years to learn and relearn, but how we do the small things is how we do everything.

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If this made you think of the small things you can do better hit the ❤️ button. Let me know what you think in the comments below.