Behind the White Coat
On the humans the system keeps leaving out
When I wrote about standing in a room nobody thought a pharmacist would be invited to, the last thing I expected was not only “I relate” but also how often this pattern keeps happening. Comments like “the original National Pharmacare Advisory Committee had no pharmacists on it” and “patients see us, governments and third-party payers never do” from colleagues made me think: why did this one land differently? Is it because it isn’t just about conferences or committees, it’s about something deeper: what we, pharmacists, think a pharmacist actually is.
Pharmacy school teaches you the facts, the science, and the ethics. What it doesn’t prepare you for is that the gray areas aren’t the exception; they’re where you spend the rest of your professional life. The decisions where evidence is incomplete, guidelines haven’t caught up, and the patient in front of you needs an answer now. Nobody tells you that this is the job. You find out at the counter.
COVID made the gray permanent.
I vaccinated 80 patients in one day in my 870-square-foot community pharmacy. Before the pandemic, 80 patients in three months during flu season was the norm. There was no playbook. No flexibility in operating hours. No one to call when a patient screamed about the six-foot rule, about the mask, about a mandate I was expected to enforce with confidence I didn’t always feel. Other practitioners had to stay home; pharmacies stayed open. We made decisions alone, in real time, under conditions nobody had prepared us for, and when it was over, the committees went back to meeting without us.
What I’ve come to understand is this: the reason pharmacists are left out of those rooms isn’t a bureaucratic oversight. It’s a failure to recognize what pharmacists actually are. We are not drug dispensers who occasionally counsel. We are clinicians trained in the moral weight of care, in the ethics of the relationship, not just the transaction. But that doesn’t fit in a reimbursement code. It doesn’t show up in a policy framework. It’s hard to put a value on the person who notices the pause.
The white coat has a way of flattening you. Patients see the credential, the counter, and the transaction. What they don’t see is everything else: the writer who goes home and reaches for words when the day won’t leave him alone, the person who grew up between cultures and learned early that belonging is never quite where you expect to find it. I didn’t become a pharmacist despite those things. I became a better one because of them. The ability to sit with ambiguity, to read what isn’t being said, to hold more than one world in your head at once, that’s not separate from the work. That is the work.
The system keeps designing pharmacy without pharmacists. What it keeps leaving out is the human part, the part that can’t be automated, mandated, or optimized away.
That’s the part worth fighting for.