At its best, health care is very much like a well choreographed ballet: No single part more important than the whole.

Think about it: The doctor makes a diagnosis. The pharmacist fills a prescription, which the patient takes until he or she is well again. Health care at its “best.”

“The problem with this ballet is if one of the guys stumbles over his foot, you could all fall to the stage,’ BBB spokesman Dan Parsons said.

Consider this not so wonderful realization in the classic film, ‘It’s a Wonderful Life.’

“You put something bad in those capsules. … It wasn’t your fault; just take a look at what you did,” the movie character said.

But gone are the days of the corner drug store. This is the age of 24-hour pharmacies.

With new drugs coming on the market every day, and cheaper generic versions replacing the older ones, Americans are more heavily medicated than ever. 

What’s more: “As the baby boomers hit Medicare age, we’re going to see the number of prescriptions being filled even more,” University of Houston College of Pharmacy Associate Professor Heidi Bragg said. “Once you hit your geriatric years, usually you’re taking four to seven medications and you multiply that by the millions of people are going to be on Medicare soon.”

It’s staggering. But one thing hasn’t changed.

“It’s still being filled by a human, and humans make mistakes,” Bragg said.

“It’s volume,” Parsons said. “It goes back to anything in commerce: When you’ve got a lot of traffic, things happen. Mistakes happen.”

In fact, the No. 1 complaint received by the Texas State Board of Pharmacy: dispensing errors. 

AP

The most recent data is for 2006. The board received more than 3,500 such complaints. In the vast majority of these cases, either the wrong drug or dosage was prescribed, or the wrong directions were given. 

That may not seem like much, in light of the fact that millions of prescriptions are written in Texas each year. But consider this: “These are not stats of all the errors that have been made --  these are stats of people who actually filed complaints,” Bragg said.

At Houston’s Better Business Bureau, they have a formula for complaints.

“For every one we get, there are 20 we don’t see,” Parsons said.

One complaint they did see came from Fe Kaplan of Sugar Land. Last June, she took her diabetic daughter to a Sam’s Club to pick up her insulin. But when the time came for her daughter to give herself a shot — “She pulled the prescription out from the bag, and she said, ‘mom, my insulin is wrong.’ and I said what?’” Kaplan said.

The pharmacy’s response?

“They apparently don’t have the right insulin, so they are substituting, hoping my daughter did not notice it,” Kaplan said.

“And the pharmacist has made a judgment call – ‘well, I can substitute this and still be OK,’” Parsons said. “Many times that’s correct.  Many times it’s not.”

It underscores the significance of the patient’s role in this complex ballet of modern medicine to never simply assume they’ve been given the “right” medicine.