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Originally Posted by joetrisman

You have to admit this failure in communication between providers happens in all of medicine and would not be limited to rphs if they got in on the game. If I had a dollar for every time I heard a case presentation (by physicians, not rphs/students/whatever) where we had drugs on board without an indication from an outside dr, I'd be going to the caymans this year.

Oh gawd... some of my MTM patients. The regimens they are on... I wish there was an easy way for me to post a de-identified screen shot. Three different insulins + glyburide + prandin + Januvia, three different drugs that affect the RAAS (including Tekturna, no longer recommended in patients with diabetes), 2 NSAIDS (great in hypertension, right???), 75 mg of HCTZ/day (regular HCTZ tabs plus 25 mg in a combo product), aspirin + Plavix + aggrenox, multiple SSRIs or SSRI + Cymbalta, dual bisphosphonate therapy, PRN albuterol inhalers (no max dose per day), PRN Advair (ummm....no), and so on. I could go on, but my hand is tired.

Originally Posted by HoltMD

So, this is why you guys are so eager to do a physician's job:

http://singularityhub.com/2011/04/17...o-waste-video/

Hint: if you make inane posts revealing your low level of comprehension while adding nothing to the conversation, you will likely be ignored.

Originally Posted by All4MyDaughter

So what's the solution? Is it better to continue status quo, where unqualified people with high school diplomas who happen to have a job answering phones in a doctor's office make medical decisions, or is it better to have a health care professional screen the patient and decide on the refill? It's problematic if the pharmacist isn't properly trained and doesn't have the time to do a thorough screen built into his or her workflow, but I'm still not sure that it's WORSE than what we currently have, which is secretaries saying "yes, whatever" to any and every request.

Originally Posted by joetrisman

You have to admit this failure in communication between providers happens in all of medicine and would not be limited to rphs if they got in on the game. If I had a dollar for every time I heard a case presentation (by physicians, not rphs/students/whatever) where we had drugs on board without an indication from an outside dr, I'd be going to the caymans this year.

To both posts above -

Two wrongs don't make a right. I don't know how to correct it appropriately, but I know it's not the above. There has to be a way to get YOU guys more training in the form of a residency where you can prescribe. I'd trust you more than the secretary on the phone.

But as it stands, you guys are not trained for it and it is fraught with problems.

Originally Posted by pinipig523

To both posts above -

Two wrongs don't make a right. I don't know how to correct it appropriately, but I know it's not the above. There has to be a way to get YOU guys more training in the form of a residency where you can prescribe. I'd trust you more than the secretary on the phone.

But as it stands, you guys are not trained for it and it is fraught with problems.

Question: are you familiar with pharmacy residencies in their current form? If so, what would you change?

ASHP (one of the big pharmacy organizations) has a goal of all new pharmacists in clinical positions undergoing a residency by 2020...

Originally Posted by Rx MPLS

Question: are you familiar with pharmacy residencies in their current form? If so, what would you change?

ASHP (one of the big pharmacy organizations) has a goal of all new pharmacists in clinical positions undergoing a residency by 2020...

I don't know enough about pharmacy residencies as I have been so engrossed in my own 4 year residency. I have had friends in pharmacy residency including outpatient care - she would probably be qualified to write the scripts that we are discussing here.

I think that if all pharmacists underwent a residency, I think that would be great.

Originally Posted by pinipig523

To both posts above -

Two wrongs don't make a right. I don't know how to correct it appropriately, but I know it's not the above. There has to be a way to get YOU guys more training in the form of a residency where you can prescribe. I'd trust you more than the secretary on the phone.

But as it stands, you guys are not trained for it and it is fraught with problems.

I was just addressing the "issue" of access to the total clinical picture of the patient that has been previously thrown out as reason why pharmacists can't prescribe. Pharmacists getting in on the game would neither be the beginning nor a change in a already systemic health care issue of communication issues between providers.

In terms of training, again, based off clinical hours and total training, I'd say that PharmDs are beyond at least a NP in terms of prescribing pharmacotherapy based off of a diagnosis. With that, I think managing the aforementioned chronic run of the mill disease states would be within our scope. However, I totally agree that diagnosing would need to require postgraduate training. There are a lot of things that I'd say pharmds could diag and prescribe for currently, but our education for physical assessments is minimal. Additionally, imo, we're taught to mostly to go from labs or diag to picking meds not coming up with differential diags based off s/sx (although this is taught but its not how we think imo....at least where Im at in my career anyway). For me to fill comfortable with diag, I'd need a hell of a lot more physical assessment training and practice with generating differential diags.

Originally Posted by joetrisman

For me to fill comfortable with diag, I'd need a hell of a lot more physical assessment training and practice with generating differential diags.

You are going to be a pharmacist! Why are you worried about differential diagnosis?

Be a freaking pharmacist!!!! Most pharmacy residents I know are occupied with administrative duties and doing presentations. One of my good friends did residency for two years. Now, he is a supply chain manager at a pharmacy. He thinks he wasted 2 years. You are not going to achieve the same skill set as a physician by doing a pharmacy residency. You may come out having more pharmacy experience.

Originally Posted by HoltMD

So, this is why you guys are so eager to do a physician's job:

http://singularityhub.com/2011/04/17...o-waste-video/

Again, not adding to the conversation, and just trolling.

Originally Posted by HoltMD

You are going to be a pharmacist! Why are you worried about differential diagnosis?

Be a freaking pharmacist!!!! Most pharmacy residents I know are occupied with administrative duties and doing presentations. One of my good friends did residency for two years. Now, he is a supply chain manager at a pharmacy. He thinks he wasted 2 years. You are not going to achieve the same skill set as a physician by doing a pharmacy residency. You may come out having more pharmacy experience.

Nothing you have said suggests that you know anything about pharmacists or residencies.

Originally Posted by HoltMD

You are going to be a pharmacist! Why are you worried about differential diagnosis?

Be a freaking pharmacist!!!! Most pharmacy residents I know are occupied with administrative duties and doing presentations. One of my good friends did residency for two years. Now, he is a supply chain manager at a pharmacy. He thinks he wasted 2 years. You are not going to achieve the same skill set as a physician by doing a pharmacy residency. You may come out having more pharmacy experience.

Give it up, dude. Quit adding fuel to the fire. As others have pointed out, you might want to learn more about the profession before you spout off.

Originally Posted by HoltMD

You are going to be a pharmacist! Why are you worried about differential diagnosis?

Be a freaking pharmacist!!!! Most pharmacy residents I know are occupied with administrative duties and doing presentations. One of my good friends did residency for two years. Now, he is a supply chain manager at a pharmacy. He thinks he wasted 2 years. You are not going to achieve the same skill set as a physician by doing a pharmacy residency. You may come out having more pharmacy experience.

I can promise you, I have not spent two years in residency just to do "administrative duties" and "presentations". As Lea said, please educate yourself before you start making broad generalizations.

Originally Posted by naseuy

Again, not adding to the conversation, and just trolling.



Nothing you have said suggests that you know anything about pharmacists or residencies.

The edit note is hilarious!

Originally Posted by All4MyDaughter

Yes, I just saw your edit. I'm not sitting here reloading the screen obsessively looking for changes to posts.

Sure, we pharmacists don't fully understand what's involved in the practice of medicine. Although, I did just spend a year working (as part of my residency) one day per week in a primary care office (non-teaching institution) as part of a pilot project. So I may have a little more insight than you're giving me credit for.

But I definitely think that someone who would spout crap like...



and



... probably doesn't understand what pharmacy entails and clearly doesn't have much respect for pharmacy.

it is the flipside of the coin Mountain was spouting saying physicians only see their patients once a year for 15 min. Nothing more I was sure in the context of the posts it was clear that this was a "turnabout is fair play" sort of statement. Also, those statements betray nothing about my own personal level of respect for the profession. They were simply personal anecdotes.

Also, I brought up my edit as a courtesy because such things can be missed. I know that I find it irritating when I respond to someones post and their edit makes my response look incomplete