Diagnosis, what is it, and why can't we do it?

[Sparda29]

So I'm confused about something. Often times when these med vs pharm wars start, the med students and physicians come in here stating that we do not have the same diagnosis skills and assessment skills.

Asides from the uber amounts of gross anatomy and histology that med students take, what is so different between the assessment skills of a physician and a pharmacist?

We both learn about signs and symptoms of a pathology, we both learn about the clinical presentation in a specific pathology, we both know mechanisms of pathologies, we go more into detail about the drugs to treat that pathology.

So tell me, what is it that physicians learn that makes them able to assess and diagnose better than a pharmacist other than the things I wrote above?

---

Members don't see this ad.

 

[pharm B]

Dude, you really want to open this can of worms? I think the biggest difference is the exposure they have to diagnosis. We spend three years in a classroom learning our stuff. They spend two years and then get thrown to the wolves. During their rotations, diagnosis is a key part of what they do (so they spend ample time on it). We don't spend anywhere near as much time as they do.

That intense study of histology and physiology is an important component of their education. We might recognize what we think is a horse, but if it's a Zebra, we don't have anywhere near the level of training needed to see it.

My wife and I already have some issues with our PA mis-diagnosing things. There's no way you could convince us to see a pharmacist for a diagnosis.

 

[MountainPharmD]

Sparda please...you should know better than to start something like this. To anyone other than an inexperienced student the answer is quite clear.

If you are a med student reading this just close the thread and move on. There is no need to start another pissing match.

 

[Phlame217]

From someone who did a few years of pharmacy school, dropped out and went to medical school, things are different. I am not trolling here, just want to say that there is a vast gap between things studied. I found that pharmacy school was not what I wanted out of life and did not fit the scope I was interested in and hence why i dropped out.

 

[Aznfarmerboi]

Its like asking why the sky is blue. They learn about differentials on diagnosis while we learn about side effects on drugs... They have tons of experience, see and manage more cases, etc. Heck, you probably dont know half the disease/disorders out there especially the ones that are not manage with pharmcotherapy.

 

[tungsten87]

From someone who did a few years of pharmacy school, dropped out and went to medical school, things are different. I am not trolling here, just want to say that there is a vast gap between things studied. I found that pharmacy school was not what I wanted out of life and did not fit the scope I was interested in and hence why i dropped out.

+1... i dont desire the career of a physician but i sure wish i had a comparable physiological knowledge base

 

[Praziquantel86]

I would trust a transport aides diagnostic skills over yours. Honestly.

Please ignore this thread.

 

[Pharmacy Kid]

A problem is that physical assessment is not standardized throughout the pharmacy schools. My amb care pharmacist said his school taught how to use ophthalmoscopes and otoscopes. My school just teaches what the physical assessment procedures are called and what they entail. That way we know what the terms in the SOAP notes by MDs, PAs, and NPs mean.

There are pharmacists that diagnose though. They are called CPP's (clinical pharmacist practitioner) and have the equivalent diagnostic training of a midlevel. I might consider this route as I am young, have no obligations, and handsome.

 

[cycloketocaine]

A problem is that physical assessment is not standardized throughout the pharmacy schools. My amb care pharmacist said his school taught how to use ophthalmoscopes and otoscopes. My school just teaches what the physical assessment procedures are called and what they entail. That way we know what the terms in the SOAP notes by MDs, PAs, and NPs mean.

There are pharmacists that diagnose though. They are called CPP's (clinical pharmacist practitioner) and have the equivalent diagnostic training of a midlevel. I might consider this route as I am young, have no obligations, and handsome.

does this have to do with anything?

 

[Jabberwocky12]

does this have to do with anything?

To troll people who get upset on what he says

 

[Pharmacy Kid]

does this have to do with anything?

Nothing, I just added the "handsome" part b/c I knew it would get the eyebrow raised WTF?? thought.

 

[Pharmacy Kid]

To troll people who get upset on what he says

Trust me, I'm no troll. I've been on this board so long, I'm a gnome.

 

[Bears683]

So I'm confused about something. Often times when these med vs pharm wars start, the med students and physicians come in here stating that we do not have the same diagnosis skills and assessment skills.

Asides from the uber amounts of gross anatomy and histology that med students take, what is so different between the assessment skills of a physician and a pharmacist?

We both learn about signs and symptoms of a pathology, we both learn about the clinical presentation in a specific pathology, we both know mechanisms of pathologies, we go more into detail about the drugs to treat that pathology.

So tell me, what is it that physicians learn that makes them able to assess and diagnose better than a pharmacist other than the things I wrote above?

It isnt the anatomy our histology that is important for diagnosis (although we do spend alot of time on it) but it is the amount of time we spend on physiology and pathology. Most of our 2nd year of med school is dedicated to pathology and disease process. The bulk of 3rd and 4th year clerkship is developing a complete differential diagnosis and we're evaluated based on how broad yet justifiable our differential is (including all zebras). Then the residency process which is dedicated to learning how to broaden and manage differentials with an experience attending leading the way.

So why is it that you can't diagnose? You don't have enough exposure to see the zebras and you don't have enough experience with the workup.

 

[Ackj]

Sure on some basic things we could probably do it, but there are just so many different diseases out there that MDs have to learn. Including crazy and rare stuff that 1:1,000,000 patients might have, just in case there's one who happens to show up in your care.

That said, sure there are some common disease states that I think I'd be able to manage; htn, dyslipidemia, dm. Of course, there's the possibility that there are underlying causes and rare diseases that mimic these conditions, but for the majority of the patients, you'd just follow the national treatment guidelines.

 

[confettiflyer]

It isnt the anatomy our histology that is important for diagnosis (although we do spend alot of time on it) but it is the amount of time we spend on physiology and pathology. Most of our 2nd year of med school is dedicated to pathology and disease process. The bulk of 3rd and 4th year clerkship is developing a complete differential diagnosis and we're evaluated based on how broad yet justifiable our differential is (including all zebras). Then the residency process which is dedicated to learning how to broaden and manage differentials with an experience attending leading the way.

So why is it that you can't diagnose? You don't have enough exposure to see the zebras and you don't have enough experience with the workup.

Bingo... the early classes are essentially the same, but they diverge late 2nd/3rd year and beyond.

The key thing is residency, though.

PharmD students w/ no real world experience who think they can diagnose are equivalent to us football fans who think we can coach a team better while watching it on TV.

I can triage and quasi-diagnose/give an educated guess on the fly, but that's about it.

 

[Sparda29]

Bingo... the early classes are essentially the same, but they diverge late 2nd/3rd year and beyond.

The key thing is residency, though.

PharmD students w/ no real world experience who think they can diagnose are equivalent to us football fans who think we can coach a team better while watching it on TV.

I can triage and quasi-diagnose/give an educated guess on the fly, but that's about it.

That pretty much answers it for me. Although, on your football point, I'm pretty sure that I can come up with better offensive game plans than what Brian Schotteinheimer is doing with the Jets.

If the Jets lose on Sunday it will be because they're offense gets one dimensional and the Steelers eat it up. The key will be the running game, and I guarantee you when the Steelers stop the running game, he's gonna start calling all passes and Sanchez will get picked off.

 

[SHC1984]

Bingo... the early classes are essentially the same, but they diverge late 2nd/3rd year and beyond.

The key thing is residency, though.

PharmD students w/ no real world experience who think they can diagnose are equivalent to us football fans who think we can coach a team better while watching it on TV.

I can triage and quasi-diagnose/give an educated guess on the fly, but that's about it.

I don't know for sure b/c I was only in medical school for one semester but the classes are not the same at all. I remember the anatomy and physiology class at Columbia medical school being MUCH harder than the anatomy and physiology class I took as a p1 in pharmacy school. At medical school the anatomy class was basically the professor giving a depth lecture on the different parts of the body...and the exams are mainly diagonistic questions like "if this happens to this vein what will most likely happen to this organ and what should be done?" etc. and some questions are much harder. Nothing really to memorize much...you mostly need to use critical thinking and be good at diagonsing a disease! most of the questions the professor didn't even talk about.

The anatomy in pharmacy during P1 was mostly memorization and the physiology was VERY basic. Nothing like medical school. The science classes are easier in pharmacy school. P1 year was the same as undergrad IMO. P2 year is harder but only b/c there is a ton of material...the material itself isn't very hard.

Also pharmacy school seem to like to treat their students like children...there are exam reviews where students are allow to argue with their professor about questions on the exam! That would NEVER happen in medical school! there is no such thing as "arguing" with the professor to get points back on exams in medical school! Sorry.

 

[Its Z]

Lexus LFA (Lot of Freakin Asininity) rolled off the assembly line.. at $400,000, I would prefer an Italian..

 

[confettiflyer]

I don't know for sure b/c I was only in medical school for one semester

wait i thought you were in dental school? next thing we know you're gonna tell us you were a stripper in a past life!

 

[SHC1984]

wait i thought you were in dental school? next thing we know you're gonna tell us you were a stripper in a past life!

hahaha....no stripping...although I am sure the money was good! lol...

I was in dental school but Columbia (and a few other colleges) are too lazy to built a seperate dental school to teach dental school courses, so Columbia just throw all the dental students in their medical school and make them take all the classes with the med students in the first 2 years. I took all the med school classes plus had an dental lab to work on my handskills...so dental students actually had MORE to do than medical students the first 2 years due to extra dental labs.

However 3rd and 4th year dental students have it easier. LOL...

I am not saying med is better than pharm...but I am just saying comparing the TWO schools the classes at med school is MUCH harder. P1 year wasn't that bad IMO. P2 year is just a TON of crap to learn but not hard either.

 

[SHC1984]

Lexus LFA (Lot of Freakin Asininity) rolled off the assembly line.. at $400,000, I would prefer an Italian..

I have a Lexus now...I think I prefer a Benz. I don't like sports cars at all though!

 

[Its Z]

I have a Lexus now...I think I prefer a Benz. I don't like sports cars at all though!

You drive my parents' Lexus.. unfitting.

Benz sucks.. when you see broken down luxury car on the side of the road, you can bet it's a mercedes. I thought you said you like McLaren. That's a sports car.

 

[SHC1984]

You drive my parents' Lexus.. unfitting.

Benz sucks.. when you see broken down luxury car on the side of the road, you can bet it's a mercedes. I thought you said you like McLaren. That's a sports car.

Your parent's drive a Lexus ES330 too? LOL...

HAHA I do love that silver McLaren...Sports cars are okay I guess, but I actually don't like driving very fast so that's why I am not sports car crazy. I like Luxury Sedans the best. McLaren is very pretty to look at but it will not be very useful for me...I will drive 50MPH on it if I own one! lol...

Also I think spending more than 100K for a car is CRAZY!!!!!!! Like 550K for the McLaren and 400k for the above Lexus is CRAZY!!!!!! LOL...I think unless I am a trillionaire or something I will never spent more than 60K to 80K on a car. I think it is smarter to buy a so~so car and a nice big house. I can see myself buying two USED luxury sedans when I finally get all my student loans paid off and a nice house.

 

[Old Timer]

First of all pharmacists diagnose all of the time. You just have to know the limits of your abilities. You have to know when it's beyond the scope of your practice. When it is, you refer the patient to their physician.

Patient comes in with a rash. You are going to decide if it's ring worm or an allergic reaction of some kind or maybe shingles. Ring worm and an allergic reaction can be treated and shingles needs to be referred. You made a diagnosis or you excluded enough things to require a physician to finalize or confirm the diagnosis.

Patient comes in and says their 1 year old is sick. Fever and a runny nose. You can ask enough questions to determine if it's viral and can be treated with acetaminophen, a vaporizer, tilting the crib and tissues or the patient needs a referral to the pediatrician or family practice doc.

Patient comes in looking for something for heartburn. You ask enough questions to determine if self treatment with and H2 blocker or a PPI is warranted. You also have to ask enough questions to decide if the patient needs a cardiac workup as that pain is really CAD.

Patient comes in and asks for a something for a yeast infection. You need to ask questions to determine if it's likely to be fungal or something else. If it's fungal how often does it occur. You might need an Ob/GYN referral or maybe the patient is diabetic.

Patient walks up to the counter and is showing signs of SOB and DOE. The patient is in obvious CHF. You make the diagnosis (even if you keep it to yourself) when you pick up the phone and call the PCP. The patient calls back to say the ER docs said if she hadn't been seen she would probably be dead.

PCP's and family docs also have a limit on their diagnostic abilities. When they run into something that they don't understand or is beyond the scope of their practice, they refer to a cardiologist, urologist, etc....

What pharmacists for the most part are not qualified to do is to touch the patient and perform a physical exam. Your diagnostic skills are limited to information elicited by patient history. But to say pharmacists don't diagnose, that's just a gross simplification and it is also factually incorrect.

 

[type b pharmD]

First of all pharmacists diagnose all of the time. You just have to know the limits of your abilities. You have to know when it's beyond the scope of your practice. When it is, you refer the patient to their physician.

Patient comes in with a rash. You are going to decide if it's ring worm or an allergic reaction of some kind or maybe shingles. Ring worm and an allergic reaction can be treated and shingles needs to be referred. You made a diagnosis or you excluded enough things to require a physician to finalize or confirm the diagnosis.

Patient comes in and says their 1 year old is sick. Fever and a runny nose. You can ask enough questions to determine if it's viral and can be treated with acetaminophen, a vaporizer, tilting the crib and tissues or the patient needs a referral to the pediatrician or family practice doc.

Patient comes in looking for something for heartburn. You ask enough questions to determine if self treatment with and H2 blocker or a PPI is warranted. You also have to ask enough questions to decide if the patient needs a cardiac workup as that pain is really CAD.

Patient comes in and asks for a something for a yeast infection. You need to ask questions to determine if it's likely to be fungal or something else. If it's fungal how often does it occur. You might need an Ob/GYN referral or maybe the patient is diabetic.

Patient walks up to the counter and is showing signs of SOB and DOE. The patient is in obvious CHF. You make the diagnosis (even if you keep it to yourself) when you pick up the phone and call the PCP. The patient calls back to say the ER docs said if she hadn't been seen she would probably be dead.

PCP's and family docs also have a limit on their diagnostic abilities. When they run into something that they don't understand or is beyond the scope of their practice, they refer to a cardiologist, urologist, etc....

What pharmacists for the most part are not qualified to do is to touch the patient and perform a physical exam. Your diagnostic skills are limited to information elicited by patient history. But to say pharmacists don't diagnose, that's just a gross simplification and it is also factually incorrect.

nice!

 

[Electrode]

Lexus LFA (Lot of Freakin Asininity) rolled off the assembly line.. at $400,000, I would prefer an Italian..

The LFA - the ultimate pillar behind my plan to begin lottery gaming full time; finally a perfect blind motivation to go to a medical school.

When I first read the specs two weeks ago, for the third time, I wished the name on my bank account statement was Gates Zuckerberg

 

[owlegrad]

Like 550K for the McLaren and 400k for the above Lexus is CRAZY!!!!!!

I had no idea it was even possible to spend that kind of money on an automobile. I assume they come with a fulltime driver?

 

[pharm B]

I had no idea it was even possible to spend that kind of money on an automobile. I assume they come with a fulltime driver?

Or a house on a trailer.

 

[owlegrad]

Or a house on a trailer.

No - a map, keys, and title in the glove box to your new house that is not on a trailer. Or maybe the map just takes you to treasure.

 

[SHC1984]

I had no idea it was even possible to spend that kind of money on an automobile. I assume they come with a fulltime driver?

There is a car worth 1 million dollars...I forgot the name of it but it's a sports car and my car crazy friend told me about it.

Yes, it's crazy when you find out how much stuff cost! LOL... I mean there are people that spend 100K on a purse!

http://cgi.ebay.com/WOWZA-30cm-HERM...725?pt=US_CSA_WH_Handbags&hash=item4cf49ba9b5

I have seen hermes bags for up to 500K before too.

 

[pharm B]

There is a car worth 1 million dollars...I forgot the name of it but it's a sports car and my car crazy friend told me about it.

Yes, it's crazy when you find out how much stuff cost! LOL... I mean there are people that spend 100K on a purse!

http://cgi.ebay.com/WOWZA-30cm-HERM...725?pt=US_CSA_WH_Handbags&hash=item4cf49ba9b5

I have seen hermes bags for up to 500K before too.

That's criminal.

 

[Cloud 9]

There is a car worth 1 million dollars...I forgot the name of it but it's a sports car and my car crazy friend told me about it.

Bugatti Veyron...1.5-2.5 mill...

 

[SHC1984]

Bugatti Veyron...1.5-2.5 mill...

Damn! Yeah...I don't know much about cars at all...I will stick with luxury sedans for the rest of my life! lol...

2.5million for a house is fine...for a car is beyond insane! lol...

 

[Cloud 9]

Damn! Yeah...I don't know much about cars at all...I will stick with luxury sedans for the rest of my life! lol...

2.5million for a house is fine...for a car is beyond insane! lol...

It really is...you know why...because a house doesn't depreciate as fast as a car...it has a much longer life. And it's stupid to have a car that goes that fast anyway because a) no road in america has no speed limit so basically you'd lose your license if you went as fast as it could and got caught and b) if you drive at the fastest speed of a bugatti veyron for instance, the tires disintegrate in about 15 minutes from the heat of friction, and there goes your 1.5 million dollar car!

 

[owlegrad]

There is a car worth 1 million dollars...I forgot the name of it but it's a sports car and my car crazy friend told me about it.

Yes, it's crazy when you find out how much stuff cost! LOL... I mean there are people that spend 100K on a purse!

http://cgi.ebay.com/WOWZA-30cm-HERM...725?pt=US_CSA_WH_Handbags&hash=item4cf49ba9b5

I have seen hermes bags for up to 500K before too.

The price is alright, but I can't see 250.00 for shipping. That's where they get you is shipping.

 

[confettiflyer]

I have seen hermes bags for up to 500K before too.

There's someone laughing as they deposit $499,998.01 into their bank account after paying off their Chinese manufacturer

 

[SHC1984]

There's someone laughing as they deposit $499,998.01 into their bank account after paying off their Chinese manufacturer

Yeah...only a few sellers are authentic on Ebay! lol...it's best to go to the stores.

 

[SHC1984]

The price is alright, but I can't see 250.00 for shipping. That's where they get you is shipping.

LOL...I always try to get the seller to waive the shipping for me when I buy things online. I hate paying shipping too.

It really is...you know why...because a house doesn't depreciate as fast as a car...it has a much longer life. And it's stupid to have a car that goes that fast anyway because a) no road in america has no speed limit so basically you'd lose your license if you went as fast as it could and got caught and b) if you drive at the fastest speed of a bugatti veyron for instance, the tires disintegrate in about 15 minutes from the heat of friction, and there goes your 1.5 million dollar car!

I always follow the speed limit so that's why I need a sedan...no sports car for me...I was in a corvette going 120MPH one time and I can feel my heart jumping OUT....Don't really care for that feeling at all. House only increase in value so it's worth it.

 

[ucrx]

I don't know for sure b/c I was only in medical school for one semester but the classes are not the same at all. I remember the anatomy and physiology class at Columbia medical school being MUCH harder than the anatomy and physiology class I took as a p1 in pharmacy school. At medical school the anatomy class was basically the professor giving a depth lecture on the different parts of the body...and the exams are mainly diagonistic questions like "if this happens to this vein what will most likely happen to this organ and what should be done?" etc. and some questions are much harder. Nothing really to memorize much...you mostly need to use critical thinking and be good at diagonsing a disease! most of the questions the professor didn't even talk about.

That sounds like my patho class I had to take.

Also pharmacy school seem to like to treat their students like children...there are exam reviews where students are allow to argue with their professor about questions on the exam! That would NEVER happen in medical school! there is no such thing as "arguing" with the professor to get points back on exams in medical school! Sorry.

That's ridiculous. Definitely not ok at my school. Students would try to argue, but unless the answer was actually wrong (or there were two absolutely correct answers) they had no hope. I never understood arguing questions if it wasn't something factual. I did speak with the professor to understand their point and see why my thinking was incorrect. Also, one question is not the end of the world.




Sorry I can't contribute to the cars discussion. I'm clueless about cars. My fiancee will pick out all my cars for me. Al I care about is that it accelerates quickly and drives fast enough when I get away from the city again.

 

[SHC1984]

That sounds like my patho class I had to take.



That's ridiculous. Definitely not ok at my school. Students would try to argue, but unless the answer was actually wrong (or there were two absolutely correct answers) they had no hope. I never understood arguing questions if it wasn't something factual. I did speak with the professor to understand their point and see why my thinking was incorrect. Also, one question is not the end of the world.




Sorry I can't contribute to the cars discussion. I'm clueless about cars. My fiancee will pick out all my cars for me. Al I care about is that it accelerates quickly and drives fast enough when I get away from the city again.

Yeah, I was just comparing the two schools that I attended and I was only in med school for a semester. I am sure if I attended UCSF pharmacy school and then a low rank med school I would most likely think pharmacy school is much more diffcult! It's very subjective and every school is different!! I am sure some pharmacy schools are 100000000X harder than others too and so are med schools...so it's hard to compare in general. There are med school harder than pharm schools and I am sure there are pharm school harder than some med schools etc.

My school sets up an exam review for students and a lot of them argue with the professors about the answer to the exam! We rarely ever get any points back either...especially the second year we NEVER get points back this year! lol...but it just feels elementary that the school sets up exam review and have people talk about exams and what they miss etc as a class.

In med school there is no such thing. If you fail an exam the professor will make an appointment to see you but as a class there is no exam review to talk about an exam after the exam. There shouldn't be something like that...you study, take the exam and then its over...no meeting should be needed afterwards to discuss the exam! lol..sounds very high school.

I don't know anything about cars either...I was just talking about insanely price items!

 

[Sparda29]

It really is...you know why...because a house doesn't depreciate as fast as a car...it has a much longer life. And it's stupid to have a car that goes that fast anyway because a) no road in america has no speed limit so basically you'd lose your license if you went as fast as it could and got caught and b) if you drive at the fastest speed of a bugatti veyron for instance, the tires disintegrate in about 15 minutes from the heat of friction, and there goes your 1.5 million dollar car!

Apparently you haven't watched Top Gear. When he's at top speed, he tells us that "the tires will be done in 15 minutes, but that's okay because we run out of fuel in 12 minutes."

For most speed demons, such as myself, it is not the top speed that gives us a thrill, but the very fast acceleration and not having to slow down for turns and curves that gives us the thrill. Besides, most people who buy super cars here on Long Island only really take them out on the weekend and either take them to the track where they can do everything they wanna do, or they head down to the Jones Beach Causeway and the whole beach highway and drag race there, and usually have a big super car hangout afterwards.

 

[spacecowgirl]

That's criminal.

Not to mention butt ugly.

I know people have a "right" to spend their money however they want, but seriously, it should be criminal to spend that kind of money on anything you can't live in, fly in or travel time in.

 

[homeslice]

LOL...I always try to get the seller to waive the shipping for me when I buy things online. I hate paying shipping too.



I always follow the speed limit so that's why I need a sedan...no sports car for me...I was in a corvette going 120MPH one time and I can feel my heart jumping OUT....Don't really care for that feeling at all. House only increase in value so it's worth it.

Uhh, where have you been the last few years?

 

[rph3664]

You won't work in retail very long before someone's gonna call up and ask you to diagnose their skin rash over the phone. I mentioned that to a woman I knew who is a dermatologist, and she just rolled her eyes.

 

[confettiflyer]

I always follow the speed limit so that's why I need a sedan...no sports car for me...I was in a corvette going 120MPH one time and I can feel my heart jumping OUT....Don't really care for that feeling at all. House only increase in value so it's worth it.

shoot what're you talking about....i hit 120 in a honda sedan once, that's about where it's gov-locked. i was more scared of getting pulled over because 100+ mph = automatic arrest and car impound in CA.

 

[confettiflyer]

Not to mention butt ugly.

I know people have a "right" to spend their money however they want, but seriously, it should be criminal to spend that kind of money on anything you can't live in, fly in or travel time in.[/QUOTE]

88 miiiiileeeeessssss perrrrr hourrrrrrrrrr!

 

[Sparda29]

shoot what're you talking about....i hit 120 in a honda sedan once, that's about where it's gov-locked. i was more scared of getting pulled over because 100+ mph = automatic arrest and car impound in CA.

That sucks, I got off with a warning after being pulled over when I went 105 mph.

 

[Marcus X]

shoot what're you talking about....i hit 120 in a honda sedan once, that's about where it's gov-locked. i was more scared of getting pulled over because 100+ mph = automatic arrest and car impound in CA.

I hit 160 in a Honda. Quite glad there were no cops around.

 

[rxlea]

How can you hit 160 in a Honda?

 

[Marcus X]

How can you hit 160 in a Honda?

By using the accelerator?