Venting about MDs vs. Pharmacists

[spacecowgirl]

Cost, formulary, contractual issues - lots of reasons.

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[karizma098]

Cost, formulary, contractual issues - lots of reasons.

gotcha. yeah we get a lot of calls in the clinic in regards to cost, but the doctor usually just changes it to something cheaper if that happens.

 

[Old Timer]

I know we save lives and lead the way to a healthier world. That's fine with me.

As for MDs vs PharmDs...well, even in my own specialty, PharmD-IDs NEVER challenge an ID. They may tell a surgeon or a hospitalist that they can't get an antibiotic without ID approval, but until we as a group are able to tell the ID they can't get an antibiotic, the MD wins. When the chips are down, the MD always wins.

Except when the a-hole ID doc wrote for Vancomycin 100 mg po bid. When called on it he told me to send them to another pharmacy. When the other pharmacy called and said Vancomycin does not come in 100mg po, he sheepishly had to admit he wanted Vibramycin. No, you don't always win. Arrogance will be your undoing.

 

[DrYoda]

I just want to vent for a second. I'm so sick of MD's taking the credit for everything about medicine. I'm sick of hearing them on the news talking about drug treatments and I'm sick of pharmacists not getting the respect they deserve when it comes to drug treatments. And I hate how pharmacists can get blamed for the stupid mistakes doctors make, yet some doctors totally disregard the pharmacists advice.

And another thing, Dipiro came and talked to our class and presented all these studies about how pharmacists add value to the acute care setting...Well DUH!!!... and noone seems to notice! Every pharmacist knows, but hospital administrators dont seem to, and definietly not the general public. Ask a lay person what a pharmacist does and you'll get the same answer everytime, they dispense meds. Ask them what an MD does, and you'll get a more insightful, well rounded answer. Where the heck are our organizations like ASHP? There needs to be MORE PR efforts. I almost feel like I should have gone to medical school instead. I feel a little bit better

We get all the chicks too, but don't worry you still have time to defect.







But to be serious for a moment, what you've noticed here isn't really about physicians taking the pharmacist's glory. It's about the basic human psychology that the person running point is the one who gets a disproportional amount of attention.

To put it simply, in life there are the QBs/widereceiver and the offensive linemen type jobs and you happen to be in the latter. And there's nothing wrong with that, but if you're going to survive(or at least be happy) in one of the more behind the scenes "O-line" jobs you need to be able to self-validate regarding the importance of your job and your contributions.

We actually have a similar breakdown among physician specialties. If someone gets a tumor cut out, the surgeon is a rockstar (at least if it's successful...) but the pathologist who diagnosed and graded the tumor? He gets nothing. The radiologist who located it and the anesthesiologist who intubated and kept the patient alive during surgery? They both get nothing too.

 

[Tinkerbell22]

LMAO! I'm part-time right now- so they won't take me seriouslyn anymore when I refer people...but yeah, I'll keep your contact on here!!! MSL's are in high demand...although our company only wants DOs and MDs, so stupid! I'm trying to change that.

I'll do it! I'll move to Macon after pharmacy school and apply for the MD program. I have nothing else better to do. haha

 

[WVUPharm2007]

just out of curiosity , why would you tell the ID they can't get an antibiotic?

Because someone with pharmacoeconomic skills has to be the hand that guides them. If not, they'd all use whatever the fancy new mrsa drug every time when a cheaper and equally efficacious alternative is available. One thing I know many physicians don't appreciate is the skill and effort put into hospital formularies. A good pharmacy director can save a hospital tens of millions. It's one thing to know what works...its another to know what works and to traverse the minefield of making business deals with pharma companies simultaneously.

 

[Its Z]

Because someone with pharmacoeconomic skills has to be the hand that guides them. If not, they'd all use whatever the fancy new mrsa drug every time when a cheaper and equally efficacious alternative is available. One thing I know many physicians don't appreciate is the skill and effort put into hospital formularies. A good pharmacy director can save a hospital tens of millions. It's one thing to know what works...its another to know what works and to traverse the minefield of making business deals with pharma companies simultaneously.

 

[meister]

As someone who's seen both sides of this issue since I worked in a pharmacy for six years before medical school, all I'll say is that some pharmacists are terrifyingly annoyingly nit-picky about stupid bullsh*t and some physicians are either flagrantly ignorant or simply stupid when it comes to drug therapy.

Getting interrupted in the middle of clinic while doing a procedure because a pharmacist wants to clarify CAPSULE VS TABLET WHEN YOU JUST PUT DOXYCYCLINE is just terrible. Pick the cheapest one, no one cares. On the other hand, getting prescriptions written by the MD's foot or written for non-existent dosages is terrible as well.

I guess one thing I've learned from the medical side of the equation is that most physicians don't have time to memorize all the insurance plans or the various governmental regulatory minutiae that change so regularly. A little understanding there would be nice.

I'm always courteous to pharmacists on the phone and on the wards. And most everyone I know appreciates their input.

 

[gotdrugs]

Getting interrupted in the middle of clinic while doing a procedure because a pharmacist wants to clarify CAPSULE VS TABLET WHEN YOU JUST PUT DOXYCYCLINE is just terrible. Pick the cheapest one, no one cares.

I'm not trying to add to the flame, but to the above that "no one cares" is a bit false.

When a third-party insurer comes to audit a pharmacy they can deny claims (and demand reversal of payment) if the pharmacist didn't fill the prescription exactly how the prescriber had written it. While I don't know if they would care and demand reversal of payment in your doxy example, I have seen them demand reversal of payment because a pharmacist didn't fill Keflex 500 #30 one tid but instead did 250mg #60 two tid (probably because he/she was out and didn't want to bother the doc).

That scenario is what prompts a lot of those "silly" phone calls.

Another thing that prompts the silly phone calls is that in general Boards of Pharmacies are real pain in the azzes. Depending on who your inspector and make-up of the board is they think pharmacists should call even in your doxy situation.

The third reason that prompts the silly calls are anal-retentive pharmacists (esp when they are new grads)

 

[spacecowgirl]

Totally agree with the PP. Just went through a routine audit where I float and it's a huge amount of work. You can lose reimbursement because you didn't put the correct days supply on eyedrops with "use as directed" instructions. Do I care if it's doxy tabs or caps? No, it doesn't matter clinically and it doesn't matter to me. It matters to the people who pay me and grant me my license however. Be annoyed with the Board of Pharmacy or the insurance companies, don't be annoyed with me.

And new pharmacists SHOULD be "anal-retentive" (I prefer cautious). Just like I'm sure new MDs are a bit more cautious than their seasoned counterparts.

 

[gotdrugs]

LOL - cautious is more PC. I'm more blunt.

I wasn't trying to imply pharmacists or new-grads should or shouldn't be anal-retentive, just that they typically are moreso at the beginning of their careers (me included) then after they get a few years under their belts.

Also, without creating a flame-war, unfortunately I've seen some docs do some things that have have led to more of these ticky-tack calls. It's a multi-factorial issue.

 

[selo]

Except when the a-hole ID doc wrote for Vancomycin 100 mg po bid. When called on it he told me to send them to another pharmacy. When the other pharmacy called and said Vancomycin does not come in 100mg po, he sheepishly had to admit he wanted Vibramycin. No, you don't always win. Arrogance will be your undoing.

Patient came to the pharmacist with a prescription for progesterone 10 mg po qd. I called the Pa who wrote the script for clarification as progesterone does not come in 10 mg. I asked her and she meant medroxyprogesterone. she said no. she said she has been on progesterone 10 mg too.She then checked with the doctor, who said it was provera instead....

 

[WVUPharm2007]

As someone who's seen both sides of this issue since I worked in a pharmacy for six years before medical school, all I'll say is that some pharmacists are terrifyingly annoyingly nit-picky about stupid bullsh*t and some physicians are either flagrantly ignorant or simply stupid when it comes to drug therapy.

Getting interrupted in the middle of clinic while doing a procedure because a pharmacist wants to clarify CAPSULE VS TABLET WHEN YOU JUST PUT DOXYCYCLINE is just terrible. Pick the cheapest one, no one cares. On the other hand, getting prescriptions written by the MD's foot or written for non-existent dosages is terrible as well.

I guess one thing I've learned from the medical side of the equation is that most physicians don't have time to memorize all the insurance plans or the various governmental regulatory minutiae that change so regularly. A little understanding there would be nice.

I'm always courteous to pharmacists on the phone and on the wards. And most everyone I know appreciates their input.

Not at all surprising' physicians want pharmacists to practice medicine when it is convenient for them.

 

[meister]

Not at all surprising' physicians want pharmacists to practice medicine when it is convenient for them.

 

[spacecowgirl]

The truth hurts, man.

 

[group_theory]

Not at all surprising' physicians want pharmacists to practice medicine when it is convenient for them.

Honest question - is deciding or changing from capsule to tablets really considered the practice of medicine and outside the scope of pharmacy?

I often write Rx without caps or tabs when both versions exist and I don't care which one is dispense. I do this, thinking it will allow the pharmacist leeway in picking between the two, in case he or she doesn't have one form in stock.

Example - ranitidine 150mg #60 Sig: 1 po bid

Would making the pharmacist pick between capsules and tablets form of ranitidine be considered outside the scope of practice?

Honest question based on the above responds. Not trying to flame or incite.

 

[WVUPharm2007]

Honest question - is deciding or changing from capsule to tablets really considered the practice of medicine and outside the scope of pharmacy?

I often write Rx without caps or tabs when both versions exist and I don't care which one is dispense. I do this, thinking it will allow the pharmacist leeway in picking between the two, in case he or she doesn't have one form in stock.

Example - ranitidine 150mg #60 Sig: 1 po bid

Would making the pharmacist pick between capsules and tablets form of ranitidine be considered outside the scope of practice?

Honest question based on the above responds. Not trying to flame or incite.

It actually depends. If you write THAT - we can chose. Unless you write "tabs"...then we have to dispense that. But there are some products where if you write the brand, we can't 100% legally change.
This is actually a rather complex question. To be able to answer it, you actually have to look into FDA Orange Book equivalencies of that specific product.

Doxy has several AB equivalency issues attached with it due to various brand names and AB ratings existing within that specific drug. So, sorry, but we have to call or else, yes, we are technically practicing medicine. It annoys us as much as it annoys you all. If y'all want to pass some sort of legislation allowing us some sort of limited ability on interchanging medications, we'd be cool with that.

 

[Sparda29]

And new pharmacists SHOULD be "anal-retentive" (I prefer cautious). Just like I'm sure new MDs are a bit more cautious than their seasoned counterparts.

One of the techs I work with tells me that I'm one of the few people she's seen going to become a pharmacist who is nonchalant about these things.

Can someone tell me about the legality of these situation?

MD writes a prescription like that Doxy situation above. Instead of calling and instead of just filling it the way it is, I rewrite it on the store Rx pad with the missing info (such as cap,tab), staple + attach, and leave a message on the docs voicemail.

 

[Socrates25]

It actually depends. If you write THAT - we can chose. Unless you write "tabs"...then we have to dispense that. But there are some products where if you write the brand, we can't 100% legally change.
This is actually a rather complex question. To be able to answer it, you actually have to look into FDA Orange Book equivalencies of that specific product.

Doxy has several AB equivalency issues attached with it due to various brand names and AB ratings existing within that specific drug. So, sorry, but we have to call or else, yes, we are technically practicing medicine. It annoys us as much as it annoys you all. If y'all want to pass some sort of legislation allowing us some sort of limited ability on interchanging medications, we'd be cool with that.

You are being disingenuous here. We're supposed to believe that pharmacists are legally allowed to script/change meds in a coumadin or lipid clinic without a doctor's oversight but they DONT have the authority to switch between caps and tabs?

BS man. Dont piss on my back and tell me its raining.

 

[Sparda29]

You are being disingenuous here. We're supposed to believe that pharmacists are legally allowed to script/change meds in a coumadin or lipid clinic without a doctor's oversight but they DONT have the authority to switch between caps and tabs?

BS man. Dont piss on my back and tell me its raining.

That's different. In a Coumadin/Lipid clinic they have access to all those little details about the patient that would allow them to make that decision.

Some states are very assbackwards when it comes to the latter situation.

 

[DYSF777]

You are being disingenuous here. We're supposed to believe that pharmacists are legally allowed to script/change meds in a coumadin or lipid clinic without a doctor's oversight but they DONT have the authority to switch between caps and tabs?

BS man. Dont piss on my back and tell me its raining.

 

[spacecowgirl]

You are being disingenuous here. We're supposed to believe that pharmacists are legally allowed to script/change meds in a coumadin or lipid clinic without a doctor's oversight but they DONT have the authority to switch between caps and tabs?

BS man. Dont piss on my back and tell me its raining.

Um, these activities would be covered by some sort of collaborative practice agreement or protocol entered into with a supervising physician. These agreements generally don't exist between clinics and unattached retail pharmacies.

I avoid calling doctors as much as possible and try to use my best judgment, but I'm not going to fault someone who is uncomfortable with that for calling for clarification.

 

[rxlea]

Honest question - is deciding or changing from capsule to tablets really considered the practice of medicine and outside the scope of pharmacy?

I often write Rx without caps or tabs when both versions exist and I don't care which one is dispense. I do this, thinking it will allow the pharmacist leeway in picking between the two, in case he or she doesn't have one form in stock.

Example - ranitidine 150mg #60 Sig: 1 po bid

Would making the pharmacist pick between capsules and tablets form of ranitidine be considered outside the scope of practice?

Honest question based on the above responds. Not trying to flame or incite.

It actually depends. If you write THAT - we can chose. Unless you write "tabs"...then we have to dispense that. But there are some products where if you write the brand, we can't 100% legally change.
This is actually a rather complex question. To be able to answer it, you actually have to look into FDA Orange Book equivalencies of that specific product.

Doxy has several AB equivalency issues attached with it due to various brand names and AB ratings existing within that specific drug. So, sorry, but we have to call or else, yes, we are technically practicing medicine. It annoys us as much as it annoys you all. If y'all want to pass some sort of legislation allowing us some sort of limited ability on interchanging medications, we'd be cool with that.

I recall a thread about this very issue regarding hydroxyzine, which is a good example I think- hydroxyzine pamoate (capsules) vs. hydroxyzine hcl (tablets). Both come in 25mg and 50mg. We would have to call in this situation, right? If the MD just wrote "hydroxyzine 25mg PO TID"?

 

[rxlea]

Um, these activities would be covered by some sort of collaborative practice agreement or protocol entered into with a supervising physician. These agreements generally don't exist between clinics and unattached retail pharmacies.

This was going to be my next comment...

 

[UES Girl]

Um, these activities would be covered by some sort of collaborative practice agreement or protocol entered into with a supervising physician. These agreements generally don't exist between clinics and unattached retail pharmacies.

I avoid calling doctors as much as possible and try to use my best judgment, but I'm not going to fault someone who is uncomfortable with that for calling for clarification.

That's what I thought too, to the best of my knowledge at our med center under the collaborative practice agreements, some of the speciality pharmacists have the ability to "initiate the prescriptions" terminology wise, prescribe even. But that doesn't mean a random chain can just switch patients meds.

Socrates, since you like expressive eye-catchers:

 

[UES Girl]

 

[Praziquantel86]

Honest question - is deciding or changing from capsule to tablets really considered the practice of medicine and outside the scope of pharmacy?

I often write Rx without caps or tabs when both versions exist and I don't care which one is dispense. I do this, thinking it will allow the pharmacist leeway in picking between the two, in case he or she doesn't have one form in stock.

Example - ranitidine 150mg #60 Sig: 1 po bid

Would making the pharmacist pick between capsules and tablets form of ranitidine be considered outside the scope of practice?

Honest question based on the above responds. Not trying to flame or incite.

Depends on the state the pharmacist is practicing in. New York, for example, is what's called a "professional judgment" state where that would be perfectly acceptable for a pharmacist to do. Other states are strict interpretation, where that prescription would be considered incomplete and require clarification.

In many cases in a strict interpretation state, the pharmacist would still pick one or the other, or have no problem interchanging dosage forms (like the Keflex mentioned above). It is technically illegal though, and they could be censured for doing it. Really stupid and bothers everyone, but such is the way of life.

And to the poster who mentioned lipid clinics - those are covered under collaborative practice agreements allowed in medical bylaws/public health law. Substituting capsules for tablets has just never been codified in many states and remains technically illegal.

 

[WVUPharm2007]

You are being disingenuous here. We're supposed to believe that pharmacists are legally allowed to script/change meds in a coumadin or lipid clinic without a doctor's oversight but they DONT have the authority to switch between caps and tabs?

BS man. Dont piss on my back and tell me its raining.

In a Coumadin clinic situation, there is a collaborative practice agreement in place allowing them the legal authority to do such things. They are, essentially, authorized to practice medicine in a limited capacity. Also, its not like some insurance company is coming in to double check every script threatening to withhold payment if every "i" isn't dotted and "t" crossed.

A retail pharmacist has to abide by the strict laws and anal-retentive standards of insurance company auditors.

Again - its about legality...and money. Again, if the medical profession wants to grant me limited prescriptive authority...I'm fine with that. But you have to change the law as written first.

Edit: I see that five people have made the same comment already...heh...

 

[WVUPharm2007]

If the MD just wrote "hydroxyzine 25mg PO TID"?

That happened just last week with a call-in. The MD had no idea what I was talking about.

Me: "Pamoate or HCL?"
Him: "Huh?!?"
Me: "Ok...Atarax or Vistaril?
Him" "I want hydroxyzine."
Me: *sigh* "Is it for itching?"
Him: "Yes."
Me: "You want Atarax...thanks."

But we legally have to clarify. If we just write down "hydroxyzine 25mg", the insurance auditor will slap a big 'ol "incomplete and invalid order" on the thing and not pay.

 

[rxlea]

That happened just last week with a call-in. The MD had no idea what I was talking about.

Me: "Pamoate or HCL?"
Him: "Huh?!?"
Me: "Ok...Atarax or Vistaril?
Him" "I want hydroxyzine."
Me: *sigh* "Is it for itching?"
Him: "Yes."
Me: "You want Atarax...thanks."

But we legally have to clarify. If we just write down "hydroxyzine 25mg", the insurance auditor will slap a big 'ol "incomplete and invalid order" on the thing and not pay.

That's what I figured. Haven't worked retail in a while so I couldn't remember if we had to or not. I know with stuff like metoprolol, the pharmacist can assume succinate vs. tartrate based on the dosing. Are they technically supposed to call on that, too?

 

[spacecowgirl]

Now I just feel like pissing on someone's back and telling them it's raining. Sounds fun.

 

[ifillrxs]

Honest question - is deciding or changing from capsule to tablets really considered the practice of medicine and outside the scope of pharmacy?

One med in particular comes to mind. Zanaflex(tizanidine) capsules have a different pharmacokinetic profile than tablets. They have a different onset and peak depending on the fasting vs fed state. Tablets have a generic equivalent but capsules do not.

 

[All4MyDaughter]

That's what I figured. Haven't worked retail in a while so I couldn't remember if we had to or not. I know with stuff like metoprolol, the pharmacist can assume succinate vs. tartrate based on the dosing. Are they technically supposed to call on that, too?

Technically, yes. One of the cardiology groups I worked with this past year LOVED to use succinate BID. We'd try to bring it up and they would say "This is how we do it." I'd say it's rarely 100% safe to assume.

 

[njac]

Now I just feel like pissing on someone's back and telling them it's raining. Sounds fun.

 

[Dr Wario]

Some of the posts in this thread make me really sad for the state of our profession. You are the medication experts, you damn well should know when things matter and when they do not and you should act accordingly in the best interest of the patient.

Clarifying doxy caps or tabs...c'mon guys, really?

 

[WVUPharm2007]

Some of the posts in this thread make me really sad for the state of our profession. You are the medication experts, you damn well should know when things matter and when they do not and you should act accordingly in the best interest of the patient.

Clarifying doxy caps or tabs...c'mon guys, really?

I guess an insurance company has never audited your place of work, huh?

 

[p-rog]

Some of the posts in this thread make me really sad for the state of our profession. You are the medication experts, you damn well should know when things matter and when they do not and you should act accordingly in the best interest of the patient.

Clarifying doxy caps or tabs...c'mon guys, really?

dude, if you don't think Caremark or other insurance companies will take back their money during an audit for this, you're ignorant. At my pharmacy, they have taken back money for something as stupid as dispensing different generic brands of albuterol inhalers (even when we were dispensing the cheaper brand).

 

[All4MyDaughter]

Some of the posts in this thread make me really sad for the state of our profession. You are the medication experts, you damn well should know when things matter and when they do not and you should act accordingly in the best interest of the patient.

Clarifying doxy caps or tabs...c'mon guys, really?

I think our colleagues in this thread have done a good job explaining why it is LEGALLY and FINANCIALLY necessary to clarify these things sometimes. Why the attitude towards your fellow professionals?

I guess an insurance company has never audited your place of work, huh?

dude, if you don't think Caremark or other insurance companies will take back their money during an audit for this, you're ignorant. At my pharmacy, they have taken back money for something as stupid as dispensing different generic brands of albuterol inhalers (even when we were dispensing the cheaper brand).

What they said.

 

[spacecowgirl]

Where's Socrates? Not back in this thread? I have to pee.

 

[WVUPharm2007]

Where's Socrates? Not back in this thread? I have to pee.

You can pee on me. I'm into that.

 

[delano2000]

You can pee on me. I'm into that.

 

[UES Girl]

Where's Socrates? Not back in this thread? I have to pee.

not a single med person I replied to, defended their point back. This usually how it goes during our class discussions. My dad was a prosecutor, then a criminal defense attorney and now a civil activist and some of his argumentative skills rubbed off on me.

 

[Dr Wario]

I think our colleagues in this thread have done a good job explaining why it is LEGALLY and FINANCIALLY necessary to clarify these things sometimes. Why the attitude towards your fellow professionals?

Because they are professionals, highly skilled, highly intelligent, professionals. Why wouldn't physicians treat us as the bottom of the heathcare food chain if we really have to do things like this. I'm well aware of the bs insurance companies try to pull, but practices like this allow them to get away with it. And even if they did take back the money for a doxy script, so freaking what? In my pharmacy that pointless call to the doctor would mean delays on at least 10 other scripts because I'm waiting on hold or talking to a clueless nurse/receptionist/janitor anyway. Speaking of which, when you call to clarify that doxy rx, do you end up speaking to the doctor or do you get a receptions that says do whatever. The nurses/MAs in the offices must be laughing their ***es off at us. Maybe if pharmacy as a profession grew up, crap wouldn't be handed to us on a daily basis?

 

[owlegrad]

Speaking of which, when you call to clarify that doxy rx, do you end up speaking to the doctor or do you get a receptions that says do whatever. The nurses/MAs in the offices must be laughing their ***es off at us. Maybe if pharmacy as a profession grew up, crap wouldn't be handed to us on a daily basis?

Haha, when I first started doing the doctor calls at my pharmacy, I assumed I would be talking to, you know, doctors. Little did I know every nurse's job in the country seems to be keeping me from doing just that.

On the plus side, I find it incredibly easy to get most nurses to go along with whatever I ask...I think I prefer talking to nurses on most issues.

But I do think it is nice that they trust us to do whatever...most times.

 

[Sparda29]

Haha, when I first started doing the doctor calls at my pharmacy, I assumed I would be talking to, you know, doctors. Little did I know every nurse's job in the country seems to be keeping me from doing just that.

On the plus side, I find it incredibly easy to get most nurses to go along with whatever I ask...I think I prefer talking to nurses on most issues.

But I do think it is nice that they trust us to do whatever...most times.

I wanna try and experiment to see if they just go along with what we recommend or if they are actually thinking.

For example, let's say there is a script for Avelox 400 mg daily for 10 days being used for CAP and it is not covered by insurance. I wonder if I call and make a recommendation to switch to a completely different class that doesn't even treat the damned bug, would they just go along.

 

[rxlea]

I wanna try and experiment to see if they just go along with what we recommend or if they are actually thinking.

For example, let's say there is a script for Avelox 400 mg daily for 10 days being used for CAP and it is not covered by insurance. I wonder if I call and make a recommendation to switch to a completely different class that doesn't even treat the damned bug, would they just go along.

I really hope you don't try that.

 

[Sparda29]

I really hope you don't try that.

I mean, if they do just accept the BS recommendation then something is wrong.

 

[All4MyDaughter]

I mean, if they do just accept the BS recommendation then something is wrong.

Or, it might mean that they trust the pharmacist's knowledge base and judgment. By giving a bogus recommendation you are violating that. It's a bad idea.

 

[DYSF777]

I wanna try and experiment to see if they just go along with what we recommend or if they are actually thinking.

For example, let's say there is a script for Avelox 400 mg daily for 10 days being used for CAP and it is not covered by insurance. I wonder if I call and make a recommendation to switch to a completely different class that doesn't even treat the damned bug, would they just go along.

And that would be stupid. Would it really be shocking to learn a nurse has less drug expertise than a pharmacist?

 

[pharm B]

I think our colleagues in this thread have done a good job explaining why it is LEGALLY and FINANCIALLY necessary to clarify these things sometimes. Why the attitude towards your fellow professionals?

I feel like I've learned a bit from reading the examples given in this thread. You might even say this is one of the threads that makes SDN useful!