Controversy!! (merged threads)

[endlesslove]

The bashing of a pharmacist's role voice your opinions of this ignorant girl's views of pharmacists' roles.

excerpt:
"Pharmacists should never second-guess a doctor unless they spot a harmful combination of drugs; the lines between the roles of physicians and pharmacists shouldn’t blur."

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[dnelsen]

I think she is right on as the article pertains to retail pharmacists. A retail pharmacist can basically be replaced by something resembling an ATM machine. Insert prescription, pills pop out.

That is retail pharmacy.

However, I agree with the follow-up comment by Aaron Johnson. Aaron described a future role for pharmacists, a so-called "Drug Information Specialist," whose role is to work closely with doctors on prescriptions. Pharmacists are no doubt more qualified when it comes to deciding the right medicine and the proper dosage.

Let the physician diagnose and the pharmacist choose the best drug and dosage.

 

[bananaface]

I can see conflict coming with this one....

To the pharmacy folks:

Remember to correct mispreceptions tactfully. If someone is unaware of what your role is, educate them, don't flame them. Winning people over is better than just winning.

- Anna

 

[ButlerPharm.D.]

I thought this opinion piece might stir up some controversy... give it a read.

Opinion Piece

 

[Caverject]

She needs to get her head out of her butt...it's clearly obvious she has not a clue as to what she is talking about

 

[DrYo12]

She needs to get her head out of her butt...it's clearly obvious she has not a clue as to what she is talking about

Why is that? Why is she so 'off the mark'?

 

[bananaface]

This article was first posted in Pre-Pharmacy for discussion. I think current students will be most interested in it, so I am going to merge the Pre-Pharm thread with this one, but leave a redirect in Pre-Pharm so that people can link in.

 

[Caverject]

Why is that? Why is she so 'off the mark'?

Well....

If you can’t handle filling prescriptions you don’t agree with, don’t become a pharmacist.

We have a right to fill or deny ANY prescription. It is part of being a professional. If I do not feel comfortable giving you an RX, I simply will not do it. Example: Oxycontin 120 1q12h and the profile shows the pt is a drug shopper and goes to multiple doctors.

Pharmacists should never second-guess a doctor unless they spot a harmful combination of drugs; the lines between the roles of physicians and pharmacists shouldn’t blur.

It is well within our rights. Not all Doctors are God and know everything about everything about drugs. There are many doctors out there that are very good about drugs, and there are some crappy ones too.

Pharmacists also have no business asking personal questions (such as whether a girl is using birth control pills for contraception.)

Oh? So I can't ask someone if they get a burning sensation when they urinate or the last time they urinated? I can't help prevent possibly a fatal problem? Better yet, why cant we ask women if it's for contraception or emergency contraception? Did the author even think to realize that there are about 10 different ways or more to do emergency contraception with birth control packs? How bout when I dispense an antibiotic for a patient that is on birth control? Is it not my right to explain the risks of unprotected sex in that situation?

Sexual activity is nothing new, and at University of Wisconsin, you don’t have to witness bartime to know many students are sexually active.

So are teenagers, soccer moms, NASCAR Dads, and all of our grandparents thanks to Viagra

It’s your business. Not mine.

No kidding.

 

[DrYo12]

We have a right to fill or deny ANY prescription. It is part of being a professional. If I do not feel comfortable giving you an RX, I simply will not do it. Example: Oxycontin 120 1q12h and the profile shows the pt is a drug shopper and goes to multiple doctors.

Fair enough. But this is adding an element of subjectivity that it unreliable at best.

It is well within our rights. Not all Doctors are God and know everything about everything about drugs. There are many doctors out there that are very good about drugs, and there are some crappy ones too.

On the other side, you have to consider that just as all doctors are not infallible, neither are pharmacists. Doctors have to make a judgement about what to prescribe, but pharmacists make a judgement about what to fill. When subjective reasoning comes into the picture, ie religious undertones, specific values, or experiential circumstances, even pharmacists can be known to make a decision that isn't necessarily in the best interest of the patient, but reflects their own bias.

 

[Caverject]

pharmacists are not the know all to end all. The ideals of health professions is to treat the patient. There are a lot of dumb pharmacists out there. Thats why it's good we have smart docs in the world and vice versa

 

[ultracet]

Its all called a system of checks and balances.. I don't know everything, you don't know everything... hopefully together we can come up with the best plan...
this includes retail whether you like it or not.
i am not an ATM machine though occaisionally i may be treated like one..

These people who are out of the healthcare loop (i.e. Italian and European studies majors) really don't bother me all that much.

I honestly don't have a high enough opinon of them for them to fire me up.

I do get rather irritated when drs. or pharmacists or nurses or others in the health care profession do not understand or try to understand the value of other professionals.

While the article was rather entertaining and obviously the girl was trying for a reaction... her opinion means nothing to me

 

[DrYo12]

Its all called a system of checks and balances.. I don't know everything, you don't know everything... hopefully together we can come up with the best plan...
this includes retail whether you like it or not.
i am not an ATM machine though occaisionally i may be treated like one..

These people who are out of the healthcare loop (i.e. Italian and European studies majors) really don't bother me all that much.

I honestly don't have a high enough opinon of them for them to fire me up.

I do get rather irritated when drs. or pharmacists or nurses or others in the health care profession do not understand or try to understand the value of other professionals.

While the article was rather entertaining and obviously the girl was trying for a reaction... her opinion means nothing to me

In theory, our system of checks and balances is designed so that each profession benefits the patient most thoroughly. However, realistically, does it work that way? Do the professions honestly collaborate to a great enough extent that patients will reap the benefits?

For example, a pharmacist is not present when a doctor is making an assessment and writiting a prescription, but a doctor is not present when a pharmacist is filling the order.

 

[ultracet]

In theory, our system of checks and balances is designed so that each profession benefits the patient most thoroughly. However, realistically, does it work that way? Do the professions honestly collaborate to a great enough extent that patients will reap the benefits?

For example, a pharmacist is not present when a doctor is making an assessment and writiting a prescription, but a doctor is not present when a pharmacist is filling the order.

I know that I don't hesitate to call a doctor and ask questions about a patient or a prescription or just to verify.

While I am not present when Drs do their jobs I will sit down with a patient and say... what did your dr tell you this was for
how did your dr tell you take this medication
what side effects did your dr tell you to expect


then i can fill in the gaps.

now granted this is in an ideal world and not everyone has time for that but for new prescriptions we should take the time. and more counseling goes on than i think even the pharmacists realize.

 

[Requiem]

Italian and European studies.

HA HA HA HA HA HA HA .



Oh by the way, I'm majoring in Geology. I hope you all will take my article on the affect of free radicals as possible carcinogens seriously!

My english professor would tear that article apart, so many ridiculous "analogous" comparisons that are so far away from the actual point hurt me when I read this.

 

[crying moo]

Italian and European studies.

HA HA HA HA HA HA HA .



Oh by the way, I'm majoring in Geology. I hope you all will take my article on the affect of free radicals as possible carcinogens seriously!

I'm thinking the same thing! I don't think we should be taking that article too seriously. I mean, anyone can have an opinion, misguided as it may be. I guess it always helps to educate "laypeople" but come on, she's young, healthy, and probably doesn't need/get exposure to the way healthcare works. Don't be so harsh on her. She'll come around when she's 50 and has uncontrolled HTN. Or maybe when her child is allergic to penicillin and she has no health insurance (Italian and European studies?) People don't really appreciate or understand pharmacists unless they actually need your services.

I wonder if any pharmacy people have written to her about this. If you write her, I hope it is done in a polite and well thought-out manner. Understand that she doesn't necessarily need to be "converted" to our POV at this point in her life. But also feel free to tell her your opinion about Italy's role in the European Union. I like pizza and spaghetti too.

 

[baggywrinkle]

I think she is right on as the article pertains to retail pharmacists. A retail pharmacist can basically be replaced by something resembling an ATM machine. Insert prescription, pills pop out.

That is retail pharmacy.

I'll remember you said that when doogie houser, resident on call, tries to treat you to death.

 

[dnelsen]

I'll remember you said that when doogie houser, resident on call, tries to treat you to death.

I guess I'm not really sure what this means

I know my comment was slightly off-topic when looking at the article, but I stand by my comment that retail pharmacy could be done by machines. All of you pharmacy students will be overqualified for your position if you choose retail pharmacy. I am not putting down how smart you are in any way.

People in this thread keep commenting about how the author of the article is a "layperson" and she doesn't understand the role of a retail pharmacist.

Bananaface said:
"If someone is unaware of what your role is, educate them"

Well, educate me then. Convince me that the majority of your job is not managing supply, dealing with insurance, counting pills, etc. None of these tasks requires the extensive training you received in pharmacy school.

 

[Lexian]

Well, educate me then. Convince me that the majority of your job is not managing supply, dealing with insurance, counting pills, etc. None of these tasks requires the extensive training you received in pharmacy school.

I'm not sure when you say, "....the majority of your job..." if you're referring to only retail/outpatient pharmacy or pharmacy as a profession on the whole, but here is a post I made that talks about the broader scope of the profession.

http://forums.studentdoctor.net/showpost.php?p=2210964&postcount=49

 

[bananaface]

Well, educate me then. Convince me that the majority of your job is not managing supply, dealing with insurance, counting pills, etc. None of these tasks requires the extensive training you received in pharmacy school.

What you are describing above is more along the lines of the role of a pharmacy technician. I have to head to school, so I will let some other people elaborate on the discretionary responsibilities of retail pharmacists.

I took the comment above as pertaining to retail pharmacy. But, in case it is of interest, here is a page that will give you an idea of some areas/settings of practice for pharmacists. http://forums.studentdoctor.net/showpost.php?p=1700928&postcount=4

 

[dnelsen]

Thank you for the replies and yes, my posts all have explicitly said RETAIL pharmacy.

I read the link from Lexian (thanks!) and I think we have similar ideas on retail pharmacy:

I am not bashing retail pharmacy certainly, because there is need for it to be there. Drugs have to be stocked and distributed.

My point is that I think that people with a PharmD degree are overqualified to work at a retail pharmacy and much of the work could be automated. I just don't understand why someone so smart - smart enough to get into and to succeed in pharmacy school - would want to work at Walgreens, CVS, etc? It just seems like a waste of talent. Maybe a pharmacist should be more like a specialty of medicine where you make an appointment to talk with a pharmacist about your medications, drug interactions, etc. etc. I think the majority of scrips filled are routine and people would love the convenience of getting their pills from a vending machine. If I get sick and get a prescription for antibiotics, I don't want to stand in line for 20 minutes to drop of my prescription and then wander around Walgreens for another 20 minutes while it is filled.

 

[dgroulx]

Here's some things that a machine can't do in retail:

Talking to each patient about the medicines that they are taking, any vitamins, herbals, etc that may interact with their current meds.

Helping people who come into the pharmacy with a rash, a bee sting or any other minor injury where they don't need to go into the ER.

Making OTC recommendations based on the meds they currently take.

Recognizing if an asthma patients is refilling their rescue med too often and their inhaled steroids not frequently enough.

Patients who see multiple doctors and may be receiving duplicate therapy (not the same med, but the same class).

Anyone want to add to the list?

 

[tupac_don]

I think she is right on as the article pertains to retail pharmacists. A retail pharmacist can basically be replaced by something resembling an ATM machine. Insert prescription, pills pop out.

That is retail pharmacy.

However, I agree with the follow-up comment by Aaron Johnson. Aaron described a future role for pharmacists, a so-called "Drug Information Specialist," whose role is to work closely with doctors on prescriptions. Pharmacists are no doubt more qualified when it comes to deciding the right medicine and the proper dosage.

Let the physician diagnose and the pharmacist choose the best drug and dosage.

YEa well, the problem with that is that pharmacists go home at 3 and doctors are on call all the time. That would mean too much double care. Physician would have to write for drugs when in hospital and pharmacist during his work time. Hmmm. I think for pharmacists to trully be drug specialists they should make a residency mandatory and pharmacists should know a lot more about pathophysiology. A lot of rationale for tx comes from knowing pathophysiology, but pharmacists don't have much. I mean yes pharmacists are taught basic pathophys but not like doctors. Although don't get me wrong I agree with you,but things would have to change to really put what you are saying into reality.

 

[tupac_don]

Here's some things that a machine can't do in retail:

Talking to each patient about the medicines that they are taking, any vitamins, herbals, etc that may interact with their current meds.

Helping people who come into the pharmacy with a rash, a bee sting or any other minor injury where they don't need to go into the ER.

Making OTC recommendations based on the meds they currently take.

Recognizing if an asthma patients is refilling their rescue med too often and their inhaled steroids not frequently enough.

Patients who see multiple doctors and may be receiving duplicate therapy (not the same med, but the same class).

Anyone want to add to the list?

Yea enter scripts. Pts should screen their scripts and computer translates writing into typed letters.

 

[baggywrinkle]

Well, educate me then. Convince me that the majority of your job is not managing supply, dealing with insurance, counting pills, etc. None of these tasks requires the extensive training you received in pharmacy school.

The bulk of retail pharmacy is indeed related to inventory management and payment issues. Topics which you will find in most all branches of pharmacy you might choose to practice in btw. Nursing home consultants are excused.

Roles of the retail pharmacist. Education. quality assurance, drug utilization, clinical review, and legal compliance. All this is done under extreme time constraint with minimal backround information input. Skipping a step because you did not have time or could not be bothered does not excuse you from responsibility for consequences resulting from that step.

On any given day you might actually need to access barely 1-2% of everything you were taught and/or picked up along the way. The rub is you
never know which 1-2% you will be needing so it had all better be on tap.

Case in point (Heads up Anna!) Last week I got a prescription from an OD for an oral antibiotic. The way it was written indicated the practitioner was unfamiliar with the drug. Nothing wrong with the prescription per se
it was just awkward. This resulted in a legal compliance check for scope of practice. After chatting with the practitioner I discovered that he had just finished coursework to allow a special rider on his license permitting him to prescribe oral antibiotics. My copy of the law limited him to topical anti-infectives so he faxed me a copy of his license and referred me to the chapter and subsection of the newly revised law. In the course of conversation I was able to drop some friendly advice on more cost efficient
prescribing of the same drug which would achieve his treatment goals with a smaller impact on her wallet.

Show me an atm machine that can do that and I'll go flip burgers.

 

[Abilene]

I have been working in a retail pharmacy for a considerable amount of time, and have since then gained tremendous appreciation for the proffession. The pharmacist I work with is nothing like a vending machine. She has earned all the respect and trust from health proffessionals, the patients, as well as everyone else in the community. Many times doctors would contact her or she would contact the doctors to discuss about patients' treatments to ensure their patients' are best taken care of. Many times people would come to her pharmacy to seek for her advice before they decide to go to their doctors. Many times she would sell her medication with not a single penny in profit, or let the patients owe her $$ with no APR % rate or due date when they don't have any Medical or insurance coverage and aren't able to pay in full...People in the community really treat her like a part of their family...I just feel VERY fortunate to get to know her and work with her...And I truly beleive that no matter what setting a pharmacist is in, if s/he does the job with all his/her heart, s/he can really make a difference...

 

[bananaface]

Case in point (Heads up Anna!) Last week I got a prescription from an OD for an oral antibiotic. The way it was written indicated the practitioner was unfamiliar with the drug. Nothing wrong with the prescription per se it was just awkward.

Yeah. I have seen that before. It's pretty common when the new residents roll in.

There are lots of things we safeguard against. Sometimes physicians do just write things down incorrectly. A few weeks ago I had a patient come from her physician's office with an order for an oral contraceptive which was written 1q4-6hprn. Her OB/GYN had delivered a baby overnight and come in in very bad shape. Sometimes patient allergies are overlooked by prescribers. Some prescribers overprescribe narcotics. Sometimes patients alter or forge prescritions and we have to use our discretion to determine if the order is legitimate. Then there are oddball things, like a prescriber writing for Lindane shampoo for the same child, repeatedly. I'm sure the list could be expanded. The point is that nobody is infallible, and pharmacists do intervene to ensure good patient care.

On the topic of emergency contraception and the discretion of those involved in prescribing and dispensing - I had a patient who requested that it be prescribed on a Saturday late in December. Her physician refused to prescribe that particular medication as a rule, so I ended up calling around to find a pharmacy that was able to dispense Plan-B on protocol. It's not as if there aren't access issues outside of objections by some pharmacists.

 

[Caverject]

Back to the topic at hand from the OP... I just spoke to a friend of mine that is a pharmacy student at the University of Wisconsin- Madison. (APhA gives you friends everywhere! ) She mentioned to me that there were over 50 letters written from pharmacy school students to the author. A professor from the pharmacy school sat down with the author and explained to her why bile was being thrown by the pharmacy students towards her article. Now, she will be writing a follow up article with this experience, but the direction of the article is remain to be seen. I am looking forward to reading this article!