Hey WVU, Re: Clinical Specialites making docs useless

[Requiem]

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Saw an interesting situation this morning, and thought back on your thread.

So I'm in the chemo hood practicing chemo checks and a hematologist comes in and goes into a smaller room (do pharmacists ever have large offices?) with a chemo pharmacist. So she brings a pile of med order sheets and is essentially almost handicapped writing chemo orders for her patients. She spends the better part of an hour in there attempting to piece together coherent orders whilst discussing everything with the pharmacist (is this ok, why is this ordered, etc.).

Now, had this been my oncologist and I had seen both sides it'd be a bit troublesome. I feel weary about an oncologist who can't write their own carboplatin doses. But the pivotal question here is, why did this happen?

We have a unique pharmacist who has somehow bypassed the entire system and is completely clinical and writes every single chemo order coming out of the hemaetological cancer floor. She is extremely capable, does all the dosing and regimen selection, orders blood work and monitors toxicities. Essentially, the physician now having a piece of her workload removed no longer practices, and ergo remembers, how to write chemo. Said pharmacist is on vacation.

So I'd agree. And that's based on the tendency of human nature. If technicians did every bit of order entry and you never ever typed into your rx program - after a period of time, individually varying of course, if that technician was removed you'd be hard pressed to enter orders as well. You'd be cumbersome, methods forgotten, etc. A key difference being here the magnitude on the patient, but the song remains the same.

 

[PharmDstudent]

Some people are just bad***es (e.g. that chemo pharmacist). Duh! 😀

My preceptor told me that he doesn't know what they're going to do now without me... What can I say? 😎

 

[MountainPharmD]

We have a unique pharmacist who has somehow bypassed the entire system and is completely clinical and writes every single chemo order coming out of the hemaetological cancer floor. She is extremely capable, does all the dosing and regimen selection, orders blood work and monitors toxicities. Essentially, the physician now having a piece of her workload removed no longer practices, and ergo remembers, how to write chemo. Said pharmacist is on vacation...

No thanks. Writing orders is the chemo doc’s job. The job of the pharmacist is to double check the orders and dispense or supervise dispensing the medication. I could go along with helping to monitor the lab work but not doing the whole thing from start to finish. If I were a chemo doc there is no way in hell I am letting anyone write orders for my patients.

If technicians did every bit of order entry and you never ever typed into your rx program - after a period of time, individually varying of course, if that technician was removed you'd be hard pressed to enter orders as well. You'd be cumbersome, methods forgotten, etc. A key difference being here the magnitude on the patient, but the song remains the same.

It happens in retail all the time. That is why I have techs so I do not have to do the typing, insurance problems, and all the other BS. I do not know how to do half the stuff on the computer and I don't care to learn. Again, thats why I have technicians. The differencs is typing and insurance are all non-judgemental tasks. I would never let a technician verify prescriptions or override DUR screens.

This whole sceanario sounds like a big disaster waiting to happen.

 

[PharmDstudent]

No thanks. Writing orders is the chemo doc's job. The job of the pharmacist is to double check the orders and dispense or supervise dispensing the medication. I could go along with helping to monitor the lab work but not doing the whole thing from start to finish. If I were a chemo doc there is no way in hell I am letting anyone write orders for my patients.



It happens in retail all the time. That is why I have techs so I do not have to do the typing, insurance problems, and all the other BS. I do not know how to do half the stuff on the computer and I don't care to learn. Again, thats why I have technicians. The differencs is typing and insurance are all non-judgemental tasks. I would never let a technician verify prescriptions or override DUR screens.

This whole sceanario sounds like a big disaster waiting to happen.

It's not retail dude... it's "c-l-i-n-i-c-a-l" pharmacy. Things can go waaaayyyy beyond dispensing in "clinical" pharmacy.



Now that I've started a fake pissing contest, I guess I'll have to leave this thread alone now or really soon.

 

[rxlynn]

Off topic, but I love your counter PharmDStudent. I'll be walking across the stage (God willing) at the exact same time on the exact same day!

 

[Praziquantel86]

The place I was just rotating at had a dedicated pharmacist verify the order against the protocol being used before it was sent to pharmacy. They definitely didn't write them though.

 

[Priapism321]

I work at one of the largest cancer hospitals (also one that is rated very highly) in the world. Some physicians have not written an order for chemotherapy in over a decade. They "verify" them all though.

 

[Requiem]

I work at one of the largest cancer hospitals (also one that is rated very highly) in the world. Some physicians have not written an order for chemotherapy in over a decade. They "verify" them all though.

Enough with cryptic hospital speak. It's like the man's best hospital in House of God. I'm not American. PM your hospital's name.

 

[Glycerin]

Enough with cryptic hospital speak. It's like the man's best hospital in House of God. I'm not American. PM your hospital's name.

It's not so cryptic when you Google "largest cancer center in the us." 😉

 

[WVUPharm2007]

I work at one of the largest cancer hospitals (also one that is rated very highly) in the world. Some physicians have not written an order for chemotherapy in over a decade. They "verify" them all though.

I can see how that's peaches and cream at Anderson...but what happens when a physician finds themselves at a cancer center in BFE Western PA and has no idea how the hell to dose anything?

Again...emerging practice always revolves around idealistic situations that can only happen in teaching hospitals. They never stop to think about hospitals like mine where it's just me and (as it was tonight) 165 patients. When the hell am I going to find time to look up and dose chemo? It ain't gonna happen.

 

[WagsTale]

It's not retail dude... it's "c-l-i-n-i-c-a-l" pharmacy. Things can go waaaayyyy beyond dispensing in "clinical" pharmacy.



Now that I've started a fake pissing contest, I guess I'll have to leave this thread alone now or really soon.

The pharmacist should not be in charge of handling a patient's chemo or any other drug regimen from start to finish. Period. That infringes on diagnosing and prescribing authority reserved only, and rightfully so, to the patient's physician. I don't give two rips if you're a "C-L-I-N-I-C-A-L" pharmacist or not.

Your "fake pissing contest" is simply that, a fake pissing contest. I'm still unsure about you, but everyone else here is on the same team regardless of which area of practice they chose to specialize in. But I digress.

To answer the original post, I too am a bit surprised that the attending physician would so quickly become helpless, or seemingly so, at prescribing an appropriate dose for their patient. I tip my hat at how knowledgeable your colleague appears to be at managing these patients at your facility, but it stinks that the weight of such a task is placed on his/her shoulders. I think that this would serve as a rude awakening for the Dr. to get their poop-in-a-group and get a handle on the management of their patients' therapy.

 

[bigpharmD]

I can see how that's peaches and cream at Anderson...but what happens when a physician finds themselves at a cancer center in BFE Western PA and has no idea how the hell to dose anything?

Again...emerging practice always revolves around idealistic situations that can only happen in teaching hospitals. They never stop to think about hospitals like mine where it's just me and (as it was tonight) 165 patients. When the hell am I going to find time to look up and dose chemo? It ain't gonna happen.

Cry me a river. I am so sick of hearing the "teaching hospital" excuse. I dont work at a teaching hospital and we have a pharmacist that does write some of the chemo and the MD double checks or the other way around. We also just hired a pharmacist to work in the outpatient chemo clinic who is revamping every order set they have.

Many of these aformentioned hospitals hire pharmacists as consultants to build their order sets and protocols or pay the MD andersons for their order sets. You just dont know it. Most likely your BFE hospital is and should only be doing very little treatment of cancer, and most cases are transferred to larger hospitals. I would not go to a hospital like yours if I had acute leukemia, sorry.

Many solid organ transplant centers across the country have pharmacists who write/order all immunosuppression and order all levels. Some of these programs are at teaching hospitals, others are not. Many transplant physicians feel the pharmacist does a better job at it and can focus on drug interactions etc that the PA, NP, or even physician do not always notice. It has nothing to do with taking over their "job."

 

[bigpharmD]

The pharmacist should not be in charge of handling a patient's chemo or any other drug regimen from start to finish. Period. That infringes on diagnosing and prescribing authority reserved only, and rightfully so, to the patient's physician. I don't give two rips if you're a "C-L-I-N-I-C-A-L" pharmacist or not.

Your "fake pissing contest" is simply that, a fake pissing contest. I'm still unsure about you, but everyone else here is on the same team regardless of which area of practice they chose to specialize in. But I digress.

To answer the original post, I too am a bit surprised that the attending physician would so quickly become helpless, or seemingly so, at prescribing an appropriate dose for their patient. I tip my hat at how knowledgeable your colleague appears to be at managing these patients at your facility, but it stinks that the weight of such a task is placed on his/her shoulders. I think that this would serve as a rude awakening for the Dr. to get their poop-in-a-group and get a handle on the management of their patients' therapy.

He/she isnt. Just because the pharmacist fills out the order set and does the calculations does not mean they are in charge of dictating therapy.

 

[MountainPharmD]

You seem to have missed this part of the OP's original statement.

We have a unique pharmacist who has somehow bypassed the entire system and is completely clinical and writes every single chemo order coming out of the hemaetological cancer floor. She is extremely capable, does all the dosing and regimen selection, orders blood work and monitors toxicities.

He/she isnt. Just because the pharmacist fills out the order set and does the calculations does not mean they are in charge of dictating therapy.

What the OP is describing sounds a bit more involved than filling out an order set and doing calculations. Everyone has thier role and everyones role is important. You wiz bang residency PharmD's who want to practice medicine make me laugh. You want to do more? You want to expand your role? GO TO FREAKIN MED SCHOOL THEN.

 

[bigpharmD]

You seem to have missed this part of the OP's original statement.






What the OP is describing sounds a bit more involved than filling out an order set and doing calculations. Everyone has thier role and everyones role is important. You wiz bang residency PharmD's who want to practice medicine make me laugh. You want to do more? You want to expand your role? GO TO FREAKIN MED SCHOOL THEN.

No actually I didnt. Sounds like she practices the same way as every other heme/onc pharmd in this country. Go to the HOPA website and peruse the job listings. I think the OP is prob making this sound worse than it actually is. I am sure this pharmd does not dictate therapy completely. They prob discuss it and choose a regimen. The fact that she writes labs and monitors toxicities is what she should be doing.

You wiz bang retailers who man the drive thru and bitch and complain about other pharmacists responsibilities as nurses and PAs surpass you and take over make me laugh. My job is not to practice medicine. My job is to round and assist with immunosuppression and medication selection, monitor for DIs and ADRs, provide education to patients, nurses, PAs, NPs and other pharmacists, assist with fullfilling CMS requirements, build order sets and protocols, assist with formulary decisions related to transplant, and conduct research in transplant.

 

[PharmDstudent]

The pharmacist should not be in charge of handling a patient's chemo or any other drug regimen from start to finish. Period. That infringes on diagnosing and prescribing authority reserved only, and rightfully so, to the patient's physician. I don't give two rips if you're a "C-L-I-N-I-C-A-L" pharmacist or not.

Your "fake pissing contest" is simply that, a fake pissing contest. I'm still unsure about you, but everyone else here is on the same team regardless of which area of practice they chose to specialize in. But I digress.

😴 It sure is boring whenever someone can't take a joke... or get a joke... or realize that something went over their head... or admit that they're out of the loop... or... well... you know... geez...

 

[WVUPharm2007]

Cry me a river. I am so sick of hearing the "teaching hospital" excuse. I dont work at a teaching hospital and we have a pharmacist that does write some of the chemo and the MD double checks or the other way around. We also just hired a pharmacist to work in the outpatient chemo clinic who is revamping every order set they have.

Your hospital is probably way richer and more properly staffed, too. You CAN NOT compare the two AT ALL. ****, if you came here, you'd probably think you landed in Deliverance and one of the hospitals from Theme Hospital.

Many of these aformentioned hospitals hire pharmacists as consultants to build their order sets and protocols or pay the MD andersons for their order sets. You just dont know it. Most likely your BFE hospital is and should only be doing very little treatment of cancer, and most cases are transferred to larger hospitals. I would not go to a hospital like yours if I had acute leukemia, sorry.

Hey, guess what, the county I work in is 85% medicaid. 8-5. They can't go to a major cancer center. Hell, they can barely afford the gas to come to my hospital. All they have is the little UPMC-run cancer outpost across the street...and they use my pharmacy. I WISH the world was as rosy as you appear to think it is with all of your fancy big city experience. 🙄

Many solid organ transplant centers across the country have pharmacists who write/order all immunosuppression and order all levels. Some of these programs are at teaching hospitals, others are not. Many transplant physicians feel the pharmacist does a better job at it and can focus on drug interactions etc that the PA, NP, or even physician do not always notice. It has nothing to do with taking over their "job."

And...AGAIN...my hospital isn't big enough to hire more than the 7 full time day/afternoon pharmacists we have on staff. So what's your point? It's not about people taking other peoples' jobs...it's about being made less useful by the system that only takes some practice situations into account. And when you aren't in a luxury situation where there are 5 billion RPHs around...can you select and dose drugs? And that's what it is.

 

[GreyFox2002]

No thanks. Writing orders is the chemo doc’s job. The job of the pharmacist is to double check the orders and dispense or supervise dispensing the medication. I could go along with helping to monitor the lab work but not doing the whole thing from start to finish. If I were a chemo doc there is no way in hell I am letting anyone write orders for my patients.



It happens in retail all the time. That is why I have techs so I do not have to do the typing, insurance problems, and all the other BS. I do not know how to do half the stuff on the computer and I don't care to learn. Again, thats why I have technicians. The differencs is typing and insurance are all non-judgemental tasks. I would never let a technician verify prescriptions or override DUR screens.

This whole sceanario sounds like a big disaster waiting to happen.

And what is so wrong with expanding the opportunities for pharmacists to contribute to patient care? Do you want pharmacists to just continue the trend of retail, or do you want the profession to raise to new heights, become viable, expand the need for us (more jobs and more money), improve patient outcomes, lower costs, maybe improve the image of our profession? I could care a less if pharmacists are dosing every onc, ped, transplant, anticoag, or ICU patient in the world. If the clinical pharmacy specialist does a better job than an MD, than who should the one be developing a drug regimen?