Interesting Discussion

[PharMed2016]

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Disclaimer: I'm not the most unbiased source of information partly due to prior education.

Had an interesting conversation with another student about how to improve patient care - my point institutionalized knowledge given that no one professional can be an expert on everything. Some actions include the use of specialized order sheets with the most optimized medications for a given patient (not a new idea - hasn't been implemented in some health systems and not complete implementation in all). Somehow we get to these points and debate ensues...

Points:
Student - Pradaxa is a good drug, much better than warfarin since you don't need to monitor.
Me - No, Pradaxa is a horrible Drug, especially given that there is no antidote. Made comment how it can be inferior to warfarin in some circumstances.

Student - All beta blockers and ACE-I are the same.
Me - No, they are most certainly not. Debate ensues.
Student - agrees that ACEI are different. BB are still the same. Goes on to lecture about a MS1 year doesn't know anything about pharmacology and has no context for argument.
Me - Drops I'm a pharmacist
Student - Discussion. Pharmacy students aren't taught about patient factors - patient doesn't want to be monitored. Still holds that all BB are the same although admits that some do have different receptor affinities.
Me - couldn't believe the sentence... not a very happy camper. Countered with Rivaroxaban (not optimal I know - but Apixaban looks interesting - haven't read newest study.)

***This is all in the context of optimizing the order sets for hospital. [Institutional Knowledge] --> better patient care --> better outcomes. Pharmacist can play a role.

Comments?

 

[FarscapeGirl]

Never mind; was in another thread but somehow posted in this one!

 

[pharmdpharmd]

We are taught that BB are not the same, and so are ACE-I, as well as the many limitations pradaxa has .. Bad student is a bad student (probably he has bad professors as well)

 

[Carboxide]

I don't understand - is this a med or pharm student?

 

[PharMed2016]

We are taught that BB are not the same, and so are ACE-I, as well as the many limitations pradaxa has .. Bad student is a bad student (probably he has bad professors as well)

I was trying to make a point about institutionalized knowledge with my colleague. Point being not one physician can know everything which large institutions like Kaiser and Cleveland Clinic recognize. (Publication last year sometime) Probably wouldn't say bad student but rather misinformed student. Understandably, there is a lot of information that you have to cram into the curriculum but in terms of pharmacology - I think as a med student (haven't gone through pharmacology), we get the equivalent of 6 units of pharmacology based on the syllabus. That is just dwarfed by the amount in pharm school between pharmacology/med-chem, PT, and other little courses that either deal with specific aspects of drugs or courses that exposes the student to drugs.

After taking a nap, a little less upset.

Trying to be an advocate of interdisciplinary teamwork - pharm but sometimes its too much trouble I'm starting to realize.

PS. Not really sure what year medical student just not 1st.

 

[Digsbe]

I'm all for utilizing everyone's expertise when it comes to treating patients. I think there is a pride factor with some individuals who must believe that they are the know all top dog (which happens in pharmacy, medicine, etc.) I also think there is an ignorance of what each profession is taught or the skill set someone else may have. I wish that healthcare would become more interdisciplinary with pharmacists and physicians collaborating under what we know best to provide individualized treatment to patients. However, I fear that healthcare is going to shift more towards mid levels having more autonomy since that may be a cheaper alternative.

 

[Kwiz]

All beta blockers are definitely not the same. Only thing along the lines of being "the same" that I was ever taught was efficacy of statins

 

[PharMed2016]

All beta blockers are definitely not the same. Only thing along the lines of being "the same" that I was ever taught was efficacy of statins

Yea, that's pretty much what I learned although there maybe some benefit to lowering LDL more which is a matter of potency. Plaque stabilizing effect is more important.

 

[PharMed2016]

I'm all for utilizing everyone's expertise when it comes to treating patients. I think there is a pride factor with some individuals who must believe that they are the know all top dog (which happens in pharmacy, medicine, etc.) I also think there is an ignorance of what each profession is taught or the skill set someone else may have. I wish that healthcare would become more interdisciplinary with pharmacists and physicians collaborating under what we know best to provide individualized treatment to patients. However, I fear that healthcare is going to shift more towards mid levels having more autonomy since that may be a cheaper alternative.

I don't think there is anything that can be done to prevent it. A lot of states already have some laws in place to give mid-levels more autonomy. At the same time, I don't think the midlevels can truly replace physicians given the depth of physician training. However, I do think that they can be a great asset to the country providing care especially given that there will be a great shortage of primary care physicians given the expansion of coverage with the ACA. That should provide at least a small boon for pharmacy with increased coverage --> increased rx. At the same time, it will more likely stressed the current shortage of primary care physicians which undoubtedly will lead to increased mid-level autonomy which will probably remain once the physician shortage is alleviated... another issue given that GME funding for residencies hasn't significantly increased in decades really. That's the main arbiter of physician supply, something I've learned since coming to medical school. They are pretty much at the limit without an increase in funding. What's interesting is that pharmacy residencies aren't quite as restricted and should definitely grow in the coming years.