IOM calls for electronic prescriptions by 2010.. what does this mean for pharmacists?

medder

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ABC News report

July 20, 2006— A doctor's poor penmanship may soon be a thing of the past. Today in a report on medication errors, the prestigious Institute of Medicine (IOM), called on physicians to electronically prescribe drugs by the year 2010.

While illegible prescriptions are one contributing factor to the 1.5 million people harmed each year by medication errors, they are not the only culprit.

The report identified patients, pharmacists, drug manufacturers, hospitals, nursing homes and doctors as contributors to the costly problem. The extra medical expense due to errors that occur in hospitals alone add up to at least $3.5 billion a year, the report said....
 

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Instead of reading a piece of paper, we will read an email. That's probably about it.
 

pharmaz88

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If it was just electronic-prescribing, I would be fine with that. (...even though you'll get even more of the PA's, NP's, etc. who just click an option in their PDA (like Cipro 100mg) that sounds good to them, even though it's obscure and impossible to find.)

My problem lies with certain individuals (one of our professors being one of them) who are actively trying to push more and more of our functionality upstream to the physician... like performing DURs, TPR's, etc. They've got this lofty idealistic vision of pharmacists performing MTM all day long, when in reality all they're doing is devaluing our worth in the eyes of prescribers and the public.
 

PhatPharm

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In school they told us that miss-readings of Dr.'s handwriting is the single biggest sources of drug errors. Is that right?
 

Requiem

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pharmaz88 said:
If it was just electronic-prescribing, I would be fine with that. (...even though you'll get even more of the PA's, NP's, etc. who just click an option in their PDA (like Cipro 100mg) that sounds good to them, even though it's obscure and impossible to find.)

My problem lies with certain individuals (one of our professors being one of them) who are actively trying to push more and more of our functionality upstream to the physician... like performing DURs, TPR's, etc. They've got this lofty idealistic vision of pharmacists performing MTM all day long, when in reality all they're doing is devaluing our worth in the eyes of prescribers and the public.

Open your mind, assert some intelligence. How could becoming more skilled and educated towards clinical responsibilities lower ones perceived level of "worth" to the public?

SO many sketchy "students" post here.
 

Shmy2008

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I'm all for prescribers using some sort of software that converts "writing" to type, but I don't like the pull-down menus of drugs. With the very little electronic prescribing that I do see, the most blatant of errors are those that obviously came from the prescriber choosing the wrong drug out of the pull-down menu. When the software also very cleverly pulls along a standard dosage regimen, the prescription appears "correct" - it then becomes the time-consuming task of the pharmacist to call the doctor to verify that they did NOT intend to change the patient who's been on Wellbutrin XL 150 mg for the past year to Wellbutrin SR 150 mg. Not that we WON'T do it (its one of the many reasons we're there)... it just seems counterproductive.
 

pharmaz88

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Requiem said:
Open your mind, assert some intelligence. How could becoming more skilled and educated towards clinical responsibilities lower ones perceived level of "worth" to the public?

SO many sketchy "students" post here.

LOL at sketchy.

Open your eyes and get in touch with reality.

The majority of patients don't want, nor need, medication therapy management. It's difficult enough to get most patients to let you counsel them thoroughly, let alone 'manage' their medications and disease states.

I never stated that clinical skills weren't important. Part of using those skills (at least in an ambulatory setting) is performing Drug Utilization Review, which is one of our functions that some are trying to push back on physicians.

Like it or not, pharmacy IS largely a dispensing role. Sure, there will always be some need for those with advanced clinical skills... but to push the work traditionally done by the pharmacy back onto the doctor, with the thought that all community pharmacists will then be solely providers of MTM services... I'm sorry, but those are just lofty ideations of out-of-touch academic types.

but to answer your question....

Most of the public sees pharmacy staff (RPh's and techs) as dispensers of pills, resolvers of Rx problems, and fixers of insurance snafus. They know that we have impressive knowledge of drugs, but very rarely do they have a need to take advantage of that. By attempting to eliminate the things they know we do, they may start to wonder why they just can't get their drugs from an atm-style machine instead. We can offer them a cornucopia of wonderful MTM services, but how many do you honestly think will bite?
 

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Requiem said:
Open your mind, assert some intelligence. How could becoming more skilled and educated towards clinical responsibilities lower ones perceived level of "worth" to the public?

SO many sketchy "students" post here.
Do you work with the public? Most of the public views the pharmacy as a fast food chain, "I want my medicine in less than 15 minutes!". The chains... ie CVS doesn't help the view when they have a policy of getting the prescription ready in 15 minutes.

You think people are going to pay pharmacists for medication therapy management? Well Mr. Smith, "you just spent 200 dollars at the doctors office... now give me 100 dollars while I educate you on your disease state and everything about your medicine. What does three times a day mean to you?"

I am all for learning more about pharmacy and the clinical aspects of it but it is hard for me to see a future of MTM with the publics current view. We are supposed to be counseling now for free... ever try and and charge for something that used to be free... people won't buy it. Anyways... 80% of the time I try and counsel a patient they seem not to care or say, "Yeah my dr already told me." Plus how can I even begin to counsel the way they teach us in school when we handling 500 scripts a day and there are 5 people in line looking at their watches.

Yes electronic prescribing is good, but pushing DUR review up stream to the dr. is not. It limits the our scope in the health care system and I don't know about you I want to keep as much resposibilities as I can for job security.
 

Jeddevil

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pharmaz88 said:
The majority of patients don't want, nor need, medication therapy management. It's difficult enough to get most patients to let you counsel them thoroughly, let alone 'manage' their medications and disease states.
The vast majority of patients don't want to talk to you for even a minute. "Just give me my drugs, let me pay and go on my way" seems to be the norm.

MTM is a nice idea, kind of like academic pharmacy heaven, but I see one big flaw in it. No one wants to pay for it. This isn't something you can do for $20 and make any money on it. Even if it was, very few patients would even be willing to pay the $20. We still have people who think they are getting the shaft with $10 copays. I can't wait to ask them for $50 to let me help them understand their medications and dz state better.

The average pt. is not going to pay a dime for MTM. During interviews with insurance managment types (some elective project we had a couple qtrs ago), the insurance line was that "they did not see any benefit to them to pay pharmacists for things that they feel are already covered in current compensation". Insurance companies are not going to want to pay for it. The govt. doesn't want to pay for anything. At this time, I don't see how pharmacists will be able pay the bills for running such a program.

I am sure there is some obscure specialty clinics somewhere that have found enough smart patients who see the value of a pharmacist managing their dz and helping them along the way. Problem is that the vast majority of Americans are not smart enough to see that pharmacists could help them overall. They would rather just get it in a minute, through a drive-thru, for as cheap as possible. It's only little pills afterall, how expensive can they be? :D

It pisses me off that academics in our future or present profession think it is great for them to help water down the current profession through giving away some of the things that make pharmacists valuable. Don't take away things that make us valuable. If anything, work to give pharmacists more responsibility and make us more valuable. I am not paying 100K for an education that is going to be devalued through members from the same profession. I am sure that the academics appreciate the grants they get through such projects, but they are hurting us IMHO. Electronic prescribing is fine, but leave DUR where it currently is.
 

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Shmy2008 said:
I'm all for prescribers using some sort of software that converts "writing" to type, but I don't like the pull-down menus of drugs. With the very little electronic prescribing that I do see, the most blatant of errors are those that obviously came from the prescriber choosing the wrong drug out of the pull-down menu. When the software also very cleverly pulls along a standard dosage regimen, the prescription appears "correct" - it then becomes the time-consuming task of the pharmacist to call the doctor to verify that they did NOT intend to change the patient who's been on Wellbutrin XL 150 mg for the past year to Wellbutrin SR 150 mg. Not that we WON'T do it (its one of the many reasons we're there)... it just seems counterproductive.
Maybe they can make a software where the Doc, actually has to type it out.

I am just a Pharm noob who knows nothing, bit ever since i got accepted to Pharmacy School, it seems like i have a sign on me directed towards my family and friends that says" ask me about your medication!!!". I dont know crap about anything, but what this tells me is that people are concerned about what they are taking. I think people are "starting" to get smart and ask questions. I definately think there is demand for MTM, just not in the retail
setting, because people are generally in a hurry. If there was just a way to inform the public about the importance of managed therapy, instead of them just assuming the Doc knows everything.

My brother-in-law was prescribed antidepressants by a family doc, what does he really know about antidepressants? Does he have any business doing that or should he have given him a referal to a specialist? I dont know, may he does know what he is talking about, but it seems like everytime someone goes the doctor because they have a cough, they walk out with a script for antibiotics. It sems like the doc just wants to give them something to make them happy, and generally it does make pts happy. There has to be something we can do to educate the public.
 

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Jeddevil said:
The vast majority of patients don't want to talk to you for even a minute. "Just give me my drugs, let me pay and go on my way" seems to be the norm.

MTM is a nice idea, kind of like academic pharmacy heaven, but I see one big flaw in it. No one wants to pay for it. This isn't something you can do for $20 and make any money on it. Even if it was, very few patients would even be willing to pay the $20. We still have people who think they are getting the shaft with $10 copays. I can't wait to ask them for $50 to let me help them understand their medications and dz state better.
Ummm...quite a few of you are sorely mistaken. Don't shoot your mouths off and try to pass it off as a fact. Your opinions are just that...so don't presume to know what the public wants.

http://www.medscape.com/viewarticle/406698_1

Abstract
Objective: To determine the level at which patients receive pharmaceutical care services and theirwillingness to pay for comprehensive pharmaceutical care services.
Design: A mail survey was sent to 2,500 adults in the United States.
Setting: Surveys were mailed to subjects' homes.
Patients or Other Participants: Subjects were randomly selected from a marketing database thatincluded representation from each of the 50 states of the United States.
Intervention(s): The survey provided a description of comprehensive pharmaceutical care, andsurvey items asked about the level of care subjects were receiving and their willingness to pay for these services.
Main Outcome Measures: Level of various pharmacy services subjects reported receiving, and thedollar amount subjects were willing to pay for comprehensive pharmaceutical care.
Results: The majority of the subjects were not receiving pharmaceutical care services. The averageamount all respondents were willing to pay for these services was $13 for a one-time consultation and $28 for thisplus 1 year of monitoring. Looking only at those respondents willing to pay (56%), the means rise to $23 and $50,respectively.
Conclusion: A majority of patients are willing to pay for pharmaceutical care services, even if theyare not now receiving this level of care. Direct payment from patients who recognize the therapeutic benefits ofpharmaceutical care may be a more viable option than is generally believed, at least until the profession can provepharmaceutical care's utility and cost-effectiveness to third party payers.

http://www.medscape.com/viewarticle/406707_print

http://www.ncpanet.org/assets/asset_upload_file544_6111.pdf#search='patients willing pay pharmacist'
 

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We have a few very busy MTM's currently in my county. In SF & San Mateo county there are more......so....MTM is a very big deal here.

Also....to all of you who are so busy, why don't you have time to counsel? So...what happens if you tell the pt the rx won't be ready for 30 min? Does your employer really get down on you? What is the worst that can happen?

I've never had an employer tell me I had to work faster - a tech, yes - & I told that tech where she could get off! But...if my employer told me I had to work faster, I'd get right on my letter of resignation as fast as I could.

I really am not trying to make judgements on the choices others make - we each have to make our own. However, sometimes, pharmacists are their own worst enemies. Unless you own your own pharmacy....it is not your money that is made. You are paid if you fill 50 or 500. I tell pts honestly how long it will take - its not uniform - it depends on how busy I am, if I'm working alone, if I'm closing for lunch...whatever. Sometimes they get mad, but oh well.......I can't make everyone happy. My job is to give them their medication & not kill them in the process.

I had a boss once who wanted to get a certain # of rxs filled so he could get the maximum bonus. But...the carrot was always out of reach. I finally told him...why not just work at the pace you are comfortable with & be happy with the income you make? We all make the same rate of pay & he's a much happier person now. That's just my own opinion & of no more importance than anyone else's!
 

pharmaz88

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SpirivaSunrise said:
Ummm...quite a few of you are sorely mistaken. Don't shoot your mouths off and try to pass it off as a fact. Your opinions are just that...so don't presume to know what the public wants.
Nice detective work there.

I deal with the public, several hundred of them, every time I step foot into the pharmacy. I can tell you that years of my repeat interactions with pharmacy-going members of the public translates into just as valid a judgement of their pharmaceutical needs and desires, as does a mail survey sent to random people off a marketing list.

But hey, your article found a majority (56%, well I suppose that technically that's a majority) are willing to pay an average of $23 per session or $50 for a year of MTM. I'll give you that. ...but as Jeddevil pointed out, good luck trying to show any profitability in that.

As those of us 'shooting off our mouths' have acknowledged, there is value in MTM. And the fact that there's some thriving MTM clinics in sdn1977's neck of the woods supports that. But there will never be enough demand for it to justify the attempts by some to totally change the face of retail pharmacy, which goes back to my original comment.
 

BME103

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I would like to respond to the article posted by SpirivaSunrise. But first, let me say that I do not doubt there are benefits to MTM services.

The inherent problems with mail survey is that usually only a small number of those who received the survey mail it back and those who do tend to be more favorable to the survey question (e.g. pharmacists in this case). This leads to selective sampling and the results may be biased. The fact that only 7.6% responded to the survey and the sample size does not represent the U.S. population (60% females, and 15% more high school graduates than the national average and more than double the U.S. college graduate > higher education > higher income) leads me to question the results of this survey.

However, even if the survey results accurately represented the opinion of the U.S. population, I question the practicability of the results. For a one-time consultation fee of $13 and $28 for this plus 1 year of monitoring, pharmacists will "consistently do the following tasks for all medications: provide detailed counseling, monitor for outcomes of medication use, check for appropriateness of medications based on individual medical history, and consult with physicians to ensure that the best possible medications are being prescribed". If you are being paid $45-55 an hour as a pharmacist, would you do all of that work for 1 year for $28? What if you have to pay higher liability insurance or/and share the $28 with the physicians, would you still do?
 

sdn1977

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BME103 said:
I would like to respond to the article posted by SpirivaSunrise. But first, let me say that I do not doubt there are benefits to MTM services.

The inherent problems with mail survey is that usually only a small number of those who received the survey mail it back and those who do tend to be more favorable to the survey question (e.g. pharmacists in this case). This leads to selective sampling and the results may be biased. The fact that only 7.6% responded to the survey and the sample size does not represent the U.S. population (60% females, and 15% more high school graduates than the national average and more than double the U.S. college graduate > higher education > higher income) leads me to question the results of this survey.

However, even if the survey results accurately represented the opinion of the U.S. population, I question the practicability of the results. For a one-time consultation fee of $13 and $28 for this plus 1 year of monitoring, pharmacists will "consistently do the following tasks for all medications: provide detailed counseling, monitor for outcomes of medication use, check for appropriateness of medications based on individual medical history, and consult with physicians to ensure that the best possible medications are being prescribed". If you are being paid $45-55 an hour as a pharmacist, would you do all of that work for 1 year for $28? What if you have to pay higher liability insurance or/and share the $28 with the physicians, would you still do?
Your comments are well spoken. In addition, some of the things seem a bit altruistic as written by this survey.....monitor for outcomes of medication use - this seems to specifiy all outcomes on all medications. From my experience, we monitor for 1 or 2 - certain INR, how frequently the "voices" are heard on Seroquel, bs between this & this.....very specific outcome & denfinitely not all outcomes.

In addition, we currently check the appropriateness of medications based on pts "medication" history. I'm not sure a medical history is feasible. If someone came to me & said oh by the way...how will this new protonix affect my immunodeficiency of VonWillebrand Factor ....well.....I'm sure still gonna have to defer to the physician on that one. I'm no hematologist & won't set myself up as one!

Finally, I think the point that is the most important is the detailed pt counseling & the return info back to the physician. From other posts, we don't give enough counseling - even if we want to. And most of us don't get back to the physicians, even though we know it might be beneficial. We just say to the pt....I think you should let your Dr know about that. Well...they often have to wade thru the receptionist, then the nurse & it may or may not be perceived as important by those people so it might not even get to the physician - the old game of "telephone". If we have an official form which is faxed...it will be noted & tossed or it might initiate a call to the pt.

I think the idea is to try to step outside the box we're in right now. We have hundreds of times the medications we had 50 years ago, but our practice methods are the same, for the most part. As phamarmacists..we have to be the force for our own change & it should be well thought out & productive not just for the pt, but also for the prescriber. Reimbursement's gonna change for all providers - not just us. But.....what are we going to want to include in our reimbursements? Is it just going to be the product (drug) - which your corporate employers will want to count... Or will it also include service - which will force your corporate employers to use a different mechanism to value your productivity.

Just some thoughts.......and too much rambling....sorry.
 

SpirivaSunrise

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BME103 said:
I would like to respond to the article posted by SpirivaSunrise. But first, let me say that I do not doubt there are benefits to MTM services.

The inherent problems with mail survey is that usually only a small number of those who received the survey mail it back and those who do tend to be more favorable to the survey question (e.g. pharmacists in this case). This leads to selective sampling and the results may be biased. The fact that only 7.6% responded to the survey and the sample size does not represent the U.S. population (60% females, and 15% more high school graduates than the national average and more than double the U.S. college graduate > higher education > higher income) leads me to question the results of this survey.

However, even if the survey results accurately represented the opinion of the U.S. population, I question the practicability of the results. For a one-time consultation fee of $13 and $28 for this plus 1 year of monitoring, pharmacists will "consistently do the following tasks for all medications: provide detailed counseling, monitor for outcomes of medication use, check for appropriateness of medications based on individual medical history, and consult with physicians to ensure that the best possible medications are being prescribed". If you are being paid $45-55 an hour as a pharmacist, would you do all of that work for 1 year for $28? What if you have to pay higher liability insurance or/and share the $28 with the physicians, would you still do?
I apologize if I came across as supporting every method and result that was found in those studies. My intention was only to state that we cannot assume to know what the public wants just because something has never been provided before. Like sdn1977 says...it may be time that we step outside of the box...
 

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museabuse said:
We are supposed to be counseling now for free... ever try and and charge for something that used to be free... people won't buy it.
Have you every purchased bottled water before? Perceptions change.
 

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I will be pumped for electronic rx's at my ghetto pharmacy. I wont have to deal with the TONS of fake, stolen and altered scripts like i do now. No more getting #10 getting changed to #100, refills added and so forth so bring it on. As for MTM, when i can get some one to get off their cell phone so i can council them, then we can talk about MTM.
 

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kvl1027 said:
Maybe they can make a software where the Doc, actually has to type it out.

If there was just a way to inform the public about the importance of managed therapy, instead of them just assuming the Doc knows everything.

My brother-in-law was prescribed antidepressants by a family doc, what does he really know about antidepressants? Does he have any business doing that or should he have given him a referal to a specialist? I dont know, may he does know what he is talking about, but it seems like everytime someone goes the doctor because they have a cough, they walk out with a script for antibiotics. It sems like the doc just wants to give them something to make them happy, and generally it does make pts happy. There has to be something we can do to educate the public.
Oh, where to start....

The prescribing programs for physicians do have the ability to type out the full prescription. Hopefully, you are not suggesting that no drop down be available to those studid doctors, who are clearly too dumb to be able to consistently and accurately pick the correct drug and sig. I will not use drop down menus if you promise to hand type every label you attach to a bottle..

I sense a disconnect between your perception of physician capability and what actually occurs. Unless I am seriously inferring incorrectly from your post, you seem to have the opinion that family physicians are not capabler of taking care of even simple medical problems and those which would require involvement of specialists. Specifically for depression, FP doctors are trained in the scoring and use of the PHQ-9 scale, Edinburgh postnatal depression scale (for post-partum depression), and the GDS (geriatric depression scale).

I suggest you concentrate on learning how to be a good pharmacist, and less time berating other professions at this time in your career.

Right now you remind me of the Pharm D resident who was going to round with us on our in-patient service for 2 weeks - At the first time I met her at table rounds prior to going to the floors, I introduced myself and welcomed her to the team. I didn't know her or her title (i.e pharmacist, medical student, etc). When she told me she was a pharmacist, I told her that I was previously a pharmacist also. Her response - "You were a B.S."
 

sdn1977

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Pilot said:
Oh, where to start....

The prescribing programs for physicians do have the ability to type out the full prescription. Hopefully, you are not suggesting that no drop down be available to those studid doctors, who are clearly too dumb to be able to consistently and accurately pick the correct drug and sig. I will not use drop down menus if you promise to hand type every label you attach to a bottle..

I sense a disconnect between your perception of physician capability and what actually occurs. Unless I am seriously inferring incorrectly from your post, you seem to have the opinion that family physicians are not capabler of taking care of even simple medical problems and those which would require involvement of specialists. Specifically for depression, FP doctors are trained in the scoring and use of the PHQ-9 scale, Edinburgh postnatal depression scale (for post-partum depression), and the GDS (geriatric depression scale).

I suggest you concentrate on learning how to be a good pharmacist, and less time berating other professions at this time in your career.

Right now you remind me of the Pharm D resident who was going to round with us on our in-patient service for 2 weeks - At the first time I met her at table rounds prior to going to the floors, I introduced myself and welcomed her to the team. I didn't know her or her title (i.e pharmacist, medical student, etc). When she told me she was a pharmacist, I told her that I was previously a pharmacist also. Her response - "You were a B.S."
Pilot - I will aplogize for my colleagues - both the insenstitive student you encountered and the individual who felt drop down menus were not suitable for electronic transcribing.

I do think there are issues with the drop down menus - especially when your staff & not you, is transcribing the prescription. XL, SR & no initials (think Wellbutrin) cause lot of confusion with regard to actual strengths & dosing which initiate phone calls to you - as you well remember from being a pharmacist. This is not a critizism of prescribers nor pharmacists - just the similarities corporations have chosen to market & name their products.

Electronic prescribing has indeed brought a new set of drug errors to pharmacists. Once you, as a prescriber, as entered the rx into your system...its in there for good. When I call for call for claification as a pharmacist, I get your office staff & they read exactly what you or your assistant entered, which was what I know, but most likely, not what you wanted & ( usually turns out really not what you wantedl) It is just very hard to fix a an error -whether it is generated by you, me or an office person. But - we have to keep in mind the pt first & try to get their situation fixed.

I, unfotunately, have to agree with you with the disdain you encountered with your BS in pharmacy. There seems to be an uncommon amount of this in these threads & these young people have no idea what all of us who have been around for awhile can offer. Perhaps one of us later will save them from a bad mistake, but untl then...I'd be happy to work with you anytime! Where are you now & where did you get your degee in pharmacy? I myself gained my PharmD in an era in which PharmD's were common in my state, but not others. I've worked with many BS Pharmacists and have found them no diffierent clinically than myself & have abilities insome areas beyond mine.

There is absolutely no place, in my mind for berating other professions nor other degress within our own profression. I hope you continue your willinginess to work with us to further rational medication use in the new era of electronice prescribing. Thanks for your input!
 

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sdn1977

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Pilot said:
B.S. in Pharmacy 1997 - SWOSU (Southwestern Oklahoma State University - Weatherford, OK)
I'd work with you & be proud to do so even though I received my PharmD 20 years before you & CA. You'd have a lot to teach me & I you, hopefully!

Best of luck!
 

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PhatPharm said:
In school they told us that miss-readings of Dr.'s handwriting is the single biggest sources of drug errors. Is that right?
Yea doctor's hand writing is a source of error. But I think it's significantly overblown, b/c nurses will administer drugs, without making sure that is the drug a doctor wants. I mean I can count on my fingers how many times I dispensed a wrong drug b/c of doctor's handwriting. And when you are not sure, call them up, that's eazy. I think that electronic order entry will be welcome change, but it will be definetly more time consuming. The good thing is that you could probably access pt's meds and notes off the computer at home, rather than having to call in or worry if your verbal order was taken correctly. It will cut down on errors, but I think it won't make much of a difference for people who pay attn and are dilligent in calling when unsure of the drug. A lot of the times drugs may look similar, but rarely are the doses similar, so you can tell what drug it is. I must say once an error occurred that Zestril was dispensed instead of Zetia. But that's one of those rare situations, and RN immediately caught on to that.

So to end my rant, yea doctor's writing may lead to error, but if ancillary stuff is vigilant and takes a little more time to clarify ambigous orders, errors due to bad pennmanship will be significantly reduced.
 

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Oh, where to start....

The prescribing programs for physicians do have the ability to type out the full prescription. Hopefully, you are not suggesting that no drop down be available to those studid doctors, who are clearly too dumb to be able to consistently and accurately pick the correct drug and sig. I will not use drop down menus if you promise to hand type every label you attach to a bottle..

I sense a disconnect between your perception of physician capability and what actually occurs. Unless I am seriously inferring incorrectly from your post, you seem to have the opinion that family physicians are not capabler of taking care of even simple medical problems and those which would require involvement of specialists. Specifically for depression, FP doctors are trained in the scoring and use of the PHQ-9 scale, Edinburgh postnatal depression scale (for post-partum depression), and the GDS (geriatric depression scale).

I suggest you concentrate on learning how to be a good pharmacist, and less time berating other professions at this time in your career.

Right now you remind me of the Pharm D resident who was going to round with us on our in-patient service for 2 weeks - At the first time I met her at table rounds prior to going to the floors, I introduced myself and welcomed her to the team. I didn't know her or her title (i.e pharmacist, medical student, etc). When she told me she was a pharmacist, I told her that I was previously a pharmacist also. Her response - "You were a B.S."
If you read my post again you might notice that there was no berating of any other profession. I apologize if I came off that way, but I assure you that was not my intent. As a matter a fact I made most of my staements in the form of a question, because I didnt know if an FP was qualified to make that decision. You now have answered this question which is much appreciated. I know it is easy to feel like when someone makes a critical statement about a physician that you are personal being attacked, but there is no need to be too sensitive. I fully intend on directing my energy into being a good Pharmacist, I was just simply adding some matter to the discussion.

As far as the drop down menu is concerned, someone made a comment about its faults and I simply made a suggestion, which you clearly answered with sarcasm. Once again no need to be too sensitive, I admit that I am a somewhat of a noob to this whole process and I have no problem being educated from you about the "ins and outs". I respect your knowledge and there is no need to feel like you profession or competance is being berated.
 

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Pilot said:
Right now you remind me of the Pharm D resident who was going to round with us on our in-patient service for 2 weeks - At the first time I met her at table rounds prior to going to the floors, I introduced myself and welcomed her to the team. I didn't know her or her title (i.e pharmacist, medical student, etc). When she told me she was a pharmacist, I told her that I was previously a pharmacist also. Her response - "You were a B.S."
I am sorry your feeling was hurt but she only pointed out the obvious.
 

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npage148 said:
I will be pumped for electronic rx's at my ghetto pharmacy. I wont have to deal with the TONS of fake, stolen and altered scripts like i do now.
I am in favor of electronic prescriptions. It makes our job a little easier but it is pretty easy to create your own electronic prescriptions. I can pretty much create one using Microsoft Words.

I received an electronic prescription last week. Everything on the prescription looked fine but I thought it was strange because it was prescribed for 2 packs of Z-Pak instead of the usual quantity of just 1. I told the costumer that I had to call the physician to verify the direction. Of course, she didnt want me to but I did it anyways. It turned out the "hospital" doesn't exist and the DEA # was also fake (if the 1st letter is not A or B, or the 2nd letter is not the prescriber's last name initial, then it is a fake). I told her I can't fill it and she quickly left the pharmacy. I think she went home to print out another electronic prescription.
 

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BME103 said:
I am in favor of electronic prescriptions. It makes our job a little easier but it is pretty easy to create your own electronic prescriptions. I can pretty much create one using Microsoft Words.

I received an electronic prescription last week. Everything on the prescription looked fine but I thought it was strange because it was prescribed for 2 packages of Z-Pak instead of the usual quantity of just 1. I told the costumer that I had to call the physician to verify the direction. Of course, she didnt want me to but I did it anyways. It turned out the "hospital" doesn't exist and the DEA # was also fake (if the 1st letter is not A or B, or the 2nd letter is not the prescriber's last name initial, then it is a fake). I told her I can't fill it and she quickly left the pharmacy. I think she went home to print out another electronic prescription.
Yeah, when I mean electronic, I mean computer to computer with no paper scripts for the patient to have.
 

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BME103 said:
I am in favor of electronic prescriptions. It makes our job a little easier but it is pretty easy to create your own electronic prescriptions. I can pretty much create one using Microsoft Words.

I received an electronic prescription last week. Everything on the prescription looked fine but I thought it was strange because it was prescribed for 2 packs of Z-Pak instead of the usual quantity of just 1. I told the costumer that I had to call the physician to verify the direction. Of course, she didnt want me to but I did it anyways. It turned out the "hospital" doesn't exist and the DEA # was also fake (if the 1st letter is not A or B, or the 2nd letter is not the prescriber's last name initial, then it is a fake). I told her I can't fill it and she quickly left the pharmacy. I think she went home to print out another electronic prescription.
The electronic prescribing which is being referred to in the article is an integrated information management system which functions, in the most simplistic way, electronically directly between prescriber and pharmacy. The patient does not receive a "printed" prescription.

However, in its more complex sense, it involves the PBM or insurance company & prescriber & pharmacy so the prescriber can access the formulary item on the patient's plan & not have to wait for us to send that information back when the claim is rejected.

For both ends of the spectrum, there are hurdles involved. The largest is the sheer comlexity of pharmaceutical data. We have thousands of line items of choices available. Another hurdle is the cost for the prescriber. They not only have to purchase the hardware & software, they usually have user fees & montly fees to maintain the data base in a current fashion.

Pharmacies already have electronic, real-time communication in place. But..we forget it took years & years to have that process become standard. We are used to the cost of maintaing our online data bases, but physicians are not.
 

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I thought you guys meant computer printed prescriptions. We receive prescriptions via email as well but not too many. I can pretty much say it will take more than a few years before electronic prescriptions will be widely used. People don't like changes especially when it will cost them money.
 

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Nope - these electronic ones are not the ones which are printed that you have seen.

Actually, in my area, they are becoming more and more common. Kaiser for one (where is Kwizard???) has had electronic prescribing in place for a long time.

We also have 2 separately large clinics (not Kaiser) - one has about 300 physicians of almost every speciality & the other is smaller - about 200. All the pharmacies in the area are on their electronic transmission link & they are on ours. We no longer fax & receive refill requests - that all goes electronically.

The real dilemma that occurs is when the information gets to a clinic the size of these or Kaiser....it goes thru a layer of people (clerks) who receive this information electronically. In one clinic - the large one, they clerk not only sends it on, she/he decides what to add or not add. That is when we get errors. I may ask, for example a clarification of dose - the pt says she takes 2 tablets...well, my refill request comes back approved for what the original rx said. The person who was reading my electronic request overlooked that I was asking for a dose increase. The other clinic, the ISS people just shoot it right to the appropriate physician's office.

I would like this layer to be removed & a more standard ISS technology to be in place to do things like verify doses, sigs, clarify directions, etc...that is not yet standard between the different systems out there.

This is all really, really expensive stuff and within the healthcare ISS information, there is a bit of a battle going on as to whose platform will become the standard. This is all tied up too in the standardization & encryption of all patient information so pts can essentially take their medical records with them on a small chip size device whereeve they go. So...we are not isolated in the discussion of how to make the information more accessible & available.
 

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sdn1977 said:
This is all really, really expensive stuff and within the healthcare ISS information, there is a bit of a battle going on as to whose platform will become the standard. This is all tied up too in the standardization & encryption of all patient information so pts can essentially take their medical records with them on a small chip size device whereeve they go. So...we are not isolated in the discussion of how to make the information more accessible & available.
It is actually very easy to do, and not expensive. Certain dialysis instruments are equipped with a patient data card. This card has the same footprint as a credit card and contains a SIMM (much like cell phones). On this card the HCP p[rograms the prescription. The patient can then go to any dialysis facility with the same instruments and recieve therapy without excess rigor.

Now couple this mid 80's technology with a new finger-print id system (the technology is in place and cheap) and you have a completely encrypted script. If you wanted to make it really fancy, go with a USB 2.0 thumb drive. In these scenarios, the hardware exists as off the shelf components available at Staples, Office Depot, and Best Buy. The only thing to be developed is a GUI applet. Give me a good coder and 3 weeks and it would be knocked out.


Hmmm....guess I need to submit this up the food chain. Thx for the idea SDN ;)
 

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ForcedEntry said:
It is actually very easy to do, and not expensive. Certain dialysis instruments are equipped with a patient data card. This card has the same footprint as a credit card and contains a SIMM (much like cell phones). On this card the HCP p[rograms the prescription. The patient can then go to any dialysis facility with the same instruments and recieve therapy without excess rigor.

Now couple this mid 80's technology with a new finger-print id system (the technology is in place and cheap) and you have a completely encrypted script. If you wanted to make it really fancy, go with a USB 2.0 thumb drive. In these scenarios, the hardware exists as off the shelf components available at Staples, Office Depot, and Best Buy. The only thing to be developed is a GUI applet. Give me a good coder and 3 weeks and it would be knocked out.


Hmmm....guess I need to submit this up the food chain. Thx for the idea SDN ;)
The difficulty, is not necessarily in programming....it is getting everyone on the same page. It took YEARS for electronic claim submission to be standardized. Currently state laws vary with regard to how each one will handle controlled drugs. Some systems are easier to "crack" into than other systems which would allow fraudulent rxs to be transmitted. There are multiple vendors, some which incorporate pt demographic, h&p & lab data & some that don't.

And yes - it is expensive. It ususally requires a software upgrade which may or may not require a hardware upgrade. The prescriber user fee is anywhere from $80-400/mo & often there is a transaction fee. This is not small change for a prescriber, particularly when he can write the lisinopril rx in 2 minutes by hand & for free.

If you're interested, there are a number of studies which have been reported in the Journal of Healthcare Infomation Management.
 

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sdn1977 said:
If you're interested, there are a number of studies which have been reported in the Journal of Healthcare Infomation Management.

Since I work in Medical device R&D I am. Maybe I can grease the squeaky wheel or get some decision makers around here to "think" about it. I just have to postulate financial gains for the company that are reasonable to prescribers...yada yada

Any links would be great.
 

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ForcedEntry said:
Since I work in Medical device R&D I am. Maybe I can grease the squeaky wheel or get some decision makers around here to "think" about it. I just have to postulate financial gains for the company that are reasonable to prescribers...yada yada

Any links would be great.
Ok....I'll give you one which was talked about on another thread. You can read a summary of a presentation by an individual who spoke on behalf of the APhA to the DEA on July 11 with regard to electronic prescribing of controlled substances. He went into the currently proprosed NCPDP Script Standard version 5.0 which is the currently recognized technology for electronic communication between prescribers & pharmacists.

He also alluded to the Electronic Signatures Global & National Commerce Act (E-sign) in which electronic signatures are treated as equivalent to written signatures..

This was reported in the July 17 APhA Journal so it should be accessible.

I'd also advise, as I recommended before, becoming involved in reading what is happening by either subscribing or becoming familiar with the Journal of Healthcare Information Management & the people within that field.

It is not enough to just have the technology. You have to make people want to use it. For example...my husband is a dentist. He has no interest in electronic prescribing - for him it is far too expensive. He writes about 10 rxs a month - mostly abx, but a few pain things or antivirals. This is definitely too costly for him. But...if it is just a part of his practice management system, - eh....its fine. He may or may not use it & he is a techno geek. He says its just easier to get on the phone & call it in.

So...you see...its not for everybody & with valid reasons. But there's a start for you to get some background into the reasons behind it.

Good Luck
 

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BME103 said:
I am sorry your feeling was hurt but she only pointed out the obvious.
I wouldn't say my feelings were hurt, I was just taken aback. I had never even met this girl, but she knew I was a BS pharmacist because her supervisor knew my wife and I when we went to pharmacy school, and he and I play basketball together once a week.

I will admit that I then asked her numerous questions that month of which I knew the answer, just so I could correct her publicly, with references supplied the following day in front of the medical residents and students. I also asked her supervising pharmacist to give her some didactic lectures on several common topics in which her information was sorely lacking (a deficiency he had noted independently).

She rotated through the NICU/PICU the next month and argued with the pediatic intensivists several times, being proven wrong on every instance. It was quite a delight to watch.
 

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Pilot said:
I will admit that I then asked her numerous questions that month of which I knew the answer, just so I could correct her publicly, with references supplied the following day in front of the medical residents and students. I also asked her supervising pharmacist to give her some didactic lectures on several common topics in which her information was sorely lacking (a deficiency he had noted independently).
I guess you acted really professional here, kinda pathetic as well.
 

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Pilot said:
I wouldn't say my feelings were hurt, I was just taken aback. I had never even met this girl, but she knew I was a BS pharmacist because her supervisor knew my wife and I when we went to pharmacy school, and he and I play basketball together once a week.

I will admit that I then asked her numerous questions that month of which I knew the answer, just so I could correct her publicly, with references supplied the following day in front of the medical residents and students. I also asked her supervising pharmacist to give her some didactic lectures on several common topics in which her information was sorely lacking (a deficiency he had noted independently).

She rotated through the NICU/PICU the next month and argued with the pediatic intensivists several times, being proven wrong on every instance. It was quite a delight to watch.
I must agree with BME here....what was the motivation other than your own personal "hurt" which would cause you to want to publicly humilate a colleague day after day? That reflects poorly not only on you, but also on your own training as a pharmacist, in my opinion.

You could have taken the high road and help instruct and work with her and shown her, by example, there is no professional differece between the degrees - or perhaps better yet, spoken to her supervisor in a private setting. However, now you have someone who really probably could care less about your training as a pharmacist & in her youth & inexperience insulted you. Now you have shown her that your goal is not to be her colleague in her education, your goal is to show her you are better, which you didn't. You only presented circumstances deliberately, in which she would be slighted. The others on rounds also see you as someone who cannot let a slight go by.

Is that really how you want to view yourself? Is that how you want your wife or her colleagues & the rest of us on this forum which have read your story to view you? I was very supportive of your BS in pharmacy & still am. However, if this is an example of how well you work with others professionally, it was an unfortunate example! Honestly, I would have expected better of someone who has chosen to go on to medicine after pharmacy.
 

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sdn1977 said:
I must agree with BME here....what was the motivation other than your own personal "hurt" which would cause you to want to publicly humilate a colleague day after day? That reflects poorly not only on you, but also on your own training as a pharmacist, in my opinion.

You could have taken the high road and help instruct and work with her and shown her, by example, there is no professional differece between the degrees - or perhaps better yet, spoken to her supervisor in a private setting. However, now you have someone who really probably could care less about your training as a pharmacist & in her youth & inexperience insulted you. Now you have shown her that your goal is not to be her colleague in her education, your goal is to show her you are better, which you didn't. You only presented circumstances deliberately, in which she would be slighted. The others on rounds also see you as someone who cannot let a slight go by.

Is that really how you want to view yourself? Is that how you want your wife or her colleagues & the rest of us on this forum which have read your story to view you? I was very supportive of your BS in pharmacy & still am. However, if this is an example of how well you work with others professionally, it was an unfortunate example! Honestly, I would have expected better of someone who has chosen to go on to medicine after pharmacy.

:clap: :clap: :clap: :clap:
 

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Believe me, I took the high road for 2 weeks, but after having to argue with her about whether or not a patient had a negative C. Diff. test for 2 days in a row (she thought she had seen it as positive on the computer, but was unable to find it again - never bothering to call the micro lab as I had), whether digoxin overdose can cause bradycardia (it can), whether magnesium is truly used for eclampsia (it is), whether Vancomycin will cover Pseudomonas (it doesn't), whether Advair can be given to a child under the age of 12 (it can), whether Advair can be dosed TID (it should not due to increased risk of seizure), and whether or not I needed to give a Beta-blocker to a CHF patient in the ICU on pressors who was acutely hypotensive and bradycardic (I had held the Coreg, but "the CHF guidlelines say you have too"), I had my reached my limit. There is a hierarchy to medicine rounds, and the physician has the ultimate right to decide what meds and when, because that is where the ultimate liability lies. Input from other disciplines is appreciated, but not when it is consistently incorrect, as in this case.

Keep in mind, all of her arguments were during rounds in front of other medicine residents and students, and in virtually every instance she would automatically take the opposite stance of my view. Hence, my responses would also be on rounds in front of everyone. She never once pulled me aside to address any patient concerns, but instead choose to voice her disapproval publicly and vocally.

A person can only take so much. So you guys can keep on beating me up, but I stand by my actions. Sometimes aggression can only be met with aggression, otherwise the initial aggressor will come to believe that his/her actions are justified at the expense of everyone else.

And by the way, my conversation with her supervisor did take place in private, in warm-up on the basketball court, after he approached me asking about her interactions with the team. Another medicine resident had gone to him to advise him of her antagonism towards not just me, but everyone. She was so disliked by all, that when she left at the end of her month we had a little celebration. She earned herself quite a reputation at the hospital, both among physicians and the clinical pharmacists (with whom she would also argue on a regular basis).

This is my second try to post this. Sorry if it repeats, but initially when I posted this I was kicked back out to the log-in screen
 

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Pilot said:
Believe me, I took the high road for 2 weeks, but after having to argue with her about whether or not a patient had a negative C. Diff. test for 2 days in a row (she thought she had seen it as positive on the computer, but was unable to find it again - never bothering to call the micro lab as I had), whether digoxin overdose can cause bradycardia (it can), whether magnesium is truly used for eclampsia (it is), whether Vancomycin will cover Pseudomonas (it doesn't), whether Advair can be given to a child under the age of 12 (it can), whether Advair can be dosed TID (it should not due to increased risk of seizure), and whether or not I needed to give a Beta-blocker to a CHF patient in the ICU on pressors who was acutely hypotensive and bradycardic (I had held the Coreg, but "the CHF guidlelines say you have too"), I had my reached my limit. There is a hierarchy to medicine rounds, and the physician has the ultimate right to decide what meds and when, because that is where the ultimate liability lies. Input from other disciplines is appreciated, but not when it is consistently incorrect, as in this case.

Keep in mind, all of her arguments were during rounds in front of other medicine residents and students, and in virtually every instance she would automatically take the opposite stance of my view. Hence, my responses would also be on rounds in front of everyone. She never once pulled me aside to address any patient concerns, but instead choose to voice her disapproval publicly and vocally.

A person can only take so much. So you guys can keep on beating me up, but I stand by my actions. Sometimes aggression can only be met with aggression, otherwise the initial aggressor will come to believe that his/her actions are justified at the expense of everyone else.

And by the way, my conversation with her supervisor did take place in private, in warm-up on the basketball court, after he approached me asking about her interactions with the team. Another medicine resident had gone to him to advise him of her antagonism towards not just me, but everyone. She was so disliked by all, that when she left at the end of her month we had a little celebration. She earned herself quite a reputation at the hospital, both among physicians and the clinical pharmacists (with whom she would also argue on a regular basis).

This is my second try to post this. Sorry if it repeats, but initially when I posted this I was kicked back out to the log-in screen
As someone else on this thread previously said...oh where to start....

This thread was originally about electronic transmission of prescription data...which was misunderstood by many. You took offense by someone's comment about the errors of drop down menus (of which there are many & actually documented in pharmacy drug information management literature) & the implication physicians cannot use them.

That aside...then you went on to criticize this pharmacy student because she referred to your degree in a disparaging manner.

Now..however, the story becomes more complete...she did not just disparage your degree, she also had inadequate or incomplete knowledge & an aggressive & immature demeanor. It appears others had difficulty with her - not just you. However, in your mind...which motivated a gleeful post....you were a continual source of antagonism. That is not to say she was not equally antagonistic - obviously, there was something wrong in her interpersonal skills to have caused such animosity.

My point here is that she would have taken care of her own reputation without any help from you. Your involvement...and the reporting & pleasure you gained from participating in it only reflects back on yourself, IMO.

I'm going to assume you are a student as well - either medical or still in your residency. Let me give you a tip when you are actually an employer. No personnel conversations should take place anywhere other than a private business area. It was inappropriate for her supervisor & for you to discuss this individual's participation on a basketball court - even if you were the only two persons around. Having been both employee & employer, if you don't follow the rules of correct business labor etiquette, law & documentation, you may be right - but you'll lose your case.

I've been on plenty of hospital rounds & in teaching hospitals, this behavior is not unique to just pharmacy students. Many different kinds of students need to learn interpersonal skills & often this is the place residents (both medical & pharmacy) learn the patience to deal with young inexperienced newcomers. This is where they find out if they are cut out for a teaching role or for a private practice role. This is where students learn - not just didactics (which was a boat she needed no help apparently in sinking) but how to work with other health professionals. Perhaps you have learned you have great medical knowledge, but not much patience when presented with someone who has lesser knowledge & a need to learn how to interact in a multidisciplinary setting - which medical attendings learn how to do in a patient & supportive way. Perhaps you have discovered private practice, where there will be very little challenge to your authority, is the place for you.

We will have to agree here to disagree. I do not feel agression must be met with agression. You have no regrets & perhaps she does not either. In either case, it is too bad because the situation might have developed differently.

What could have happened if you had one day after rounds or at another time asked if the two of you could sit down over coffee? As a pharmacist, you could have approached her about her manner, which you knew early on was off putting. You had a unique perspective the other medical students & medical residents did not - you are a pharmacist yourself. However, you chose not to help this girl develop what she was lacking in interpersonal skills. The team you became was "us" against "her" - not just "us". Perhaps you could never have turned it around, but the point was - you didn't try. You just chose to ignore her arguments rather than taking what you are as a pharmacist & turning it around to a learning opportunity for both of you. However, her own clinical supervisors apparently were sorely lacking in teaching skills as well. These should have been the first people who intervened.

Whatever....she is gone & you have not only have no regrets you also had a celebration. However right you may have been - it still appears you all lost something with this encounter & none of you found anything which strengthens yourself professionally. As someone who has taught in a pharmacy school & been in the cirumstance of witnessing inappropriate medical & pharmacy student behavior....I can only observe this month of interaction did not reflect well on either of you!
 

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It is not a matter of disagreement. That is fine and should be encouraged. However, your desire to make her look bad not only shows your malice for her but it also shows how poorly you have conducted yourself as a health care professional.

I think her comment about your degree bothered you greatly. The fact that you started a thread about the lack of difference between your BS degree and the current Pharm.D. degree confirms this. However, I think this has to do more about your self esteem or the lack of it. As a result, you have the need to be always right and more importantly, to be respected and praised. I think her comment only not offended you but also embarrassed you in front of your collegues. I am sorry that you ego got hurt but the way you have conducted yourself is just pathetic.

I also sense that you have the need to have the last word in any argument so I will step back and let you.
 

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PILOT -- Way to hijack a thread and turn it into your own personal bi#ch session about how the mean little pharmacy student called you an RPH. Who cares!! The fact that you remember all the things that she disagreed with you on, right or wrong, shows that you are a pathetic, bitter individual. Grow up and get over it, or at least go cry about it somewhere else.
 

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sdn1977 said:
As someone else on this thread previously said...oh where to start....

This thread was originally about electronic transmission of prescription data...which was misunderstood by many. You took offense by someone's comment about the errors of drop down menus (of which there are many & actually documented in pharmacy drug information management literature) & the implication physicians cannot use them.

That aside...then you went on to criticize this pharmacy student because she referred to your degree in a disparaging manner.

Now..however, the story becomes more complete...she did not just disparage your degree, she also had inadequate or incomplete knowledge & an aggressive & immature demeanor. It appears others had difficulty with her - not just you. However, in your mind...which motivated a gleeful post....you were a continual source of antagonism. That is not to say she was not equally antagonistic - obviously, there was something wrong in her interpersonal skills to have caused such animosity.

My point here is that she would have taken care of her own reputation without any help from you. Your involvement...and the reporting & pleasure you gained from participating in it only reflects back on yourself, IMO.

I'm going to assume you are a student as well - either medical or still in your residency. Let me give you a tip when you are actually an employer. No personnel conversations should take place anywhere other than a private business area. It was inappropriate for her supervisor & for you to discuss this individual's participation on a basketball court - even if you were the only two persons around. Having been both employee & employer, if you don't follow the rules of correct business labor etiquette, law & documentation, you may be right - but you'll lose your case.

I've been on plenty of hospital rounds & in teaching hospitals, this behavior is not unique to just pharmacy students. Many different kinds of students need to learn interpersonal skills & often this is the place residents (both medical & pharmacy) learn the patience to deal with young inexperienced newcomers. This is where they find out if they are cut out for a teaching role or for a private practice role. This is where students learn - not just didactics (which was a boat she needed no help apparently in sinking) but how to work with other health professionals. Perhaps you have learned you have great medical knowledge, but not much patience when presented with someone who has lesser knowledge & a need to learn how to interact in a multidisciplinary setting - which medical attendings learn how to do in a patient & supportive way. Perhaps you have discovered private practice, where there will be very little challenge to your authority, is the place for you.

We will have to agree here to disagree. I do not feel agression must be met with agression. You have no regrets & perhaps she does not either. In either case, it is too bad because the situation might have developed differently.

What could have happened if you had one day after rounds or at another time asked if the two of you could sit down over coffee? As a pharmacist, you could have approached her about her manner, which you knew early on was off putting. You had a unique perspective the other medical students & medical residents did not - you are a pharmacist yourself. However, you chose not to help this girl develop what she was lacking in interpersonal skills. The team you became was "us" against "her" - not just "us". Perhaps you could never have turned it around, but the point was - you didn't try. You just chose to ignore her arguments rather than taking what you are as a pharmacist & turning it around to a learning opportunity for both of you. However, her own clinical supervisors apparently were sorely lacking in teaching skills as well. These should have been the first people who intervened.

Whatever....she is gone & you have not only have no regrets you also had a celebration. However right you may have been - it still appears you all lost something with this encounter & none of you found anything which strengthens yourself professionally. As someone who has taught in a pharmacy school & been in the cirumstance of witnessing inappropriate medical & pharmacy student behavior....I can only observe this month of interaction did not reflect well on either of you!
You are wise beyond your years and we all have something to learn from you.
 

Baxter81

Senior Member
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Nov 1, 2005
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Jeddevil said:
PILOT -- Way to hijack a thread and turn it into your own personal bi#ch session about how the mean little pharmacy student called you an RPH. Who cares!! The fact that you remember all the things that she disagreed with you on, right or wrong, shows that you are a pathetic, bitter individual. Grow up and get over it, or at least go cry about it somewhere else.
Seriously PILOT, no one wants to hear you whine like a little Bit*H...Go somewhere else loser.