group_theory

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This question applies more toward retail pharmacy

a common trend that I have observed is the general public going to their local pharmacist for solutions to their self-diagnosed problems.

Joe Public might go up to the counter with a self-diagnosed heartburn, and ask the pharmacist for "the best medication to treat this heartburn". Joe Public will not tell you that his heartburn is a substernal pressure with a funny sensation radiation down both arms. He'll just go up to the counter, and ask for heartburn medication

If you were the pharmacist, would you go "there are several OTC medications for heartburn in isle 5 ..." or would you go "sir, i suggest you see your doctor about that heartburn. it might be more serious"

My question (since I'm not a pharmacist/pharm student) is where is the line drawn between answering the question and referring the matter to a physician/Emergency Room?

During cold/flu seasons, you probably get tons of people who have sinus congestions/headaches who just want medications to alleviate their symptoms. Would most of you suggest some type of medication (like that Sudafed commercial with the actor suggesting everyone takes Sudafed) or would you refer them to their physicians?

Basically, where is the line drawn between answering the patient/consumer's question and referring them to the appropriate health care provider?

Not trying to be a troll. I'm just trying to learn more about other professions (by asking questions)

Thanks in advice for your answers
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jdpharmd?

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It's 2:13am and I have an exam at 8am, but I just wanted to add a quick reply. I promise I'll write more when I find some time.

Ok, so first you're suggesting that the patient is having an MI, but he has come to the pharmacy for advice regarding his "heartburn"? That much is obvious.

I'm not quite sure where you're looking to go with the congestion/flu angle. Are you suggesting that we should refer any patient with a cold to his/her PCP? Is the patient somehow an uncontrolled hypertensive or diagnosed with BPH? Narrow angle glaucoma? Are you implying that congestion is somehow a symptom of some other major disease that will go forever undiagnosed without immediate medical treatment?

Part of our job is knowing when a pt should attempt self treatment. For instance, it would be appropriate to suggest a non-sedating H1 antag for a patient who complains of red eyes/sneezing when the cacti are blooming. If a patient has purulent discharge with severe, chronic sinus pressure and a fever, it doesn't make sense to advise them to take some sudafed and get over it.

We LIKE our patients to visit their doctors. It doesn't take any business away from us.

On a final note: I'm not suggesting that ALL of my patients have enough common sense to get step out of the rain, but when they ask for a suggestion, it's just that. A patient isn't going to come strolling in with a missing leg and ask where the band aids are... at least it hasn't happened THIS week.

If you'd like to "treat" everyone with a rhinovirus who demands a full course of broad spectrum antibiotics and a pint of tussionex, I'll be happy to give them your number. ;)
 

loo

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Adding information:

Pharmacists, like other health professionals, are taught to think critically, analyze information, and ask questions---especially ask questions.

Your pharmacy education will give you enough information to "take the training wheels off", but a lot of your education will come from experience, continuing education, and the environment you choose to work in. This is not to say that hospital pharmacists cannot recommend otc products to consumers, etc.

You are not taught to take things at face value. No pharmacist I know would ever just point to an isle without asking questions.
 
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dgroulx

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I've only completed my first semester of pharmacotherapy, but so far we have been taught to ask various questions in order to find out more details. The pharmacist's triage gives you three options; advise the patient to see his/her physician, recommend an OTC, recommend that the patient does nothing. Our preceptor will pretend to be a patient and will have symptoms that may or may not be something more serious and may or may not be on other medication. We have 5 semester of this and it gets progressively more difficult. Experience will help all the more with the more common complaints. In school, the scenarios are not always what you would see in real life.
 
K

kim.

The pharmacists that I work with always ask things like "how long have you had these symptoms" etc and typically will tell the patient that if this is something that persists you need to see your doctor. (in the case of a cold etc) A call that we get quite often is "what can I take for a yeast infection." This is one that we ALWAYS tell them that they must see their doctor because chances are it could be something worse that a yeast infection...
 

group_theory

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jdpharmd? said:
It's 2:13am and I have an exam at 8am,

(snip)

Are you suggesting that we should refer any patient with a cold to his/her PCP?

(snip)

If you'd like to "treat" everyone with a rhinovirus who demands a full course of broad spectrum antibiotics and a pint of tussionex, I'll be happy to give them your number. ;)
First - I want to thank you for taking the time to answer my question, even though you had an exam the next morning (I hope it went well)

And second, I'm not suggesting the pharmacist always refer patients/consumers/customers (what is the correct term anyway?) to their physicians. I'm curious as to when you might refer someone to their physician as oppose to recommending an OTC medication. Do they teach you this in school, or is it something that you pick up along the way (no formal education about this subject)?

Oh - in reference to the Sudafed commercial - in case some of you are unaware of this commercial - it's for Sudafed sinus. In this commercial, people will go up to the pharmacist, tell him their symptoms, and the pharmacist will point to Isle 5 (which is stock only with Sudafed) without asking any questions. I know it is only a commercial but I also know people (including some of my relatives) who would prefer to take their questions first to the pharmacist rather than the doctor. This is probably due to 1. an attempt to save money 2. fear of doctors 3. more people trust pharmacist than physicians (as least that's what someone told me - i don't have any data on that)

Anyway, the Sudafed commercial is the origin of this question. I'm just curious as to how pharmaicists will respond to patient's queries

Beautiful day today - I'll think I'll go study

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28657

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group_theory said:
I'm curious as to when you might refer someone to their physician as oppose to recommending an OTC medication. Do they teach you this in school, or is it something that you pick up along the way (no formal education about this subject)?

Anyway, the Sudafed commercial is the origin of this question. I'm just curious as to how pharmaicists will respond to patient's queries
I can understand your concern with what the Sudafed commercial presented. And to answer your question about formal education - when we learn about all of the OTC drugs we also learn the proper population for recommending those drugs. I'm taking that class right now and it's the one that worries me the most for "real life". Sure, immuno might be a bitch of a class and really hard, but the stuff I learn in my OTC class I HAVE to remember.
 

GravyRPH

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kim31kim said:
The pharmacists that I work with always ask things like "how long have you had these symptoms" etc and typically will tell the patient that if this is something that persists you need to see your doctor. (in the case of a cold etc) A call that we get quite often is "what can I take for a yeast infection." This is one that we ALWAYS tell them that they must see their doctor because chances are it could be something worse that a yeast infection...
That's not always true. The general rule is that if it is a first time yeast infection, then, yes, they should always see their doctor to be sure its what they think it is and not something worse. However, there are many women who have recurrent yeast infections who know that they are having the same symptoms, trigger, etc. This is a population in which we can save a doctor's valuable time by counseling them properly. Recommend a proper treatment, tell them what to expect, and when to see their doctor if things don't improve.
 

Triangulation

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GravyRPH said:
That's not always true. The general rule is that if it is a first time yeast infection, then, yes, they should always see their doctor to be sure its what they think it is and not something worse. However, there are many women who have recurrent yeast infections who know that they are having the same symptoms, trigger, etc. This is a population in which we can save a doctor's valuable time by counseling them properly. Recommend a proper treatment, tell them what to expect, and when to see their doctor if things don't improve.
Wow. Cool Gravy!! dunno if i already learned that this year, but it was good to hear either way.
 

Samoa

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When someone comes to me with a complaint of any kind, I will always ask questions to make sure it isn't something more serious than the person realizes. For example, back when I was an intern I was out in the OTC aisle one day trying to learn stuff, and a guy came up to me asking for a recommendation on something to take for his cough. After a few questions it was clear the man had pneumonia, plus he was over 65, so I told him emphatically to go home, call his doctor, and tell him exactly the symptoms he had told me, and if he was unable to reach his doctor, to go to the emergency room as soon as possible. Most of the time, it IS just a cold, but sometimes you get this gut feeling that there's more going on than just the simple complaint.

But sometimes I don't have time to ask all the questions I would like, and so my practice when making a recommendation has been to give parameters as well for going to see their doctor, or heading for the ER. Patients come to the pharmacist because they don't know if their symptoms are serious enough to bother their doctor, and so simply telling them where the line is between a serious and a non-serious complaint is enough help.
 

jdpharmd?

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A recent NACDS survery found that:

-Consumers said they wanted advice on the relationship between a prescription drug and an OTC medication. Over 50% said they wanted help from somebody in the pharmacy to determine the best medication for them.

-When asked to rate, on a scale of 1 to 10, with 10 being extremely important and 1 having no value, how important is it to have help in the drugstore picking the right OTC product, 73% gave a score of 8 or better and 53% chose 10. When it comes to having help on whether it's ok to take an OTC with an RX medication, 64% of consumers gave a rating of 10.

Taken from Drug Topics, April 5th 2004 :cool:
 
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