Pharmacists can't write excuse notes???

[Deja]

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Your local ED is inadequate if that's true in your area

I guess The 3 different cities I have worked at rural and metro are all inadequate, only you can save us from this mess now, hurry up and graduate the almighty one

 

[Deja]

Oh, I'll also say that in regard to edema, you could have wasted an immense amount of her time as well- if I was working up every patient I had with pedal edema for heart failure, I'd be thrown out of the office. It's like referring everyone with chest pain to the ER, it's just a huge waste of resources for everyone involved. So if acting, your anecdote supports my assessment that pharmacists lack the clinical acumen to provide anything but common sense advice (see your doctor) in the vast majority of situations. And the reason I'm stating all of this is because I'm tired of "provider" creep. Pharmacists are pushing for more patient care and expanded scope not because of qualifications, but because of market saturation leading to desperate scrambling to find new work to be done.

Ummm I told her to see her physician, she chose the ER herself, also my point was that yes I don't know what hell was wrong with her and I wasn't going to diagnose her but I also know that in this case she needed to get herself checked

this whole time you and sb have been talking about that we need to refer every single patient to their doctor for every little thing, my point is that most of the times, we know when to refer and when to just tell people take an antihistamine because they get seasonal allergies every year

I mean seriously, do you really want every single patient with seasonal allergies referred to you guys? I also noticed that you guys never addressed a point that someone else made... would you guys advocate to remove all OTC medications? because OTC is generally for self care, since you guys are advocating everyone should get a full check up for every single small problem (is this not waste of resources?), then OTC would not make any sense

 

[deleted480308]

Ummm I told her to see her physician, she chose the ER herself, also my point was that yes I don't know what hell was wrong with her and I wasn't going to diagnose her but I also know that in this case she needed to get herself checked

this whole time you and sb have been talking about that we need to refer every single patient to their doctor for every little thing, my point is that most of the times, we know when to refer and when to just tell people take an antihistamine because they get seasonal allergies every year

I mean seriously, do you really want every single patient with seasonal allergies referred to you guys? I also noticed that you guys never addressed a point that someone else made... would you guys advocate to remove all OTC medications? because OTC is generally for self care, since you guys are advocating everyone should get a full check up for every single small problem (is this not waste of resources?), then OTC would not make any sense

If the patient makes a self-determination to handle something with over the counter, I have no issue with that as it falls under their own autonomy. Patients make that call knowing it's solely their decision. My concern is that if someone from the health care universe takes on the roll of advising someone they don't need to see a physician for an issue, they are now setting up a situation in which the patient believes they are now confirmed safe enough to not need a physician. Telling someone that they don't need to see a doc for something becomes a situation in which one is issuing a diagnosis. Offering a medical diagnosis, particularly one that leads a patient to not seek timely evaluation from a physician is a moral liability and simply shouldn't happen. It's nothing specific to pharmacists, it's just something non-physicians shouldn't be doing.

 

[Deja]

If the patient makes a self-determination to handle something with over the counter, I have no issue with that as it falls under their own autonomy. Patients make that call knowing it's solely their decision. My concern is that if someone from the health care universe takes on the roll of advising someone they don't need to see a physician for an issue, they are now setting up a situation in which the patient believes they are now confirmed safe enough to not need a physician. Telling someone that they don't need to see a doc for something becomes a situation in which one is issuing a diagnosis. Offering a medical diagnosis, particularly one that leads a patient to not seek timely evaluation from a physician is a moral liability and simply shouldn't happen. It's nothing specific to pharmacists, it's just something non-physicians shouldn't be doing.

The biggest problem here is that you do not think that pharmacist knows when to refer and when to just make a recommendation and if it doesn't work then go see a physician... you'd rather we say nothing at all and refer them straight to you... my question now is, if we really did refer everyone to you, would that not be a waste of resources?

I also think that you are severely under estimating just how many questions we get per hour

 

[deleted480308]

The biggest problem here is that you do not think that pharmacist knows when to refer and when to just make a recommendation and if it doesn't work then go see a physician... you'd rather we say nothing at all and refer them straight to you... my question now is, if we really did refer everyone to you, would that not be a waste of resources?

I also think that you are severely under estimating just how many questions we get per hour

I find a concern about wasting resources to not be important to the question about scope of practice given the training and performance of a history and physical evaluation to develop an accurate diagnosis. Someone takes on a lot of moral responsibility when they, as a professional likely to be believed by a patient, tells a patient their condition isn't serious and doesn't need to be seen by a physician for a proper evaluation. It's inappropriate given the level evaluation that both training and logistics a pharmacist is capable of offering.

But I get it, we're going to end up disagreeing here

 

[VA Hopeful Dr]

Man, this thread is something special.

If y'all will permit me, here are my thoughts as a practicing physician:

I love the doctors that give out too many z-packs. Those are worthless these days anyway (resistance rates through the roof) so they aren't taking away a valuable antibiotic, they have essentially no risk of c. diff, and the only real worry is a very slight increase in cardiac events in the over 50 crowd. Now the ones that overuse Augmentin or Levaquin, that's a different story.

I am 100% OK with pharmacists doing the stuff most of y'all are talking about. If someone mentions a symptom, for goodness sake its OK to suggest an OTC med that should help. I'd love an added caveat along the lines of "if that doesn't help or it gets worse, I'd go see a doctor", but I'd bet 99% of y'all are doing that already.

I know very little about pharmacist training, especially this advanced practice pharmacy stuff, but I don't see the point of it. Most of y'all already complain (and rightfully, I think) about not having enough staff to do the job you have now. Why would you want to take on more tasks, especially as I very much doubt if the corporations most pharmacists work for these days would pay you much more for it.

 

[Abby Atwood]

Man, this thread is something special.

If y'all will permit me, here are my thoughts as a practicing physician:

I love the doctors that give out too many z-packs. Those are worthless these days anyway (resistance rates through the roof) so they aren't taking away a valuable antibiotic, they have essentially no risk of c. diff, and the only real worry is a very slight increase in cardiac events in the over 50 crowd. Now the ones that overuse Augmentin or Levaquin, that's a different story.

I am 100% OK with pharmacists doing the stuff most of y'all are talking about. If someone mentions a symptom, for goodness sake its OK to suggest an OTC med that should help. I'd love an added caveat along the lines of "if that doesn't help or it gets worse, I'd go see a doctor", but I'd bet 99% of y'all are doing that already.

I know very little about pharmacist training, especially this advanced practice pharmacy stuff, but I don't see the point of it. Most of y'all already complain (and rightfully, I think) about not having enough staff to do the job you have now. Why would you want to take on more tasks, especially as I very much doubt if the corporations most pharmacists work for these days would pay you much more for it.

Azithromycin concentrates in the lungs and can overcome some resistant MIC's

 

[VA Hopeful Dr]

Azithromycin concentrates in the lungs and can overcome some resistant MIC's

As most doctors are using it for sinus infections (ie. not the lungs) or bronchitis (ie. viral), I'm not sure if that makes any difference.

 

[Abby Atwood]

As most doctors are using it for sinus infections (ie. not the lungs) or bronchitis (ie. viral), I'm not sure if that makes any difference.

It definitely does. There is a reason why azithromyicin is recommended for pneumonia by IDSA guidelines, but is not recommended for sinus infections.

 

[beautifulrobot]

If the patient makes a self-determination to handle something with over the counter, I have no issue with that as it falls under their own autonomy. Patients make that call knowing it's solely their decision. My concern is that if someone from the health care universe takes on the roll of advising someone they don't need to see a physician for an issue, they are now setting up a situation in which the patient believes they are now confirmed safe enough to not need a physician. Telling someone that they don't need to see a doc for something becomes a situation in which one is issuing a diagnosis. Offering a medical diagnosis, particularly one that leads a patient to not seek timely evaluation from a physician is a moral liability and simply shouldn't happen. It's nothing specific to pharmacists, it's just something non-physicians shouldn't be doing.

Interesting logic... Who do you think makes the determination that a drug is available OTC to begin with? I get that the FDA might seem like a bunch of faceless bureaucrats - but the folks at FDA are very much part of the "health care universe." Why are you ok with a regulatory agency concerned with public health condoning a patient's ability to make self-diagnoses and decide to self-treat with OTC products if it could lead to a patient not seeking timely evaluation from a physician? Why you cool with the FDA taking such moral liability?

I find it interesting that the "liability line" is crossed when a patient consults with a pharmacist who has extensive professional education and training in self-treatment with OTC products (including when it's appropriate and when someone should see a physician), but you don't seem to have a problem with the appropriateness of the availibility of OTCs to begin with.

 

[deleted480308]

Interesting logic... Who do you think makes the determination that a drug is available OTC to begin with? I get that the FDA might seem like a bunch of faceless bureaucrats - but the folks at FDA are very much part of the "health care universe." Why are you ok with a regulatory agency concerned with public health condoning a patient's ability to make self-diagnoses and decide to self-treat with OTC products if it could lead to a patient not seeking timely evaluation from a physician? Why you cool with the FDA taking such moral liability?

I find it interesting that the "liability line" is crossed when a patient consults with a pharmacist who has extensive professional education and training in self-treatment with OTC products (including when it's appropriate and when someone should see a physician), but you don't seem to have a problem with the appropriateness of the availibility of OTCs to begin with.

I'm libertarian in my
Govt philosophy, so a patient should be able to buy what they want to buy...

 

[npage148]

Wouldn't your libertarian view point to be let pharmacist do what they want and if they hurt a patient the market will correct itself and people wouldn't go to that pharmacy anymore?

 

[deleted480308]

Wouldn't the libertarian view point to be let pharmacist do what they want and if they hurt a patient the market will correct itself and people wouldn't go to that pharmacy anymore?

In a world without govt licensing, absolutely.

But the concept behind govt licensing is to excuse the consumer from the necessity of investigating the providers competency for a task. With a govt endorsed license the public is told to trust that we are skilled and trained at what we are doing. If we are going to operate in the licensure environment via govt it's the govt's responsibility to restrict people to their proper scope.

 

[beautifulrobot]

I'm libertarian in my
Govt philosophy, so a patient should be able to buy what they want to buy...

Ok, so FDA and the DEA shouldn't exist and drug regulation shouldn't be a thing, and you don't think it is appropriate to limit what drugs people can buy, alright... whatever. So the issue is that people shouldn't trust anyone in the healthcare universe except for physicians in advising them on what drugs to buy, and that's because physicians are the only people trained to make that assessment, regardless of what the patient's complaint is. Got it.

This was already pointed out several times, but you don't actually have evidence to support that pharmacist facilitated self-treatment results in delaying needed physician evaluations or are harmful in any way. You also haven't addressed the potential harm to both the patient and society that can result from pharmacists inappropriately referring patients to seek medical care they most likely don't need (saying that the harms are a result of bad medicine/doctors and that the waste of resources isn't an issue is not based in reality). Should I just take your word that it's inappropriate for pharmacists to provide self-treatment recommendations, something that is the cornerstone of pharmacy training and has been done by pharmacists for several decades? I mean, that's fine if that's what you want to believe, but you're doing yourself a disservice.

 

[npage148]

In a world without govt licensing, absolutely.

But the concept behind govt licensing is to excuse the consumer from the necessity of investigating the providers competency for a task. With a govt endorsed license the public is told to trust that we are skilled and trained at what we are doing. If we are going to operate in the licensure environment via govt it's the govt's responsibility to restrict people to their proper scope.

You're adorable. "I'm free market except when I can posture a point which directly benefits me."

 

[VA Hopeful Dr]

It definitely does. There is a reason why azithromyicin is recommended for pneumonia by IDSA guidelines, but is not recommended for sinus infections.

You mean the IDSA guidelines that are 10 years old? Heck, as recently as 2010 most guidelines still said macrolides were effective for sinus infections. Or do you mean the guidelines that are being updated right now and I'd bet you $50 to the charity of your choice will exclude macrolides from single therapy empiric treatment in that update?

In my area, s. pneumonia resistance rates for macrolides are at 60% with an MIC >16. Now admittedly, my geographic region does have some of the worst resistance rates to everything in the country, but even if the national average is 1/3rd ours, that's still a 20% resistance rate. No way macrolides stay where they are.

 

[deleted480308]

You're adorable. "I'm free market except when I can posture a point which directly benefits me."

Feel free to disagree but misrepresentation isn't necessary

 

[Abby Atwood]

You mean the IDSA guidelines that are 10 years old? Heck, as recently as 2010 most guidelines still said macrolides were effective for sinus infections. Or do you mean the guidelines that are being updated right now and I'd bet you $50 to the charity of your choice will exclude macrolides from single therapy empiric treatment in that update?

In my area, s. pneumonia resistance rates for macrolides are at 60% with an MIC >16. Now admittedly, my geographic region does have some of the worst resistance rates to everything in the country, but even if the national average is 1/3rd ours, that's still a 20% resistance rate. No way macrolides stay where they are.

Study exists showing tissue concentrations of 3 mg/kg in soft tissues in general (including upper respiratory tract and prostate). Another study published around the same time showed greater concentration in bronchioles compared with other parts of the respiratory tract.

 

[CetiAlphaFive]

I can't read this thread anymore.

I swear, with the amount of dancing the participants are doing around the original points, I'm envisioning a classical ballet.

 

[VA Hopeful Dr]

Study exists showing tissue concentrations of 3 mg/kg in soft tissues in general (including upper respiratory tract and prostate). Another study published around the same time showed greater concentration in bronchioles compared with other parts of the respiratory tract.

Once again, that's nice but likely not clinically relevant. We'll see what the new guidelines say when they release them, but my money as I've promised is on my way of thinking.

 

[Abby Atwood]

Once again, that's nice but likely not clinically relevant. We'll see what the new guidelines say when they release them, but my money as I've promised is on my way of thinking.

It's a little relevant since that concentration would be greater than the bacteria's MIC (greater than MICs considered resistant). Resistant bacteria may still be inhibited depending on site of infection.

 

[SilentCool]

Guy came back a few days later and said the court didn't accept notes from pharmacists and wanted a note from a physician. WTF?

Same reason they wouldn't have accepted a note from the cashier. Selling/dispensing isn't the same thing as diagnosing/treating.