PharmD = Dr. revisited...

[UES Girl]

Do you think pharmacists devote an equal amount of time and effort to a patient's medical treatment? In which settings?

Prescribing drugs is not the extent of a physician's involvement in "medical treatment," and this seems to be what you're missing.
Going over histories, physical examination, testing, diagnosis, treatments - and a TYPE of treatment is prescribing mediciations. That's where you come in. I agree that pharmacists play an essential role, but can you really say they have an EQUAL role in patient care?

EDIT: I'm not saying this is the way it SHOULD be, I'm just commenting on the status quo from my perspective. I work in primary care and in an ED, and ALL the docs I work with just get annoyed by a call from the pharmacy. Why? Usually the pharmacists don't have any idea of the medical state of the patients, both in regard to acute pts and management of chronic illness. They don't know the specs of the pt's situation, so docs don't want to hear their opinions. I do believe there should be more professional communication and collaboration between docs and pharms, FWIW.

In the outpatient setting, darling. Patients don't come to see Drs. a few times a week - I know even with the one of the best insurance plans Kaiser has to offer, I can't afford to pay co-pays frequently to go see my doctor if I have a cold for example. But I might stop by the pharmacy and talk to a pharmacist instead so he can help me pick out a cold medication.

Pharmacists don't have as much medical knowledge on the state of the patient or chronic illness management ? No **** - we don't spend two years studying Elsevier's Essentials of Medicine and learning how to triage. Just like you don't spend four years studying drugs and it's ridiculous on your part to expect to have the same amount of knowledge you learn in your one semester of your watered-down version of pharmacology as we in our entire path of pharmacy education.

Pharmacists in this state at least already have prescribing rights. We learn priciple of diagnostics, not to the same extent as docs of course but nevertheless. We are a valuable asset to every medical team, which fortunately for me is acknowledged at my school and my hometown.

As for when we come in, you are mistaken there too since you probably have no pharmacy shadowing experience. At our hospital at least, the pharmacist has a direct access to all the patient's labs, history, symptoms, treatment plan and etc. They actually review all of it, prior to filling the script sent by a doctor, to make sure the doc didn't mess up the dosage, regimen or etc. or to see if the prescribed medication correlates to the labs properly. If a mistaken is found, Dr. is paged with a suggestion to correct the problem and nothing is getting filled until a corrected script is sent down.

During my IPPE experiences at the hospital: pharmacists round with docs in the morning. Doctors diagnose, pharmacists suggest the best regimen. This is how it should be and how I believe it will be in the distant future nation wide.

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[illegallysmooth]

In the outpatient setting, darling.

OK. I've also worked in inpatient medicine. I never saw a pharmacist on the floor. Just my experience.

Patients don't come to see Drs. a few times a week - I know even with the one of the best insurance plans Kaiser has to offer, I can't afford to pay co-pays frequently to go see my doctor if I have a cold for example. But I might stop by the pharmacy and talk to a pharmacist instead so he can help me pick out a cold medication.

Nor should they go see the docs for a cold. I agree, this is a perfectly reasonable expectation of the role of a pharmacist. Pt can also call their physician's office and the Dr can tell them what to get, but most pts don't do this.

Pharmacists don't have as much medical knowledge on the state of the patient or chronic illness management ? No **** - we don't spend two years studying Elsevier's Essentials of Medicine and learning how to triage.

Well, of course. There's no reason to explain or defend the profession. My point was simply to challenge the statement that pharmacists have an equal role in the medical care of a patient. I don't agree.

Just like you don't spend four years studying drugs and it's ridiculous on your part to expect to have the same amount of knowledge you learn in your one semester of your watered-down version of pharmacology as we in our entire path of pharmacy education.

It's ridiculous on my part? Really? Can you point out where I made this contention? I don't know where this attitude is coming from, but I never insinuated that physicians have exactly the same pharmacological knowledge as pharmacists. It doesn't speak well on your behalf to be insulting the education of physicians, by the way.

Pharmacists in this state at least already have prescribing rights.

IMHO: yikes.

We learn priciple of diagnostics, not to the same extent as docs of course but nevertheless.

Yep.

We are a valuable asset to every medical team,

Yep.

which fortunately for me is acknowledged at my school and my hometown.

great.

.

 

[rxlea]

If I had a dollar for everytime our pharmacists caught a mistake that a doc made, I would be rich. IMHO, I don't think docs should necessarily be prescribing, especially for complicated therapies. They just don't have the pharmacological knowledge just as pharmacists don't have the diagnostic knowledge to figure out what someone has. They can diagnose and suggest treatment, but when it comes to dosing and drug interactions, etc, I have to say that it seems the clinical pharmacists are doing a better job. I am not trying to insult doctors as I talk to some of the most well-known and competent doctors in the nation, but man, what our clinical pharmacists do is pretty damn amazing, too. We should work as a team.

 

[PharmEXP]

If I had a dollar for everytime our pharmacists caught a mistake that a doc made, I would be rich. IMHO, I don't think docs should necessarily be prescribing, especially for complicated therapies. They just don't have the pharmacological knowledge just as pharmacists don't have the diagnostic knowledge to figure out what someone has. They can diagnose and suggest treatment, but when it comes to dosing and drug interactions, etc, I have to say that it seems the clinical pharmacists are doing a better job. I am not trying to insult doctors as I talk to some of the most well-known and competent doctors in the nation, but man, what our clinical pharmacists do is pretty damn amazing, too. We should work as a team.

Two

 

[weetzie00]

If I had a dollar for everytime our pharmacists caught a mistake that a doc made, I would be rich. IMHO, I don't think docs should necessarily be prescribing, especially for complicated therapies. They just don't have the pharmacological knowledge just as pharmacists don't have the diagnostic knowledge to figure out what someone has. They can diagnose and suggest treatment, but when it comes to dosing and drug interactions, etc, I have to say that it seems the clinical pharmacists are doing a better job. I am not trying to insult doctors as I talk to some of the most well-known and competent doctors in the nation, but man, what our clinical pharmacists do is pretty damn amazing, too. We should work as a team.

+1 ! I hope one day in a rainbowy future, we all work together as a happy family of practitioners. People coming together and combining their expertise will only improve the quality of care.

 

[rxlea]

+1 ! I hope one day in a rainbowy future, we all work together as a happy family or practitioners. People coming together and combining their expertise will only improve the quality of care.

I am willing to do what it takes to put the patients' needs first. If this means putting aside ego, or even working alongside people I don't necessarily get along with everyday, so be it. Patients come first. Nothing less than that.

 

[XeroSkills]

If I had a dollar for everytime our pharmacists caught a mistake that a doc made, I would be rich. IMHO, I don't think docs should necessarily be prescribing, especially for complicated therapies. They just don't have the pharmacological knowledge just as pharmacists don't have the diagnostic knowledge to figure out what someone has. They can diagnose and suggest treatment, but when it comes to dosing and drug interactions, etc, I have to say that it seems the clinical pharmacists are doing a better job. I am not trying to insult doctors as I talk to some of the most well-known and competent doctors in the nation, but man, what our clinical pharmacists do is pretty damn amazing, too. We should work as a team.

and therefore we should be getting paid equally as a team

 

[PharmEXP]

and therefore we should be getting paid equally as a team

That's an idea

 

[illegallysmooth]

We should work as a team.

Absolutely.

I do have to disagree with you when you state that docs shouldn't necessarily be prescribing. Docs prescribe based on what they see, hear and feel. Docs may disagree on treatment modalities based on different opinions of what they see, hear and feel. If it's the doc's job to assess and diagnose, it must also be the doc's job to prescribe. You cannot separate treating the illness because the pharm is more famililar with pharmacologics in general. Many specialists spend decades dealing with a subset of medical diagnoses and become experts in prescribing for these illnesses with wisdom and knowledge that only comes from patient experience, and not from a textbook. They are the ones who follow up with patients, who see side effects and patient outcomes, who see different presentations of the same illness and see how they respond to different therapies.

I would like to underscore that pharms and docs should be working as a team, especially in complex cases. It was never my point that this should not be the case, only that I believe in the vast majority of present cases it just isn't happening.

 

[tncekm]

and therefore we should be getting paid equally as a team

^ Enough with the socialist propaganda.

Anyway, although I do get sick of the various fields fighting to have the word "doctor" tacked onto their title, I think pharmacists are probably the most deserving of the bunch--whoever approved of the juris doctor, on the other hand, needs to go to hell.

Plus, if a DNP can refer to themselves and their joke of an "academic doctorate" as "Dr.", why not someone with a real education--like a pharmacist.

Here is my commitment to you: I will "always" refer to PharmD's as "Dr So-and-so" when speaking to patients.

My commitment to DNP's: I will "always" refer to them as "Nurse so-and-so" when speaking to everyone.

 

[PharmGrrlJax]

.

My husband is a clinical pharmacist, all he does is spend time on the floor, looking over charts, talking to doctors, nurses, counseling patients, writing TPNs, getting consults for coumadin, antimicrobials etc... He has an on call cell phone and is just as likely to get a call from a patient as a medical professional (how many doctors would deal with that?). And he IS respected! The doctors listen to his thoughts about the patients and their meds because he is an expert in his field and he has earned the doctor's resepct time and again. I am sorry that you haven't had the oppourtunity to work with a pharmacist like him, but I hope for your sake you do. Pharmacists are a great asset to any medical team, but unfortunately the Medical profession seems to be made up of people who don't think anyone's contribution is nearly as valuable as their own.

 

[tncekm]

...unfortunately the Medical profession seems to be made up of people who don't think anyone's contribution is nearly as valuable as their own.

It's the same with everyone, unfortunately. Not just med professionals.

 

[PharmGrrlJax]

Absolutely.

I do have to disagree with you when you state that docs shouldn't necessarily be prescribing. Docs prescribe based on what they see, hear and feel. Docs may disagree on treatment modalities based on different opinions of what they see, hear and feel. If it's the doc's job to assess and diagnose, it must also be the doc's job to prescribe. You cannot separate treating the illness because the pharm is more famililar with pharmacologics in general. Many specialists spend decades dealing with a subset of medical diagnoses and become experts in prescribing for these illnesses with wisdom and knowledge that only comes from patient experience, and not from a textbook. They are the ones who follow up with patients, who see side effects and patient outcomes, who see different presentations of the same illness and see how they respond to different therapies.

I would like to underscore that pharms and docs should be working as a team, especially in complex cases. It was never my point that this should not be the case, only that I believe in the vast majority of present cases it just isn't happening.

I wish this were the case, in my experience you can always tell which sales rep has been through which doctor's office, because miracoulously that drug is the new miracle drug and suddenly is utilized all the time...until the next miracle drug rep comes through.

 

[rxlea]

Absolutely.

I do have to disagree with you when you state that docs shouldn't necessarily be prescribing. Docs prescribe based on what they see, hear and feel. Docs may disagree on treatment modalities based on different opinions of what they see, hear and feel. If it's the doc's job to assess and diagnose, it must also be the doc's job to prescribe. You cannot separate treating the illness because the pharm is more famililar with pharmacologics in general. Many specialists spend decades dealing with a subset of medical diagnoses and become experts in prescribing for these illnesses with wisdom and knowledge that only comes from patient experience, and not from a textbook. They are the ones who follow up with patients, who see side effects and patient outcomes, who see different presentations of the same illness and see how they respond to different therapies.

I would like to underscore that pharms and docs should be working as a team, especially in complex cases. It was never my point that this should not be the case, only that I believe in the vast majority of present cases it just isn't happening.

Yes, but it is when the doc thinks that his opinions are the only correct ones and subsequently refuses to accept recommendations from other practitioners. This is what I am trying to point out: that sometimes, doctors just don't know. And they should be able to admit that and turn to someone who does. Many of our doctors and residents call their mobile pharmacists or even call down to the main pharmacy and say, "I don't know what is the best therapy for this...what do you think?" or "I am not sure about the dosing on this" or "Do you have any recommendations?" This is where teamwork comes into play. A pharmacist's role is to advocate for the best treatment possible. Their job becomes difficult when a doctor cannot put his ego away for one second to consider the patient's best interest.

 

[illegallysmooth]

My husband is a clinical pharmacist, all he does is spend time on the floor, looking over charts, talking to doctors, nurses, counseling patients, writing TPNs, getting consults for coumadin, antimicrobials etc... He has an on call cell phone and is just as likely to get a call from a patient as a medical professional (how many doctors would deal with that?). And he IS respected! The doctors listen to his thoughts about the patients and their meds because he is an expert in his field and he has earned the doctor's resepct time and again. I am sorry that you haven't had the oppourtunity to work with a pharmacist like him, but I hope for your sake you do. Pharmacists are a great asset to any medical team, but unfortunately the Medical profession seems to be made up of people who don't think anyone's contribution is nearly as valuable as their own.

Your husband sounds awesome. I hope I get to work with dudes like him too!

I could just as easily say the same thing about pharmacy profession from some of these posts! Geez. What I have been saying here is that doctors SHOULD be working more with pharmacists. But apparently if you fall short of saying that pharmacists should rule the earth, you're a pompous member of the "medical profession."

Everyone here needs to relaxxxx.

 

[illegallysmooth]

I wish this were the case, in my experience you can always tell which sales rep has been through which doctor's office, because miracoulously that drug is the new miracle drug and suddenly is utilized all the time...until the next miracle drug rep comes through.

You wish that were the case? You wish that docs prescribed based on the findings of their clinical assessment?

Come on. You're being proposterous. Sure there's always gonna be drug companies pressuring practices to choose one statin over the other, but it's not like a physician takes a look at a female with a UTI and prescribes a statin because a drug rep bought him lunch. Poo-pooing the other profession to this sort of extent only makes you look ridiculous.

 

[weetzie00]

I wish this were the case, in my experience you can always tell which sales rep has been through which doctor's office, because miracoulously that drug is the new miracle drug and suddenly is utilized all the time...until the next miracle drug rep comes through.

Lol so true. Drug reps work the doctors really hard here. Half the customers come in with their voucher cards that the doctors gave them. These doctors just want free crap and is happy to endorse anything that reps are willing to give them. I really wish they would practice as a professional and not as a walking advertisement. Pharmaceutical industries are sneaky. It doesn't help that they are targeting patients directly now, telling them all to "Ask their doctor." What do they know? Why do we all go to school for several years so our patients can tell us what they need lol.

 

[PharmGrrlJax]

Your husband sounds awesome. I hope I get to work with dudes like him too!

I could just as easily say the same thing about pharmacy profession from some of these posts! Geez. What I have been saying here is that doctors SHOULD be working more with pharmacists. But apparently if you fall short of saying that pharmacists should rule the earth, you're a pompous member of the "medical profession."

Everyone here needs to relaxxxx.

Your previous post came across as someone that was saying pharmacists sit down in their little cave and have nothing to do with patient care. Many in this forum have pointed out that in their experience the pharmacist has a much more active role in patient care than you were saying. It comes across as negating the entire profession. Since most people reading this forum have picked this profession that is being negated, people will get a bit riled up. Just like you did when I made my statement about not acknowledging the contributions of others.

 

[illegallysmooth]

Yes, but it is when the doc thinks that his opinions are the only correct ones and subsequently refuses to accept recommendations from other practitioners. This is what I am trying to point out: that sometimes, doctors just don't know. And they should be able to admit that and turn to someone who does. Many of our doctors and residents call their mobile pharmacists or even call down to the main pharmacy and say, "I don't know what is the best therapy for this...what do you think?" or "I am not sure about the dosing on this" or "Do you have any recommendations?" This is where teamwork comes into play. A pharmacist's role is to advocate for the best treatment possible. Their job becomes difficult when a doctor cannot put his ego away for one second to consider the patient's best interest.

Yeah, and a doc's job becomes difficult when a pharmacist gives the ER a hard time with a set of orders because of what he or she knows about the drug and DOESN'T know about the patient.

It's a two-way street. I completely agree with you on the concept of teamwork. But doc's aren't the only ones with egos.

 

[illegallysmooth]

Lol so true. Drug reps work the doctors really hard here. Half the customers come in with their voucher cards that the doctors gave them. These doctors just want free crap and is happy to endorse anything that reps are willing to give them. I really wish they would practice as a professional and not as a walking advertisement. Pharmaceutical industries are sneaky. It doesn't help that they are targeting patients directly now, telling them all to "Ask their doctor." What do they know? Why do we all go to school for several years so our patients can tell us what they need lol.

Yeah, I hate when I get free antibiotics for my sinus infection because my doc had some samples from a drug rep. What a crime.

 

[rxlea]

Lol so true. Drug reps work the doctors really hard here. Half the customers come in with their voucher cards that the doctors gave them. These doctors just want free crap and is happy to endorse anything that reps are willing to give them. I really wish they would practice as a professional and not as a walking advertisement. Pharmaceutical industries are sneaky. It doesn't help that they are targeting patients directly now, telling them all to "Ask their doctor." What do they know? Why do we all go to school for several years so our patients can tell us what they need lol.

My favorites are the isomers of various drugs. Claritin vs Clarinex, Effexor vs. Pristiq, Provigil vs. Nuvigil (which is really just the one active enantiomer unlike Provigil which is racemic).

 

[weetzie00]

Yeah, and a doc's job becomes difficult when a pharmacist gives the ER a hard time with a set of orders because of what he or she knows about the drug and DOESN'T know about the patient.

It's a two-way street. I completely agree with you on the concept of teamwork. But doc's aren't the only ones with egos.

I can agree that we all have egos to an extent... but pharmacists have to work a LOT for respect.

 

[illegallysmooth]

Your previous post came across as someone that was saying pharmacists sit down in their little cave and have nothing to do with patient care. Many in this forum have pointed out that in their experience the pharmacist has a much more active role in patient care than you were saying. It comes across as negating the entire profession. Since most people reading this forum have picked this profession that is being negated, people will get a bit riled up. Just like you did when I made my statement about not acknowledging the contributions of others.

These people you are speaking of should learn to read a bit more critically. If I say that pharms don't have a certain role in the majority of patient cases, it doesn't mean I'm saying they shouldn't. My entrance into this discussion started by responding to the contention that pharmacists have an equal role in patient care. I still disagree. Of course there will be pharmacists that are very involved --- but on the whole, looking at the majority of inpatient and outpatient cases in the United States, it is not true.

 

[PharmGrrlJax]

You wish that were the case? You wish that docs prescribed based on the findings of their clinical assessment?

Come on. You're being proposterous. Sure there's always gonna be drug companies pressuring practices to choose one statin over the other, but it's not like a physician takes a look at a female with a UTI and prescribes a statin because a drug rep bought him lunch. Poo-pooing the other profession to this sort of extent only makes you look ridiculous.

I think you are looking at things from the most idealistic of views. Drug reps have more influence than most people realize. And they don't just try to influence doctors. They are at the hospital, trying to pressure the pharmacists and doctors to change formularies. Many times my husband has to prepare detailed reports proving why this miracle drug doesn't work the way the drug rep tells them and why it isn't worth the patient paying 100s more per dose. Most doctors don't have time to read the literature for each and every drug that comes through the market, so they don't alwys prescribe the BEST medication for the job. Not all antibiotics work the best, same with all the other drugs out there.

And when I worked in retail there was a particular doctor that prescribed the same three drugs to every patient of his we saw. So not all doctors prescribe based on clinical findings.

 

[rxlea]

Yeah, and a doc's job becomes difficult when a pharmacist gives the ER a hard time with a set of orders because of what he or she knows about the drug and DOESN'T know about the patient.

It's a two-way street. I completely agree with you on the concept of teamwork. But doc's aren't the only ones with egos.

Uhm...at our hospital, pharmacists have access to the exact same information a doc does. They carry laptops around with them if they aren't sitting in their mobile pharmacy in front of their computer...so I am not sure what you are talking about here. But whatever you say! lol Glad you enjoyed our thread!

 

[illegallysmooth]

And when I worked in retail there was a particular doctor that prescribed the same three drugs to every patient of his we saw. So not all doctors prescribe based on clinical findings.

I give up. There's an amount of ridiculousness I cannot stomach the strength to respond to

 

[rxlea]

I can agree that we all have egos to an extent... but pharmacists have to work a LOT for respect.

+1....did you see that video I posted in the off topic thread called "Pharmacy Respect"? It is hilarious.

 

[PharmGrrlJax]

These people you are speaking of should learn to read a bit more critically. If I say that pharms don't have a certain role in the majority of patient cases, it doesn't mean I'm saying they shouldn't. My entrance into this discussion started by responding to the contention that pharmacists have an equal role in patient care. I still disagree. Of course there will be pharmacists that are very involved --- but on the whole, looking at the majority of inpatient and outpatient cases in the United States, it is not true.

So do you think that they should or should not be a part of patient care? I feel their expertise is not replaceable, therefore should be part of patient care. Thus why I picked this profession.

 

[rxlea]

I give up. There's an amount of ridiculousness I cannot stomach the strength to respond to

Have a great evening!

 

[illegallysmooth]

Uhm...at our hospital, pharmacists have access to the exact same information a doc does. They carry laptops around with them if they aren't sitting in their mobile pharmacy in front of their computer...so I am not sure what you are talking about here. But whatever you say! lol Glad you enjoyed our thread!

I WISH this was the case at my hospitals. Sincerely. I don't have experience with this system, so I don't know how pharmacists process the info on various patients or if they pay attention to the same info as physicians, but it would be SO helpful.

 

[illegallysmooth]

So do you think that they should or should not be a part of patient care? I feel their expertise is not replaceable, therefore should be part of patient care. Thus why I picked this profession.

Hon, I'm not going to repeat everything I wrote. If you care what I think, read my posts carefully. I made my views clear.

 

[rxlea]

I WISH this was the case at my hospitals. Sincerely. I don't have experience with this system, so I don't know how pharmacists process the info on various patients or if they pay attention to the same info as physicians, but it would be SO helpful.

Integrated systems are the way to go!! It would help us ALL!!

 

[UES Girl]

Yeah, and a doc's job becomes difficult when a pharmacist gives the ER a hard time with a set of orders because of what he or she knows about the drug and DOESN'T know about the patient.

It's a two-way street. I completely agree with you on the concept of teamwork. But doc's aren't the only ones with egos.

You can't have it both ways buddy, you can say here that doctors are better at prescribing because they deal with patients and prescribe based on what they feel hear and touch and pharmacists are lessersuited for prescribing because they learn about the drugs but not the patients.

How do you think we are taught in our schooling ? Drug XYZ is so and so ? We learn medicine as a subject and THEN we learn drugs pertainining to the subject. For example for allergic dermititis - I first learn about the condition and how to DIAGNOSE IT, symtoms, signs and etc. Then I learn the appropriate treatments for it.

What you are saying still doesn't make any sense. Let's say you see a patient on the floor and you know he has an allergic dermitits. You can feel, touch and hear it as you put it. But what makes you think you will be better at recommending a treatment for it than I will ? When you have maybe 10 minutes chunk of the lecture on the appropriate drugs in medical school, while I spent 3 weeks studying the same thing.

Another reason while physicians IMHO is poor prescribers is because they fall into a niche of prescribing comforT meds - presicely what you described - stuff they are familiar with and prescribed for a while. First, that's a poor approach because that poses potential problems since "MFD", my favorite drug, may have an ADE with another med a patient is on - something a doctor is usually not suited to catch. Secondly, we, as a health profession are moving away from generic approach towards personalized molecure medicine and cookie cutter treatments docs are so comfortable with just don't cut it anymore.

 

[rxlea]

You can't have it both ways buddy, you can say here that doctors are better at prescribing because they deal with patients and prescribe based on what they feel hear and touch and pharmacists are lessersuited for prescribing because they learn about the drugs but not the patients.

How do you think we are taught in our schooling ? Drug XYZ is so and so ? We learn medicine as a subject and THEN we learn drugs pertainining to the subject. For example for allergic dermititis - I first learn about the condition and how to DIAGNOSE IT, symtoms, signs and etc. Then I learn the appropriate treatments for it.

What you are saying still doesn't make any sense. Let's say you see a patient on the floor and you know he has an allergic dermitits. You can feel, touch and hear it as you put it. But what makes you think you will be better at recommending a treatment for it than I will ? When you have maybe 10 minutes chunk of the lecture on the appropriate drugs in medical school, while I spent 3 weeks studying the same thing.

Another reason while physicians IMHO is poor prescribers is because they fall into a niche of prescribing comforT meds - presicely what you described - stuff they are familiar with and prescribed for a while. First, that's a poor approach because that poses potential problems since "MFD", my favorite drug, may have an ADE with another med a patient is on - something a doctor is usually not suited to catch. Secondly, we, as a health profession are moving away from generic approach towards personalized molecure medicine and cookie cutter treatments docs are so comfortable with just don't cut it anymore.

I am SO looking forward to pharmacogenetics during P1 year! Woot!

 

[UES Girl]

I am SO looking forward to pharmacogenetics during P1 year! Woot!

Taking it right now, best class ever ! It will be an orgasmic experience, I promise.

 

[rxlea]

Taking it right now, best class ever ! It will be an orgasmic experience, I promise.

That makes me even more excited!

 

[illegallysmooth]

You can't have it both ways buddy, you can say here that doctors are better at prescribing because they deal with patients and prescribe based on what they feel hear and touch and pharmacists are lessersuited for prescribing because they learn about the drugs but not the patients.

Actually, that is what I'm saying.

How do you think we are taught in our schooling ? Drug XYZ is so and so ? We learn medicine as a subject and THEN we learn drugs pertainining to the subject. For example for allergic dermititis - I first learn about the condition and how to DIAGNOSE IT, symtoms, signs and etc. Then I learn the appropriate treatments for it.

Ok, but at the end of pharmacy school, how many patients have you seen/felt/heard and diagnosed with allergic dermatitis based on your own clinical findings?

What you are saying still doesn't make any sense. Let's say you see a patient on the floor and you know he has an allergic dermitits. You can feel, touch and hear it as you put it. But what makes you think you will be better at recommending a treatment for it than I will ? When you have maybe 10 minutes chunk of the lecture on the appropriate drugs in medical school, while I spent 3 weeks studying the same thing.

Because I would have likely seen hundreds of patients with allergic dermatitis in person, with my own eyes, including cases of differing severity. It's interesting you picked allergic dermatitis and not, oh, pericarditis.

Another reason while physicians IMHO is poor prescribers is because they fall into a niche of prescribing comforT meds -

What you call comfort meds, another may call "a medicine with predictable effects which I have seen work in hundreds of similar cases." LOL.

presicely what you described - stuff they are familiar with and prescribed for a while. First, that's a poor approach because that poses potential problems since "MFD", my favorite drug, may have an ADE with another med a patient is on - something a doctor is usually not suited to catch. Secondly, we, as a health profession are moving away from generic approach towards personalized molecure medicine and cookie cutter treatments docs are so comfortable with just don't cut it anymore.

So you're sayings docs don't use the newest and greatest as much as they should? Wait...doesn't that constrast the earlier comments about influence from drug companies? Secondly, in my grad program I've learned a hefty lot about pharmacogenetics and my lecturers have all been...wait for it...physicians. Pharmacists don't have a monopoly on research, common sense or the advancement of medicine.

,

 

[UES Girl]

,

That's what I'm getting at - you may have seen hundreds of patients and learned how to immediately diagnose a patient but you are far less familiar with the appropriate treatment options than I am. Simply because you aren't getting the same background education about appropriate treatments for each conditions as I am. You just can't cram weeks worth of training into one watered down pharmacology lecture in semester. You may know the generic endorsed by AMA good-for-all 2-3 main treatments, while I learn 10-12 alternative therapies, each more appropriate than others based on patients medical and Rx history, income or social factors even.

I picked allergic dermatitis because that's from my lecture from last week, not because there is some hidden message to it.

The fact that your lecturers have all been physicians is not suprising and quite typical in fact - it's a known phenomenon that usually SOPs utilize Pharm.D/Ph.D faculties while SOMs utilize MD/Ph.Ds faculty because they are experts in different areas.

I'm done for tonight as I have an exam tomorrow. Argue away.

 

[illegallysmooth]

That's what I'm getting at - you may have seen hundreds of patients and learned how to immediately diagnose

I didn't say immediately. The appropriate diagnosis of a given illness may come after a slew of tests which need to be interpreted. The interpretation may then indicate a specific treatment modality, when several are available. Therefore the treatment is dependent on a clinician's findings. It's not always cut and dry - diagnosis: X. Treatment: Y. I don't think someone should be prescribing for pneumonia when they haven't heard the lungs. Just my opinion.

a patient but you are far less familiar with the appropriate treatment options than I am. Simply because you aren't getting the same background education about appropriate treatments for each conditions as I am. You just can't cram weeks worth of training into one watered down pharmacology lecture in semester.

Again with this. Please stroll up to a cardiologist and tell him that his knowledge of cardiopulmonary drugs corresponds to only "a watered down pharmacology lecture." In a friendly discussion, this is not only arrogant but insulting. And exceedingly ignorant.

You may know the generic endorsed by AMA good-for-all 2-3 main treatments, while I learn 10-12 alternative therapies, each more appropriate than others based on patients medical and Rx history, income or social factors even.

I picked allergic dermatitis because that's from my lecture from last week, not because there is some hidden message to it.

The fact that your lecturers have all been physicians is not suprising and quite typical in fact - it's a known phenomenon that usually SOPs utilize Pharm.D/Ph.D faculties while SOMs utilize MD/Ph.Ds faculty because they are experts in different areas.

I'm not at a SOM. I'm at a comprehensive cancer institute (which includes a hospital and research center).

I'm done for tonight as I have an exam tomorrow. Argue away.

.

 

[tncekm]

Uhm...at our hospital, pharmacists have access to the exact same information a doc does. They carry laptops around with them if they aren't sitting in their mobile pharmacy in front of their computer...so I am not sure what you are talking about here. But whatever you say! lol Glad you enjoyed our thread!

Seriously, intentional or not, you make it sound like doctors are essentially useless. *sigh*

If everybody just knows their role and respects their colleagues, all is well.

 

[rxlea]

Seriously, intentional or not, you make it sound like doctors are essentially useless. *sigh*

If everybody just knows their role and respects their colleagues, all is well.

LOL not intentional at all. Docs are NOT useless and neither are pharmacists. We all know our roles but we shouldn't be afraid to reach out to each other either. Although, there IS this one doctor that is rather useless...but she is just the exception

 

[rxforlife2004]

The assistant dean of UF COP is a Pharm.D. and she refers to herself as Dr. Jane Doe, Pharm.D.

Yeah, tell her to go to ICU unit of a hospital and address herself as "Dr." so and so. I guarantee you she'll be written up in a lengthy paper...

Back in school, the professors are allowed to address themselves as "Dr" so and so because a bunch of naive students who have no clue what the actual job is like....once they're out.

 

[UES Girl]

.

And what makes you think we haven't heard the lungs or that we don't have physical assesment skills labs as part of our training ? Are you actually insinuating ( by bringing a cardiologist example) that the knowledge on drugs you are getting in medical school is comparable to the one we are getting in pharmacy school ? This is what I am talking about - get off your high horse. I at least don't argue that I am an expert in something in which I am not.

Just like a cardiologist has years of experience - so does a cardiogy specialized pharmacist - pharmacists have cardiology residencies too, just like medical school graduates. I shadowed one as a mattered of fact, so while a cardiologist is earning years of worth experience and drug-related knowledge, what exactly do you think a cardiology specialized pharmacist is doing ?

 

[UES Girl]

Yeah, tell her to go to ICU unit of a hospital and address herself as "Dr." so and so. I guarantee you she'll be written up in a lengthy paper...

Back in school, the professors are allowed to address themselves as "Dr" so and so because a bunch of naive students who have no clue what the actual job is like....once they're out.

This seems to be quite a common practice at our hospital and I don't see any papers coming out so far.

 

[illegallysmooth]

And what makes you think we haven't heard the lungs or that we don't have physical assesment skills labs as part of our training ? Are you actually insinuating ( by bringing a cardiologist example) that the knowledge on drugs you are getting in medical school is comparable to the one we are getting in pharmacy school ? This is what I am talking about - get off your high horse. I at least don't argue that I am an expert in something in which I am not.

Oh my god. Do you even read what I write? Seriously. I'm baffled by your lack of reasoning. I'm not saying you've never heard a pair of lungs in your life. I'm saying the lady being seen for pneumonia - you aren't listening to HER lungs, are you? Or do you actually do a clinical assessment on every patient? No? Are you touching them, palpating the abdomen, listening to breath sounds, etc? Then you shouldn't be prescribing. This is my point.

You continue to insult the medical profession by comparing their pharmacologic knowledge to "a watered down lecture." I defy you to ask a cardiologist about his knowledge of cardiopulmonary drugs. There's a reason we go through 8 years of school including two of clinical rotations and at least a 3 year residency, which may or not be followed by a fellowship. Our training doesn't end in school.


Just like a cardiologist has years of experience - so does a cardiogy specialized pharmacist - pharmacists have cardiology residencies too, just like medical school graduates. I shadowed one as a mattered of fact, so while a cardiologist is earning years of worth experience and drug-related knowledge, what exactly do you think a cardiology specialized pharmacist is doing ?[

Well, I don't think they are examining the patient. That is my entire point, and one you continue to miss.[/QUOTE]

 

[rxlea]

And what makes you think we haven't heard the lungs or that we don't have physical assesment skills labs as part of our training ? Are you actually insinuating ( by bringing a cardiologist example) that the knowledge on drugs you are getting in medical school is comparable to the one we are getting in pharmacy school ? This is what I am talking about - get off your high horse. I at least don't argue that I am an expert in something in which I am not.

Oh my god. Do you even read what I write? Seriously. I'm baffled by your lack of reasoning. I'm not saying you've never heard a pair of lungs in your life. I'm saying the lady being seen for pneumonia - you aren't listening to HER lungs, are you? Or do you actually do a clinical assessment on every patient? No? Are you touching them, palpating the abdomen, listening to breath sounds, etc? Then you shouldn't be prescribing. This is my point.

You continue to insult the medical profession by comparing their pharmacologic knowledge to "a watered down lecture." I defy you to ask a cardiologist about his knowledge of cardiopulmonary drugs. There's a reason we go through 8 years of school including two of clinical rotations and at least a 3 year residency, which may or not be followed by a fellowship. Our training doesn't end in school.


Just like a cardiologist has years of experience - so does a cardiogy specialized pharmacist - pharmacists have cardiology residencies too, just like medical school graduates. I shadowed one as a mattered of fact, so while a cardiologist is earning years of worth experience and drug-related knowledge, what exactly do you think a cardiology specialized pharmacist is doing ?[

Well, I don't think they are examining the patient. That is my entire point, and one you continue to miss.

I think what chebs is trying to say is that the pharmacy field is changing in favor of clinical assessments. At my pharm school, we will be learning to do clinical assessments which is essentially examining the patient. Granted we won't be doing an in depth analysis of blood tests or anything (although we will have access to labs and the pharmacists here at the hospital adjust dosing or make recommendations as needed based on the labs), but we will be able to tell if a patient has an infection or cold or something like that. We can examine a patients legs to see if they should be getting birth control or listen to the lungs to listen for asthma, etc. We can already administer vaccinations and in some states, pharmacists can prescribe within their scope of practice (coumadin clinics, diabetes specialist, etc). I don't think it is an assault on doctors, just that pharmacists are becoming a more integral part of the clinical team.

 

[illegallysmooth]

I think what chebs is trying to say is that the pharmacy field is changing in favor of clinical assessments. At my pharm school, we will be learning to do clinical assessments which is essentially examining the patient. Granted we won't be doing an in depth analysis of blood tests or anything (although we will have access to labs and the pharmacists here at the hospital adjust dosing or make recommendations as needed based on the labs), but we will be able to tell if a patient has an infection or cold or something like that. We can examine a patients legs to see if they should be getting birth control or listen to the lungs to listen for asthma, etc. We can already administer vaccinations and in some states, pharmacists can prescribe within their scope of practice (coumadin clinics, diabetes specialist, etc). I don't think it is an assault on doctors, just that pharmacists are becoming a more integral part of the clinical team.

It'd be fine if that what "chebs" is saying. But it isn't. If someone is going to make the ridiculous statement that pharms should be prescribing instead of docs, then he/she should be able to be completely comfortable doing an entire physical exam and interpreting every single clinical finding - including films, specialized testing (i.e. EEGs) and films. If not, what are you going to do? How well would you trust every doctor's written clinical assessment? Would you bet your livelihood on it? You'd have to trust every minute detail on the doctor's findings AND his/her interpretation of the findings. Do you see what I'm saying? What if the correct intervention is non-pharmacological? Do you shuffle the patient back to a physician? This is preposterous.

I'm all for collaboration between pharms and physicians, as I have said multiple, multiple times. But to state that pharms should be prescribing and NOT docs is absolutely ridiculous.

Furthermore, Chebs is outright insulting the pharmacologic knowledge of physicians and pretends that it's the profession of pharmacy being insulted here. Physicians spend 8 years in school and at least 3 years of further training before they are practicing on their own, often with additional years of residency and/or fellowship. Please ask an anesthesiologist about anesthetic and analgesic drugs. Please ask a cardiologist about amiodarone. I don't think you'll find the knowledge is limited to a "watered-down 10 minute portion of a lecture" - and to actually believe that would be the case is more ignorant than I can describe. On this board, I've hear people saying that doctors are not suited to evaluating and implenting new treatments, and then that doctors are too easily swayed by drug reps and DON'T prescribe based on clinical findings. It's all just ridiculous. Perhaps you've spent so much time definding your profession that you've lost hold on reality when you start talking about physicians in general. I don't mean to direct this right at you, but rather to the multiple people here making the above noted statements.

 

[tungsten87]

It'd be fine if that what "chebs" is saying. But it isn't. If someone is going to make the ridiculous statement that pharms should be prescribing instead of docs, then he/she should be able to be completely comfortable doing an entire physical exam and interpreting every single clinical finding - including films, specialized testing (i.e. EEGs) and films. If not, what are you going to do? How well would you trust every doctor's written clinical assessment? Would you bet your livelihood on it? You'd have to trust every minute detail on the doctor's findings AND his/her interpretation of the findings. Do you see what I'm saying? What if the correct intervention is non-pharmacological? Do you shuffle the patient back to a physician? This is preposterous.

I'm all for collaboration between pharms and physicians, as I have said multiple, multiple times. But to state that pharms should be prescribing and NOT docs is absolutely ridiculous.

Furthermore, Chebs is outright insulting the pharmacologic knowledge of physicians and pretends that it's the profession of pharmacy being insulted here. Physicians spend 8 years in school and at least 3 years of further training before they are practicing on their own, often with additional years of residency and/or fellowship. Please ask an anesthesiologist about anesthetic and analgesic drugs. Please ask a cardiologist about amiodarone. I don't think you'll find the knowledge is limited to a "watered-down 10 minute portion of a lecture" - and to actually believe that would be the case is more ignorant than I can describe. On this board, I've hear people saying that doctors are not suited to evaluating and implenting new treatments, and then that doctors are too easily swayed by drug reps and DON'T prescribe based on clinical findings. It's all just ridiculous. Perhaps you've spent so much time definding your profession that you've lost hold on reality when you start talking about physicians in general. I don't mean to direct this right at you, but rather to the multiple people here making the above noted statements.

+1.

perhaps the most important aspect of prescribing is the thorough diagnosis. pharmacists are not trained to diagnose at the same level of detail as physicians and are usually called upon to mediate a patient on a complex regiment of medications or catch mistakes in the pharmacy/make recommendations to physicians. while our role as (future) hospital pharmacists are extremely important, I think a lot of pharmacy students are somewhat disillusioned in thinking that they will have a glamorous "clinical" job that gives similar amounts of patient contact as physicians get(again, there are exceptions). anyone who thinks physicians should not be able to prescribe and that pharmacists because med students only take one semester of pharmacology is crazy. a lot of this knowledge is gained through clinical rotations and residencies (especially specialties). when working in a health care setting it is important for one to acknowledge his or her role and the fact of the matter is that pharmacists are second class health care providers. does this mean i do not think pharmacists can make a difference or that pharmacist intervention is essential? no. but at least understand that the physician should be making the most important decisions for the patient as they are trained to do so and are also held accountable for these decisions.

 

[ResearchPharmD]

It'd be fine if that what "chebs" is saying. But it isn't. If someone is going to make the ridiculous statement that pharms should be prescribing instead of docs, then he/she should be able to be completely comfortable doing an entire physical exam and interpreting every single clinical finding - including films, specialized testing (i.e. EEGs) and films. If not, what are you going to do? How well would you trust every doctor's written clinical assessment? Would you bet your livelihood on it? You'd have to trust every minute detail on the doctor's findings AND his/her interpretation of the findings. Do you see what I'm saying? What if the correct intervention is non-pharmacological? Do you shuffle the patient back to a physician? This is preposterous.

I'm all for collaboration between pharms and physicians, as I have said multiple, multiple times. But to state that pharms should be prescribing and NOT docs is absolutely ridiculous.

Furthermore, Chebs is outright insulting the pharmacologic knowledge of physicians and pretends that it's the profession of pharmacy being insulted here. Physicians spend 8 years in school and at least 3 years of further training before they are practicing on their own, often with additional years of residency and/or fellowship. Please ask an anesthesiologist about anesthetic and analgesic drugs. Please ask a cardiologist about amiodarone. I don't think you'll find the knowledge is limited to a "watered-down 10 minute portion of a lecture" - and to actually believe that would be the case is more ignorant than I can describe. On this board, I've hear people saying that doctors are not suited to evaluating and implenting new treatments, and then that doctors are too easily swayed by drug reps and DON'T prescribe based on clinical findings. It's all just ridiculous. Perhaps you've spent so much time definding your profession that you've lost hold on reality when you start talking about physicians in general. I don't mean to direct this right at you, but rather to the multiple people here making the above noted statements.

I don’t understand why you are so resistant against the idea of pharmacists prescribing medication when medication is our profession. It may not be our job to diagnose diseases, but it is our job to treat those diseases. I run a continuing medical education program and I assure you that not all physicians are competent or up-to-date with the current literature. Some of the doctors that I have encountered are still prescribing medications with high rate of mutation when there are other alternative therapies with much lower mutation profile and higher efficacy.

Furthermore, what do you think will happen when there are more patients than physicians to manage them? With current expansion of healthcare coverage, a lot more patients will be introduced into a healthcare system that is somewhat fixed in terms of personnel. I personally feel that pharmacists are underutilized in the current system given our training. However, I feel that the pharmacy profession will continue to expand to meet the needs of the current healthcare system. I have talked to pharmacists who I have considered pioneers in the clinical pharmacy and they have described a lot of resistance from physicians when clinical pharmacy was first introduced and practiced. But look at where we are now. Clinical pharmacists are now respected and integral members of healthcare teams nationwide. Thus, I think you should be more open to progress.

 

[ResearchPharmD]

+1.

perhaps the most important aspect of prescribing is the thorough diagnosis. pharmacists are not trained to diagnose at the same level of detail as physicians and are usually called upon to mediate a patient on a complex regiment of medications or catch mistakes in the pharmacy/make recommendations to physicians. while our role as (future) hospital pharmacists are extremely important, I think a lot of pharmacy students are somewhat disillusioned in thinking that they will have a glamorous "clinical" job that gives similar amounts of patient contact as physicians get(again, there are exceptions). anyone who thinks physicians should not be able to prescribe and that pharmacists because med students only take one semester of pharmacology is crazy. a lot of this knowledge is gained through clinical rotations and residencies (especially specialties). when working in a health care setting it is important for one to acknowledge his or her role and the fact of the matter is that pharmacists are second class health care providers. does this mean i do not think pharmacists can make a difference or that pharmacist intervention is essential? no. but at least understand that the physician should be making the most important decisions for the patient as they are trained to do so and are also held accountable for these decisions.

I disagree with you 100%. Pharmacists are NOT second class health care providers. I find that statement extremely insulting to current and future pharmacists. Pharmacists and physicians have different emphasis, but one is not better than the other. The fact is, pharmacy students receive a lot more training in pharmaceutical management than medical students. Pharmacists are better equipped to properly manage patients’ treatment regimen due to our training and knowledge of pharmaceutical products and their interactions. Keep in mind that optimal treatment outcome depends just as much on proper management by pharmacists as accurate diagnosis by physicians.