Pharmers on Midlevels

[quickfeet]

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Sorry, I just read this all now... I didn't think this would start a whole huge argument. Anyways I think most midlevels are very nice people and I get along with all I work with, I just wished the physicians who supervised them (or who are supposed to be doing so) did a little more of it. I really do not understand how many of them got prescriptive authority in the first place. Like TAP said, some of them only have a scope of practice that includes a dozen or so drugs. That was more the whole point of the thread, a pharmacy discussion on mid-level prescribers rather than a this profession versus that one.

 

[All4MyDaughter]

In my state, the midlevel's scope of practice is identical to that of his or her supervising MD/DO. So anything the doc can write for, the midlevel can write for (legend drugs). Controls are a different matter.

 

[MountainPharmD]

u are awesome, and your posts always bring out a good laugh. I would seriously consider driving up I-45 and buy you a beer

Wow! Someone reads what I post? I never knew.

I guess our little medical friend tucked tail and ran. It would be nice to have one of them come over and engage in an intelligent convesation rather than sling insults and old sterotypes around.

 

[schrute]

I guess our little medical friend tucked tail and ran. It would be nice to have one of them come over and engage in an intelligent convesation rather than sling insults and old sterotypes around.

The management of patient medication—particularly in the outpatient setting—has historically been intrinsically linked to primary care medicine, implicit to the understanding that medication management entails more than simply plugging numbers into a formulary while ignoring related or other health concerns / issues. I recognize that in many instances, a formula is fine, and hospital / physician groups that sign contractual agreements with pharmacists to monitor & manage medications can choose to do so within the context of mutually agreed-upon management guidelines. But my comment re-posted here from the DO forum was conveniently incomplete:

http://www.ashp.org/DocLibrary/Advoc...ch-Letter.aspx


"The American Society of Health-System Pharmacists (ASHP) supports H.R. 5389, a bill that would provide coverage for "clinical pharmacist practitioner services" under Part B of the Medicare program.

Clinical pharmacists bring a unique knowledge of pharmaceutical agents, their mechanism of action, and drug interactions that is separate from the knowledge base of physicians.

This bill takes that important first step in utilizing the health professional with the education and training uniquely directed toward the appropriate use of medications, the pharmacist. Simply put, the time has come to begin addressing the medication use problems that cause adverse drug events and add needless costs to our health care system."


My contention is that generating another bill via direct billing from pharmacists for "clinical practitioner services" is not in the best interest of medicine because it a.) adds another layer of medicolegal & financial bureaucracy to patient care by generating more billing, b.) opens the door for stand-alone pharmacist-based primary care settings, and c.) insinuates that physicians are incapable, uneducated or simply too busy to deal with "the appropriate use of medications," and transforms the pharmacists' role from that of advisory to that of independent practitioner. Pharmacists may be trained in "the appropriate use of medication", but so are physicians, PAs, NPs--not to the educationally-defined extent of pharmacists, but nor are pharmacists trained in the care of patients to the extent of physicians/PAs/NPs, which is the direction our healthcare field needs to go/is going: opposite the direction of fragmented care with numerous layers of billing.


"Practice of medicine" vs "practice of pharmacy."


(i'm not allowed to repost the 'scope of practice' data)

http://www.pharmacypracticenews.com/index.asp?show=dept&section_id=51&issue_id=631&article_id=15162

 

[Me_Gusta_Drugs]

I rarely ever post but after reading this doctors posts I just have one thing to say..
This guy is ******ed.

I'm just glad hes a doctor because if he was a pharmacist saying these things I'd be so embarassed and ashamed of my profession.

He's just exuding insecurity with a small penis right now.

 

[tungsten87]

I rarely ever post but after reading this doctors posts I just have one thing to say..
This guy is ******ed.

I'm just glad hes a doctor because if he was a pharmacist saying these things I'd be so embarassed and ashamed of my profession.

He's just exuding insecurity with a small penis right now.

 

[rxlea]

Clearly, The Doctor doesn't see that the ship has already sailed on that one.

 

[Filler]

 

[spacecowgirl]

My contention is that generating another bill via direct billing from pharmacists for “clinical practitioner services” is not in the best interest of medicine because it a.) adds another layer of medicolegal & financial bureaucracy to patient care by generating more billing, b.) opens the door for stand-alone pharmacist-based primary care settings, and c.) insinuates that physicians are incapable, uneducated or simply too busy to deal with “the appropriate use of medications,” and transforms the pharmacists’ role from that of advisory to that of independent practitioner. Pharmacists may be trained in "the appropriate use of medication", but so are physicians, PAs, NPs--not to the educationally-defined extent of pharmacists, but nor are pharmacists trained in the care of patients to the extent of physicians/PAs/NPs, which is the direction our healthcare field needs to go/is going: opposite the direction of fragmented care with numerous layers of billing.

I'm sorry you feel I inaccurately truncated your post. I took out the scope of practice statement we all know about already.

a) no one wants to work for free. We have been providing cognitive services forever and not getting paid. Reimbursement is shrinking and part of this is about finding other payment sources to make pharmacies sustainable.

b) where is your factual basis for this?

c) there is a lot to know, more than any one person can know about medicine today. It's not saying doctors are incompetent, it's saying there is no way for one person to have the breadth of knowledge that combining specialties can provide. If you feel threatened by this, that is on you.

Again, where are you getting this independent practitioner business? Have you ever worked with a clinical pharmacist? It's nothing like what you are talking about, you are just fearmongering. And that's the only reason I am defending the profession against you, so that just maybe you won't go around desseminating false information about something you clearly know nothing about. If you had any experience you would know that what you are fearing is not the goal of advancing pharmaceutical care.

 

[PSYCHNP]

First lets take out this statement "pharms trying to be primary care providers." Despite all the students with thier heads filled with BS from the ivory tower of acedemia most experienced practicing Pharmacists have no desire to be a primary care provider.

To the last part of your statement I have to ask why? Who better to manage a patients medications than a Pharmacist? It would be nice if Primary Care Docs would do it but it isn't happening. There is not much being managed when you have to carry 5000 active patients and in order to make any money you have to double book 15 minute appointments from open to close 5 days a week. There is not much time to manage anything during a 15 minute appointment every 6 months.

Most Primary Care Docs have there hands full with all that is involved with the physical exam, diagnosis of any problems and the selection of appropriate drug therapy. Do you need to be an MD to adjust someones medications per a written protocol? There are many ways a Pharmacist can help. Considering 90% of all Doctors visits end up with a prescription being written for something we are all ready a big part of what you do.

The best model I have seen is the VA's system. If the civillain world adopted it there would be a huge cost saving as well as improvement in outcomes.
Imagine the time you would have to spend with your patients if you had a good competent Pharmacist helping you manage medication therapy! Again do you need to be an MD to read lab values and adjust medications based on a predesigned protocol that you have written and approved?

Oh wait there I go again! My head in the clouds wanting to be a primary care docotr. Shame on me!!! I know there is no way I could look at lab values and adjust medications. Gosh sir you started your cholesterol medication 3 months ago and have had only a slight imporovement. Your LFT test are fine and you have no complaints of muscle pain or weekness. You have changed you diet and started an exercise program. I see you have lost five pounds good for you. Hmmmm what should we do? Gosh, I am in over my head we better kick this up to the MD. I am only a Pharmacist after all and all I know how to do is count the cholesterol medication.

I agree with Dr. Shrute on this one. Pharmacists are not MD/DOs, NPs, or PAs. If they wish to prescribe they need the necessary physical assessment skills.

To Mountainpharm and Quickfeet if you all want to prescribe meds I suggest you go to the University in Hawaii with the PharmD/FNP program. If you are not willing to put in the necessary studies then continue to stand behind a counter all day. Case closed.

 

[DYSF777]

I agree with Dr. Shrute on this one. Pharmacists are not MD/DOs, NPs, or PAs. If they wish to prescribe they need the necessary physical assessment skills.

To Mountainpharm and Quickfeet if you all want to prescribe meds I suggest you go to the University in Hawaii with the PharmD/FNP program. If you are not willing to put in the necessary studies then continue to stand behind a counter all day. Case closed.

I didn't think it could get any dumber...

 

[quickfeet]

I agree with Dr. Shrute on this one. Pharmacists are not MD/DOs, NPs, or PAs. If they wish to prescribe they need the necessary physical assessment skills.

To Mountainpharm and Quickfeet if you all want to prescribe meds I suggest you go to the University in Hawaii with the PharmD/FNP program. If you are not willing to put in the necessary studies then continue to stand behind a counter all day. Case closed.

You do realize that my entire post was about how incompetent mid-level providers are and why its dangerous that they even have the prescriptive authority they do, right? Because nothing in the original post said a single thing about pharmacists have an expanded scope into anything. That is basically a peripheral topic that emerged throughout the course of the thread.

 

[PSYCHNP]

You do realize that my entire post was about how incompetent mid-level providers are and why its dangerous that they even have the prescriptive authority they do, right? Because nothing in the original post said a single thing about pharmacists have an expanded scope into anything. That is basically a peripheral topic that emerged throughout the course of the thread.

What you are saying is like the pot calling the kettle black. I don't know how many times, lowly nurses, have to correct errors made by so called pharmDs (who are not even a real doctors).

I mean, these self proclaimed doctors usually can't even print out med sheets accurately. So, before you start putting down others please take a look at yourselves.

 

[PSYCHNP]

You do realize that my entire post was about how incompetent mid-level providers are and why its dangerous that they even have the prescriptive authority they do, right? Because nothing in the original post said a single thing about pharmacists have an expanded scope into anything. That is basically a peripheral topic that emerged throughout the course of the thread.

Whether it be a peripheral topic or a current one please do not comment on skills you are not trained to do (i.e. prescribing).

Unless you can do better please refrain from criticizing others on SDN who put in the necessary studies to perform their given healthcare role.

Like I said earlier, if so called "doctors of pharmacy" want to prescribe they need to go to MD/DO, NP, or PA school.

 

[WVUPharm2007]

Wooooooooooo!

Flame war back on!



------

To put on my serious cap for one second, disappointing as it may be, all of the nonpharmacists should probably read up on MTM. It has a history of improving outcomes, decreasing costs, and in some cases increasing visits to practitioners...it's typically a rather win-win situation for everyone involved. It's adjunctive care, not replacement care.

 

[Quiksilver]

Schrute I have to be honest, you sound ridiculous. How do you feel about midlevels? Is it just pharmacy that you have a problem with?

Your argument are hypocritical, you claim that our education is over-doing it when compared to medical students in terms of knowing medications but on the other side, the art of diagnosis is not taught enough to pharmacy students. How can you think that medical students and residents know enough of pharmacology and therapeutics? The students and residents I know look like deer in headlights when trying to pick a medication. While I don't think anyone here is claiming enough knowledge that they can diagnose, I don't think that you can argue that when it comes down to it, providers don't know as much pharmacology, kinetics and therapeutics as they should.

Your other point about adding a layer of billing, you do realize that pharmacies do get reimbursed for filling prescriptions right? We also get reimbursements for vaccines as well. I don't understand how this adds a layer.

I also don't get this fragmented care that you speak of. Pharmacists who provide clinical services work within a group practice. Meaning that this patient care is more like a team then just one individual. Which brings me to the last point, we save the health care system money.

I'm beginning to think you are just a pre-med or that you have never seen a pharmacist.

 

[MountainPharmD]

I agree with Dr. Shrute on this one. Pharmacists are not MD/DOs, NPs, or PAs. If they wish to prescribe they need the necessary physical assessment skills.

To Mountainpharm and Quickfeet if you all want to prescribe meds I suggest you go to the University in Hawaii with the PharmD/FNP program. If you are not willing to put in the necessary studies then continue to stand behind a counter all day. Case closed.

Oh dear God what I have I done? All of a sudden its idiots on parade.

PSYCHNP you are way late to the party and no where near what anyone was discussing. Never once was there any talk of Pharmacists prescribing meds. The original point of the thread was to point out how some, not all, midlevel practioners do not know what they are doing.

Thanks to Dr. Shrute we branched off into a discussion of Pharmacists managing a patients medication therapy. For reasons he has still yet to justify he does not think a Pharmacist is qualified to manage a patients medications.

 

[BelleMD2B]

This is -- by far -- the most entertaining thread I have read on SDN.

I'm trying to decide who has given better replies...WVUPharm or MountainPharmD.

Seriously guys, thank you for making my Wednesday. I was getting a little bored.

Please Schrute...please return.

 

[Sparda29]

I agree with Dr. Shrute on this one. Pharmacists are not MD/DOs, NPs, or PAs. If they wish to prescribe they need the necessary physical assessment skills.

To Mountainpharm and Quickfeet if you all want to prescribe meds I suggest you go to the University in Hawaii with the PharmD/FNP program. If you are not willing to put in the necessary studies then continue to stand behind a counter all day. Case closed.

So I suppose the 2 semesters of physical assessment mean nothing?

 

[schrute]

I'm sorry you feel I inaccurately truncated your post. I took out the scope of practice statement we all know about already.

a) no one wants to work for free. We have been providing cognitive services forever and not getting paid. Reimbursement is shrinking and part of this is about finding other payment sources to make pharmacies sustainable.

b) where is your factual basis for this?

c) there is a lot to know, more than any one person can know about medicine today. It's not saying doctors are incompetent, it's saying there is no way for one person to have the breadth of knowledge that combining specialties can provide. If you feel threatened by this, that is on you.

Again, where are you getting this independent practitioner business? Have you ever worked with a clinical pharmacist? It's nothing like what you are talking about, you are just fearmongering. And that's the only reason I am defending the profession against you, so that just maybe you won't go around desseminating false information about something you clearly know nothing about. If you had any experience you would know that what you are fearing is not the goal of advancing pharmaceutical care.

Not that you would know, but I have INTIMATE knowledge of the CCP profession, which is actually the impetus for my posting (not some desire to randomly start fires in random forums).

Currently 33 states allow pharms to enter contractual agreements for collaborative care that allows pharms to recommend and/or implement medication changes. I don't feel threatened by such agreements, or the fact that pharms have more educationally-defined knowledge on pharmacokinetics, etc. The "independent practitioner" comment was in the context of "potential"...eg. someone putting a wedge in the door for pharms to be able to bill for services that are essentially "primary care" services, RE comments such as these RE billing for cognitive services:

First, while pharmacists and pharmacies certainly need to be worried about reimbursement issues etc I think this issue often clouds the enormous opportunity pharmacists could offer patients, the US health care system in general, and our own profession. Community pharmacists are very accessible health care workers who, in the current dispensing model of pharmacy (IE the pharmacist's salary/wage is tied to a product) are vastly under utilized for the amount of education they receive. In general, a pharmacist's training/education includes, of course, the study of medications but also the study of diseases and disease state management. Many pharmacists even hold additional certifications that further strengthens training in areas such as diabetes management, asthma management, heart disease, etc. In other words, pharmacists can, could, and should be involved in chronic disease state management of patients.
http://forums.studentdoctor.net/showthread.php?t=607107

Arguments (and mentalities) like these—that because your education is 4-yrs, you are essentially justified in fulfilling the role of a primary care practitioner—are what I'm talking about.

It's the same argument that we hear optometrists make all the time; it's the same argument we hear chiropractors make all the time; it's the same argument we hear DNPs make all the time: various fields are increasingly expanding the breadth of their education & training and consequently argue & lobby that graduates of said education are, reflexively, entitled to expand their scope of practice. IE: BILL.

Med management & "cognitive services" are the bread & butter of primary care (eg. FP), and the suggestion that physicians be relegated to mere ‘diagnosticians' with the actual management of patient care available to anyone with specialty training (eg. PharmDs) is a joke.

You do understand that, right? You're basically suggesting that patients go to physicians for Dx and initial drug selection, and beyond that, they're free to go to any WalMart or Kmart (or, eventually, private CCP clinic? …again, "potential") and receive their ongoing care from a pharmD, within the realm of services they would be licensed to provide (which would include the OVERWHELMING majority of chronic disease states: HTN, DM, hyperlip, etc, etc, etc&#8230😉.

The medical profession is not going to roll over and let that happen, I'm merely telling you that.

'Benefit design should balance physician and pharmacist roles
In general, physicians support the concept of collaborative drug management but believe that the practice of medicine and the responsibility for overall patient care should remain in their control. This is consistent with current models of pharmacist involvement in patient care that range from patient education and hospital rounds to prescribing privileges for pharmacists under established protocols. The American College of Clinical Pharmacy (ACCP) holds that in the model drug management relationship, the physician would diagnose the patient and make the initial treatment decision and subsequently authorize the pharmacist to "select, monitor, modify, and discontinue medications as necessary to achieve favorable patient outcomes" ( A CC P 1997). Under this arrangement, the association asserts that the physician and pharmacist would share the risk and responsibility for patient outcomes. The physician's ongoing involvement in the patient's care also would need to be clearly defined.'
--MedPac

 

[schrute]

Sorry, I just read this all now... I didn't think this would start a whole huge argument. Anyways I think most midlevels are very nice people and I get along with all I work with, I just wished the physicians who supervised them (or who are supposed to be doing so) did a little more of it. I really do not understand how many of them got prescriptive authority in the first place. Like TAP said, some of them only have a scope of practice that includes a dozen or so drugs. That was more the whole point of the thread, a pharmacy discussion on mid-level prescribers rather than a this profession versus that one.

To address your specific question (as long as I'm here), midlevels provide an invaluable service when appropriately trained. I've met horrible PAs / NPs and great ones, but in general, their role is "assistant" (eg. inherent to the title "physician assistant") so understandably they are not as well versed on meds as pharmDs and clinical care as physicians.

But something I've always respected about the PA profession (which several family members and close friends of mine are in) is that since their inception, they've ALWAYS respected & stayed within the bounds of their education & designed role. Despite the fact that studies show PAs consistently hover near 85-90% of the functionality of a primary care doc, particularly in a rural setting, the PA profession has never gotten on board the "expanding scope of practice" bandwagon everyone else is on.

As a side note, I recently served on a committee examining the expansion of our hospital system and how to allocate healthcare dollars accordingly. The most desired area at the request of medical staff (residents, attendings, everyone) was ancillary support with patient care, ie, PAs and NPs, because those midlevels are trained to function at a capacity that entails many of the same job responsibilties as a physician, just with a more narrowed scope. The NP and--especially--PA fields are only going to get bigger, so complain about their deficiencies all you will, they are and will continue to be highly saught after.

 

[Its Z]

none of the opinions posted on this thread will make any impact or change the way we practice the professions we have chosen. only thing it will accomplish is to increase the resentment against other professions which is neither productive nor necessary. time will be better spent trying to impove what youre doing instead criticizing others.

yeah i spend alot posts discussing nonsense but this sort of post really serve no purpose. just sayin.

 

[spacecowgirl]

You do understand that, right? You're basically suggesting that patients go to physicians for Dx and initial drug selection, and beyond that, they're free to go to any WalMart or Kmart (or, eventually, private CCP clinic? …again, "potential") and receive their ongoing care from a pharmD, within the realm of services they would be licensed to provide (which would include the OVERWHELMING majority of chronic disease states: HTN, DM, hyperlip, etc, etc, etc&#8230😉.

That's quite a leap of logic from anything I've said 😕 and your "evidence" is an SDN post.

Obviously your experience with CCP and my experience are completely different because how you are presenting this, even as "potential", is unlike anything I have seen or heard about amongst my colleagues, at state or national conventions, etc. Indepdent practice is certainly not the goal of my work. I personally don't care about billing so long as somehow the dollars allocated to the clinic account for that time. I don't care if I generate a shiny bill with some CPT code on it. But the finance people seem to care.

I'm going with Z on this now, I give up. We are clearly on different pages here.

 

[cbrons]

Schrute, von Hayek was a good man. Respect

 

[WVUPharm2007]

Schrute, von Hayek was a good man. Respect

We got cockamamie slippery slope arguments running awry. Z apparently, somehow, acting as the voice of reason. The mods telling me to stop trolling, as usual. And just when this thread couldn't get any douchier, we got to throw in compliments to economic ideologues.

----

If this thread was a smell, it would be Cleocin Suspension.

 

[cbrons]

We got cockamamie slippery slope arguments running awry. Z apparently, somehow, acting as the voice of reason. The mods telling me to stop trolling, as usual. And just when this thread couldn't get any douchier, we got to throw in compliments to economic ideologues.

----

If this thread was a smell, it would be Cleocin Suspension.

Oh I think my post was actually relevant to the topic at hand.

Perhaps the most influential exposition of classical liberalism the world has ever seen.

Wait actually maybe it wasn't related to the topic at hand... my bad... I will now exit stage left

 

[rxlea]

I was thinking more of metformin smell, Mike.

 

[cycloketocaine]

We got cockamamie slippery slope arguments running awry. Z apparently, somehow, acting as the voice of reason. The mods telling me to stop trolling, as usual. And just when this thread couldn't get any douchier, we got to throw in compliments to economic ideologues.

----

If this thread was a smell, it would be Cleocin Suspension.

The mods asked you to quit trolling? Regarding this thread?

 

[spacecowgirl]

If this thread was a smell, it would be Cleocin Suspension.

well done

 

[WVUPharm2007]

Oh I think my post was actually relevant to the topic at hand.

Perhaps the most influential exposition of classical liberalism the world has ever seen.

Wait actually maybe it wasn't related to the topic at hand... my bad... I will now exit stage left

Keynes was smarter.

*imagines cbrons head exploding*

----

 

[schrute]

Keynes was smarter.
----

Ha! Explains everything.

 

[rxforlife2004]

SCHRUTE...dude...relax man. Why so serious? relax dude. We ain't gonna take your jobs away, man. Calm down...I can't stand smelling poop and giving rectal exams...so yeah, won't touch ur job. You're safe. Now STFU and get back ur azz to work.

 

[ttopping]

Schrute: I feel like a majority of people who have posted have already said what I'm thinking, specifically mountain so there's really no reason to re-post those ideas. I am still curious as to your responses to his question regarding medication management since you've yet to answer.

That being said, I think what's being missed here is the fact that we're not around to try and steal jobs from physicians. I think you're seriously mislead in your view on pharmacy services as a whole and how we can help impact the health field. I know it's been said, but we're apart of the health TEAM. It's not a one man show. We can't do things without you guys and you can't do things without us, and with the expansion of our practice, we're just trying to add our expertise into the mix and help, not replace.

Not quite sure what you're trying to get at with nurses catching pharmacist mistakes. It happens, that's what the team is for. People make mistakes, and thankfully the rest of the team is there to help make sure the patient doesn't suffer. Giving that example would be like me pointing out (as a pharmacy student) the mistakes I've seen physicians make. Everyone plays a role. I certainly don't think the physician is a ***** for doing something a student knows is clearly wrong, and as a future pharmacist I certainly would hope a nurse would be able to catch something we missed in the pharmacy.

I'm with quicksilver, it's sad to think that there are upcoming physicians who for really uninformed reasons, look down at pharmacy when so many others (residents all the way to attendings) realize how important we can be if utilized WITH the team, not a separate entity. Pharmacy school has a primary base in disease state understanding before we get into the medications, so we certainly aren't blindly memorizing meds and picking them based on indications. We see things from a different perspective, and in my experience on rotations, the more perspectives, the better the outcome. Less is missed, and the patient is better off.

 

[FarscapeGirl]

SCHRUTE...dude...relax man. Why so serious? relax dude. We ain't gonna take your jobs away, man. Calm down...I can't stand smelling poop and giving rectal exams...so yeah, won't touch ur job. You're safe. Now STFU and get back ur azz to work.

So I may be taking this thread off on another tangent, but rxforlife2004 is so right. I think after pharmacy school, I'll be able to manage drug therapy for someone's diagnosed condition. I also think, after an entire class on OTC drugs, I'll be able to help someone select a OTC product and refer them when they need to see a PCP or their meds aren't working, whether they're OTC or prescribed. I already can give vaccines, help guide someone to quit tobacco, and soon hand out emergency contraception. I'm sure I'll feel comfortable doing more in the field of pharmacy. But I have no desire to be a doctor.

Today in class, someone suggested making a private room available in pharmacies for counseling. This concerns me. First of all, I've never seen someone really embarrassed during counseling. Second of all, I have a feeling this would encourage people even more to lift up shirts or worse to show off some horrible skin ailment. Seeing dermatological disorders are not my cup of tea, and so not part of my job description. That is what PCPs are for and part of the reason I have no desire to be one.

 

[FarscapeGirl]

What you are saying is like the pot calling the kettle black. I don't know how many times, lowly nurses, have to correct errors made by so called pharmDs (who are not even a real doctors).

I mean, these self proclaimed doctors usually can't even print out med sheets accurately. So, before you start putting down others please take a look at yourselves.

Okay, responding to a troll here (seriously, what kind of health student are you??), but I didn't know every single MD had the ability to print out med sheets accurately and that's what made them real doctors. In fact, I'd be very surprised by this considering the large amount of prescriptions I get that are printed on paper that was put into the printer the wrong way. However, I do not equate this with the MD's or their nurse's abilities to provide clinical care (although I might not want to hire them as administrative assistants if they ever change careers).

That is all.

 

[PharmBound2011]

Okay, responding to a troll here (seriously, what kind of health student are you??), but I didn't know every single MD had the ability to print out med sheets accurately and that's what made them real doctors. In fact, I'd be very surprised by this considering the large amount of prescriptions I get that are printed on paper that was put into the printer the wrong way. However, I do not equate this with the MD's or their nurse's abilities to provide clinical care (although I might not want to hire them as administrative assistants if they ever change careers).

That is all.

Question - What kind of Health student are you? Why do you not make sense?

PsychNP - I'm an NP. Once again, I'm an NP.🙄

 

[rxlea]

Today in class, someone suggested making a private room available in pharmacies for counseling. This concerns me. First of all, I've never seen someone really embarrassed during counseling. Second of all, I have a feeling this would encourage people even more to lift up shirts or worse to show off some horrible skin ailment. Seeing dermatological disorders are not my cup of tea, and so not part of my job description. That is what PCPs are for and part of the reason I have no desire to be one.

Then you better not work for IHS. I think private rooms are a good thing, though. I have always thought that the tiny little counseling windows near the pick up window (or at the pick up "window") don't provide enough privacy, but that's just a personal opinion. We shouldn't diagnose but it certainly is within our scope to "assess"- tell the difference between an emergency and non-emergency for example. I can think of a several times that patients came into the retail pharmacy I worked at in the ghetto asking what they should take for various things and the pharmacist ended up telling the patients to go to urgent care. If we didn't "assess" we would just sell somebody some product and send them on their way potentially putting them at risk. My professor tells us that when a patient comes up to the consultation window asking about what to take or asking about dehydration or something, we should say, "Why do you ask?"

 

[FarscapeGirl]

Question - What kind of Health student are you? Why do you not make sense?

PsychNP - I'm an NP. Once again, I'm an NP.🙄

I totally didn't realize PSYCHNP was PsychNP, but now I presume his/her stauts says health student because his/her specialty doesn't have a title. The NP doesn't stand out when the whole login name is all caps.

PsychNP, I should point out that I'm glad nurses have caught PharmDs' mistakes, especially if it prevented a med error. Honestly, we all make mistakes, and the systems we work in should be set up so there are multiple checks. Sometimes, some people make lots of mistakes, and these people, regardless of their status, are frustrating and dangerous for the rest of us (which I believe was more along the line of the initial topic of this post).

 

[PharmBound2011]

PharmBound2011, now I'm confused. Was your question directed to me? I was responding to PsychNP's comment that PharmDs or 'so-called real doctors' in PsychNP's words can't even print out med sheets. I pointed out that a large amount of prescriptions I get aren't printed correctly, but that does not mean that I doubt the clinical expertise of the people who print them.

I also wondered why PsychNP's status says health student, but now I presume it's because his/her specialty doesn't have a title.

PsychNP, I should point out that I'm glad nurses have caught PharmDs' mistakes, especially if it prevented a med error. Honestly, we all make mistakes, and the systems we work in should be set up so there are multiple checks. Sometimes, some people make lots of mistakes, and these people, regardless of their status, are frustrating and dangerous for the rest of us (which I believe was more along the line of the initial topic of this post).

it wasn't directed towards you at all. her title says health student because there isnt a designation on SDN for NPs.

And it was supposed to be a joke. I was tryna pull a leslie nielson, EPIC fail.

http://wimp.com/leslienielsen/

 

[FarscapeGirl]

it wasn't directed towards you at all. her title says health student because there isnt a designation on SDN for NPs.

And it was supposed to be a joke. I was tryna pull a leslie nielson, EPIC fail.

http://wimp.com/leslienielsen/

Woops. 🙄 Now that I get it, it's very funny. This is what I get for procrastinating with studying by hanging out on SDN. Sorry for ruining the joke!

 

[npage148]

It's really not surprising some doctors feel so threatened by pharmacists getting collaborative agreement prescribing powers. They have previously been "attacked" by PAs and NP and now we want to go after them. They have slowly come to accept these mid-levels.

In all honesty and setting all the Ashville project stuff aside they should be asking for our help. Everytime I work I constantly hear complaints from patients about how their doctors are Jackoffs becasue they either have no time to talk to them about their problems, need to schedule appointments 3 months out, or take 14 days to call in a refill. The majority of patients are definitely being let down by their PCPs.

Combine this with the typical gross mismanagement of basic disease states (Avandia as 1st line for type II, Z-pack for acute bronchitis, or Norvasc for uncomplicated HTN) and you would think they'd be asking for help instead of shunning it.

 

[KARM12]

Dude, we're all in this together. I've worked with good and bad MDs, PAs. NPs, PharmDs...

I have no desire to touch patients...the thought of that makes me cringe, but I will help you do other things. Can't figure out how to manage that aminoglycoside or vancomycin? I'm on it. Too lazy to adjust the warfarin for that INR? I can help. Most physicians I've worked with could care less about titrating insulin, managing warfarin, and following lipids.

 

[VA Hopeful Dr]

Dude, we're all in this together. I've worked with good and bad MDs, PAs. NPs, PharmDs...

I have no desire to touch patients...the thought of that makes me cringe, but I will help you do other things. Can't figure out how to manage that aminoglycoside or vancomycin? I'm on it. Too lazy to adjust the warfarin for that INR? I can help. Most physicians I've worked with could care less about titrating insulin, managing warfarin, and following lipids.

Y'all have to understand, these days it seems like everyone who's ever even set foot in a hospital is trying to get in on what, traditionally, has been the role of the physician. Some of it is quite benign (even very helpful/improves outcomes) - vanc/aminogly dosing. Some of it is less so - minute clinics, increasing CRNA scope. Nowadays the gut reaction is to say "nope, you can't take on additional responsibility" since doing otherwise has gotten us into trouble in the past.

That said, generally speaking, I have no issue with y'all taking on management of chronic meds. However for me to get completely behind the idea, I"d want a closer relationship with the pharmacist doing this than just "the person who works at the pharmacy where some of my patients go".

 

[cycloketocaine]

Just a question.....do mods not close threads anymore when they are becoming unproductive/counterproductive?

I've seen quite a few of these lately and I can remember when threads were closed when they became nasty......but it seems that some of the newer mods like to join in.

Just a thought.

 

[FarscapeGirl]

Y'all have to understand, these days it seems like everyone who's ever even set foot in a hospital is trying to get in on what, traditionally, has been the role of the physician. Some of it is quite benign (even very helpful/improves outcomes) - vanc/aminogly dosing. Some of it is less so - minute clinics, increasing CRNA scope. Nowadays the gut reaction is to say "nope, you can't take on additional responsibility" since doing otherwise has gotten us into trouble in the past.

That said, generally speaking, I have no issue with y'all taking on management of chronic meds. However for me to get completely behind the idea, I"d want a closer relationship with the pharmacist doing this than just "the person who works at the pharmacy where some of my patients go".

I think most of us advocating for pharmacists managing chronic meds with doctors realize the doctors would need to have a relationship with us before doing so. We discuss in school setting up additional services in our future pharmacies, and one of the suggested steps is letting nearby providers know about the service. That's the case whether it's managing warfarin or providing vaccines. I know for the vaccines, it can be especially helpful for the doctors, as it's expensive for a small office to keep vaccines around that may or may not be used.

 

[owlegrad]

Just a question.....do mods not close threads anymore when they are becoming unproductive/counterproductive?

I've seen quite a few of these lately and I can remember when threads were closed when they became nasty......but it seems that some of the newer mods like to join in.

Just a thought.

I hate when threads are closed. Just my 2 cents.

 

[tungsten87]

I hate when threads are closed. Just my 2 cents.

agreed... especially since there have been numerous great points from both sides in this thread.

 

[cycloketocaine]

agreed... especially since there have been numerous great points from both sides in this thread.

I wasn't referring to this one as much as one over in the pre-pharm forum. This is just the one I was reading when the thought crossed my mind.

 

[KARM12]

Y'all have to understand, these days it seems like everyone who's ever even set foot in a hospital is trying to get in on what, traditionally, has been the role of the physician. Some of it is quite benign (even very helpful/improves outcomes) - vanc/aminogly dosing. Some of it is less so - minute clinics, increasing CRNA scope. Nowadays the gut reaction is to say "nope, you can't take on additional responsibility" since doing otherwise has gotten us into trouble in the past.

That said, generally speaking, I have no issue with y'all taking on management of chronic meds. However for me to get completely behind the idea, I"d want a closer relationship with the pharmacist doing this than just "the person who works at the pharmacy where some of my patients go".

You bring up a great point. I agree that I wouldn't just let any pharmacist play around with a patients meds. Not all pharmacists are created equal. You do need someone that you can trust and that knows what they are doing.

 

[WVUPharm2007]

"I don't care what my role is, someone just give me a damn job." -- WVUPharm2007