Role of Phamacist

[kwakster928]

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I have been reading forums thread here and there, and it seem like there is healthy discussions on all sort of topics. It brings me to a question. what can we as a phamacist do to bring down the misconception that we are just drug counters? Is pharmacy school doing anything to change public's perception of us? Do you all see in a future where we will be seen as drug experts rather than counters by public also most importantly among other health professionals? I totally agree that we all should expect each other's profession, but what do we do now or can we do in the future to get respect from others? any personal stories you guys want to share (a story where you felt really good to be a phamacist)? or any other suggestions? what do you all think?

 

[WVUPharm2007]

The only professionals we seem to get any flak from are the older ones and the insecure ones that probably don't know any better. Quick story, a phamacist I workwith (Pharm.D.) used to do consulting at a cancer clinic. There was a young oncologist, about 34, and an older nurse. In casual conversation, the young oncologist called him Dr. Genericpharmacist. The nurse then said in a belittling tone, "he's not a doctor." So the oncologist says to the pharmacist, "you've got a PharmD, right?" The pharmacist replies, "yeah." So the oncologist turns his head to the nurse and said, "He's every bit of a doctor as I am, and you'd better call him one from now on." See, just don't trust anyone over 40.

I've seen studies that show morbidity and mortality rates tend to improve when a pharmacist is consulting. I think that as time progresses and we begin to analyze the usefulness of having PharmDs around, clinical pharmacists will earn the respect of other health professionals.

 

[kwakster928]

interesting story...

personally i couldn't careless about this whole calling phamacist "doctor" thing. yeah i wouldn't mind if someone call me dr so and so but i wouldn't care if they dont. I would rather have a repect from others that if they ever have a drug question, they can count on me for a professional advice. in opposite, if i find that there need to be a intevention on my part, i hope they will take my advice seriously. I guess it is what you make up to be. I planning on studying my butt off at the phamacy school. i rather impress others by my knowledge rather than stupid title that comes after my name. even though it is nice.. i am not going ot lie...

 

[htyotispharm]

Once people realize our importance, they will come around. My friend is a pharmacist who works at a rural hospital with about 8 other pharmacists. Ironically, all 9 RPHs got tired of the abuse from the physicians and nurses so 6 of them put in resignations and 1 want to go to part-time. Within a month, the hospital was going to be left with 2 FT pharmacists and 1 part-time Rph. It got so bad that a letter was sent to the Board of Pharmacy, Board of Medical Examiners, and to the Board of Nursing. Suprisingly, his salary went from $83,200 to $91,000 and the other health care providers starting treating them like gold. THEY REALIZED NO ONE ELSE IS TRAINED AS EXPERTS IN THE USE AND DISPENSING OF MEDICATIONS EXCEPT PHARMACISTS.

 

[GravyRPH]

Or perhaps that no one else is legally allowed to dispense the medications. It sounds more like a supply and demand issue, then a new degree of respect.

 

[VCU07]

This is an interesting post that has been debated a lot. I personally believe that we will not be recognized as drug experts and doctors until those pharmacists with bachelor degrees retire. In addition to this, there are many older MDs that are stubborn and want to keep their niche in medicine as drug experts. Most of the younger MDs that I have talked to are grateful for PharmDs. One told me that he just prescribes a drug in a particular class and hopes the pharmacist will pick up on something better that could be used. Unfortunatly, I think it will be another 10 to 20 yrs before something drastic occurs.

 

[raindrop]

We are seen as "pill counters" because when most Americans see a pharmacist, it is in the retail setting. The average person walks into a Walgreens/CVS/Rite Aid/Walmart/Target/Albertson's/Shaw's/Long's ... etc pharmacy, drops off the prescription, sees the RPh or tech count the pills into a vial, label it then ring it up. The stuff we do behind the counter, the interpretation, the interactions, the overdose/underdose, the duplicate therapies, and everything else, they rarely see.

There is SO much that can happen in the fifteen minutes between the time the Rx is dropped off to the time it is rung up.

Lynn

 

[surgery]

I personally believe that we will not be recognized as drug experts and doctors until those pharmacists with bachelor degrees retire.

This is absoulutely the biggest B.S. I've ever heard. First of all, all pharmacy graduates take the same board exam in order to be licensed, whether it is a B.S. or PharmD. I am sure there are many with PharmDs that failed the exam, and there are many with B.S. that ACE the board. We, physicians don't respect your degree, we respect your expertise in pharmacology. Just look at a post by IDPHARM regarding the treament for VRE with Amoxicillin, he is a PharmD crying out loud. Your statement is an absolute insult to the pharmacy profession!

In addition to this, there are many older MDs that are stubborn and want to keep their niche in medicine as drug experts.

Where did you get this idea? Medical and pharmacology knowledge come with experience, I personally respect many pharmacists because I do consider them to be the experts, even though they cannot answer some of my questions before looking it up, it's ok. But I honestly can name a few medicine that I use which some pharmacists, especially the young ones have no knowledge about. And I have to know my commonly prescribe drugs in and out because I do usually counsell them when I prescibe these medications. I am far from a drug expert, but malpractice insurance is very expensive and you guys are not paying for it.

I am sure VCU has a great program, but if this is what they teach in school, I would love to hear from your Dean.

 

[GravyRPH]

It's now how much you know, it's how fast you can find the answer. 😉

I always have to look up the answer's to the doc's question. They're usually not calling to ask the dose of amoxicillin. It's usually something wierd like Vancomycin in an 11 year old. I don't want to dose that off the top of my head. If, for nothing more, than to double check my answer.

 

[baggywrinkle]

This is an interesting post that has been debated a lot. I personally believe that we will not be recognized as drug experts and doctors until those pharmacists with bachelor degrees retire. In addition to this, there are many older MDs that are stubborn and want to keep their niche in medicine as drug experts. Most of the younger MDs that I have talked to are grateful for PharmDs. One told me that he just prescribes a drug in a particular class and hopes the pharmacist will pick up on something better that could be used. Unfortunatly, I think it will be another 10 to 20 yrs before something drastic occurs.

You miss the whole point. I have never had a problem being respected as a drug expert even though I am "only" a B.S. pharmacist. It is not required to thrash about in esoterica, all that needs be done is meat and potatos pharmacy -- and it doesn't matter WHAT practice setting you work in. Snagging errors which are so basic as to be no brainers for any reasonable pharmacist (Clonidine for Klonopin in a pedi for sleep) generates a lot of trust and will open many doors building the manner of practice you desire in your profession. The trick is to tactfully MAKE SURE the culprit is aware that you have bailed his/her butt out of harm's way. When you do it right their thanks are profound and sincere. They do not forget.

 

[VCU07]

All of you who replied to my post did so b/c you missed my point. First of all, I never said that BS pharmacists know less than PharmDs, but you have to understand that having a BS is not the same as having a PharmD. PharmDs (by degree) are doctors, BS pharmacists are NOT. I have a BS, does that make me a doctor? Second, the MD who repliled to my post is incorrect. It is true that some (not all) older doctors don't respect Pharmacists nor other health care professionals. I am sure many of the pharmacists out there can agree to that. There have even been younger MDs who have told me the same thing. I was not saying this to disgrace pharmacy, I said it b/c it is TRUE! Also, they don't teach this in pharmacy school. In fact, they teach us to work together for solutions. I hope we can work together to find cures, but its the real world that some MDs are stubborn and want no help from anyone else. Sorry if I pissed off anyone.

 

[bananaface]

VCU07- I think that surgery was trying to make a supportive statement, one that deserves our appreciation. In general, I have found that physicians do understand that pharmacists are drug experts. Just because every once in awhile you run across someone who acts as if they do not understand the nature of pharmacist's training, it does not mean we should generalize and say that physicians don't appreciate us. If you have the skills necessary to speak to a physician or other healthcare on a professional level, they will be likely to respect you regardless of your specific degree.

With all of the differences in life experience, the difference between a Pharm.D. and a B.S. in pharmacy cannot be used to sort people into different competency levels. I don't buy the idea that medical and pharmacology knowldege come exclusively from experience (no disrespect intended), nor do I think they are all learned in school. School gives us the basics and teaches us how to gather and apply information. Because of the extra time Pharm.D. students have in school, we get a bit more breadth than the BS program previously offered. This does not mean our education is superior, because it's all about what we make of it afterwards. We are lucky if we have the chance to do the Pharm. D. program, because we will have the opportunity to choose from amongst of different practice sites. And, we get a bit more time to decide what practice sites interest us most. That's my 2 cents.

About the other question in the initial post....
Do you think that having pictures of a counting tray on the news any time a pharmacy related story is aired has anything to do with the slow change in public preception?

 

[baggywrinkle]

With all of the differences in life experience, the difference between a Pharm.D. and a B.S. in pharmacy cannot be used to sort people into different competency levels. I don't buy the idea that medical and pharmacology knowldege come exclusively from experience (no disrespect intended), nor do I think they are all learned in school. School gives us the basics and teaches us how to gather and apply information. ?

Little sister, you sure got that right. We sort ourselves into different competency levels. For pharmacists, your knowledge database will never be
better than it is 1-5 years or so out of school while the learnin is still fresh and you've logged some miles under your keel. After that point, unless you have a digital memory, alzheimers and age starts to catch up with you. To some extent you can compensate with charm and dashing good looks 😀
but having good references handy and knowing how to use them is what will save the day.

Seriously, as long as you are consistant with the people you serve and you are straight with them when you do screw up you will be suprised at the loyalty you will command. My hero, Don Degani of Durango Colorado, graduated in 1951 and ran his own store for over thirty years. The loyalty of his patrons was so intense that he could close a store down by moving across town. He is finally retired. Rest assured he is missed.

 

[bananaface]

How is this rating scale?

Rugrats: 1 year of experience or less
Prince(ss) Charming: 1-5 years of experience
Hot grandma/grandpa: 5+ years of experience and *sizzling* hot
Old ogre: 5+ years of experience and NOT so easy on the eyes
Wizard: 5+ years of experience and a digital memory

j/k

I just finished finals, so I am having difficulty staying serious.

 

[godfather]

No disrespect to pharmacists, but believe me a doctor that doesn't know the meds he's prescribing and is not a expert at them won't be in practice for very long. My experiences from rotating on virtually every service while i was in med school and through residency is that the doctor knows more about the medications than anybody and any book. the reason is he is prescribing those medications day in and day out and HE IS SEEING FIRST HAND THE EFFECTS THESE MEDS HAVE ON THE PATIENT. This is not something your going to read out of a book and tell him about. Generally speaking from the services i rotated on, usually when the physican had questions, it would be questions on meds that he didn't know because he didn't have as much experience with them and usually they weren't related to his specialty. And even then he usually knew more than anybody on the team about the med but wanted more info, and here he usually would ask one of the students, interns, or pharmacists to look it up. In my experience there are so many meds and new ones are coming out all of the time, no body is going to know all of them. However whoever is prescribing them and seeing their effects is the one that is going to know the most about that particular medication. Ie i know very little about oncology drugs, as i don't use them day to day but resusatative drugs and anesthetic drugs i know better than my own heart beat. Here even if i go into a PDR and read about some of these oncology drugs i gurantee you i won't know them better than an oncologist that's using them every day. I hope this doesn't get taken as disrespect by any pharmacist (partially because i'm dating one) because during residency i have more than one time been saved by a pharmicist( one time prescribed a med that a patient had a history of severe allergy to and the pharmacist picked up on it), but if physicans don't know the drugs they're prescribing or are relying on pharmacists fill them in, they're not going to be in the business for a very long time.

 

[kwakster928]

I sometimes wonder if the world could live without the pharmacist. Let's just look at the world. Physicians do have a right to dispence (i think) and if she and he is sure about the medication effects on a patients, why does phsycians need us for? even though i am very excited about the profession i am about to enter, but honestly sometimes, i just feel let down.

 

[surgery]

I sometimes wonder if the world could live without the pharmacist. Let's just look at the world. Physicians do have a right to dispence (i think) and if she and he is sure about the medication effects on a patients, why does phsycians need us for? even though i am very excited about the profession i am about to enter, but honestly sometimes, i just feel let down.

Good question, let me take a shot at it.
I believe, physicians are not allowed to dispense medications to their patients for profits, we have samples in the office that we often give it to patients, those are supposed to be free (it's possible some doctors sell it), we can however, purchase or stock medicine(with a license) for office use, such as glucocoticoids, local anesthetics, etc.

To answer your main question, does our society need pharmacists? My answer is yes. We need pharmacists to work in retail to dispense medications and responsible for any potential errors, including checking and counting pills. Some community pharmacists involve in counselling and other primary care education (like diabetes, geriatrics), I don't know whether there is any positive clinical outcome, may be somebody can quote us a study.

I want to quote you a study: The impact of critical care pharmacists on enhancing patient outcomes. Intensive Care Med. 2003 May;29(5):691-8. "Pharmacist involoving in clinical care of critically ill patients is associated with optimal fluid management and substantial reductions in the rates of adverse drug events, medication administration errors, and ventilator-associated pneumonia." My experience is there is a role for clinical pharmacists (especially in a multidisciplnary team) in optimizing drug therapies (like monitoring Vanco levels), reduce polypharmacy/duplicate therapies and reduce unnecessary prolongation of therapies. These will result in better patient outcome and reduce health care cost.

Although, these pharmacists are usually found in tertiary care or teaching hospitals, many clinical pharmacists may not be as involved in patient care in smaller community hospitals.

I assume you are accepted into a pharmacy program. My feeling is you are not totally sure about this profession and has doubts about the role of a pharmacist. I urge you to be careful about the decision, it's 4 years of your time, and you will need to do some studying to be a decent student, in addition to the money you will invest to obtain the degree. If you hate to go to work every morning as a pharmacist, it's not worth making $100k (well, at least for me).

 

[kwakster928]

Yes surgery to answer your question, yes i have been accepted, but I do stand by my decision as becoming a phamacist. I am excited and wanted to get there every second. reason i am am posting these message is for me and others to know how pharmacist is viewed among peers. they are somewhat positive, and somewhat negative, i could careless. I just wanted to know what other peoples are thinking. It is extremely interesting and informs me quite a bit. thank you very much for the study you posted. I think pharmacist has a lot of work to get rid of public's perception as pill counters, and i am willing to be on the front line. again thanks again for your views. everyone's veiws are important and informative no matter the content.

 

[baggywrinkle]

I sometimes wonder if the world could live without the pharmacist. Let's just look at the world. Physicians do have a right to dispence (i think) and if she and he is sure about the medication effects on a patients, why does phsycians need us for? even though i am very excited about the profession i am about to enter, but honestly sometimes, i just feel let down.

It would be a very poor idea to eliminate the pharmacist in both hospital and
retail settings.

The pharmacist is the only healthcare professional with a deep knowledge of physical chemistry, stability and compatability. Walk into any sterile products lab. You will see compounding happening there and in the community

The retail pharmacist is quite often the first professional interface with the healthcare system many people see. They wander in with a problem, not wanting to spend the money for a visit to the clinic and the pharmacist has enough training to guide them to professional help when it is warranted.

I now practice in Washington state which is very progressive allowing a wide variety of health care practitioners prescribing authority. Trust me when I tell you that those who do not sport an MD/DO after their name would have no business dispensing out of their office where they would not enjoy the benefit of a drug specialist giving their work the once over before the patient consumes it. As a group these second level practitioners are highly skilled and very competent, but everyone has off days and every group has their
"flicted" children that need closer watching than the others.

That includes pharmacists. Who checks the checker? Why the patient if they
have their wits about them

 

[jdpharmd?]

No disrespect to pharmacists, but believe me a doctor that doesn't know the meds he's prescribing and is not a expert at them won't be in practice for very long. My experiences from rotating on virtually every service while i was in med school and through residency is that the doctor knows more about the medications than anybody and any book. Here even if i go into a PDR and read about some of these oncology drugs i gurantee you i won't know them better than an oncologist that's using them every day.

It's great if you've met such knowledgeable docs so far, but believe me when I say that the vast majority are not like that. It's not uncommon to see docs writing for whatever the local drug rep has been pushing that week. The truly dangerous doctors (or pharmacists, etc) are those who don't know their own limits. Just because the last patient didn't have a severe adverse rxn to the particular drug doesn't mean that it's the case for everyone else. "Guess and check", using live patients as guinea pigs, is not an acceptable strategy. Prevent the error BEFORE it reaches the patient.

I hope that you're using "PDR" as a generic term. The PDR is considered one of the absolute worst drug references. They are provided to doctors for free because the company that publishes them charges a large fee for insertion. They consist of package inserts provided by the drug companies. Consider it a gigantic advertisement.

Best of luck learning 4 years of med school, 3 years of residency, and 4 years of pharmacy school! You'll be a heck of a doctor. Are you from UofM? Wayne State? (I was born in Detroit). 👍

 

[ultracet]

No disrespect to pharmacists, but believe me a doctor that doesn't know the meds he's prescribing and is not a expert at them won't be in practice for very long..

Ok. Time to throw my 2 cents in this one...

Alright for background. My dad is a doctor and my mom is a pharmacist and I am starting my 3rd year in pharm school in the fall. ( yeah i know it makes me cool) *Sarcasm*

Having said that, dinner table discussions around here are ususally educational.
In having discussions with my dad, while he does know the effects of the drugs he give he has no idea whether it interacts with CYP 3A4 or 2C9 or even that those enzymes exist. The fact is, his education stopped at P450. Doctors are not exposed to the indepth pharmacology of most drugs and have no idea what receptors they act on or how that could affect anything else. Yes you don't smoke while on BC but WHY? What enzyme does smoking have anything to do with and does this affect any other medications or conditions the patient might have?

Some physicians my have taken the time to learn the pharmacology of a certain set of medications down to the molecular level. But that is what we are beign taught in school.

Pharmacists are the medication experts. Pharmacy school is 4 years, med school is 4 years. I know the practical experience in medicine takes quite a bit longer and then you must specialize but the in class learning is the same amount of time.

Most pharmacists are extremely overeducated for their jobs. If they were utilized maybe they wouldn't forget everything they are taught in school.
Most physicians i know do respect pharmacists but they have NOOOO idea exactly what pharmacy school intails.

I personally find it refreshing when a doctor takes the time to learn as much as s/he can about the medications he is providing. I have found in a lot of cases if they are really interested in learning about it they will ask the pharmacist for any information they have.

 

[bananaface]

My experiences from rotating on virtually every service while i was in med school and through residency is that the doctor knows more about the medications than anybody and any book. the reason is he is prescribing those medications day in and day out and HE IS SEEING FIRST HAND THE EFFECTS THESE MEDS HAVE ON THE PATIENT. This is not something your going to read out of a book and tell him about. Generally speaking from the services i rotated on, usually when the physican had questions, it would be questions on meds that he didn't know because he didn't have as much experience with them and usually they weren't related to his specialty.

And, who did the doctor consult regarding drugs outside of his area of expertise?

Seeing side effects firsthand is beneficial for physicians, but is too narrow of a scope to use for prescribing decisions. Many times a negative outcome may take place in only patients with specific risk factors. Many times there are drug interactions with drugs a specialist may not be familiar with. Pharmacists' knowledge represents the collective experience of many more patients than a single physician could hope to see in a lifetime. Any physician who relies soley on what he or she has observed in their own practice won't be a physician for very long, at least not a successful one. 😉

And what was your experience with general practitioners? They aren't limited to just a few drugs that they are very familiar with. You can't expect a GP to know everything about every drug or be able to limit their prescribing activities to a narrow spectrum of standbys.

 

[loo]

How do we change our "image"?

1. Make sure you join your state/national pharmacy organizations and become involved the the political and legal process. Apathy only hurts the profession.

2. Educate, not berate. This includes most health professionals.

Thanks for your support, surgery!