Scope of Practice Question

[GymMan]

I take back what I said about this thread, perhaps is it fun to see grownups act like imbeciles.

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[UNMorBUST]

A DPM (or whatever specialty it is writing it) is the one responsible for the script NOT you. You can advise a doc but you don't have final authority.

If the patients life could be negativly effected i would hope a pharmacist would speak up rather then mindlessly fill scripts. Pharmacists go through years of schools to know what drug is used for what purpose and the effects. Why not trust them when they have something to say? And yes pharmacists are also responsible for a script. A friends coworker ( who is a pharmacist )is actually going to lose his job for a script overdose. So EVERYONE is responsible for the script.

 

[GymMan]

If the patients life could be negativly effected i would hope a pharmacist would speak up rather then mindlessly fill scripts. Pharmacists go through years of schools to know what drug is used for what purpose and the effects. Why not trust them when they have something to say? And yes pharmacists are also responsible for a script. A friends coworker ( who is a pharmacist )is actually going to lose his job for a script overdose. So EVERYONE is responsible for the script.

Yes but not solely. He can question no doubt (and of course I hope he would) but it should be brought to the attention of another party, not completely based upon his decision. He is there to act as a failsafe not the sole ultimate decider. Consult and discuss, not act in final authoritative tones or decree/deem right vs wrong.

 

[IamMDMBA]

You're not a judge and jury, you're a licensed healthcare professional. If you think a script is wrong then address it above yourself, not make final decisions yourself. If pharmacists make final calls on meds prescribed than why to hell do we need DOCTORS? Why not you just have a pt. call you and ask what YOU would suggest they take. How about a drive-thru pharmacy, where Harold and Millie come in and just ask your opinion on what's best for their self diagnosis -- arrived at from searching google themselves? Seems logical, no?

If a doc writes a script and sends a pt. home with it, he assumes liability and -- assumes it WILL be filled according to HIS specs. If you change it or toss it, then when the pt. croaks, will YOU assume liability for deciding it WASN'T warranted? I think not. If so, damn, a doc can just send pt's to you and bill them for their visit and his time. No need to even eval the pt. -- let the pharmacist at Walmart handle it.

For someone who came on berating everyone for acting juvenile, looks like you turned out to be the biggest one of all.....

 

[npage148]

Licensed podiatrists may not treat any part of the human body other than the foot, according to Section 7001 of New York State Education Law. You are not allowed to treat fractures of the malleoli or perform cutting operations on the malleoli. A licensed podiatrist who treats another part of the human body may be subject to charges of professional misconduct, for practicing beyond the defined scope of podiatry

However, a podiatrist is limited to prescribing medications for the purpose of treating conditions of the foot, despite the fact that any medications prescribed may also have other systemic effects on the patient. Drugs prescribed by a podiatrist may be administered by any route, including intravenously.

I wouldn't fill and Rx for Ambien for more than 7 days. I also wouldn't fill your ambien for RLS or your prozac for neuropathy. Last time I checked they were a little above the foot

 

[bigpharmD]

I think the real problem is that no one really knows what podiatrists do. I know they do stuff with the feet, but other than that I have no clue. I cant really say what they should or should not be prescribing. Just a ?, but how much pharmacology do the pods get on school? The problem with many prescribers (especially PAs, NPs) is they just add meds and dont truly understand the medications. They know x drug treats x condition so lets prescribe it.

 

[bigpharmD]

Yes but not solely. He can question no doubt (and of course I hope he would) but it should be brought to the attention of another party, not completely based upon his decision. He is there to act as a failsafe not the sole ultimate decider. Consult and discuss, not act in final authoritative tones or decree/deem right vs wrong.

great post...i am a consultant not a prescriber...

 

[JEWmongous]

I wouldn't fill and Rx for Ambien for more than 7 days. I also wouldn't fill your ambien for RLS or your prozac for neuropathy. Last time I checked they were a little above the foot

Pods have more than the foot in the majority of states FYI. Majority include the ankle and most have below the knee (soft tissue). A few even have the ENTIRE leg (knee down with surgery). I wouldn't throw out a script if it was in this pod's scope of practice.

 

[Danmanwrx]

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[npage148]

Pods have more than the foot in the majority of states FYI. Majority include the ankle and most have below the knee (soft tissue). A few even have the ENTIRE leg (knee down with surgery). I wouldn't throw out a script if it was in this pod's scope of practice.

Well in NY, it would be out of the scope of practice and since I practice in NY I would throw it out. If I was working in a different state, I'd take that into consideration

 

[bigpharmD]

Pods have more than the foot in the majority of states FYI. Majority include the ankle and most have below the knee (soft tissue). A few even have the ENTIRE leg (knee down with surgery). I wouldn't throw out a script if it was in this pod's scope of practice.

My point exactly. I just dont think peole have a clue on what all PODs do. For example, I have a friend in POD school who has a picture of him wearing a stethoscope. He got mad when I asked him why he needed that to treat feet.

 

[ohhyourgod]

My point exactly. I just dont think peole have a clue on what all PODs do. For example, I have a friend in POD school who has a picture of him wearing a stethoscope. He got mad when I asked him why he needed that to treat feet.

havent you seen the little mermaid? scuttles listens for the heart beat on the foot, duh

 

[Quiksilver]

Here's the thing, what gives you the right to make decisions on which med is appropriate on that pt. or condition specific to that pt., without a history of that pt.,etc.? A DPM (or whatever specialty it is writing it) is the one responsible for the script NOT you. You can advise a doc but you don't have final authority. If you question the script, then question it above the prescribing doc if you feel the need. You can't just arbitrarily deem a script useless and toss it out. Wtf? How did you get a license to practice meds while in pharm school? Or am I missing something WVU in WV allows their pharm students to do? You'd have to drink moonshine in the WV hills, to believe you're in the right to make a call to void a script with no further questions asked.

We are equally responsible for the script that was written, since DR. DPM wrote an Rx, saying that "YES! this patient really does need this medication." When we fill it, we are legally saying "yes, this DR. DPM knows what he is doing and this medication is perfectly acceptable under his scope of practice" We can get our asses sued because of anyone's negligence with an Rx pad. SO you better believe that we would be the Rx nazis that we are in this thread.

I sure as hell would call the doctor; if I deem it to be outside his scope of practice, by law, that paper becomes null and void, since the doctor had no legal grounds to prescribe it in the first place. So yes, We can decide if it is appropriate or not... Do you think we are mindless monkeys that only do whatever the doctors want? IF you are, you are no different then anyone else in this thread.

Does it mean that it would be void without questioning, no! And i don't think that you would find one pharmacist that would come out and actually say that they would void it on the spot. If a podiatrist has a good reason, I will fill it. We want to see a patient be treated just like anyone else.

your comment of West Virginia wins you points on your maturity score, way to set yourself apart from the "children" in this thread. I hope your boss/administrator reads your comments. Thanks for playing.

 

[RxWildcat]

I think this whole thread boils down to the majority of non-pharmacy people posting here having very little knowledge about what a pharmacist does and is responsible for. Some of the post here have been pretty comical and downright incorrect, but I think we're all on the same page (well, maybe most of us at least).

 

[215512]

I think this whole thread boils down to the majority of non-pharmacy people posting here having very little knowledge about what a pharmacist does and is responsible for. Some of the post here have been pretty comical and downright incorrect, but I think we're all on the same page (well, maybe most of us at least).

+1 now can we please close this?

 

[UW66]

+1 now can we please close this?

lololololololol

 

[NatCh]

I think this whole thread boils down to the majority of non-pharmacy people posting here having very little knowledge about what a pharmacist does and is responsible for. Some of the post here have been pretty comical and downright incorrect, but I think we're all on the same page (well, maybe most of us at least).

Reading through this thread AND the one on the Pharmacy board, I think the lack of knowledge goes both ways towards each of our professions. Pharmacists and Podiatrists have far more education, training, and ability than we get credit for from the general public. Having a couple of friends who are Pharmacists, I've found out just how well-trained and capable they are, and they have found out just how capable and well-trained I and my colleagues are. Mutual respect goes a long way towards providing excellent patient care (which is the ultimate goal, in case anyone forgot).

Nat

 

[jonwill]

I think the real problem is that no one really knows what podiatrists do. I know they do stuff with the feet, but other than that I have no clue. I cant really say what they should or should not be prescribing. Just a ?, but how much pharmacology do the pods get on school? The problem with many prescribers (especially PAs, NPs) is they just add meds and dont truly understand the medications. They know x drug treats x condition so lets prescribe it.

Good point. Podiatry has evolved quite a bit over the last few decades into what I would term a surgical sub-specialty. Podiatrists are foot and ankle surgeons who do everything from bunions, hammer toes, and ganglion cyst removal to flatfoot reconstruction and ORIF of ankles. Our residencies include an intern year in which we rotate through services such as IM, ID, gen surg, vasc surg, plastics, etc.

Our schooling is nearly identical to MD/DO's in the first few years (many of our programs are largely integrated with MD/DO over the first few years) and differs quite a bit in the last few years as we obviously start to focus more on the lower extremity.

As I stated a few pages ago, this is all theoretical. NO PHYSICIAN will treat conditions or write for scripts that are not commonly treated within their specialty. I don't care if "they could". They won't! And medicine is only getting more specialized!

 

[diabeticfootdr]

I wouldn't fill and Rx for Ambien for more than 7 days. I also wouldn't fill your ambien for RLS or your prozac for neuropathy. Last time I checked they were a little above the foot

Painful DPN is in the scope of practice for DPMs in NYS. I did my residency there and treated it nearly on a daily basis. I'm still licensed there as well.

A pharmacist doesn't determine the scope of practice for any profession. The state legislature does and the state board and AG make administrative law.

So if a valid prescription was presented by a patient you'd be ethically obliged to fill it.

SSRIs aren't commonly used for painful DPN since they have a fairly high NNT of 6.7. The new SNRI has a more favorable profile in addition to the anticonvulsants.

 

[RxWildcat]

A pharmacist doesn't determine the scope of practice for any profession.

No one said they did.

So if a valid prescription was presented by a patient you'd be ethically obliged to fill it.

Key word valid, meaning based on a valid pt-dr relationship and prescribing within the scope of ones practice. I don't think anyone's got a problem with that.

 

[hyperpodia]

No one said they did.



Key word valid, meaning based on a valid pt-dr relationship and prescribing within the scope of ones practice. I don't think anyone's got a problem with that.

Some, pharmacists will second guess a prescription from a Dentist or Pod

But the proper procedure would be to call the doctor and clarify that the prescription is legit. A pharmacist can not unilaterally decide not to fill a script.

 

[All4MyDaughter]

A pharmacist can not unilaterally decide not to fill a script.

Actually, we can. If there is a problem with a script we have a number of options. Here are just a few:

-Call the prescriber to discuss/rectify the problem. Fill if the matter is satisfactorially resolved.
-Call the provider and secure more appropriate therapy. Often done in the case of major drug interactions or when a patient cannot pay for the expensive brand name medication prescribed.
-Decline to fill and return the script to the patient. They can take it elsewhere.
-Confiscate the script and turn it over to law enforcement (forged narcotic script, for example).

Pharmacists practice pharmacy, just as physicians practice medicine, dentists practice dentistry, podiatrists practice podiatry, etc. The professional services of a licensed healthcare provider are theirs to give solely at the their own discretion. Pharmacists don't run around rejecting scripts on a regular basis (why would we?) but we certainly CAN and DO reject them occasionally, and it is within our discretion to do so.

 

[UNMorBUST]

Actually, we can. If there is a problem with a script we have a number of options. Here are just a few:

-Call the prescriber to discuss/rectify the problem. Fill if the matter is satisfactorially resolved.
-Call the provider and secure more appropriate therapy. Often done in the case of major drug interactions or when a patient cannot pay for the expensive brand name medication prescribed.
-Decline to fill and return the script to the patient. They can take it elsewhere.
-Confiscate the script and turn it over to law enforcement (forged narcotic script, for example).

Pharmacists practice pharmacy, just as physicians practice medicine, dentists practice dentistry, podiatrists practice podiatry, etc. The professional services of a licensed healthcare provider are theirs to give solely at the their own discretion. Pharmacists don't run around rejecting scripts on a regular basis (why would we?) but we certainly CAN and DO reject them occasionally, and it is within our discretion to do so.

Good post

 

[teamplayer23]

lololololololol

:troll:

 

[BMBiology]

You are so right. We really want to work on someone's feet all day, every day.

 

[All4MyDaughter]

No, no, no. This thread has been pretty civil (at least lately) until the troll reared his ugly head. Mod staff will take care of that. No flames, please.

 

[HumidBeing]

Members are requested to use one account only when posting on our forums. Trolling through the use of an alternate account does not excuse the main account from being held responsible.

 

[Aznfarmerboi]

Some, pharmacists will second guess a prescription from a Dentist or Pod

But the proper procedure would be to call the doctor and clarify that the prescription is legit. A pharmacist can not unilaterally decide not to fill a script.

A pharmacist can unilaterally decide not to fill a script if his/her professional judgement calls for it. There are many scenarios where this happen.

 

[GymMan]

How does a thread, which is found imainly in a podiatric interest forum, acquire so many pharm people here? Do you pharm guys find this serendipitously while earching something else? I'm miffed at how all-of-a-sudden this topic is being besieged by so many non-pod members?

 

[SpirivaSunrise]

I'm still a little baffled as to why we're having an issue here; the laws and regulations regarding prescribing beyond a practitioner's scope of practice are fairly straightforward. Here is a sample quoted from New York's Office of the Professions…which oversees the practice of both pharmacy and podiatry in the State).

Podiatry - Prescribing and Dispensing Medications

• A licensed podiatrist may prescribe medications only for the treatment of a condition of the foot. A licensed pharmacist may question the podiatrist who is prescribing a medication which is intended for another condition, e.g., anti-depressants that are prescribed for a foot condition.
• The licensed podiatrist, as authorized, may prescribe or dispense medications administered to a portion of the human body other than the foot (such as an injection or pill) for the purpose of treating the foot.
• Licensed pharmacists may ensure that a prescriber is not prescribing beyond his or her practice. Therefore, it is not only appropriate, but ethical, for a pharmacist to question a podiatrist who prescribes medications that are indicated for a condition other than treatment of the foot. A pharmacist is not obligated to fill any prescription if the pharmacist has questions about the appropriateness of the prescription.

I don't see a lot of ambiguity there. In addition, the scenario in question involves Zolpidem. This is an undisputable schedule IV substance, and as per federal regulations, a pharmacist has corresponding responsibility to ensure that this medication is prescribed correctly. The DEA and CFR clearly state:

Title 21, Code of Federal Regulations, Section 1306.04 provides, in pertinent part, that: "A prescription for a controlled substance to be effective must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice. The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription. An order purporting to be a prescription issued not in the usual course of professional treatment or in legitimate and authorized research is not a prescription within the meaning and intent of Section 309 of the Act (21 U.S.C. 829) and the person knowingly filling such a purported prescription, as well as the person issuing it, shall be subject to the penalties provided for violations of the provisions of law relating to controlled substances."

A pharmacist is required to exercise sound professional judgment when making a determination about the legitimacy of a controlled substance prescription. Such a determination is made before the prescription is dispensed. The law does not require a pharmacist to dispense a prescription of doubtful, questionable, or suspicious origin. To the contrary, the pharmacist who deliberately looks the other way when there is reason to believe that the purported prescription had not been issued for a legitimate medical purpose, may be prosecuted along with the issuing practitioner, for knowingly and intentionally distributing controlled substances, a felony offense.

What is the pharmacist expected to do when presented with a prescription that raises questions? Although a pharmacist may be reluctant to "get involved," there really is no choice. The pharmacist is involved because their professional responsibilities makes him or her subject to the requirements of the CSA.

Bottom line is, it's a pharmacist's responsibility to question every prescription presented to them. This does not mean that after a discussion with said prescriber, the two can't come to an agreement that the prescription is indeed appropriate and falls within the prescriber's practice.

 

[diabeticfootdr]

I’m still a little baffled as to why we’re having an issue here; the laws and regulations regarding prescribing beyond a practitioner’s scope of practice are fairly straightforward. ...............

That was an informative post.

I completely agree with it.

My disagreements above where with the pharmacists/students who said they would offer a blanket rejection for a certain medication because it was written by a DPM. When, as clarified by your post, the medication could be written off label and be legitimate and if questioned, deserves a phone call to the prescriber.

 

[SpirivaSunrise]

That was an informative post.

I completely agree with it.

My disagreements above where with the pharmacists/students who said they would offer a blanket rejection for a certain medication because it was written by a DPM. When, as clarified by your post, the medication could be written off label and be legitimate and if questioned, deserves a phone call to the prescriber.

Absolutely. It's a two-way street. There is no reason for the pharmacist to flat-out reject the prescription without first hearing out the prescriber in terms of why they feel the course of therapy is needed. And on the other hand, the prescriber has no right to say "you must fill this because I prescribed it".

The end result should be optimal patient care. These checks and balances are out there specifically to ensure that. The prescriber has a right to explain their case, and the pharmacist has every right to question/reject it. Egos should not come into play...

 

[diabeticfootdr]

How does a thread, which is found imainly in a podiatric interest forum, acquire so many pharm people here? Do you pharm guys find this serendipitously while earching something else? I'm miffed at how all-of-a-sudden this topic is being besieged by so many non-pod members?

There's a thread in the pharmacy forums talking about this thread and how WVU "spanked" all the stupid pods and put us in our place. Here's my latest post from over there.

Quote:
Originally Posted by WVUPharm2007
But, really, you don't need to be concerned about my opinion, anyway. I don't work in retail for reasons such as this. In retail, every day we see practitioners prescribing drug therapy irrationally and with overbearing God complexes (do as I say, druggist!!!) It's one thing to have physicians dealing with us as if they all have IQs of 190 and we are mental midgets...oh no...now apparently the podiatrists think they are better than everyone and should get privileges as such, too. Nah...F' that. I'm in a cozy hospital. Physicians call me with drug therapy questions sporting a nice, thankful attitude and I don't have to deal with non-physicians that think they have physician prescribing privileges. I don't have to deal with the possibility of a podiatrist rolling up to TCU and checking a patient's ECG because they are worried about their legs getting proper circulatory perfusion.

Reply by diabeticfootdr:

I laugh every time I read you put down "retail pharmacy" or doctors that use retail pharmacy, as if your hospital practice is more important.

I mainly laugh because I am a podiatric hospitalist. I am employed by a hospital. I direct a wound healing center inside a hospital. I admit my own patients and continue all their home medications. I write for Lantus and sliding scale insulin. I use beta-blockers in perioperative situations. I use LMWH postoperatively. I use Ambien to help the patients sleep in the hospital.

I get along great with our pharmacists. The always catch any mistakes and call me and we have a polite conversation. The other day we had a nice conversation about what to use for PONV since Zofran was not working.

All of these are considered in my scope as they are needed for me to be an independent foot and ankle surgeon and they are standard surgical practice. We co-admit with I-med if someone has ESRD, CAD, uncontrolled T2DM. We are not afraid to consult FP, I-med, renal, cardio, and psych, which we do frequently.

More than anything, I'm trying to education you on what a podiatrist does. Yes, most clinic podiatrists do not admit their own patients and prefer to be consultants. But academic podiatrists, especially those associated with residency programs are as active as I am. Residency training has changed greatly for DPMs. Residency training is focused on foot/ankle surgery and how to be an independent surgeon.

Podiatrists are not idiots, just because they don't have an MD - as you insinuate. I don't think PharmD's are idiots. I value their opinions. I just don't appreciate your (WVU's) online attitude. I'm sure not under the vail of internet anonymity you act differently, if you've continued to be employed.

So when you comment that you won't have to deal with someone like me, you are probably wrong - since as I stated, I am a hospitalist too.

 

[NatCh]

Everybody take a deep breath and relax. This is just your typical internet forum fight. In practice things are much more collegial and professional (at least in Oregon; I don't know about West Virginia). The great majority of podiatrists don't try to prescribe out of scope, and the great majority of Pharmacists can handle questionable prescriptions professionally. When you have someone of Dr. Rogers' stature doing the high level of work that he does, the Pharmacists in his hospital I'm sure have come to learn that he knows what he's doing (even if Pharmacy students on the internet don't think so).

You know how the typical pre-med trash talk starts to fade out as students become med students and then become Residents? As people mature in their careers, pecking order becomes less of an issue and taking care of patients using the most capable person (not degree) becomes more important.

I'm not surprised that Pharmacists are protective of their role. They are underappreciated in the scheme of health care. When a patient is sick or broken and gets help healing, they are thankful and appreciative of their doctors and nurses and will often take the time to say so, but how often do you hear of patients thanking their Pharmacist? Most people think of them as "just pill counters" but they are more capable and valuable than that. It's like when people say Podiatrists are "just nail trimmers." We all know it's not the case.

So any time you all would like to stop insulting one another...

 

[165007]

I wouldnt even waste time on a person like him.

I have been around a lot of clinical pharmacists, and I can tell you, hes not a typical one.

 

[UW66]

my heart goes out for the people that have to deal with him in the real world, goodgrief.

 

[GymMan]

There's a thread in the pharmacy forums talking about this thread and how WVU "spanked" all the stupid pods and put us in our place. Here's my latest post from over there.

Quote:
Originally Posted by WVUPharm2007
But, really, you don't need to be concerned about my opinion, anyway. I don't work in retail for reasons such as this. In retail, every day we see practitioners prescribing drug therapy irrationally and with overbearing God complexes (do as I say, druggist!!!) It's one thing to have physicians dealing with us as if they all have IQs of 190 and we are mental midgets...oh no...now apparently the podiatrists think they are better than everyone and should get privileges as such, too. Nah...F' that. I'm in a cozy hospital. Physicians call me with drug therapy questions sporting a nice, thankful attitude and I don't have to deal with non-physicians that think they have physician prescribing privileges. I don't have to deal with the possibility of a podiatrist rolling up to TCU and checking a patient's ECG because they are worried about their legs getting proper circulatory perfusion.

Reply by diabeticfootdr:

I laugh every time I read you put down "retail pharmacy" or doctors that use retail pharmacy, as if your hospital practice is more important.

I mainly laugh because I am a podiatric hospitalist. I am employed by a hospital. I direct a wound healing center inside a hospital. I admit my own patients and continue all their home medications. I write for Lantus and sliding scale insulin. I use beta-blockers in perioperative situations. I use LMWH postoperatively. I use Ambien to help the patients sleep in the hospital.

I get along great with our pharmacists. The always catch any mistakes and call me and we have a polite conversation. The other day we had a nice conversation about what to use for PONV since Zofran was not working.

All of these are considered in my scope as they are needed for me to be an independent foot and ankle surgeon and they are standard surgical practice. We co-admit with I-med if someone has ESRD, CAD, uncontrolled T2DM. We are not afraid to consult FP, I-med, renal, cardio, and psych, which we do frequently.

More than anything, I'm trying to education you on what a podiatrist does. Yes, most clinic podiatrists do not admit their own patients and prefer to be consultants. But academic podiatrists, especially those associated with residency programs are as active as I am. Residency training has changed greatly for DPMs. Residency training is focused on foot/ankle surgery and how to be an independent surgeon.

Podiatrists are not idiots, just because they don't have an MD - as you insinuate. I don't think PharmD's are idiots. I value their opinions. I just don't appreciate your (WVU's) online attitude. I'm sure not under the vail of internet anonymity you act differently, if you've continued to be employed.

So when you comment that you won't have to deal with someone like me, you are probably wrong - since as I stated, I am a hospitalist too.

Thanks. I had no idea where these pharm guys came from. I guess acting like a 2 yr old is ok for WVU then. Maybe Similac baby formula should be there most filled drug-of-choice.

 

[RxWildcat]

There's a thread in the pharmacy forums talking about this thread and how WVU "spanked" all the stupid pods and put us in our place.

No one said anything even close to that?

 

[RxWildcat]

Thanks. I had no idea where these pharm guys came from. I guess acting like a 2 yr old is ok for WVU then. Maybe Similac baby formula should be there most filled drug-of-choice.

How is he acting any different then everyone else arguing here?

 

[NatCh]

How is he acting any different then everyone else arguing here?

Ignorance, condescension, immaturity, and lack of respect went both ways in this flame war. It's fairly embarrassing for both professions.

It's always a good idea when using the internet to pretend that colleagues are lurking and reading. The things we post on the internet can stay there for years, and sometimes one's identity on the internet magically intersects with real-life.

Y'all ready to move on yet?

Nat

 

[phillypd]

of course................So how about that butt kickin' the Patriots put on AZ today.....horrible

 

[navyprincess]

I just joined the site and happened to run across this looking for podiatrists that have joined the Navy.

Anyway, I did my residency at a VA. I fought the pharmacists constantly to get antibiotics for diabetic foot infections. The pharmacists would rather keep a diabetic on a PICC line and Vanco for 6 weeks than prescribe linezolid and get them home. I also had a clinical pharmacist change the dosage of Vanco on my patient (increased to 1600mg) without my consent. I am thankful for pharmacists to double check my prescription, lord knows that we all make mistakes, however I do not appreciate being told how to treat my patient or being limited on the type of treatment by a pharmacist. And by the way, I have placed female patients on birth control because of meds that I prescribed for neuropathy. When I can send my weeping wounds to the pharmacist for treatment or a patient with painful neuropathy, then I will accept them telling me what I can and can't prescribe.

By the way, diabeticfootdr has written roughly 20 or more articles. I am proud to have someone like him in our profession. We need more podiatrists that are able to look at patients as a whole and not just as a foot or ankle.

 

[phillypd]

Hi.....i was thinking about going thru the navy for my DPM degree....but i was uncertain about a few things.......After your residency....where did they send you?

 

[aphistis]

I also had a clinical pharmacist change the dosage of Vanco on my patient (increased to 1600mg) without my consent. I am thankful for pharmacists to double check my prescription, lord knows that we all make mistakes, however I do not appreciate being told how to treat my patient or being limited on the type of treatment by a pharmacist.

I bet if you asked the pharmacist, that's exactly how he would describe what he did by changing your order. Perspective, princess, perspective.

 

[navyprincess]

Actually, the pharmacist changed the dosage on a patient with a creatinine clearance of roughly 35 (it was an honest mistake). Obviously, the patient's kidneys could not handle an increased dose, that is why I, as the DOCTOR, did not increase the vanco dose.

 

[aphistis]

Actually, the pharmacist changed the dosage on a patient with a creatinine clearance of roughly 35 (it was an honest mistake). Obviously, the patient's kidneys could not handle an increased dose, that is why I, as the DOCTOR, did not increase the vanco dose.

OK, Doctor. It looks like you're going to work however hard you need to, Doctor, to completely miss my point, Doctor. Doctor, have a nice day, Doctor, and don't let those bumbling pharmacist monkeys get you down. Doctor.

 

[navyprincess]

Ok, I think you are actually missing the point. My job is to take care of my patients and look out for their well being. It is difficult to do this when there are others "monkeying" around with the treatment plan. Obviously you have never had to worry about such things.

Love the condescending tone. You must have a great bedside manner.

 

[whiskers]

Diabeticfootdr, I feel sorry for any pharmacist that refuses to fill your prescription! You appear to know the medicine and physiology behind disease processes very well plus you seem to be on top of the current literature.

You would/did make them look like medical idiots.

This thread, for me, has highlighted the obvious discrepencies in training models between peripheral service providers (such as pharmacists) and physicians.

Every competent physician is acutely aware of the medical physiology and mechanism of action behind the medications they prescribe for their patients.

It is fact that the FDA and pharm companies can not make the investment of zillions of dollars to market every drug for every possible disease process taht could benefit from it. That is why there is off label prescribing, which REQUIRES MEDICAL PHYSIOLOGY UNDERSTAINDING and patient interaction, not simply reading a blurb in the packet insert and letting that dictate medical treatment.

After reading this thread and the contributions from the young pharm members, I am beginning to wonder if the pharmacy profession has sacrificed hard core medical training to tailer their programs to the retail outlets where most pharmacists work. If so, it does a great diservice to the profession of pharmacy.

As I said, it appears that the medical training model and the pharmacy training model have a large educational gap developing between them and is reflected in the "I will not honor this prescription" cop out we are seeing here today.

Not understanding the medical physiology is no excuse to deny a prescription and I really feel sorry for their educational experinces and lack of exposure to the medicine they think they know.

Those on this forum that said they would not fill it are hiding behind their lack of knowledge on medical physiology and their misguided attempt at interpreting the law.

My advice is if you run into one of these medically ignorant folks in reality, chuckle a bit and then let them ring up your 3 paris of socks and bag your potato chips and soda...

But send your pts to the academic pharms, the ones who actually paid attention in pharmacy school and understand medical physiology 101.

But that soon will not be a problem as we will join the MD/DO brothers/sisters.

 

[aphistis]

But that soon will not be a problem as we will join the MD/DO brothers/sisters.

Speaking of, how is that initiative (something with 2015 in the name, I think?) coming along? Is it getting anywhere?

 

[MountainPharmD]

This thread, for me, has highlighted the obvious discrepencies in training models between peripheral service providers (such as pharmacists) and physicians. .

That is the funniest statement I have ever read on SDN! Someone on the podiatry forum calling pharmacists "peripheral service providers." If thats not the pot calling the kettle black I do not know what is!

My advice is if you run into one of these medically ignorant folks in reality, chuckle a bit and then let them ring up your 3 paris of socks and bag your potato chips and soda... :

When I run into one of those podiatrist that thinks they are an MD I will chuckle. If I need my calluses trimmed or my toenails cut I be sure to see a podiatrist. Otherwise I will see an actual MD if I have a medical problem.


I found this thread by doing a search on scope of practice. I was looking for threads in reference to dental sop. When I started reading I had no idea this thread would turn into a pissing contest between pharmacists and podiatrists. Anyway I found it to be a good read. I think Spiriva had the best post which should end all discussion.

My best podiatrist prescription was about a month ago. Levaquin 1 bid. Called the guy up and he said he wanted it twice a day because the patient had a really "bad" infection and he thought twice a day would be better. I shudder everytime I get a prescription written by a podiatrist.