Should Pharmacists perform physical exams?

[thelonius]

i.e, checking arms/legs for peripheral edema, lymph nodes, neurological, eye, ENT exams, etc...Apparently our faculty thinks we should since they have included it in our curriculum, almost like they are training us to be mini PCP's. What do you all think? Is this realistic or practical? I would also be interested in hearing from any pharmacists who actually perform any of these exams since I have yet to witness this in the real world.

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[lord999]

Not I. My Patient Assessment class was a joke (we learned nothing useful), and I feel unconfortable doing it. Heck, I'm not a physician, PA, or NP, I already have too much to do as a pharmacist to worry about adding a skill that incompetence in could kill someone when there are MUCH better trained personnel that have the eye and motivation to do it.

 

[WVUPharm2007]

Everyone has that stupid physical diagnosis survey course. It's mostly to familiarize yourself with how everything works. Today I had a that a patient had in her profile rales upon auscultation. You are expected to know what that means and what it's indicative of. If yuo don't have that course, you will be lost.

 

[Mags]

Not I. My Patient Assessment class was a joke (we learned nothing useful), and I feel unconfortable doing it. Heck, I'm not a physician, PA, or NP, I already have too much to do as a pharmacist to worry about adding a skill that incompetence in could kill someone when there are MUCH better trained personnel that have the eye and motivation to do it.

Pretty much agree here. We don't get enough practice IN school to make us competent in this area. I'd rather leave it in the hands of another health care professional (that is until I go back to school and become a PA myself)l Even so I plan to work half/half (pa/pharmacist) and when I work as a pharmacist I will not perform physicals even though i might have the knowledge as PA.

 

[thelonius]

I agree that the hands-on aspect of physical exams will confer a greater understanding of the diseases that we are helping to treat and improve our professional communication skills. However, our professors feel that, because we are the most accessible healthcare providers, we are in an appropriate position to do this. The increasing class sizes along with the proliferation of pharmacy schools (at least 3 new ones in TN alone in the past year) and therefore pharmacists assures me that the shortages in our field are transient. Noone is suggesting that pharmacists replace PCP's-that is of course ridiculous. I am talking about minor health issues. Should we be taking measures like this to be more competitive tomorrow?

 

[Mags]

Well it may help to understand the disease state, but technically, our scope of practice does NOT include diagnosing, it would be stepping into AMA territory. So it might be "interesting", but we still can't diagnose, so it would somewhat be a waste of both the patient and pharmacist use of time.

 

[PharmDstudent]

Pretty much agree here. We don't get enough practice IN school to make us competent in this area. I'd rather leave it in the hands of another health care professional (that is until I go back to school and become a PA myself)l Even so I plan to work half/half (pa/pharmacist) and when I work as a pharmacist I will not perform physicals even though i might have the knowledge as PA.

Why wouldn't you just go to med school? That way, you could set up a true doctor-in-a-box shop which would include RXs.
Seriously, why PA?

 

[Shmy2008]

I think a lot of what would be realistic for pharmacists to perform would be monitoring... for example, before you refill a patient's morphine Rx, slap a pulse-ox on their finger and see what their O2 sats are to ensure proper dosing... check someone's BP before refilling their lisinopril to ensure that the dose they're on is working (or not working, as the case may be)... have an asthma patient blow into a peak flow before refilling their albuterol inhaler... the list goes on and on. I'm on fourth-year rotations and I've used some aspect of our patient assessment course on each of the four rotations I've been on so far... I think it's definitely a worthwhile course.

 

[KARM12]

I think knowing how to correctly take BP is important...other than that....I became a pharmacist so I don't have to really touch people.

 

[njac]

Why wouldn't you just go to med school? That way, you could set up a true doctor-in-a-box shop which would include RXs.
Seriously, why PA?

I don't know Mags' reason, but I know after 4 years of undergrad and 4 years of PharmD school, I'm pretty sure I wouldn't want to take on another 4 years plus residency. I'm not sure how long PA programs are but I would almost guarantee she'd be back in the workforce sooner going that route.

 

[PharmDstudent]

I don't know Mags' reason, but I know after 4 years of undergrad and 4 years of PharmD school, I'm pretty sure I wouldn't want to take on another 4 years plus residency. I'm not sure how long PA programs are but I would almost guarantee she'd be back in the workforce sooner going that route.

If that was someone's reason, it would be pretty shallow.
I wouldn't be able to stand working under an MD if I had a doctorate. It would feel degrading. The whole thing sounds like regression to me.

 

[tussionex]

i agree with WVU, the physical assesment course is just to make the body and the disease processes more concrete. you'll have a better handle on what you need to know when you read a chart if you've seen or heard it at least once.

 

[njac]

on my last rotation I did a couple days on an emergency surgery team. I worked with a nurse practitioner who was great about letting me feel or listen to things she thought were noteworthy (with patient's permission of course).

While we may not use those skills daily in our practice (whatever it may be) I think it's useful to know what the tests are, how they are performed, and what they are testing for.

 

[Old Timer]

While you are never going to be presented with the opportunity to perform these exams completely you may have the opportunity to perform some of them on rotation as NJAC did. I had that opportunity when I was on rotation.

They come in handy when you can help decide if a patient can be treated themselves or be referred to an MD. I once saw a man who was having a stroke and while it was not the only thing that made me call 911, the neurologic exam where they squeeze your fingers showed clear one sided weakness and off to the ER he went. I have used the pinch the skin technique on people who might be dehydrated. I used my stethoscope on my mother-in-law to get her to the ER when she was in CHF.

So all in all, I'm glad I learned them.....

 

[Aznfarmerboi]

I agree. Most of the physical exams that we do are there to help us have a more concrete understanding of the disease state. In most cases, they are easily done such as auscultation. It is not hard to hear a S1, S2, or a S3 (when appropriate), but obviously differentiating a S4 is more of something that a physician should handle rather than us. Most of the hands on experience that we do are nowhere what doctors, nurses, and PAs do, nor trained what to watch out for.
However, for some disease states such as asthma, copd, bp, and diabetes, we should be able to do physical exams. These tests are relatively fast and are crucial to us in monitoring and optimizing their drug therapy. It doesnt take us more than a minute to have a patient use their peak flow meter or take their bp in front of us. Most of the patients asks for refills anyway without going to their PCP for years at time. Personally, I dont see those tests as anything different than asking a patient if he at anytime during his smoking cessation therapy had any triggers.

 

[Mags]

If that was someone's reason, it would be pretty shallow.
I wouldn't be able to stand working under an MD if I had a doctorate. It would feel degrading. The whole thing sounds like regression to me.

shallow? lets wait till you have 140k in school loan s, and have enough experience in life to realize LIVING life, is a wonderful thing..

i considered medicine.. medicine is a lifestyle, eat breath sleep. I dont want that lifestyle, I don't. .. and I personally dont feel working under an MD would be a degredation. Being a PA would allow me the patient interaction I love, less school, no residency, still be able to independently prescribe (in this state), not have the malpractice issues, AND have a life.

I could work part time as a pharmacist and part time as a PA and that would be the right blend for ME. Everyone has a different idea of what they want for life, and after 6 years of school and major debt already, and the fact insurances are paying less and less for MDs, and want more and more mid level providers, it would be absolutely stupid for me to go to med school at this point, and wouldnt allow me a life outside of medicine. Ive done my homework on this.

*Edited to add*
A lot of PA's in my state practice almost independently, the attending just has to read and electronically "sign" the chart note, and thats it. Ive seen PA's do everything from general internal medicine here to stem cell transplant at one of the foremost oncology centers in the nation. And a lot of MD's appreciate PAs, the PAs can conquer the more normal, majority of stuff, while the strange and complicated is left for the MD.

 

[njac]

Mags - I was thinking the same thing. I think feeling degraded because you work under another professional is rather shallow.

all of the healthcare professional schools seem to be pushing the multidisciplinary teams so that we are all respected and utilized to provide the best patient care.

 

[Mags]

Mags - I was thinking the same thing. I think feeling degraded because you work under another professional is rather shallow.

all of the healthcare professional schools seem to be pushing the multidisciplinary teams so that we are all respected and utilized to provide the best patient care.

My tipsy self eating mickey d's at 12 am says "Word Homez" LOL

 

[PharmDstudent]

shallow? lets wait till you have 140k in school loan s, and have enough experience in life to realize LIVING life, is a wonderful thing..

i considered medicine.. medicine is a lifestyle, eat breath sleep. I dont want that lifestyle, I don't. .. and I personally dont feel working under an MD would be a degredation. Being a PA would allow me the patient interaction I love, less school, no residency, still be able to independently prescribe (in this state), not have the malpractice issues, AND have a life.

I could work part time as a pharmacist and part time as a PA and that would be the right blend for ME. Everyone has a different idea of what they want for life, and after 6 years of school and major debt already, and the fact insurances are paying less and less for MDs, and want more and more mid level providers, it would be absolutely stupid for me to go to med school at this point, and wouldnt allow me a life outside of medicine. Ive done my homework on this.

*Edited to add*
A lot of PA's in my state practice almost independently, the attending just has to read and electronically "sign" the chart note, and thats it. Ive seen PA's do everything from general internal medicine here to stem cell transplant at one of the foremost oncology centers in the nation. And a lot of MD's appreciate PAs, the PAs can conquer the more normal, majority of stuff, while the strange and complicated is left for the MD.

You've made your case .
Although, I wouldn't do PA if you genuinely love practice. Sometimes there really are greener pastures. I just see an MD as being greener than a PA license.
However, time is of the essence, and you would have less time to practice after another 10+ years of med school, internships, residencies, etc.
If it were me working as a PA in that state and situation, I'd be afraid that the MD would make me figure out the strange and complicated because of the PharmD. Although, if that were ever the case, maybe you'd be doing exactly what you wanted to do in the first place!

 

[PharmDstudent]

Mags - I was thinking the same thing. I think feeling degraded because you work under another professional is rather shallow.

all of the healthcare professional schools seem to be pushing the multidisciplinary teams so that we are all respected and utilized to provide the best patient care.

It would be degrading to me! I don't want to be someone else's b****, because of my knowledge, experiences, and educational background.
I could just see it now, "Ms. X, I need you to figure out the best treatment for this celiac patient. I don't have time, so just report to me after you figure it out. Don't worry, I'll sign off on your scripts."

While the institutions push for teams, I'm not so sure if this is followed in reality. The only thing I saw PAs do at the hospital I used to work at was ask the questionnaires. They didn't work with a team who was trying to figure anything out. Their duty with the patient was equivalent to the RNs, but without the dirty work.
It was like the PA's were wasting the patient's time just so that they could keep their jobs .
-Let me clarify, the PAs asked the same questions from the questionnaires that the nurses had already asked.

 

[psurocks]

no, we dont have the training to perform one

 

[cycloketocaine]

no, we dont have the training to perform one

Some of us do, but there is a reason I quit nursing.

 

[sdn1977]

Nope - I don't perform pa's. I was exposed to lots while in school - taught them from an academic perspective & did my share of that which applied in my realm while on rotations (in which I was ALWAYS with a nursing & med student - the benefit of being in a univ with all 3 right there in place).

I can't "hear" the heart sounds anymore, 30 years later. But, I can take a bp just fine & do - did about 3 this week. I never do when I'm working hospital - there is ALWAYS someone more skilled than me in place to do a pa there.

In retail, I use it, like Old Timer does, to rule out situations which need to go "right now" to the hospital, those that need to go home & call their dr & those that just need to buy something & go away (they come in once to twice a week, each & every week!!!!).

I see far more rashes, bites, mouth sores & are described sx in places my own children wouldn't share with me (anynomity is a good thing). It doesn't involve a complete pa, but its good to know & understand that if you're in CHF, why do some pts have edema in the legs & others have trouble breathing, but no peripheral edema? (you need to understand the pathophysiology of right & left sided heart failure). Its also good to understand what the sx are of vaginosis & fungal vaginal infections - otherwise, you're no better than the grocery clerk which says that Vagisil is on sale & that out to do the trick!

But - I do believe it should be part of the curriculum, because as Tess said, you've got to be able to read & understand a chart & know when the rx says clonidine 0.1mg bid if sys>145 or dys>90 you know what that involves - after all you've got to reinforce that with the pt.

 

[firefighter9015]

There are many reasons to learn PA. The first is that to earn provider status (For things such as MTM services) an area that most be present is the physical exam. . Another reason is, that all colleges of pharmacy must teach it to be accrediated. Lastly, sometimes we as pharmacist can tell if something is due to drug therapy better than other healthcare professionals.

 

[njac]

classy!

 

[MacGyver]

Well it may help to understand the disease state, but technically, our scope of practice does NOT include diagnosing, it would be stepping into AMA territory. So it might be "interesting", but we still can't diagnose, so it would somewhat be a waste of both the patient and pharmacist use of time.

That wont stop anything, it certainly didnt stop the midlevels. How long before the pharmD faculty start screaming "doctor shortage" and about how they should be able to bill Medicare for new patient diagnoses?

This is a means to an end and it has absolutely nothing to do with patient care and everything to do with $$$$$

 

[MacGyver]

They didn't work with a team who was trying to figure anything out. Their duty with the patient was equivalent to the RNs, but without the dirty work.
It was like the PA's were wasting the patient's time just so that they could keep their jobs .

Agreed to a large extent but pharmacists are doing the same thing. After all, EVERYBODY has a study showing that "patient care" is improved when you have extra people involved. Hell I could write a study showing that "patient care" is improved when a pharmacist talks to a patient every single day about hteir medications or if a doctor makes a house call every single day to check on their patients. I guess that means Medicare should start payign armies of PAs and NPs to go visit patients at home every single day of hteir lives to make sure htey dont get sick.

 

[PharmDstudent]

Agreed to a large extent but pharmacists are doing the same thing. After all, EVERYBODY has a study showing that "patient care" is improved when you have extra people involved. Hell I could write a study showing that "patient care" is improved when a pharmacist talks to a patient every single day about hteir medications or if a doctor makes a house call every single day to check on their patients. I guess that means Medicare should start payign armies of PAs and NPs to go visit patients at home every single day of hteir lives to make sure htey dont get sick.

Are you suggesting professional babysitters? OMG!

 

[no-see-um]

Pharmacists should be involved in patient care enough to make observations that could be important in recognizing the side effects of drugs dispensed. The full physical exam is something that a pharmacist should not be performing, but he or she needs to be schooled in it to understand what primary and even advanced care providers need to be applying. Such a familiarity would allow for the proper patient care dialogue that needs to exist between pharmacists and other health care professionals.

 

[Jbuprepharm]

hello, I am a pharmacist, no, I won't grab your balls and make you cough

 

[Hels2007]

Checking blood pressure, blood sugar or cholesterol are certainly within a pharmacist's scope of practice. They can be and should be done. However, a traditional physical with auscultation, etc. is not within our scope of practice, we are not adequately prepared for this, and it also doesn't fit well with our main function of ensuring the safe and effective use of drugs.

For those too lazy to read the above, simple answer. NO.

 

[sdn1977]

That wont stop anything, it certainly didnt stop the midlevels. How long before the pharmD faculty start screaming "doctor shortage" and about how they should be able to bill Medicare for new patient diagnoses?

This is a means to an end and it has absolutely nothing to do with patient care and everything to do with $$$$$

Again - glad to see you back! Are the back to school physicals over??? Lots of time on your hands to surf the forums???

Welcome back - again.

Oh - we've been billing Medicare for years - Part B for glucose test strips & Part D since 2005.

Do you want Part D???? I can't think of a pharmacist who'd refuse to give that one up - its yours for the taking!

Though....nothing related to diagnosis - altho we do need to call & bug your staff for a drg code - but, I do know the "big" ones - that allow us to bill for diabetic supplies. You can have all the rest - thanks!

 

[Old Timer]

Checking blood pressure, blood sugar or cholesterol are certainly within a pharmacist's scope of practice. They can be and should be done. However, a traditional physical with auscultation, etc. is not within our scope of practice, we are not adequately prepared for this, and it also doesn't fit well with our main function of ensuring the safe and effective use of drugs.
For those too lazy to read the above, simple answer. NO.

This will become a staple of MTM in the future. As long as you are not diagnosing, you can perform many of these functions. There is no reason when monitoring an asthmatic, you would not listen to his/her lungs. As MTM becomes entrenched in the practice of pharmacy these functions will become more commonplace....

 

[Dr JPH]

My thought would be this. Unless you are adequately trained in the full physiology behind the process and have the ability to accurately distinguish one disease process from another, then performing a physical exam to look for pathophysiologic signs is useless.

Lets say a patient comes to you for a refill of their Lisinopril and you check their BP (example given by another poster above). How is their blood pressure going to affect what you do?

Lets say theyre on a beta blocker and an ACE. They come to you for refills, you check their BP. Theyre tachycardic and hypertensive. You tell them they need to be on different meds or perhaps higher dosages. They walk outside and drop dead of a PE.

Well, if you had done a thorough physical exam perhaps you would have caught that. They would have had a low pulse ox, decreased breath sounds in one or more fields, perhaps reproducible pleuritic chest pain.

So if you are simply looking at snippets of clinical information you cant really do anything with the information.

Now...are you going to be held responsible for that? The patient dies. "Well your honor, the victim got his pressure checked by the pharmacist and although it was elevated the pharmacist never told the victim that he was in imminent danger and needed to seek immediate medical attention."

Same can be said for checking blood sugar, pulse ox or even listening to heart & lungs.

I dont get a CT Scan on patients who I KNOW are going to the OR. The information isnt going to change my management of this patient.

If you want to perform physical exams, make diagnoses and manage patients medically then you need to pursue other training.

Just my $0.02

 

[thelonius]

Are you suggesting that Pharmacists should not even be involved in monitoring patients?

 

[spacecowgirl]

Lets say a patient comes to you for a refill of their Lisinopril and you check their BP (example given by another poster above). How is their blood pressure going to affect what you do?

What would you do?

 

[pharmboy30]

No, I don't want to touch people.

 

[tussionex]

What would you do?

nothing. i don't want to touch people either.

 

[All4MyDaughter]

Yesterday we learned about (and practiced) taking height and weight measurements, pulses, respiratory rates, oral temps, and blood pressures. It's more for pharmacists who do intensive MTM and disease state management (as in pharmacist run clinics like at the VA). It certainly doesn't hurt anyone to learn it (although I don't like touching people either).

No one is suggesting that we are going to do a physical when someone comes into Kroger to get their 1000th refill on their Norvasc. But here's something that I have seen happen in Kroger:

Patient comes in for BP refill...

"Sarah, I'm here to pick up my water pills, but I just took my BP on that machine over there and it was REALLY high. Do you think I should double up on my medication?"

Now in that case I would advise the patient to call his doctor about his uncontrolled BP (and NOT double up on his dose!). If I were experienced in taking manual BP's I might be able to take his BP myself and clarify for him what it actually is as those automated machines are often inaccurate. But that's only if the pharmacist knows what they are doing with the manual BP cuff - if you don't you won't get an accurate reading anyway.

If the BP was extremely elevated and/or the patient was having other symptoms I'd call an ambulance for him/her.

 

[spacecowgirl]

nothing. i don't want to touch people either.

No I mean Dr JPH, as a doctor, how is the patient's BP going to affect what he/she does?

 

[hyperioncu]

My thought would be this. Unless you are adequately trained in the full physiology behind the process and have the ability to accurately distinguish one disease process from another, then performing a physical exam to look for pathophysiologic signs is useless.

Lets say a patient comes to you for a refill of their Lisinopril and you check their BP (example given by another poster above). How is their blood pressure going to affect what you do?

Lets say theyre on a beta blocker and an ACE. They come to you for refills, you check their BP. Theyre tachycardic and hypertensive. You tell them they need to be on different meds or perhaps higher dosages. They walk outside and drop dead of a PE.

Well, if you had done a thorough physical exam perhaps you would have caught that. They would have had a low pulse ox, decreased breath sounds in one or more fields, perhaps reproducible pleuritic chest pain.

So if you are simply looking at snippets of clinical information you cant really do anything with the information.

Now...are you going to be held responsible for that? The patient dies. "Well your honor, the victim got his pressure checked by the pharmacist and although it was elevated the pharmacist never told the victim that he was in imminent danger and needed to seek immediate medical attention."

Same can be said for checking blood sugar, pulse ox or even listening to heart & lungs.

I dont get a CT Scan on patients who I KNOW are going to the OR. The information isnt going to change my management of this patient.

If you want to perform physical exams, make diagnoses and manage patients medically then you need to pursue other training.

Just my $0.02

Definitely yes, perhaps not to to the extent that an md would do it, but since a pharmacist has an important preventive role, it will definitely work to the advantage of a patient.
The role of the pharmacist will evolve to the full range of preventive care and management of diseases through mtm, since the training of md and pharmd are different their scope of action rather than overlap each other will become a cooperation to the benefit of a patient. Any techniques or knowledge that may contribute to help someone, no matter if it doesnt "fit someone's job description" is very helpful to learn

 

[tussionex]

No I mean Dr JPH, as a doctor, how is the patient's BP going to affect what he/she does?

i still dont want to touch people!

 

[hyperioncu]

i still dont want to touch people!

there is an small problem, pharmacist profession is in a process of redefining itself ( MTM, prescribing rights etc, vaccination) if pharmacist fail to get into their realm as many tools as they can , and validate themselves as more than pill-dispensers, the future may not look as bright. The pharmacist of today may look very different from the one one of tomorrow, even though changes will be probably more visible in clinical pharmacy, it will change the entire profession as a whole. Very likely that Board Certified Specializations become standard, and the inte grationof techniques such as ascultation , standard in the pharmacist everyday

 

[Epic]

i still dont want to touch people!

yeah right... until he's your patient.

 

[Corona]

I'll pass

 

[PharmDstudent]

yeah right... until he's your patient.

That's definitely a possibility down here in New Orleans. Although, I'm not much for the salt and pepper beard he's been sporting. The beard ages him.

 

[njac]

My thought would be this. Unless you are adequately trained in the full physiology behind the process and have the ability to accurately distinguish one disease process from another, then performing a physical exam to look for pathophysiologic signs is useless.

Lets say a patient comes to you for a refill of their Lisinopril and you check their BP (example given by another poster above). How is their blood pressure going to affect what you do?

Lets say theyre on a beta blocker and an ACE. They come to you for refills, you check their BP. Theyre tachycardic and hypertensive. You tell them they need to be on different meds or perhaps higher dosages. They walk outside and drop dead of a PE.

Well, if you had done a thorough physical exam perhaps you would have caught that. They would have had a low pulse ox, decreased breath sounds in one or more fields, perhaps reproducible pleuritic chest pain.

So if you are simply looking at snippets of clinical information you cant really do anything with the information.

Now...are you going to be held responsible for that? The patient dies. "Well your honor, the victim got his pressure checked by the pharmacist and although it was elevated the pharmacist never told the victim that he was in imminent danger and needed to seek immediate medical attention."

Same can be said for checking blood sugar, pulse ox or even listening to heart & lungs.

I dont get a CT Scan on patients who I KNOW are going to the OR. The information isnt going to change my management of this patient.

If you want to perform physical exams, make diagnoses and manage patients medically then you need to pursue other training.

Just my $0.02

so a pharmacist may not catch that - but do you really think every PCP would catch it too?

 

[hyperioncu]

so a pharmacist may not catch that - but do you really think every PCP would catch it too?

Pharmacy Department, Barzilai Medical Center, Ashkelon, Israel.
OBJECTIVE: The purpose of this study was to record prospectively the frequency of medication order errors in a general hospital in Israel with the objective of assessing the impact of pharmacist intervention in preventing potential harm. METHODS: The study was conducted during a 6-month period. A total of 160 medication order errors were detected at the hospital of which 60.6% were prescription errors and 39.4% were therapy ones. Principal types of errors detected were incorrect dosage (27.5%), interactions between drugs (20%), incorrect drug (12.5%), route (11.2%) and frequency (11.2%). Medication error rate by degree of severity was calculated per 100 patient days. The highest rate was found in Hemato-Oncology (2.48), followed by Intensive Care (0.82), Surgery (0.48) and Internal Medicine (0.26). Anti-infective drugs were the most prevalent class of drugs in which errors occurred (38.7%) followed by total parenteral nutrition preparations (21.8%), antineoplastics (15.6%) and anticoagulants (11.3%). Changes in medication orders due to pharmacists' intervention only occurred in 73.8% of error cases, most referring to dosage or route change (37.5%).

 

[hyperioncu]

red flags that pharmacist can detect

 

[MacGyver]

there is an small problem, pharmacist profession is in a process of redefining itself ( MTM, prescribing rights etc, vaccination) if pharmacist fail to get into their realm as many tools as they can , and validate themselves as more than pill-dispensers, the future may not look as bright. The pharmacist of today may look very different from the one one of tomorrow, even though changes will be probably more visible in clinical pharmacy, it will change the entire profession as a whole. Very likely that Board Certified Specializations become standard, and the inte grationof techniques such as ascultation , standard in the pharmacist everyday

Translation: we PharmDs are feeling unloved and dont get the same respect/importance that the physicians get. Therefore we are unilaterally going to try and squeeze into their turf so we can pretend to be doctors too! That way everybody will think of the pharmacist as their primary care doctor and we'll get to make tons more money!