use of pharmacist over computer?

[deltamed]

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This post isn't meant as an attack on pharmacists. It is merely borne of ignorance and I would like some intelligent feedback.

What is the use of pharmacists, and what can they do that a computer cannot?

I mean, basically, from what I understand the pharmacist's job is to make sure the patient gets the right meds, that there aren't any bad interactions between drugs, that the patient understands what to do with the drugs, and occasionally to compound drugs.

From what I've observed though:
1) drug interactions are well documented and have very logical, if complicated rules that can and are often flagged by a computer
2) meds are rarely dispensed by the actual pharmacist and usually are dispensed by a technician with minimal but adequate training.
3) part of the physician's job is to explain use of meds to the patient so why is that function duplicated?

I guess if the patient cannot read a person at the drugstore to re-explain regimen details would be useful. And of course I can see the use of pharmds to research and drug companies. But if tomorrow every commercial pharmacist dissapeared, leaving the techs to dispense the medicine and call the physicians if a question arose, what would be the problem?

Thanks for the input.

 

[HessExpress]

Why can't robots replace physicians and surgeons as well? Oh right, there is robotic surgical devices now...

 

[Caverject]

Techs will never dispense in the United States, unless it is with the military which they have done that for many years now

 

[kwakster928]

dean at my school put it this way.

let's just think about the airplane. these days all the commercial airliners come with the computer program that so sophisticated that the airplane can virtually fly itself to the destination and land, and the technology is getting better and better. question for you and us is that are we really ready to put our lives and the responsiblity of flying an airplane with 400 people 8 miles up on a computer program?

pharmacist used to (and still) be the frist healthcare provider the general public seek to get their health care questions answered. if you look at numbers pharmacist do see most of patients per day than any other healthcare providers. it is the economics and efficiency that put pharamcist on distributing roles today. ask yourself this question. let say you are a general public who do not have any idea education on professional eductaion on medicine. would you trust a someone who has mear high school degree dispencing medication who do not have idea but to read what the computer warning give you? or would you want to have a someone who do look of the computer warning to double check the computer program that was designed for its particular purpose are doing what it is supposed to do?

yes it is also def physicians job to explain what the medications are for and how to supposed to use them. then why the heck do we still have so much damn people suffering from ADRs? yes it is also part pharmacist fault too. i do not care how sophisticated the computer system is, it only work if the all the data there to run the program. for instance let say you have a patients who only provide you with the partical medical history. what good is the damn computer program if pt tells you the only half of the story? what if the pt tells you the one drug forgot to tell you the other, and prescription the pt is about to get has ADR so severe that pt might die? will the computer program catch it then?

you say pts call the physican to ask question about the drug they are taking... hmmm.. let me see i dare you to receive 100 calls or more a day asking question regarding every prescription you wrote. you have a nice day. i think a lot of people do see us working behind the counter and do not see the other side of pharmacy one dare about doing. do not look down our profession just because we work in rite-aid, cvs and some grocery stores. yes we do not get fancy offices in the hosptial with our name tags on the office door, no we cannot generate millions of dollars putting votox on people's faces. before you generalize us being useless part of the healthcare system why do you need nurses when you have all the knowledge and man power you have? why do you just simply write order expect some other people do it for you?

i tend to look at Rx as prescribers suggestion toward drug therapy rather than the order. we dispense the Rx because we agree with the suggestion given by prescriber, and we have every right not to if we do disagree with the suggestion with regitimate reasons. please do not look at pharmacy as we give whatever people write on a piece of paper. computer can only tell you what is right and wrong. there is no middle ground. heck computer only work with 0 and 1. there is some human aspect that computer can never understand such as emotion and personal interaction.

 

[Trancelucent1]

I really think that you should read the Pfizer Career Guide in Pharmacy to get a new point of view of what pharmacists actually do http://www.pfizercareerguides.com/pharmacy.html. I am planning on doing a residency after my 8 years of schooling that I need in order to earn my PharmD. I hope to do a residency specializing in Infectious Disease or Ambulatory Care. After that, I would like to work with physicians (gasp), in monitoring a patients care in a hospital or ambulatory clinic. Pharmacists are an integral part of the healthcare system. Not everyone that has a PharmD is working retail and I really think that you should take a look at the Pfizer link to better inform yourself.

 

[dgroulx]

I'll address some aspects of retail pharmacy, though you need to understand that there are many more types of pharmacists than just retail.

Lots of people come to the pharmacy for advice on rashes, birth control questions, blood pressure questions, diabetes questions, etc. This happens every day. Computers can't help them, techs can't help them. If they pick up a blood glucose meter at the pharmacy, we teach them the correct way to use it. We answer questions about their medications that the doctors don't seem to have time for anymore. We talk to patients who have just received their first blood pressure med and are scared.

Computers aren't the answer. If a patient gets one med at Walgreens and another one at CVS, the computer system won't have a clue. I've been a computer programmer since 1979 and I wouldn't trust them. They are only as good as the person who entered the data.

If patients come in for OTC meds, they need to ask us about drug interactions. You don't type in prescriptions for OTC meds, but they can cause interactions just the same. What if a patient is on verapamil and needs a laxative? What if a person has aspirin sensitive asthma and takes ibuprofen because it doesn't contain aspirin? Most people ask the pharmacist if it is okay.

There is a lawsuit right now because a doctor prescribed IBU 600, the tech hit the override key on the computer interaction screen so the pharmacist didn't see the warning, then the tech told the patient that it was okay to take it because it didn't contain aspirin when the woman picked it up. The woman died. Techs should never be presumptuous enough to think that they have the knowledge to counsel patients, but that should be a subject of another thread. I hope the tech got fired, but it was ultimately the physicians mistake. It's hard to believe that a doctor could have made an obvious mistake like that, but it happens a lot. Thank God the pharmacists catch most of them.

We tell people whether they should take their medicine with food, without food, at bedtime, etc. It very rarely is specified on the prescription. A friend of mine just got a prescription for metoprolol and the physician didn't tell him that he needs to take it with food. Maybe the doctor's are depending on pharmacists to do that for them. I don't really know.

There are hundreds of more examples. Pharmacists are the drug experts of the health care team.

 

[GravyRPH]

I think he was talking about the every day run of the mill staff pharmacist. This is a pretty common question so apparently a lot of the public have similar ideas/questions.
I've obviously worked with technicians, and, trust me, you don't want them dispensing without pharmacist oversight. Sure, there are some excellent technicians, but the vast majority are undertrained and lack the basic knowledge to know when things just aren't right (even if the computer says it is).
Like the above post, I wouldn't trust a computer without any human oversight, and I doubt the general public would either. I doubt that law will be passed anytime soon.
Haven't we discussed this all before. Perhaps try searching for robot dispensing.

 

[GravyRPH]

I hope the tech got fired, but it was ultimately the physicians mistake. It's hard to believe that a doctor could have made an obvious mistake like that, but it happens a lot. Thank God the pharmacists catch most of them.

With, I'm sure, some pharmacist culpability since they are ultimately responsible for whatever happens in the pharmacy. Sounds like poor training to me. No tech would be caught dead doing that in my pharmacy.

 

[meister]

There is a lawsuit right now because a doctor prescribed IBU 600, the tech hit the override key on the computer interaction screen so the pharmacist didn't see the warning, then the tech told the patient that it was okay to take it because it didn't contain aspirin when the woman picked it up. The woman died.

This example was entirely the pharmacist's fault, because he is 100% responsible for anything that happens in his pharmacy (besides some stupid HIPAA violations). This is simply a case where the pharmacist was relying too much on his tech, and the tech made an error. This only explains the initial "overriding" of the interaction, however. How do you explain the fact that the tech was counseling on a new prescription when (at least in CA) the pharmacist is required to consult on all new prescriptions? If the pharmacist had been doing that, then he would have caught the aspirin allergy.

And I don't know about the programs in use at other pharmacies, but for Savon/Osco/Albertsons, all that is required to "override" an interaction or a cross-sensitivity is entering 3-5 characters. Any pharmacist who relies completely on his techs to catch stupid stuff like this is asking for trouble.

If anyone should have been fired it was the pharmacist.

 

[dgroulx]

If anyone should have been fired it was the pharmacist.

The pharmacy itself is being sued along with the prescribing physician who was currently treating her asthma and knew about her aspirin sensitivity. I don't know if the pharmacist was fired or not. This current case was brought to our attention in school so we can learn from it. They didn't tell us where/when it occured, only that the lawsuit is happening now. The pharmacist didn't hear the tech counseling, because the patient picked up the medication at the drive through window.

The purpose of this class I am taking is to recognize drug therapy problems because they happen all the time and will definately occur while we are working as pharmacists. This furthers my point that pharmacists should not be replaced by computers or techs.

 

[deltamed]

I'll address some aspects of retail pharmacy, though you need to understand that there are many more types of pharmacists than just retail.

Lots of people come to the pharmacy for advice on rashes, birth control questions, blood pressure questions, diabetes questions, etc. This happens every day. Computers can't help them, techs can't help them. If they pick up a blood glucose meter at the pharmacy, we teach them the correct way to use it. We answer questions about their medications that the doctors don't seem to have time for anymore. We talk to patients who have just received their first blood pressure med and are scared.

Computers aren't the answer. If a patient gets one med at Walgreens and another one at CVS, the computer system won't have a clue. I've been a computer programmer since 1979 and I wouldn't trust them. They are only as good as the person who entered the data.

If patients come in for OTC meds, they need to ask us about drug interactions. You don't type in prescriptions for OTC meds, but they can cause interactions just the same. What if a patient is on verapamil and needs a laxative? What if a person has aspirin sensitive asthma and takes ibuprofen because it doesn't contain aspirin? Most people ask the pharmacist if it is okay.

There is a lawsuit right now because a doctor prescribed IBU 600, the tech hit the override key on the computer interaction screen so the pharmacist didn't see the warning, then the tech told the patient that it was okay to take it because it didn't contain aspirin when the woman picked it up. The woman died. Techs should never be presumptuous enough to think that they have the knowledge to counsel patients, but that should be a subject of another thread. I hope the tech got fired, but it was ultimately the physicians mistake. It's hard to believe that a doctor could have made an obvious mistake like that, but it happens a lot. Thank God the pharmacists catch most of them.

We tell people whether they should take their medicine with food, without food, at bedtime, etc. It very rarely is specified on the prescription. A friend of mine just got a prescription for metoprolol and the physician didn't tell him that he needs to take it with food. Maybe the doctor's are depending on pharmacists to do that for them. I don't really know.

There are hundreds of more examples. Pharmacists are the drug experts of the health care team.

Thanks for the information. I guess a lot of the general public just doesn't know all that because it's the more complicated cases that actually see the pharmacist. I for one have never talked to a pharmacist face to face and know many others who also haven't. Pharmacists should strive to make themseves more visible to make the general public understand their importance.

 

[meister]

The pharmacist didn't hear the tech counseling, because the patient picked up the medication at the drive through window.

That doesn't matter, the pharmacist is still responsible for any dispensing that takes place at the pharmacy. Obviously the tech should have told him that it was a new prescription, but the pharmacist should have been more careful.

In a perfect world, we would have pharmacists ringing people up and not having to worry about counseling on new prescriptions while at the same time phoning doctors about incomplete prescriptions and also filling. But big drugstore chains expect the pharmacist to do just that, and as a result stuff gets overlooked. It's unfortunate, but that's the way it is.

Anyway, I'm not sure what my point is. I definitely agree that it would be nearly impossible to replace pharmacists with computers or techs armed with computers. It seems like there should be some sort of middle ground, however. Like a pharmacist assistant or something. Something that is different from interns. Like you could go to school and get a BS in pharmacy or something then get licensed to do really basic stuff like counsel on new prescriptions. That'll never happen though.

 

[Mags]

. Pharmacists should strive to make themseves more visible to make the general public understand their importance.

ding ding ding..i for one am for advertising our benefits to patients so they can realize our value

but just a note.. we already are the "most visible" b/c we are the most accessible in all of health care.. we're probably the most visible but the least understood.. which is why education for patients on what pharmacists can provide, is critical

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computers cant check all the information in the world, especially if the patient is practicing poly-pharmacy... people=good... i wouldnt want a computerized doctor.. and i sure as hell wouldnt want a computerized pharmacist..

 

[GravyRPH]

...Computers cant check all the information in the world, especially if the patient is practicing poly-pharmacy... people=good... i wouldnt want a computerized doctor.. and i sure as hell wouldnt want a computerized pharmacist..

Actually, I disagree. I think computers could do a much better job than humans in preventing poly-pharmacy. A universal database could log and cross-referene every prescription filled for a single person based on a bar coded I.D. referenced prescription. The technology is capable to do that today, it's just not available.

 

[Mags]

Actually, I disagree. I think computers could do a much better job than humans in preventing poly-pharmacy. A universal database could log and cross-referene every prescription filled for a single person based on a bar coded I.D. referenced prescription. The technology is capable to do that today, it's just not available.

yes.. agreed.. but i wasnt refering to a universal system..i was refering to the system in place.. and what happens if a bug/virus attacks a computer?? then we're all up the creek w/o a paddle.....

i for one will always prefer people in place of computer systems.. that is to say, i'd rather have a person than a completely self service system... and although i am computer savy myself.... there are still services computers cant provide that we can as human beings..