Walgreens Developing Software That Will Eliminate The Need Of Most Pharmacist?

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vinny808

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My friend interviewed with Walgreens a year ago and the DM flat out told him WAGS was developing software that will eliminate the need of most retail pharmacist. Not sure when this will happen but by the looks of automation, AI, machine learning and the rise of tech, its probably in our future. Thoughts?

- Vince in San Francisco

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This wouldn't surprise me one bit. Things are changing and they are changing fast. Just look at Target and Chase. Automation is taking over.

Healthcare is so inefficient. Look at how much money we waste on unnecessary procedures and ineffective medications. Do we really need that much schooling to work as a pharmacist or as a physician? The whole system is just ready for change and you will be rewarded handsomely if you can do it.


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The whole system is just ready for change and you will be rewarded handsomely if you can do it.

This is definitely a reason why I went into informatics. I'm early in my career and already feel more valued for my technical skills than I did for my clinical knowledge. I'm just hoping to ride the wave of configuring and maintaining the automation until AI takes over or the software/hardware is refined to a point where no pharmacist is needed for it to function.
 
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I don't have any faith in the chains being able to develop and implement something like this widely for about 20 years and by that time I'll be long gone. Now if it was Amazon or Google coming in saying they were going to disrupt the retail pharmacy market I'd move my timeline down to 10-15 years. The software really isn't that hard to develop after all the advances that have been made in the last 10 years in AI research. Their biggest hurdle will be getting the laws changed in each state while there is a political climate that has a rising fear of job loss due to automation.

In a way the chains hurt themselves by encouraging the oversupply of pharmacists through funding schools and overhyping the profession. It's a lot harder to claim a need and lobby for tech-check-tech or automated verification when there are hordes of unemployed pharmacists out there.
 
Thankfully, due to the ineptness of CVSs IT dept...I'm not concerned.

Long term, the death of all labor is going to happen.
 
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I highly doubt we will get to the point of full automation for things like pharmacy in the next decades. Computer assisted decision making is going to become a bigger and bigger component, and informatics knowledge is going to be an essential skill to in the workforce of the future, but there are still so many unknowns in terms of the risks and benefits of most treatment options that a high level of subjective valuation (i.e. human consciousness) still goes into the process. It might get to a point where a computer provides the options to the patient, educates/provides informed consent to the patient, and also assesses the patients understanding of their choices. It just seems like there is a lot more research that needs to be done before we can program a computer to do all those things effectively and accurately... although if I really think about it, us humans don't consistently do a great job with those things, either...
 
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Labor will be obsolete by the time pharmacists are automated. Think of all the small "rest-stop" towns that will die off once truckers are automated.
 
My friend interviewed with Walgreens a year ago and the DM flat out told him WAGS was developing software that will eliminate the need of most retail pharmacist. Not sure when this will happen but by the looks of automation, AI, machine learning and the rise of tech, its probably in our future. Thoughts?

- Vince in San Francisco
WAG is coming out with a new rx processing system designed to replace Intercom Plus. I'm sure there will be some enhancements that will "allow us to spend more time with patients to providers value added services such as immunizations and perform medication therapy management, etc" (or similar corporate speak) However, EVERY state board of pharmacy require a pharmacist in charge and I doubt that will change
 
(Sigh)

I love how executives think AI solves a bunch of problems where one of the biggest complaints is that more than it doesn't work, it never works well. Think of it this way, when was the last time you had to deal with an automated help desk? Should be straightforward right? There aren't too many complaints or information points that would be too difficult to deal with. However, try finding one that actually diverts more than 30% of the calls (which is the contract standard right now for any one that does not require a numeric input like account numbers or prescription refill numbers in most cases). There's "passable" software for an automated call center that takes care of the absolute stupidest members of society away from the call center employment. And for really low-level functions, it's better than hiring Indians.

AI Technology has been in its current form since the late-60s, early-70s. AI only works in three uses cases at present:
1. Things that humans cannot do as a sensory reaction needs to be too fast (like fly an unstable airframe or maintain fuel injection in a post-1960s car) or too dangerous/not possible (fireworks manufacturing)
2. Things that are too much information for a human to process (DMDC-STARS Birmingham, find me every blonde-haired, blue-eyed female veteran that is over 5' 6" and has F52.8 as a conditional diagnosis out of all active personnel)
3. Things that the performance difference between a human and AI is imperceptible to the customer.

3 is tricky, because given the choice between some out of the country speakee Angrish and a poor speech recognition (Dragon) AI, I'll take the AI. But for things where the customer would notice and could trace, that'd be a problem. That's why Robodoctor and Robopharmacist while makeable as a crude object, is not anywhere near a sufficient standard yet to replace a human.

And technically complicated things like flight autopilot and driving, you still have the human nearby observing the task and can takeover (and the risks differential is such that people are willing to accept crashed planes and cars for the benefit).

And for the call center example, AI gets easily defeated when an out-of-context problem shows up. So, I tend to use word salad and thought derailment patterns to get a real human when talking with a PBM help desk line: "I like claims! Doctors offices smell like Mr Clean! What's the frequency of 219582A6, Kenneth?" really throw off the AI call center enough that they will find a human (to confirm you are crazy as simply hanging up will get the company in trouble with the board).

Pharmacy and Medicine isn't practiced badly enough for an AI to be a reasonable alternative as of right now. It may be in the future if the personnel cuts are so bad that people are willing to go for alternatives. However, the way it's always worked out is that you find cheaper people than you find AI. AI is pretty expensive (especially when you figure in the payouts from your AI failing). That's why I see a reasonably bright future for low-paid PA's and NP's, CNA's where there is a judgment function and some physical matters where AI doesn't do well consistently enough in both to work. Now pharmacy techs, who have no judgment function normally and only a physical one, I can see them being automated away. Now super-"clinical" techs that replace your anticoagulation pharmacist, that I see quite the future for as how often does anticoagulation require real judgment?
 
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"AI Technology has been in its current form since the late-60s, early-70s."

That's clearly not right and the general public really started taking notice when IBM's Watson computer won Jeopardy. The next big shock will be in 2 years when they start operating self-driving cars in limited locations as a taxi service. The vast majority of what retail pharmacists do is something that the newer AI techniques excel at, which is pattern matching. For DUR and counseling they could use off-site pharmacists.
 
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"AI Technology has been in its current form since the late-60s, early-70s."

That's clearly not right and the general public really started taking notice when IBM's Watson computer won Jeopardy. The next big shock will be in 2 years when they start operating self-driving cars in limited locations as a taxi service. The vast majority of what retail pharmacists do is something that the newer AI techniques excel at, which is pattern matching. For DUR and counseling they could use off-site pharmacists.

The Turk - Wikipedia

Define "newer". Do you know how much background preparation that Watson had to have to go on Jeopardy? Yeah, if you use the Turk programmers and maintainers, anyone in computer science can get that to work as a one-time matter, but not consistently without supervision. And no, Watson still is basically the same underlying technology (cluster/classification/neural networks) that past systems used and they do date from the 1960s-1970s (but has computer advantages in pressing the buzzer correctly to timing if you knew how Jeopardy works). Yes, computing power has increased, but not really our understanding of how to get those techniques to work. And yes, the self-driving cars are like plane autopilot. It works, but it has an error rate that has to be sustained, and none of them work well enough in inclement weather (and I don't mean the usual rainstorm or snow, I mean situations where the actual answer is not to drive at all) yet that it's releasable. I think this is a solvable problem to an extent, but like all AI, there's only so much you can do to train the algorithm? Watson was great PR, but if you notice the news from that time, Watson (and AI in general) never really has done very well in situations where you cannot define the problem very well, which hilariously enough, is what medicine is like.

That's kind of why Google can't get rid of their PageRank/TrustRank/HITs curators. Yeah, the underlying algorithm is quite explainable, but it requires lots and lots of manual curation, else you get the anti-Semitic AI bot:
Microsoft’s Chatbot ‘Tay’ Just Went on a Racist, Misogynistic, Anti-Semitic Tirade – Adweek

AI has been hyped every decade as solving many problems. Most forget that there was an AI Winter:
AI winter - Wikipedia

It's not that AI is not done in medicine, what is clinical decision support really if not AI rebranded? But, it's what the applicability of that AI is to your actual problem. What we train humans at present is to recognize and sort the problem into the right clinical decision support tool, and that turns out not to be easy.

I can tell you from very direct experience (to the point that I was present for the Watson tests) is that Watson has no credibility outside of the scientists and programmers that run the system:
IBM Watson Jumps Onboard Biden's Cancer Moonshot Initiative
VA signs $6 million contract for IBM Watson to advise PTSD treatment

Both turned out to be negative in terms of actual use. Mainly for the reasons just discussed, except the additional one is that cancer informatics could really, really use some work in terms of secondary data construction:
As I lay dying

and that prevents any meaningful work as there is not a good enough input situation to Moneyball cancer work.

The main challenge in using AI has always been to define a solvable problem and even harder, to define when a situation is out of context and you're relying on instinct. If the curriculum really were that deterministic, you all would never have done your practical 1600 hour internship. Unless you really had other experiences, that's really when you find out whether or not a candidate can hack it as a practitioner. Most of that is training that we cannot seem to pin on the curriculum, those situations where you should know that you are out of your depth, and those situations where ranking what's wrong takes a real backseat to the immediate situation. If you do have the resources to keep up a bunch of programmers to be the Turk, then it'll also work, but is it sustainable for the problem at hand?

Don't worry, your job won't be going away. It'll just get worse, such that only the most efficient pharmacists can keep up, and not for career long periods of time. AI will put a floor down on terms of how unproductive a pharmacist can be before termination, but won't replace a pharmacist willing to work to the limit. John Henry is a decent tall tale to describe what the future will be. Humans still exist, but will always be on the marginal brink.
 
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Yes. 100% yes.

Despite my worries about pharmacists going away, it'll be worth it to laugh at the Medical Deities who truly believe in the mythos of their profession.

There is nothing that can't be automated.

If you read the articles, even the M.D.s defending the profession end up backed into the "uhhh... Artificial intelligence can't have Empathy!"

Modern medicine boils down to guidelines and algorithms that AI could easily preform.
 
Modern medicine boils down to guidelines and algorithms that AI could easily preform.
I would respectfully disagree with you. What makes a good doctor isn't what he knows, but his acknowledgement of what he doesn't know. The human body is extremely complex and nothing is cookie cutter. Why do you think they have so many years of training?
 
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All it takes is a few major lawsuits from prescription oversights/ automated machinery failures/glitches in the system. Then comes the public uproar about checks and balances. I don't think it's going to be that easy to automate away the complex roles of pharmacists and physicians. Even if this was possible, I still think we are decades away from it being largely accepted by the public.
 
Let us be serious. I work in a mail order pharmacy where we fill 100,000 orders a day. I am one of the lucky pharmacist who gets to fix the automation machines all day. On a daily basis there are hardware and software issues. Software and hardware updates usually lead to migraine headaches. Honestly, if WAG is to install complete machines then someone has to maintain and update these machines and likely due to Board of Pharmacies needing a PIC and consults, it will be a pharmacist. Has anyone here ever driven a car that didn't need maintenance?
 
Eh, wasn't Walgreens centralized dispensing pharmacy in Florida, and their new pharmacists sitting outside of the pharmacy, also supposed to end the need for most pharmacists? Neither of the projects ever spread, so I'm not to worried about this new one ending pharmacist jobs either.
 
I would respectfully disagree with you. What makes a good doctor isn't what he knows, but his acknowledgement of what he doesn't know. The human body is extremely complex and nothing is cookie cutter. Why do you think they have so many years of training?

I'm not sure how to agree or disagree with the 45 words of absolute nothing you just posted
 
I've said it before and I'll say it again: Until the DEA or whoever decides that the responsibility to police narcotics is actually on the prescriber and not the pharmacist, our jobs are plenty safe. A computer is not going to look at a script and go "this is a pill mill" - and even if it could be programmed that way, no programmer would want that liability (nor would the company want the plausible deniability"
 
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My friend interviewed with Walgreens a year ago and the DM flat out told him WAGS was developing software that will eliminate the need of most retail pharmacist. Not sure when this will happen but by the looks of automation, AI, machine learning and the rise of tech, its probably in our future. Thoughts?

- Vince in San Francisco
A DM at Walgreens doesn't know anything on that level. It was more than likely a store manager not a rph, showing the interviewee his my way or the highway approach. They oversee 10 to 15 stores. Just talk..happens a lot in the corporate world.
 
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I'm not sure how to agree or disagree with the 45 words of absolute nothing you just posted
There's no need to be insulting.. Simply stated a good doc knows his limits and not all patients fit into algorithms and guidelines
 
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There's no need to be insulting.. Simply stated a good doc knows his limits and not all patients fit into algorithms and guidelines
Would be nice to have some examples. Not saying there aren't plenty of good ones by the way.
 
CPOE was supposed to eliminate the need for a lot of pharmacist FTE's...we see how that went twenty years later. Just as many issues with those systems as the old hand written methods.
 
There's no need to be insulting.. Simply stated a good doc knows his limits and not all patients fit into algorithms and guidelines

You're describing a doctor that doesn't practice evidence based medicine.

Would be nice to have some examples. Not saying there aren't plenty of good ones by the way.

I thought he was joking at first.

I made a post mocking the smoke and mirrors M.D.s like to project around what they actually do, and someone responded by saying "No, you're wrong! I've seen the wizard. Not sure what curtain you're talking about. "
 
Johnny Count-By-5's is alive! And he is taking your job. No disassemble!


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You're describing a doctor that doesn't practice evidence based medicine.



I thought he was joking at first.

I made a post mocking the smoke and mirrors M.D.s like to project around what they actually do, and someone responded by saying "No, you're wrong! I've seen the wizard. Not sure what curtain you're talking about. "


100% yes. I understand doctor jobs are difficult, but it's nothing a machine can't do.
 
You're describing a doctor that doesn't practice evidence based medicine.



I thought he was joking at first.

I made a post mocking the smoke and mirrors M.D.s like to project around what they actually do, and someone responded by saying "No, you're wrong! I've seen the wizard. Not sure what curtain you're talking about. "

100% yes. I understand doctor jobs are difficult, but it's nothing a machine can't do.

Risk/benefit analysis and evidence based medicine is a major component of how medicine is practiced yes, but to think a machine or objective valuation can be substituted for human cognition is pretty far fetched.

Ex. Patient is presented with two options for lung pathology intervention. Option 1 has the best outcomes but requires Rx dependance. Option 2 has lower percentage of positive outcomes and higher 5yr mortality but requires no long term therapy. <--This decision can be done by a computer, yes. But what if one option decreases vital capacity and patient is a concert orchestra member? What if our patient is financially limited? What if the person values pharmaceutical independence over efficacy? Do you rate their "outcomes value" on a scale and input this into the algorithm? What if the algorithm cant account for the additional parameter, do you call IT and have them rewrite the program?


EBM is and should be the standard physicians follow but the more you learn about clinical medicine, the more you understand that it has a large subjective component.

-Side point: Patient compliance and trust in their provider affects outcomes, it would be hard to see a machine providing this same type of relationship.
 
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Risk/benefit analysis and evidence based medicine is a major component of how medicine is practiced yes, but to think a machine or objective valuation can be substituted for human cognition is pretty far fetched.

Ex. Patient is presented with two options for lung pathology intervention. Option 1 has the best outcomes but requires Rx dependance. Option 2 has lower percentage of positive outcomes and higher 5yr mortality but requires no long term therapy. <--This decision can be done by a computer, yes. But what if one option decreases vital capacity and patient is a concert orchestra member? What if our patient is financially limited? What if the person values pharmaceutical independence over efficacy? Do you rate their "outcomes value" on a scale and input this into the algorithm? What if the algorithm cant account for the additional parameter, do you call IT and have them rewrite the program?


EBM is and should be the standard physicians follow but the more you learn about clinical medicine, the more you understand that it has a large subjective component.

-Side point: Patient compliance and trust in their provider affects outcomes, it would be hard to see a machine providing this same type of relationship.

There is already a term that exists for the faulty logic you're applying called the "AI fallacy."

Despite my worries about pharmacists going away, it'll be worth it to laugh at the Medical Deities who truly believe in the mythos of their profession.

There is nothing that can't be automated.

If you read the articles, even the M.D.s defending the profession end up backed into the "uhhh... Artificial intelligence can't have Empathy!"

Modern medicine boils down to guidelines and algorithms that AI could easily preform.
 
Risk/benefit analysis and evidence based medicine is a major component of how medicine is practiced yes, but to think a machine or objective valuation can be substituted for human cognition is pretty far fetched.

Ex. Patient is presented with two options for lung pathology intervention. Option 1 has the best outcomes but requires Rx dependance. Option 2 has lower percentage of positive outcomes and higher 5yr mortality but requires no long term therapy. <--This decision can be done by a computer, yes. But what if one option decreases vital capacity and patient is a concert orchestra member? What if our patient is financially limited? What if the person values pharmaceutical independence over efficacy? Do you rate their "outcomes value" on a scale and input this into the algorithm? What if the algorithm cant account for the additional parameter, do you call IT and have them rewrite the program?


EBM is and should be the standard physicians follow but the more you learn about clinical medicine, the more you understand that it has a large subjective component.

-Side point: Patient compliance and trust in their provider affects outcomes, it would be hard to see a machine providing this same type of relationship.

To me, that doesn't seem like a decision that requires a ton of schooling to find an answer. More like what's most convenient for the patient when talking about therapy.

Side Note: I agree with you totally that trust in a provider increases patient compliance. However, just like how this thread talks about how a pharmacist's knowledge can be replaced by a machine, so can a physicians. Now, whether that's the best for the health of patients is a completely different argument.
 
I really don't know much about ai learning but it would exciting if the system learned something bizarre like it mislearning (or Mis reading) januvia is jantoven and dispensing warfarin to everyone. How long would it take for people to figure that out without a rph doing a final check.
 
I wonder how the pharmacist ai would deal with a patient bringing in a zpak script written for qty #5 at 5pm on a Friday? Send the patient home and fax the MD for monday? Lol. Can't legally program the robot Rph to change it without consulting the md office can we?
 
I wonder how the pharmacist ai would deal with a patient bringing in a zpak script written for qty #5 at 5pm on a Friday? Send the patient home and fax the MD for monday? Lol. Can't legally program the robot Rph to change it without consulting the md office can we?

Easy, dispense 1 pack and give it 4 refills.
 
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As long as diagnosis and prescribing aren't automated, pharmacy wont be either
 
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Risk/benefit analysis and evidence based medicine is a major component of how medicine is practiced yes, but to think a machine or objective valuation can be substituted for human cognition is pretty far fetched.

Ex. Patient is presented with two options for lung pathology intervention. Option 1 has the best outcomes but requires Rx dependance. Option 2 has lower percentage of positive outcomes and higher 5yr mortality but requires no long term therapy. <--This decision can be done by a computer, yes. But what if one option decreases vital capacity and patient is a concert orchestra member? What if our patient is financially limited? What if the person values pharmaceutical independence over efficacy? Do you rate their "outcomes value" on a scale and input this into the algorithm? What if the algorithm cant account for the additional parameter, do you call IT and have them rewrite the program?


EBM is and should be the standard physicians follow but the more you learn about clinical medicine, the more you understand that it has a large subjective component.

-Side point: Patient compliance and trust in their provider affects outcomes, it would be hard to see a machine providing this same type of relationship.

I don't see where an md is needed here.
 
AI can't talk to the patient and doctor and use clinical judgement, which is why the pharmacist is there in the first place. Anyone can match data entry to a hard copy. Maybe it would lower workload and cut the need for pharmacists in stores with overlap but that's about it; every pharmacy will still need a pharmacist on duty and most pharmacies only have one to begin with.
 
I don't see where an md is needed here.

Not the strongest example but I didn't want to get too detailed as far as a specific pathological example and the clinical decisions making involved in that instance.
 
This cheap garbage company is going to develop a software to replace pharmacists?

LOL ... these ******s haven't even been able to make IC plus run efficiently ... it's really a ****ty system and they cannot fix many of the issues with it .. it literally stops working from just a bit of rain and has a million other problems.

DMs are *****s and are at the very bottom of the corporate ladder. They are clueless fools for the most part.
 
Not a single pharmacy management system I've come across, not a single one, can be described as even mediocre. Not PDX, not IC+, not ConnexUs (which is a GUI overlay of PDX like lord said), and definitely not RxConnect. They are all hot garbage, the hotness of garbage varying in degree, and proficiency at using any of this software is defined in terms of how many workarounds you know to get from point A to point B in the least miserable way possible.

And "they" think they can write software that will precipitate mass RPH unemployment?

LOL

Same thing with actual pharmacists. Even with mass amounts of new grads there are so many bad pharmacists that cling to their jobs. So much inertia.
 
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I quit WAG in Feb 2016. Back then my DM was saying initial roll out of the software would begin late 2016. That didn't happen. They talk about how revolutionary this software will be. I'll believe it when I see it. I can't say how many times we were left with our software offline for days at a time just because it was hot outside. Or windy. Or rainy.
 
You're describing a doctor that doesn't practice evidence based medicine.



I thought he was joking at first.

I made a post mocking the smoke and mirrors M.D.s like to project around what they actually do, and someone responded by saying "No, you're wrong! I've seen the wizard. Not sure what curtain you're talking about. "

Practicing evidence based medicine isn't the difficult part. It is when the patient deviates from the EBM.

I'm a 4th year (graduate on Saturday), and on my first rotation last May I had a patient on our general medicine service for hepatic encephalopathy along with ascites and non-bleeding esophageal varices. I noticed his ascites and esophageal varices medication regimens were not optimized (read: non-existent). I recommended Propranolol titrated to a HR of 55-60 and Spironolactone/Lasix in a 100:40 ratio as per the AASLD guidelines. The chief resident on my team was kind of shocked by the recommendation, but obliged. We titrated appropriately and then BOOM patient had a fall that led to an increased LOS (sorry taxpayers). EBM sometimes comes with consequences, and a computer will not always be able to recognize when the intervention (like mine) were not appropriate. I've learned from the mistake, and was not as aggressive in the future. I encountered two more patients with esophageal varices over the course of my remaining rotations, and titrated appropriately even when the goal was not met as fast as I wanted.
 
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Practicing evidence based medicine isn't the difficult part. It is when the patient deviates from the EBM.

I'm a 4th year (graduate on Saturday), and on my first rotation last May I had a patient on our general medicine service for hepatic encephalopathy along with ascites and non-bleeding esophageal varices. I noticed his ascites and esophageal varices medication regimens were not optimized (read: non-existent). I recommended Propranolol titrated to a HR of 55-60 and Spironolactone/Lasix in a 100:40 ratio as per the AASLD guidelines. The chief resident on my team was kind of shocked by the recommendation, but obliged. We titrated appropriately and then BOOM patient had a fall that led to an increased LOS (sorry taxpayers). EBM sometimes comes with consequences, and a computer will not always be able to recognize when the intervention (like mine) were not appropriate. I've learned from the mistake, and was not as aggressive in the future. I encountered two more patients with esophageal varices over the course of my remaining rotations, and titrated appropriately even when the goal was not met as fast as I wanted.


Any good pharmacist would literally be like "WHAT ARE YOU THINKING?!"

Since the patient had encephalopathy, that means there are nitrogenous substances within the systemic circulation and nitric oxide which has vasodilating effects in the first place and adding on a Beta Blocker too aggresively would act synergistically. I can understand wanting to lower blood pressure to prevent variceal hemmorage but even the guidelines you followed says lowering blood pressure of the patient worsens survival!

I'm glad you learned from your mistakes though, a lot of physicians are very set in there ways and won't change.
 
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