Separate names with a comma.
Discussion in 'Medical Students - MD' started by TOMFighter, Jun 13, 2008.
other than ring you up?
From what I see, he:
2)probably knows a few extra calculations and pharmacodynamics
3)moniters controlled substances
4)and from the angle he is at, he usually looks Down on his customers..
5) may be someone who doesnt want much dialogue..
6)has a hard time opening his own shop with the infamous CVS, etc
They don't count pills.
They keep track of your prescriptions to make sure the doctor prescribes the appropriate dose and to look for any possible drug interactions (this is why it is smart to pick one pharmacy and stick with it, so you know they have all your drugs on record).
I've seen pharmacists absolutely save physicians' a$$es before; don't discount how important they can be. Remember when Dennis Quaid's newborn twins were in the news because they got some ridiculous amount of heparin? Well, I guarantee that would happen 10x more often if not for pharmacists. Also, we used to have a pharmacist round with us in the ICU and you'd be surprised how much they can add to patient care.
The ones working in the hospital can be invaluable, especially when working in the ICU.
They know way more than you will ever know about pharmacodynamics and pharmacokinetics, side effects, and toxicities of many drugs- as that is one part of their primary responsibilities (clinical or retail). And like an above poster has stated, they will save your sorry a$$.
Think again. A required responsibility of retail pharmacists is to give patient counseling with the dispensing of prescriptions.
So based on this reasoning, we can say that we, as future physicians, will look down on nurses, techs, and patients just because we're physicians? Well done.
Agreed. These days many medicine teams in hospitals have a pharmacist that rounds with them and monitors their prescriptions. There are a ton of things to keep track of with complicated patients and when you have a dozen patients each on twenty meds, it's pretty helpful to have someone "suggest" that you don't want to prescribe both X and Y to a patient due to the drug-drug interactions, or "suggest" that 30mg is too high a dose for someone with a particular ailment. Having someone on the team who really knows pharmacology (and has the time and training to focus in on it), rather than just throwing drugs at a patient willy nilly, is huge. So yeah, a good and alert pharmacist will have your back. They also often meet with the patients at discharge and discuss their drug regimen, which may improve compliance.
I think he was saying, with tongue-in-cheek, that retail pharmacists usually stand on a higher level than the customers...so they literally look "down" at the patients.
You won't truly realize the value of a pharmacist until you've been in residency and are responsible for God knows how many patients, each of whom seem to be on 15-20 different meds. Only then will you recognize how little you really know. While many pages are annoying, pharmacy pages are usually legit and can often keep you out of trouble. They help out a ton, and are great to have around.
I think it's kind of silly how little pharmacists are allowed to do in the US. In many other countries pharmacists can give you a wide array of prescription medications for low-grade medical issues. Aside from hospital pharmacists who may play a more active roll in patient care, I think this is a very relevant question. Certainly they look for drug interactions, but, and correct me if I'm wrong, don't modern pharmacy computer systems automatically flag these (e.g. Walgreens) for the pharmacists to review? I would imagine the same is true of dosage- as long as they know your age, height, and weight there's no reason the system can't automatically flag drugs or dosages that that are over pre-defined reasonable maximums. Does it really take a pharmacist to double check with the doctor? I wouldn't be surprised if they already delegate this to pharmacy aids/techs. One thing I didn't see mentioned here is that some drugs must be mixed with other things or activated in some way. But again, can't a high school-aged pharmacy tech follow the instructions on the side of the box without a 4 year advanced degree? I'm really not arguing that pharmacists are useless- I'm arguing that they should have a little more leeway in the US in working with the pubic. And this is one way, mind you, to help decrease healthcare costs. (Bypassing doctors for the simplest of medical ailments that can be better treated with medications just slightly stronger than OTC).
Pharmacists arent needed for dosing, drug interaction, or safety issues. A computer is much more efficient to point out problems with a computer-order entry system.
It's not quite that simple. Renal dysfunction, liver disease, etc. can all affect medication dosing. In transplant medicine there's also no way a computer algorithm could accurately dose the various immunosuppressants that need to be monitored.
don't you guys have PDA's that tell you dosage information though? Also, when I go to CVS for example to pick up a prescription, everything's in the computer. I was always under the impression that the computer automatically gives you a warning that X patient is on two drugs that aren't supposed to go together. Doesn't the hospital work like that also?
sorry, just curious
That's true to some degree. But your age, height, weight are only part of the equation. Some drug dosages may be inappropriate in someone with poor kidney or liver function, or with a certain condition or living normally at a certain electrolyte balance as his/her baseline. There is no reasonable maximum for everyone of a certain age and weight. There are drug drug interactions. There are folks with allergy histories. There are duplicate drugs using the same mechanism that need to be eliminated. There are combo drugs that can enable someone taking a lot of pills to take fewer. There are shortages and recalled lots of drugs forcing someone to suggest alternatives. And the literature continues to come out suggesting different regimens and approaches faster than places like Walgreens can update. So yeah, a lot of this can be done via computer and is, but at some level someone has to review what the computer spits out and notify the doctor. because you don't want to sit around dealing with automated alerts all day when someone human can analyze the med list, tell you where you went wrong and suggest what you really should be doing.
The thing is - there is no way to KNOW if a patient has SIMPLEST OF AILMENT. Some of the simplest symptoms may turn out to be something major. You can't ask a patient, "hey, you only have something simple, right? A midlevel could PROBABLY help you out, right?"
Heck no. They're gonna want to see the doc.
Garbage. If pharmacists want to be doctors, they should go through appropriate training.
A pharmacist will never know the subtleties of administering a medication without the experience a physician acquires through years of clinical training and followup.
The PDA is fine for simple stuff. If you need to know the typical dose of bactrim to give to a 60kg person with X infection, you will get that info. You will also get a list of potential complications and contraindications. you may even get a handful of drug interactions. But no, your PDA isn't going to tell you what to prescribe to, say, a 60 year old status post kidney transplant, who is already on a couple dozen other meds. you don't prescribe in a vacuum. The other stuff a patient is on, and the conditions he has, affect the dose.
As for your CVS example, I suspect you are a very uncomplicated case without multiple comorbidities and not on twenty drugs. So yeah, for a patient like you, a simple CVS computer warning is probably plenty. Not so much for someone perhaps with organ failure issues on 20+ meds and sometimes with interactions not between two drugs, but when combined with a third or 4th or 6th drug etc. Someone at the hospital has to be on top of this. Sometimes it is the physician. But more commonly, the person who eyeballs this and uses the computer info as well as a knowledge of pharmacology and some of the patient info to catch various snafus is the pharmacist. Because this is the person actually focused on the drugs/dosages.
The problem with computer-ordering systems and computer checking is that they are dumb - they will automatically red flag ANY possible drug-drug interaction, even if it is remote. It takes someone (sometimes a physician, sometimes a pharmacist) to look at the orders and decide "no bid deal" versus "oh ****, shouldn't do that"
Just as an example - say a CHF patient is on lasix with potassium supplementation and you want to start spironolactone. A computer will throw red flags.
An elderly medicine paatient on coumadin for afib and now has pneumonia - have fun picking an antibiotic without getting red flagged by a computer checking system.
Yes, as a physician, you should also know about possible drug-drug interactions and what to look out for. But if you have 5-15 patients, each with 10-25 scheduled and prn medications, it's hard to keep tract of all of them and possible interactions while carrying out your other duties. Someone who is dedicated to just the pharmaceutical aspect of patient care, who has time to look over the medications and make recommendations, who has time to keep current on latest developments/research (either pre-market or post-market testing) can be a valuable asset.
Good points above. A computer can't distinguish between a minor potential drug-drug interaction and a major, potentially life-threatening one.
Sure it can- to a degree. I'm not saying that value judgments aren't sometimes required with particularly complex conditions, but a well designed system can be programed with any number of variables to produce relevant results. Drugs x-y can be life-threatening, drugs p-q cause discomfort. The system could flag combination x-y with a red marker, and combination p-q with a yellow or blue indicator. If the ESRD indicator is checked p-q might be bumped up to level orange or red requiring physician consult. Any combination of drugs or conditions that can be programmed into a pharmacist's head can be programmed into a computer (value judgments aside). And since non-hospital pharmacists are usually just double-checking or tweaking physician orders, it's the physician who's making the value judgments in the end anyway.
Note- I've never worked in a pharmacy, I'm just saying it's possible to have computer systems perform some of the primary function of a Walgreens pharmacist. And again, hospital pharmacology is a different story.
I think if you look at group theory's post above, you will see that such a flag system is used at many hospitals, but still not particularly effective because when you have 20 drugs, and each can interact with 1 or more of the others or in combo with multiple others, you can end up with many hundreds of different red flags. Someone has to go through and sort out which ones are worth a physician's time to consider (Because if you have a dozen sick and crashing patients you aren't going to want to be at the computer spending a whole lot of time with this). So you do your best, but if someone with some more focused knowledge, and the time to actually spend time with this makes a suggestion, it's going to be a huge help.
I'm not trying to be an a$$ or anything when I say this since I know its going to sound a bit blunt coming out. But after a few years of med school when you start seeing patients, think about your sentiment of computers handling drug interactions when they come to you with a diagnosis from WebMD.
Honestly, I am not quite sure that there is a lot they do that a computer wouldn't be more efficient at.
However, given the current state of half paper/half computer based records keeping, they are important.
Drug interactions are usually much more straightforward than the almost never typical presentation of most disease.
at the point of this thread.
So basically....they're a store manager but for controlled substances....they know the science behind everything.....do a little bit of counseling....etc.....could potentially act as a safety net to Docs...
Not potentially. This is their most important role in no small way.
They also can provide information on new drugs, run poison control centers, report new drug interactions, work in drug approval process, assist in clinical trials, assist on P&T committees researching new therapies, and other stuff you guys may/may not not be interested in doing as an MD.
I'm a 4th year student currently on an "advanced" general medicine (patients in step down units from ICU, not get med/surg) rotation at a local private hospital. Every morning I go through the medication profiles of about 80 patients. It takes a little over an hour - less come Friday.
Anyway, a big part of my job there is followup - so we renally dosed that Lovenox 10 days ago, but guess what - as other issues have been addressed now the patient no longer needs renal dosing and is currently inadequately anticoagulated. Not all physicians will go back and increase the dose (after a couple days to see that the increased renal function isn't a fluke).
Ditto for antibiotics - often increase or decrease doses due to changes in renal function.
Warfarin - I'm responsible for all of the warfarin dosing for the patients on my units - I run my recommendations past the preceptor but I actually write the orders for the days dose. I had a great talk with a physician the other day about it - he was asking why I picked such doses, etc etc and we talked PK/D and it was all well and good. He brought up that in his training he'd been taught to start patients on 10 mg to "load" them. That just isn't (shouldn't) be done anymore - you end up fighting the supratherapeutic INR 3-5 days from now.
I know this is a med student forum - so many of you may be surprised how at my real job (inpatient hospital pharmacy) how many residents and attendings ask for my opinion on drug selection and dosing - even after I tell them that I am a student/intern. Even things like logistical issues - attending endocrinologist wanted to know if we could make D20W for a hypoglycemic patient. We can, but due to osmolarity you can't put anything higher than D12.5W through a peripheral line - he didn't know that, I did, and we agreed the situation wasn't worthy of putting a central line in the patient.
I understand that physicians are in an odd spot right now as far as mid-levels, etc. Having parents who are RNs I actually prefer to see nurse practitioners when possible (I am a simple patient and rarely have anything worthy of needing to see a MD). But a (good) pharmacist has a very important role and you can't trust the PDA to make professional judgement - ie: penicillin allergy and the use of cephalosporins. Plus you all are busy, sometimes I have the time to call the patient's home pharmacy and get the real scoop on the doses, how often refilled (measure of compliance), and what they personally know about the patient.
And techs don't call MDs - only pharmacy students (interns) and pharmacists (varying on state laws) can call MDs - techs cannot legally take verbal orders if there are any changes to be made.
oh - another quick thing. We all read our share of journal articles, no? Ours are exclusively about drugs - we may have read something recently about a new dosing scheme for a medication that would apply to your patient. Wouldn't you want to hear about that?
Good job, njac. You very tactfully and knowlegeably put Tom and any others on this thread who are completely ignorant or unaware of the responsibilities pharmacists have in their place. Tom appears to be a very insecure medical student who feels threatened by the knowledge pharmacists have. This insecurity of his is reflected in his apparent sense of exclusivity and superiority he seems to express in his posts. A well educated physician or any other health care professional recognizes his limits and uses all of his resources for patient care. Tom comes short of this standard by arrogantly stating that pharmacists will NEVER know the "subtleties" that come with proper administration of drugs.
Whoever said physicians are the drug experts? Lol, Tom and whoever agrees with him is ridiculous. Pharmacists don't go through 6-8 years of training after high school just to ring up your purchase, count pills, etc... The arrogant physician believes he knows more about drugs than any pharmacist ever will. Anyone who believes this is wrong. Physicians are many times completely ignorant about drugs, their dosage forms, etc... I work in a pharmacy and all too often, we receive prescriptions for drugs with wrong dosage form and other mistakes. Tom and others who believe physicians are God: Physicians WILL never come close to the knowledge pharmacists have about pharmaceuticals. You guys take one year of pharmacology, perhaps. Pharmacists are trained in every aspect.
Be within the realms of your professional expertise, future physicians. You are trained in the diagnosis, pathology, and pathophysiology of disease. You are not drug experts. Similarly, pharmacists are trained in pharmaceuticals. We are not experts in diagnosis even though we receive some training in pathophysiology and disease. What's so difficult to comprehend about that? I suggest some of you people realize this. Let's all come together for the well being of our future patients and stop casting judgements and superiority on one profession or another. Tom, you sound like one of the older physicians who is insecure about working with pharmacists. I have heard many present generation med students and graduates are excited and realize the extensive knowledge pharmacy students and graduates have. Get over yourself. You are probably not even an MD yet and you seem to already feel like you are "Almighty God". I mean all of this with a humble heart and sincerity. Do not take offense, but you really sound full of yourself.
Why are you even browsing the allo forums. I sense that you are the insecure one.
For most people, once they hit the halfway point of their MS-III year - and certainly by the time they're in residency - they realize how invaluable hospital pharmacists are. I've been helped by Pharmacy for drug dosing, interactions, indications and the like more times that I can count.
This guy is a troll.
Don't feed the troll.
Can anyone sense the irony of this post?
Let me answer your question indirectly. If you take this seriously, this one little thing may be the first step of something that actually saves your life and dramatically improves its quality (and it makes pharmacists a lot less irritating). First, take this screening test: http://counsellingresource.com/quizzes/goldberg-mania/index.html . Pay particular attention to questions such as
I need less sleep than usual.
I have so many plans and new ideas that it is hard for me to work.
I feel a pressure to talk and talk.
I have more new ideas than I can handle.
I have been irritable.
It's easy for me to think of jokes and funny stories.
I have been full of energy.
If you score high on that test, consider getting appropriate care from a psychiatrist. If not, I would continue to self-reflect and look into what might be bothering you. You might just be irritated or there may be something deeper. If you have an ailment that is treatable by pharmaceuticals, you may find that a pharmacist can be very helpful in answering questions or concerns that you may have. Even if you don't realize that not everyone in the public has a science education and knows where to look things up. Some people really use pharmacists as a resource for problems that they have with their medication. Also, as several people have pointed out, pharmacists save lives every day by catching prescribing errors and by making sure that the patient gets the medication they need as opposed to something else. Ever notice someone else's mail in your mailbox? It happens to me every week. Not a big deal. What if a pharmacist had the accuracy of a mail carrier? How about if you got someone else's medication every week? You think that might have a negative impact? Think about it.
This guy's a troll, dude. Read his other posts.
Absolutely.. (like when you are in court looking up at the judge) Thank you Blade!
Also they may dialogue, but no where near the extent of a profound physician..
I wont discount them anymore but it doesnt take a lot of extrapolation to say "take some benedryl or just use 1% hydrocortisone cream..
That pharm D in the ICU thats a whole different tier.. (to think you are innocently giving someone some digoxin?)
**When ever I go to the pharmacy there is usually a print out of the side effects and interreactions of that med.
**Also, geez (another can of worms) whats up with the pharmacists at CVS and Rite Aid with expired prescriptions???????????????
And can save a lot of money. The Happy Hospitalist - www.thehappyhospitalist.blogspot.com - had some 90-year old woman come in with dozens and dozens of medications. She was discharged with 6 meds. A pharmacist could definitely help reduce the laundry list medications of many elderly people.
Yes, true. I hope it's treatable and he gets the help he needs. Maybe he doesn't want to be a troll and just can't help it due to some underlying problem that he's not aware of.
we're only here because someone gave us a heads up on the pharmacy student forum.
It's something that comes with time - by the end of your residencies you will appreciate us more.
Yeah, my M1 mentor was a geriatrician, and his charting system was all on a computer, so he'd enter in all their meds/changes to meds, and invariably, the computer would pop up with several different "potential interaction!!!" alerts that he had to override. The drug combination was perfectly appropriate in the situation, but there was a "potential interaction."
One of his first threads was about how derm wasn't really that competitive so we should all stop gunning, and then there was another where he insisted that doctors would always be the highest paid people in any society--in both forums he persisted, angrily, despite all evidence to the contrary.
It became apparent to me after arguing with him that he was either acutely manic or a troll--and a douchebag either way.
njac--Thanks for the informative, much needed heads up!!
Looks like acute mania is still in your differential in any case. I would guess that Bipolar I & II and cyclothymia would be overrepresented among trolls. These can often be treated (so we are told) or at least mitigated. Grandiosity, jumping from idea to idea, irritability, pressure to talk, saying inappropriate things, talking fast, etc. all lend themselves to trolling. Rather than getting angry with the guy, I'm considering that maybe there is an underlying illness that he really has no control over unless he gets some help. There are of course various personality disorders that could lead to trolling (Narcissism, etc.) that should be in the differential as well.
Actually, I'm a real M1 entering this fall...
I'm just trying to collect as much information as possible so I can plan accordingly.
Well, you're displaying certain traits that go beyond the usual information gathering. Just because you are entering M1 in the fall doesn't mean you don't have issues. It's also not a good thing to anger the people you are trying to get information from. Also not a good sign. You'll learn more about it in psych. I don't mean this in a bad way or to be derogatory.
The stats on Match rates are deceiving. They are listed as percent accepted WHO ARE INTERVIEWED.....I thought it was percent accepted WHO APPLY.
It's an easy mistake to make and doesn't justify calling someone a troll.