Prescribing powers for pharmacists case against

[badxmojo]

hey guys I'm a second year pharmacy student. In one of my classes we have to do a debate... our topic is prescribing powers for pharmacists (undneath physician supervision). I'm trying to get points on both sides.. I'm having trouble fiding points against prescribing powers for pharmacists.. I figured maybe you guys might be able to help.. please be nice.. no need to trample on me.. we're all on the same team right ;-)

thanks in advance!

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[kenmc3]

Well, I’m not really sure in what circumstance a pharmacist would need to prescribe medicine… Nurse practitioners and PA have power to prescribe meds under physician supervision but they are performing the role of a doctor. Pharmacists, while they have much more knowledge about drugs than physicians don’t really have the need to prescribe. Let me put it this way, physicians are trained to diagnose and treat disease/injury etc pharmaceuticals are a tool at their disposal to be used to cooperation with other treatment options. In my option a pharmacist prescribing drugs could have two effects:

1) It could undermine the physician, perhaps the drug of choice wouldn’t match up with other treatments the physician has in mind. Even though pharmacists have a much greater understanding of pharmacology and biochemistry – physicians have a greater knowledge of disease and treatments.

2) One argument for pharmacists being able to prescribe meds would be to save physicians time in having to write refill prescriptions or changing medications due to side effects etc. But my argument to this is: Maybe the drug choice wasn’t working because the problem was initially misdiagnosed and it would take a physician to re-evaluate that matter. Also, patients need to check in wither their doctors periodically to keep them apprised of their condition. If pharmacists could prescribe meds I think patients would visit their doctors less which could have bad outcomes.

These are just my opinions I am not against it per say, I just don’t see a reason for it. Also, you were looking for some negatives (this is what I see).

 

[EvoDevo]

I'm going to move this to the Allo thread. Probably more appropriate there. Good luck!

 

[AJM]

I don't know if I have any good arguments against limited prescribing powers for pharmacists, but just wanted let you know about my positive experience with this kind of thing:

My primary care continuity clinic is at the VA, and there is a Pharmacy clinic there specifically at the disposal of the primary care physicians that I refer a ton of my patients to. I think it's a wonderful idea. The typical way we use the clinic is when we have a patient that we're having a hard time with BP control or lipid control, so we send them to the Pharm clinic to work on ramping up their BP meds or statins. It really helps me out a lot because my clinic is always booked at least 4 months in advance, so the Pharmacists can work with my more high-maintenance patients on a more frequent basis while they're waiting to see me. As a caveat to this, however, is when I place the referral, I have to give very specific instructions to the pharmacists as to which meds the patients should be on, and which ones I want adjusting, and what the patient's goal BP or LDL should be. The pharmacists then have free range in checking labs, seeing the patients in their clinic, and adjusting the doses of the meds I asked them to alter. However, if a patient has maxed out on a med, or needs to change because of side effects, the pharmacists contacts me in order to approve any medication change. That way I'm not out of the loop, and can still direct the overall care of the patient. Oh yeah - and I still continue to see these patients regularly - I usually send them in the first place because I'm not physically able to see them as often as they need to be seen.

There are other things this clinic does, but the function I've listed above has been the most helpful for me, personally. I think the system really works well, as long as there are very good lines of communication between the pharmacist and the physician.

I guess that reminds me of a potential argument against - if the pharmacist changes patients' medications without informing or getting the approval of their physician, it can lead to very disjointed medical care, and potentially hazardous interactions. (ie, if the physician doesn't know a patient is on X medication, and then prescribes med Y, which is harmful when taken with med X)...

Just my 2 cents...

 

[medic170]

If pharmacists were to prescribe, then it would just be easier to have doctors fill prescriptions. Doctors treat patients, pharmacists fill prescriptions, I really don't see why the role of the pharmacist should be any different than it is?

 

[badxmojo]

Hey guys thanks very much for your input. I was a bit dithery about asking the question... Thought I might get my head bitten off lol..

I don't know if since I'm in pharm school and i'm getting a skewed point of view but it seems like prescribing powers for pharmacists is deifnelty something that you are going to come across more and more. As one of you stated..it is mostly something that will occur in a clinic where a pateint will be referred to a pharmacist after already being diagnosed..like HIV, Diabetes, HTN. I know if you work for indian helath services ( treating native americans on the there reservations) that the pharmacists are considered primary health care providers. I don't know if that means they diagnose as well. I'm not so sure how I feel about that. I think that underneath the guidance of a doctor a pharmacists can definetly be utilized especially when treating complicated diseases like diabetes, HIV.

thanks again

 

[JMalley]

Hey guys thanks very much for your input. I was a bit dithery about asking the question... Thought I might get my head bitten off lol..

I don't know if since I'm in pharm school and i'm getting a skewed point of view but it seems like prescribing powers for pharmacists is deifnelty something that you are going to come across more and more. As one of you stated..it is mostly something that will occur in a clinic where a pateint will be referred to a pharmacist after already being diagnosed..like HIV, Diabetes, HTN. I know if you work for indian helath services ( treating native americans on the there reservations) that the pharmacists are considered primary health care providers. I don't know if that means they diagnose as well. I'm not so sure how I feel about that. I think that underneath the guidance of a doctor a pharmacists can definetly be utilized especially when treating complicated diseases like diabetes, HIV.

thanks again

Should you clarify the question…To What type of Pharmacist should have prescribing powers? I think the common perception if the Chain Store Pharmacist…not the ones who are in Long Term care facilities, Hospital Pharmacists that actually do rounds etc.
These are pharmacists that have a significant amount of patient contact.

You do realize that you are probably setting yourself up for additional certification… more time in school, another professional exam, continuing education….

 

[oudoc08]

My wife is a pharmacist, and she does a great job about keeping my ego from getting to large in this area. We were at a dinner w/ friends one night, and I accidentally popped of something about, "the first time SOME PHARMACIST argues with me about a medication..." Oops. I didn't get any for awhile over that one. Maybe the rest of us first years could use some of the same. Actually, I've often wondered why pharmacists don't have some limited prescribing authority, but recently, I've come to be of the opinion, that unless absolutely necessary, the "too many cooks in the kitchen" argument seems valid. You run the same risk as when a patient has several doctors. Perhaps medicines get prescribed twice. What if a patient uses more than one pharmacy? What happens when a physician and a pharmacist disagree on the appropriate course of treatment?
I've thus come to the conclusion that pharmacists should have EMERGENCY prescribing authority. Lets say the patient can't get ahold of their physician on a weekend to refill their blood pressure medication. Or maybe a patient comes in after clinic hours wheezing with an empty Albuterol inhaler w/ no refills. They have currently only a couple of options, neither of which are convenient. Either somehow get the doctor on call who may or may not be familiar w/ their condition, or go to the ER (costly and a waste of resources) and see another doctor unfamiliar w/ their condition. It seems to me that a pharmacist who has the patients medication profile, would have the knowledge base to be able to decide the best course of action to take. In these cases, that would be to likely refill those medications, without fear of overstepping their scope of practice, or admonishment and possible disciplinary action by their employer, the prescribing physician or their state pharmacy board. My wife said in the case of the asthmatic, that she would refill the albuterol anyways, as it is in the best interest of the patient, but it would be nice to have legislation in place to protect those doing so. That said, the best way to keep the process from deviating somewhere that it was not meant to be, is to have a mandatory oversight committee made up of physicans and pharmacists, to review each case individually for appropriateness.
As far as further prescribing authority, my wife and I both agree, that her training did not prepare her to assess and diagnose medical illness. She is an incredible asset for pharmacological intervention of an established medical problem, but as most clinical issues are dynamic, she would run the risk of being unaware of issues best brought up in clinic, not standing on the other side of the pharmacy counter. As far as pharm D's in the hospital setting, again I think the role of consultant is far more appropriate than practitioner. We each have a job to do, and in the hospital, primary patient care is well covered by the patient's physician. (BTW, I've talked to my wife about all this, and having been a retail pharmacist for the last 5 years, she agrees.) She maintains that if she had wanted to be a doctor, she would have gone to medical school, and given that there isn't an overt need to have general or even targeted prescribing authority, she wants no part of it. Especially since we pay about a hundred bucks per year for her malpractice, and mine will likely be around a hundred GRAND a year by the time I get out.

 

[AlternateSome1]

Pharmacists are not trained to diagnose patients. While they know what a drug does, they will not have the ability to take a history, perform a physical exam, order tests, interpret x-rays/lab results, etc. I can't see why a pharmacist would need to be able to prescribe anything when they aren't able to determine what a patient needs. AJM's post makes a lot of sense to me, but I still would worry about a pharmacist missing something that they simply aren't trained for. Imagine the law suits...

AS1

 

[Doc 2b]

1) It could undermine the physician, perhaps the drug of choice wouldn’t match up with other treatments the physician has in mind. Even though pharmacists have a much greater understanding of pharmacology and biochemistry – physicians have a greater knowledge of disease and treatments.

How do you think pharmacist understand drug pharmacokenetics, and drug interaction? They do learn about pathology and diagnosis, but on a more limited scale.

Being the son of a pharmacist I understand where the OP is heading with this, I think. There was a push about ten years ago to allow pharmacist to act as PAs. For those of you who question the role they would play, question answered. I don't see why anyone would have a problem with this, my dad and several of my friends from college (who are pharmacist or in school) would make excellent PAs. They do learn about differential diagnosis, and pathology of disease, thats how they know what drugs to prescribe better than physicians. The element missing is clinical training, such as listening to breath/heart sounds. While they do get some of this type of training, at least my father did (had to round with medical students a couple of months), they lack the overall ability to cllinically diagnose. I feel that if this were offered in school or in a CME type thing additional accredidation would be warranted.

 

[badxmojo]

for those of you whose argument is that a pharmacist should not prescribe because they cannot diagnose. I must clarify.. that the pharmacist would be working with a physcian. The physcian would diagnose the pateint.. and then refer the patient to the pharmacist.

 

[VCU07]

I am a second year pharmacy student. While we do not learn to fully diagnois we do learn to interperate lab results (Na, K, Cl, BUN, Scr, etc...). In fact, our therapy class centers around understanding the patho of a disease state. MDs will determine what is going on and we then prescribe an apporpriate therapy. There is a big move going on to have pharmacists manage drug therapy allowing physicians more time to diagnose and monitor. I don't think the general public, including other health professionals, know how well trained current PharmD students are becoming. In our 4th year we do go on rounds with the hospital staff each morning and answer questions as they are asked. I know many physicians do not like this idea, but thats how health care is becoming. We should all work together for positive health outcomes.

 

[Fermata]

I think that pharmacists serve a great role to keep physicians in check if the prescription sounds way out of wack.

That being said, physicians(dentists, etc.) should be the only ones with prescription rights so they can function as the head of the team.

It's all about liability.

 

[VCU07]

PS- This is NOT how healthcare is becoming. I don't know about you, but where I come from, I have never seen a doctor say, "Patient X, now that we have found out you have disease Y, I will refer you to pharm. z to let them decide what to do."

This is an absurd idea. Maybe we can even get a new degree handed out that will have people check what drugs a pharmicist prescribes . What we don't need in healthcare is a more complicated system, which is what your new system would bring. Keep on dreamin', though.

First of all, I don't know where you are from, but it is happening. At the least it is happening at pharmacy schools that are part of health systems. This is the problem with healthcare...staff do not want to be more open minded.

 

[Espion]

I am a second year pharmacy student. While we do not learn to fully diagnois we do learn to interperate lab results (Na, K, Cl, BUN, Scr, etc...). In fact, our therapy class centers around understanding the patho of a disease state. MDs will determine what is going on and we then prescribe an apporpriate therapy. There is a big move going on to have pharmacists manage drug therapy allowing physicians more time to diagnose and monitor. I don't think the general public, including other health professionals, know how well trained current PharmD students are becoming. In our 4th year we do go on rounds with the hospital staff each morning and answer questions as they are asked. I know many physicians do not like this idea, but thats how health care is becoming. We should all work together for positive health outcomes.

I'm really not trying to flame here, I love pharmacists! But, my first thought was, "Never, ever treat the labs." So I wouldn't use that as an argument for your case.
We have PharmD students rounding with us as well. They've given some great off-the-cuff lectures. I view them as an incredibly valuable source of information. As for the argument at hand, I'd have to ponder on it.

 

[awdc]

I've thus come to the conclusion that pharmacists should have EMERGENCY prescribing authority. Lets say the patient can't get ahold of their physician on a weekend to refill their blood pressure medication. Or maybe a patient comes in after clinic hours wheezing with an empty Albuterol inhaler w/ no refills. They have currently only a couple of options, neither of which are convenient. Either somehow get the doctor on call who may or may not be familiar w/ their condition, or go to the ER (costly and a waste of resources) and see another doctor unfamiliar w/ their condition. It seems to me that a pharmacist who has the patients medication profile, would have the knowledge base to be able to decide the best course of action to take.

I'd have to disagree. While your example sounds simple enough and most cases probably wouldn't be complex at all, the danger still arises from the pharmacist's lack of training, education, and experience in ruling out conditions that might be mimic the medication problem at hand. Maybe it was really a panic attack or GAD. Or, maybe there is a new onset serious underlying complication of a patient's condition. What if this asthmatic ran out of his albuterol refills b/c he was puffing away at a status asthmaticus? A delay in treatment b/c the patient decided to go to the pharmacy instead of the ED has the potential for a seriously bad outcome. Pharmacists may have the best knowledge base at times but that knowledge isn't quite as coupled to actual patient application as physician training is. To make a point relating to the above example, I'll pose this question. Who better would know if/when there should be adequate signs of improvement or if intubation or mech. vent. is iminent in status asthmaticus? This is just one example, imagine the endless permutations with different conditions. As such, I think pharmacists are valuable consultants but are not adequately trained to be interventionalists.

And if a patient has to call the on-call doctor for a simple prescription refill, then so be it. The pharmacist would still have the pt's med profile and can cross-check with it. It may be inconvenient for the on-call physician and patient but I think it's worth it if patients know they don't have to decide between the pharmacist or the physician in an emergency (which might not be perceived as an emergency to a patient).

Any rebuttals out there are welcome, of course.

 

[tupac_don]

They probably shouldn't have prescribing powers for the same reason that doctors shouldn't do another year of medical school to become "drug experts" and distribute medicine. It is not good when prescribing/dispensing powers are both in the hands of one person. The role of a pharmicist is to check the drugs that are prescribed on the basis of a diagnosis by the doc. Until pharmicists learn to diagnose, they should not be prescribing because diagnosis lies at the heart of deciding which medicine to give. This is such a ridiculous argument in my opinion, why can't everyone be happy with their career and its purpose.

It's not as ridiculous as it sounds. Actually I think it would be a real good idea for pharmacists to have limited prescribing authority. This might be very helpful and save your time. Now I agree, that it should be limited to specific disease states and to stabilized pts. But trust me I for one wouldn't mind if I didn't have to be called for every single thing. Also as one poster said in emergency situations pharmacists should be allowed to prescribe. But definitely they shouldn't have routine prescribing power and I agree with you that pharmacists can't diagnose and therefore can't know all the pertinent data relevant to the pt.

You do know that in some states pharmacists actually DO have limited prescribing power, I think Statins, and BC pills. But again they are rather limited.

 

[badxmojo]

Exactly. We should all work together. The problem is the short stop (pharmacist) on this team wants to play first base (physician). That isn't how a team works. IMO, They should just put one more year of intensive pharmacology training into medical school and end this debate here and now. I don't think you realize what a detriment to pharmicists that would be if physicians started to play the game that you guys are playing. How much easier would it be if there didn't need to be "drug experts" because that would be done in a split second by your doc after you are diagnosed.

Ku06 that is not very logical. I know med chool is super internsive.. and theres a lot of information that doctors have to remeber as far as pathophysiology.. I don't think that many Doctors will have enough time and even capacity to become drug experts. You think that a year of pharmacology will make you a drug expert? Most 4th year pharm D graudates are not drug experts. Pharmacists become experts after many years. The good ones really dedicate thereselves to learning about drugs.. it takes time!

 

[UseUrHeadFred]

I don't think that many Doctors will have enough time and even capacity to become drug experts. You think that a year of pharmacology will make you a drug expert? Most 4th year pharm D graudates are not drug experts. Pharmacists become experts after many years. The good ones really dedicate thereselves to learning about drugs.. it takes time!

You have fallen into his trap. His point was that pharmacists shouldn't think that by taking an extra class (or even years of classes) they could diagnose even the simplest of conditions. To borrow your phrase, "most 4th year medical students can't even do that." Thus, if you cannot diagnose an illness, you cannot prescribe something for said illness.

 

[peehdee]

its about power and control.

if you start giving anyone that knows a little bit about drugs the power and control to prescribe, what's next? give the patients the right to prescribe for themselves (under supervision of physician) ? because they take it all the time, they know what the side effects are, they know what they need?

what's the point of 'supervision'? i mean if the pharmacist is going to be checked by the physician everytime the pharmacist writes one, why don't u just have the physician write it out to begin with? get my point? either give full rights or don't do it all.

 

[apgmph]

its about power and control.

if you start giving anyone that knows a little bit about drugs the power and control to prescribe, what's next? give the patients the right to prescribe for themselves (under supervision of physician) ? because they take it all the time, they know what the side effects are, they know what they need?

what's the point of 'supervision'? i mean if the pharmacist is going to be checked by the physician everytime the pharmacist writes one, why don't u just have the physician write it out to begin with? get my point? either give full rights or don't do it all.

I don't think that giving pharmacists prescribing rights is about power or control. Do you feel the same way about PA's or NP's?? What makes them (after 2 yrs of school) experts in the same matter? I am an outsider here...neither a physician or a pharmacist, but am a health care professional (MPH) and work with almost ALL types of health care professionals. So, maybe I'm hoping I can give an unbiased response. I don't think all pharmacists should have prescribing rights. It depends on the practice site. Retail pharmacists have no need to prescribe. But I would think in a hospital setting, it would be beneficial. It would one allow the physician and pharmacist to WORK TOGETHER as a team and alleviate the work load on the physician. From my knowledge, most clinical pharmacists have to do a residency (anywhere from 1-2 yrs) and specialize just as a MD would. This in my opinion is great benefit to the health care industry. The point of any profession is to improve the quality of health for every individual. We, as an industry, cannot do that until ALL professions learn to work together and not want all the "power" to themselves. It has to be a team effort. And if that means allowing clinical pharmacists to have prescribing rights...I say go for it!

 

[oudoc08]

I'd have to disagree. While your example sounds simple enough and most cases probably wouldn't be complex at all, the danger still arises from the pharmacist's lack of training, education, and experience in ruling out conditions that might be mimic the medication problem at hand. Maybe it was really a panic attack or GAD. Or, maybe there is a new onset serious underlying complication of a patient's condition. What if this asthmatic ran out of his albuterol refills b/c he was puffing away at a status asthmaticus? A delay in treatment b/c the patient decided to go to the pharmacy instead of the ED has the potential for a seriously bad outcome. Pharmacists may have the best knowledge base at times but that knowledge isn't quite as coupled to actual patient application as physician training is. To make a point relating to the above example, I'll pose this question. Who better would know if/when there should be adequate signs of improvement or if intubation or mech. vent. is iminent in status asthmaticus? This is just one example, imagine the endless permutations with different conditions. As such, I think pharmacists are valuable consultants but are not adequately trained to be interventionalists.

And if a patient has to call the on-call doctor for a simple prescription refill, then so be it. The pharmacist would still have the pt's med profile and can cross-check with it. It may be inconvenient for the on-call physician and patient but I think it's worth it if patients know they don't have to decide between the pharmacist or the physician in an emergency (which might not be perceived as an emergency to a patient).

Any rebuttals out there are welcome, of course.

Perhaps the patient wouldn't be in status asthmaticus if he didn't have to wait around for the physician to fax over a refill? Besides, you're taking a position that the patient isn't cognizant of his/her condition. Most asthmatic patients have a better idea of their status than anyone. I highly doubt any patient in true status could or would attempt to go anywhere but to the ER. Most patients who can't breathe don't wait in line at the pharmacy. Your reasoning is attempting to err in favor of the patient, and I appreciate that, but at the same time, you're stretching for the zebra, and disregarding the horse. Pharmacists aren't stupid people, and to assume that someone, especially a medical professional, can't recognize a respiratory emergency such as acute SOB when they see one, is a little pretentious. Without getting personal, as I note you are MS (as am I), I would have less confidence that most 1st and 2nd year medical students would be able to identify significant respiratory distress, (being exposed minimally if at all to patient care, than a practicing pharmacist who has not only pharmacy school and rotations, but also experience under their belt). Anyway,I have to believe that an ambulance would be summoned to treat and transport the patient, and that they wouldn't stand around scratching their heads encouraging to hit the albuterol for the 15th time. If the patient were truly to the consideration of being intubated, I, again, highly doubt they would be standing at the pharmacy counter. Most asthmatics just aren't that stupid, and if they are in that amount of denial, then why do you assume they would be cognizant enough to seek medical care anyway, instead of just sitting in their living room waiting to get better.
The fact is, many physicians aren't as accessible as we would like them to be, and in my opinion the overwhelming majority of the time, the benefit would outweigh the risk. In the few cases in which it would not, there are enough confounding variables such as that above, to make it difficult to place specific blame. Again, by having a physician/pharmacist review for each incident would make it a rare case that a pharmacist would opt to use that authority, but the presence of an exception regulation would also protect them, and allow them to act in the best interest of the patient, without fear of legal or professional discipline.
my $.02

 

[group_theory]

Let's examine this from another angle - What is the argument FOR pharmacist having prescription power?

What need is there currently? How will this solution solve this need?

Will there be limitations? Who exactly will be given this power? All pharmacists? Only those who have done residencies? Those who round in hospitals w/ medical teams?

Is the current educational setup adequate for this task? Will it require additional training?

How will medical records be consolidated if the SOAP notes are with the MD/DO/PA/NP and the rx being determined and dispensed is by the PharmD/BSPharm, esp if they are in seperate locations (say private clinic and local pharmacy). Will the plan be up-scalable to be able to handle hundreds of patients a day doing this? Who will pay for the cost of electronic medical records (if this is the solution)

 

[kwakster928]

i am one of the few who absolutely do not support the prescribing. we (pharmacist) should not be given the right to prescribe. but i think it sort of make sense to refill already prescribe medicine in emergency cases. idea of pharmacist prescribing the first drug without identified diagonosis is absurd. however, we do get training on how to read lab values not much as x rays.

 

[Jalopycat]

Here's a question. Are pharmacists willing to pay the high medical malpractice insurance that doctors currently pay?

On one of my rotations we had a pharmacy student who rounded with us. She was really helpful on the team when we needed some advice about drugs, but she did not know a thing about physical exams. Yes, maybe she could diagnose somebody if given a list of their complaints and lab results, but the physical exam is one of those things that takes a long time to get good at. There are plenty of things an exam could pick up that a lab result may not. We had one patient on our team with an aortic stenosis. All the medical students took turns listening to the murmur. I asked the pharmacy student if she wanted to listen, too. She did not know where to put the stethoscope on the patient to hear the murmur. I don't fault her for that because that's not what she's in school to do. But on that note,to answer the original question, No, I do not think pharmacists should be writing drug orders.


I also thought about the possibility of the "team" approach someone mentioned earlier. That would work fine until a patient has a bad outcome. Would a good pharmacist really want to put himself/herself in a position of liability for the patient's care over a mistake someone else made? For instance, say a kid comes in for a throat infection and the doctor irresponsibly writes, "no allergies" on the chart when in fact, the kid is allergic to penicillin. The pharmacist, not knowing this, prescribes penicillin and the kid quits breathing. Technically, the pharmacist is the one who wrote the order so he is to blame. If I was a pharmacist, I would feel really hesitant to just trust someone else did their job right, before I wrote the drug order.

I just don't get it. It seems like there's this big calling right now for nurses, psychologists, social workers, etc.. to have prescribing rights. You want prescribing rights? Fine. Go to medical school!

 

[kwakster928]

Here's a question. Are pharmacists willing to pay the high medical malpractice insurance that doctors currently pay?

On one of my rotations we had a pharmacy student who rounded with us. She was really helpful on the team when we needed some advice about drugs, but she did not know a thing about physical exams. Yes, maybe she could diagnose somebody if given a list of their complaints and lab results, but the physical exam is one of those things that takes a long time to get good at. There are plenty of things an exam could pick up that a lab result may not. We had one patient on our team with an aortic stenosis. All the medical students took turns listening to the murmur. I asked the pharmacy student if she wanted to listen, too. She did not know where to put the stethoscope on the patient to hear the murmur. I don't fault her for that because that's not what she's in school to do. But on that note,to answer the original question, No, I do not think pharmacists should be writing drug orders.


I also thought about the possibility of the "team" approach someone mentioned earlier. That would work fine until a patient has a bad outcome. Would a good pharmacist really want to put himself/herself in a position of liability for the patient's care over a mistake someone else made? For instance, say a kid comes in for a throat infection and the doctor irresponsibly writes, "no allergies" on the chart when in fact, the kid is allergic to penicillin. The pharmacist, not knowing this, prescribes penicillin and the kid quits breathing. Technically, the pharmacist is the one who wrote the order so he is to blame. If I was a pharmacist, I would feel really hesitant to just trust someone else did their job right, before I wrote the drug order.

I just don't get it. It seems like there's this big calling right now for nurses, psychologists, social workers, etc.. to have prescribing rights. You want prescribing rights? Fine. Go to medical school!

agree. it is time to stop giving these privileges like a present under the christmas tree. pharamacist are thought to work with the known diagonisis, and interpret the lab results and other signs and syptoms and possibly come up with the drug of chose, if drug was chosen, we have knowledge to offer recommendations to 1. change in dosage, 2. change in drug in a same class may be more economical, 3. change in drug so that side effect can be minimized.

it is competely right. i have no idea what heart murmur sound like. i dont even know where i should place stethoscope to listen to pt breathing.

to answer your question regarding your second paragraph, personally i am willing to pay higher insurance premium if i was given more scope of practice thus more risks involved. just like car insurance. but that case where you are mentioning, both party is to blame. physican should have asked the question during his/her diagnosis, again pharamcist should have asked the same question to double check. we all do this at all of the pharmacies. (well at least where i worked).

 

[badxmojo]

"You have fallen into his trap. His point was that pharmacists shouldn't think that by taking an extra class (or even years of classes) they could diagnose even the simplest of conditions. To borrow your phrase, "most 4th year medical students can't even do that." Thus, if you cannot diagnose an illness, you cannot prescribe something for said illness"


I can't stress enough that the pharmacist will not be diagnosing. He/she will be working in conjunction with the physician. The physician will diagnose.. the pharmacist would prescribe..under certain protocols. (example pharmacist cannot prescribe oxycontin for diabetes) I am well aware that any pharmacist who thinks he can outdiagnose a physcian is lunny.

Here are some examples where i feel a pharmacist can really help....
Diabetes manegment clinic for example. The doctor has already diagnosed the pateints. The pateint will probably go back for periodic check ups. But the doctors does not need to be seeing the pateint every month just to slightly adjust the drug therapy. If there is aproblem.. that the pharmcist feel they don't have the training to deal with, they can refer the pateint back to the physician.

I just saw a guest lecture by a women who works in an HIV clinic. She is a pharmacist. She said the doctors refer the pateints to her because HIV has soo many drugs associated with it that they feel the pharmacist would be better trained to counsel the pateint and adjust there drug regime. I'm not saying a doctor who has specialized in HIV treatment couldn't do this.. but in areas where there is a paucity of HIV specialist MD's.. a pharmacist can really make a difference.

 

[awdc]

Perhaps the patient wouldn't be in status asthmaticus if he didn't have to wait around for the physician to fax over a refill? Besides, you're taking a position that the patient isn't cognizant of his/her condition. Most asthmatic patients have a better idea of their status than anyone. I highly doubt any patient in true status could or would attempt to go anywhere but to the ER. Most patients who can't breathe don't wait in line at the pharmacy. Your reasoning is attempting to err in favor of the patient, and I appreciate that, but at the same time, you're stretching for the zebra, and disregarding the horse. Pharmacists aren't stupid people, and to assume that someone, especially a medical professional, can't recognize a respiratory emergency such as acute SOB when they see one, is a little pretentious. Without getting personal, as I note you are MS (as am I), I would have less confidence that most 1st and 2nd year medical students would be able to identify significant respiratory distress, (being exposed minimally if at all to patient care, than a practicing pharmacist who has not only pharmacy school and rotations, but also experience under their belt). Anyway,I have to believe that an ambulance would be summoned to treat and transport the patient, and that they wouldn't stand around scratching their heads encouraging to hit the albuterol for the 15th time. If the patient were truly to the consideration of being intubated, I, again, highly doubt they would be standing at the pharmacy counter. Most asthmatics just aren't that stupid, and if they are in that amount of denial, then why do you assume they would be cognizant enough to seek medical care anyway, instead of just sitting in their living room waiting to get better.
The fact is, many physicians aren't as accessible as we would like them to be, and in my opinion the overwhelming majority of the time, the benefit would outweigh the risk. In the few cases in which it would not, there are enough confounding variables such as that above, to make it difficult to place specific blame. Again, by having a physician/pharmacist review for each incident would make it a rare case that a pharmacist would opt to use that authority, but the presence of an exception regulation would also protect them, and allow them to act in the best interest of the patient, without fear of legal or professional discipline.
my $.02

I totally agree with you that most asthmatics are much more aware as to the severity of their condition. And yes, pharmacists aren't stupid and yes, I was taking the route of the zebras. I just don't see the benefits of convenience as easily acceptable to the risks involved. And we're not just talking about asthmatics here or people with just one condition.

 

[stoic]

I don't know if I have any good arguments against limited prescribing powers for pharmacists, but just wanted let you know about my positive experience with this kind of thing:

My primary care continuity clinic is at the VA, and there is a Pharmacy clinic there specifically at the disposal of the primary care physicians that I refer a ton of my patients to. I think it's a wonderful idea. The typical way we use the clinic is when we have a patient that we're having a hard time with BP control or lipid control, so we send them to the Pharm clinic to work on ramping up their BP meds or statins. It really helps me out a lot because my clinic is always booked at least 4 months in advance, so the Pharmacists can work with my more high-maintenance patients on a more frequent basis while they're waiting to see me. As a caveat to this, however, is when I place the referral, I have to give very specific instructions to the pharmacists as to which meds the patients should be on, and which ones I want adjusting, and what the patient's goal BP or LDL should be. The pharmacists then have free range in checking labs, seeing the patients in their clinic, and adjusting the doses of the meds I asked them to alter. However, if a patient has maxed out on a med, or needs to change because of side effects, the pharmacists contacts me in order to approve any medication change. That way I'm not out of the loop, and can still direct the overall care of the patient. Oh yeah - and I still continue to see these patients regularly - I usually send them in the first place because I'm not physically able to see them as often as they need to be seen.

There are other things this clinic does, but the function I've listed above has been the most helpful for me, personally. I think the system really works well, as long as there are very good lines of communication between the pharmacist and the physician.

I guess that reminds me of a potential argument against - if the pharmacist changes patients' medications without informing or getting the approval of their physician, it can lead to very disjointed medical care, and potentially hazardous interactions. (ie, if the physician doesn't know a patient is on X medication, and then prescribes med Y, which is harmful when taken with med X)...

Just my 2 cents...

I'm not sure why this post hasn't been talked about more. A lot of you guys seem to be standing on a mountain shouting about maintaining boundries and such.

Simply put, the sort of thing posted above is going to become the norm. I can only see this helping patients. Lets face it, adjusting cholesterol meds is not rocket science. Patients who require complicated management (comorbids, renal/liver problems) are always going to deal with the physicians, but in patients with simple management, pharmacist are qualified to adjust dosages.

If doing this can lead to tighter control of HTN or hyperlipidemia which can lead to fewer long term problems, i fail to see how it's a bad thing. Pharmacist are not out to take over the job of physicians. I Know a lot of pharmacist, and they choose to go to pharmacy school (which in my state is actually harder to get into than the med school). The point is that pharmacist want to help patients, and this is one way that they might be able to.

 

[DrPharm]

We had one patient on our team with an aortic stenosis. All the medical students took turns listening to the murmur. I asked the pharmacy student if she wanted to listen, too. She did not know where to put the stethoscope on the patient to hear the murmur. I don't fault her for that because that's not what she's in school to do. But on that note,to answer the original question, No, I do not think pharmacists should be writing drug orders.

I'm surprised at this. At our Pharmacy school, there is a Physical Assessment course where we learn the basis of physical examinations (blood pressure, heart rates, diabetes screening and more -- I haven't taken the class yet).

But back to the prescribing subject. Now after listening to a lot of the reasonings, I personally think that if Pharmacists were to be able to prescribe, that it should be limited to only hospital pharmacists working along side physicians. Also, it should also be limited to those who have gone through residencies and understand the system. Community pharmacists should not be able to prescribe medications because that would just be chaotic (i feel that the patient should go to the physicians first). Then the pharmacist should somewhat monitor to the best of the scope and ability and consult the patient on taking the medications and answer any questions the physician wasn't able to.

But in the end, I think the big push is pharmacy is that they want to gain more respect from the healthcare community. We do not want to be viewed as just 'pill pushers' and counters behind a counter. Most PharmDs nowadays have gone through just as much education as MDs but without residencies (although more pharmD graduates are becoming more interested in post grad residencies to pratice in clinics). Many nowadays have there bachelors before going on to Pharmacy school which is a 4 year doctoral program (same as MD program).

We all have our duties. Patients should visit the physicians for diagnosing and consulting and pharmacists should fill, monitor and consult. This is important in healthcare service because pharmacist are more accessible to the community---but they should not have prescribing powers (at least the typical community chain store pharmacists shouldn't).

And reiterating the last poster, "Pharmacist are not out to take over the job of physicians."

A lot of pharmacists who could have gone to medical school decide to go to pharmacy school because they don't want to deal with diagnosing. And I agree, it's getting tougher to get into pharmacy school. At our school, it was 1 seat for every 5 applicants. And there are fewer pharmacy schools than medical schools so the chances of getting in decrease.

"The point is that pharmacist want to help patients, and this is one way that they might be able to." Quoted

What are your thoughts?

 

[ultracet]

On one of my rotations we had a pharmacy student who rounded with us. She was really helpful on the team when we needed some advice about drugs, but she did not know a thing about physical exams. Yes, maybe she could diagnose somebody if given a list of their complaints and lab results, but the physical exam is one of those things that takes a long time to get good at. There are plenty of things an exam could pick up that a lab result may not. We had one patient on our team with an aortic stenosis. All the medical students took turns listening to the murmur. I asked the pharmacy student if she wanted to listen, too. She did not know where to put the stethoscope on the patient to hear the murmur. I don't fault her for that because that's not what she's in school to do. But on that note,to answer the original question, No, I do not think pharmacists should be writing drug orders.

another poster addressed this but i'm going to throw my thoughts in as well..

background...
3rd year pharm student

For our entire 3rd year we do have a physical assessment class.
it is EXTREMELY limited.
We learn how to take blood pressure (after all we see more people than drs do and can possibly catch HTN sooner!)
We also learn how to listen to the heart and where to listen for which valve.
we have to know what S3 and S4 heart sounds sound like and also what a murmur sounds like
we have looked in the ears to see what normal vs abnormal looks like.
We have looked down the throat
We have looked in the eyes to check for retinal abnormalities
We have listened to lung sounds and had to know the difference between wheezing, crackles etc.
We have had to learn where all of the pulses are
How to check for edema, pitting edema, and how it is graded
We have also had to learn what certain symptoms look like such as the effects of extreme hypercholesterolemia
We spend extensive amounts of time gaining a patient's history in a multitude of our classes.

This list is not complete and is only for the first semester.

I will say that I cannot diagnose and I cannot do a complete physical assessment.

I absolutely despise that my professors (board certified- residency trained- pharmds) insist that we learn how to diagnose, the treatment guidelines

I am going to refer those of you who are interested in finding out what I, as a 3rd year student in a 4 year program, am expected to know to this thread:
http://forums.studentdoctor.net/showthread.php?t=162809

I have listed objectives for one sequence of my Therapeutics I course.

My goal here is to educate as many medical professionals as possible as to how overeducated pharmacists are to be a slave for CVS.

 

[stoic]

Why are pharmacy schools overeducating their students? Why are so many schools moving to a pharmd when this only adds more time to the education process? This seems very strange to me. It seems that in desire to gain more prestige from other healthcare providers pharms are trying to change what the definition of pharm is. If you wanted to be in healthcare for the prestige then you shouldn't have picked pharm (and probably not healthcare). This is not to say that pharms are not a very valuable resource, but why does it bug you so much if people know you as pill pushers when you went into the field knowing you would have to deal with these misconceptions.

PS.--- Where I am from I have an easier time getting to talk to my doctor (through my nurse) then to a pharm. because they are scooting around the pharmacy doing stuff.

And it must not bother you to be going into a field where people might mistake you for an arrogant *******...

"Over educating" students? There is such a thing? Particuarly in a field such as health care where there is so very much to know? Maybe instead of pushing for "prestige," schools are just trying to give pharmacist more and more information to help patients with.

 

[VCU07]

Why are pharmacy schools overeducating their students? Why are so many schools moving to a pharmd when this only adds more time to the education process? This seems very strange to me. It seems that in desire to gain more prestige from other healthcare providers pharms are trying to change what the definition of pharm is. If you wanted to be in healthcare for the prestige then you shouldn't have picked pharm (and probably not healthcare). This is not to say that pharms are not a very valuable resource, but why does it bug you so much if people know you as pill pushers when you went into the field knowing you would have to deal with these misconceptions.

PS.--- Where I am from I have an easier time getting to talk to my doctor (through my nurse) then to a pharm. because they are scooting around the pharmacy doing stuff.

First of all from your previous posts you know absolutly nothing about the pharmacy cirriculum and need to do some research. In addition to this, all programs are now PharmD programs...there are no BS pharm programs left (at least in the US). Also, there is no such thing as "overeducating" pharmacists. That is like saying that there are overeducated physicians...it makes no sense. If you think all pharmacists end up working in retail pharmacies to "push pills," your wrong. Being a pharmacist entails more than just pushing pills. Pharmacists save the careers of many physicains on a daily basis by catching mistakes in prescriptions written by MDs, DOs, and other health care providers. Getting the best education we can is not about "prestige." It is about gaining the best amount of knowledge we can to help treat and cure disease and illness. Did you go to med school for the prestige? If so, you did it for the wrong reasons. You def. need to change your views of the health care system and how it works if you plan on becoming a successful physican. By the way, I would say that most people find it easier to see their pharmacist, not physican. Does all this seem "strange" to you?

 

[stoic]

I did not come up with any of phrases that you are accusing me of saying. If you would read the previous posts, I was replying to posts in which the person said, "My goal here is to educate as many medical professionals as possible as to how overeducated pharmacists are to be a slave for CVS." and to the person who said, "But in the end, I think the big push is pharmacy is that they want to gain more respect from the healthcare community. We do not want to be viewed as just 'pill pushers' and counters behind a counter. Most PharmDs nowadays have gone through just as much education as MDs but without residencies (although more pharmD graduates are becoming more interested in post grad residencies to pratice in clinics). Many nowadays have there bachelors before going on to Pharmacy school which is a 4 year doctoral program (same as MD program). "

Chew on that for a while before you go shooting off your mouth. For those of you who posted these comments, you now know what this person has to say about what you think...

Your post and it makes no sense. I have read and re-read it, and have no idea what your point is.

Are pharmacist over educated? Or are they monkey's that need no education?

 

[stoic]

Just trying to put words in my mouth. I was only responding to posts that were made earlier. I find it odd that if someone thinks (a previous poster) that if pharm's are "to overeducated to be slaving away at CVS", why the answer to this problem should be to increase what they do in practice rather than to scale back the education for a pharm who works at CVS versus in a hospital. This is not a rude question, but you seem very touchy about it. Maybe if you follow this formula of referring to past posts and then reading my response you will understand why I am asking questions. I am not coming up with these talking points, I am merely trying to gain perspective on what the these people were thinking when they said what they said and how this relates to expanded practice of pharmacy.

ok

 

[kwakster928]

some of the perception of the retail pharmacy is true. it will take tremendous effort to change people's perception of retail pharmacist being the "pill pushers" rather than the "healthcare professionals". not many people use pharmacist for what they are trained for. they simply dont even bother asking the simple question such as "what am i taking this pill for" over educated i dont know, but it is a lot better than undereducated. i think the notion of prestige is non-sense. i think it exist for most immature stuck up people. for most part, people i happen to deal with, and consider myself very lucky for this, is that they are willing to listen, willing to work with others.

i think biggest problem with the today's pharmacy is that it is mostly coporation driven. you know how bad things get when it comes strictky to business. money take presedence over patients, it is sad but true. another thing is that all the residencies and other post-graduate level training, the pharamcist do not get compensated very well for extra years they have put in. sometimes they make less than the regular pharamcist who happen to have no residency experience. it is some of our job (people who happen to be intereting in residencies, or people who completed residency) to prove to the rest of the world the our exisitence. we have to prove to them what benefits the organization (hospital) will gain by employing us (pharmacist who completed residency). i believe some of the studies are being done in hospital regarding efficacy of having these pharamcist around. i think the initial reports seem to be positve. we have a lot of work to do, but it is ultimately all of our job to make the patient better.

as far as prescription authorites go, i think i pretty must made my point against it. but i am willing to listen other views. i am somewhat glad that this has not been such a who's better than who discussion.

 

[ultracet]

Just trying to put words in my mouth. I was only responding to posts that were made earlier. I find it odd that if someone thinks (a previous poster) that if pharm's are "to overeducated to be slaving away at CVS", why the answer to this problem should be to increase what they do in practice rather than to scale back the education for a pharm who works at CVS versus in a hospital. This is not a rude question, but you seem very touchy about it. Maybe if you follow this formula of referring to past posts and then reading my response you will understand why I am asking questions. I am not coming up with these talking points, I am merely trying to gain perspective on what the these people were thinking when they said what they said and how this relates to expanded practice of pharmacy.

My main problem started here when I did not quote the two people where I drew these points from. I guess I figured that people who read the last post have read the entire thread.

i honestly do think most pharmacists are overeducated to be doing what they are doing at CVS so please direct your antiovereducated posts at me.

for the most part retail stores are very busy and it is a problem we face in daily life. most would love to offer extra services but simply do not have the staffing or the time (isn't that the way it is in pretty much everything?)
I think offering diabetes management, HTN clinics, lipid clinics, smoking cessation, etc are fantastic things that i one day hope to offer however there are certain things i will never do.

As a CVS pharmacist i do not need to know how to read an EKG. period.
Its great that i know what drugs effect what aspect of the EKG so if someone has QT prolongation i can make a recommendation but i really don't care what it looks like on an EKG.....
i guess i'm going to be a bad retail pharmacist.


i do honestly think that the education we are attaining in pharm school is geared to the clinical pharmacist who is going to do a residency and specalize. Typically they do not specialize in community pharmacy.

after all there is a huge shift right now toward the definition of what kind of graduate should a pharmd be. it is a generalist practitioner. Our curriculum committe is currently reviewing our courses to see if that is what our school is producing. Specialty education should be reserved to those who specalize. However, I do agree that all health care professionals need to be exposed to what is out there.

There are many out there who wish to work in a hospital, rounding with doctors and that is fantastic.

personally i want patient interaction. i want to sit down and talk to someone and help them in any way i possibly can.

i did not enter pharmacy for the prestige of the profession and honestly i think it is ridiculous that anyone would enter any aspect of healthcare for that reason. everyone's main goal should be to help people

On another note... i do believe in collaborative practice agreements. I think if i build a relationship with a Dr. and they think i am qualified enough to give flu shots, monitor side effects, adjust existing dosing, or initiate smoking cessation plans i think that would be an excellent relationship.
I think most MDs know their limitations as I believe most pharmacists know theirs.

 

[phoenixsupra]

. IMO, They should just put one more year of intensive pharmacology training into medical school and end this debate here and now.

Noooooo!! Don't even think such a horrible thing. One awful semester was way more than I'd ever want of that sort of binge and purge mega memorization crap.

 

[owen_osh]

Here are some examples where i feel a pharmacist can really help....
Diabetes manegment clinic for example. The doctor has already diagnosed the pateints. The pateint will probably go back for periodic check ups. But the doctors does not need to be seeing the pateint every month just to slightly adjust the drug therapy. If there is aproblem.. that the pharmcist feel they don't have the training to deal with, they can refer the pateint back to the physician.

I'm actually not so sure that this would be an appropriate role for a pharmacists. Ideally, a doctor has ongoing follow-ups with a patient not only to adjust medication, but to maintain a patient-physician relationship. This may sould touchy feely, but it actually is essential since the management of DM and other chronic diseases depends not only on medications but also on behavioral modification.

I think this brings up another problem with pharmacists prescribing. Namely, not every illness is best treated with drugs. Would pharmacists really be adqequately trained to employ the full range of treatment modalities that physicians use? I'm afraid pharmacists might tend to treat every illness with drugs since that is what they know best how to do.

Finally, I think there would be a potential conflict of interest if the pharmacist stands to profit from both prescribing and filling a patients perscription. Some pharmacists might perscribe unneccessary or more expensive drugs.

 

[kwakster928]

Finally, I think there would be a potential conflict of interest if the pharmacist stands to profit from both prescribing and filling a patients perscription. Some pharmacists might perscribe unneccessary or more expensive drugs.

this is very interesting point. what i thought in shool is that maximum theraputic outcome with minimum economic burden on the pt. but pharmacy is pridominately coporation driven, this might be true in somec case (hope it isn't). in japan, physicians are getting paid some portion for prescribing certain drugs. you guys jealous?

 

[ultracet]

ok 2 points.....

1. pharmacies make the most money on OTC generic meds (which are also the cheapest to the patient) but no that does not mean they should say hey everyone needs to buy x otc store brand whether you need it or not.

2. ethics should play a role in all aspects of health care. drs should not prescribe a drug b/c a sales rep or a patient told them to without doing their own independent literature searches (PDR doesn't count in my book either you need at least micromedex)
pharmacists should not advise a patient to buy something just because it would be profitable for them.
think about it like this..
pharmacists already have prescription power over OTC medications. people come to the counter every day and ask about the meds on the shelves and what is appropriate for them to take. some of those meds are just as dangerous as what are rx only.

if they are not already suggesting unnecessary therapies to make a profit then i don't really think it will start if they have a practice agreement with a dr.

i honestly wouldn't recommend anything to a patient that i would not recommend to my family.

 

[kwakster928]

ok 2 points.....
1. pharmacies make the most money on OTC generic meds (which are also the cheapest to the patient) but no that does not mean they should say hey everyone needs to buy x otc store brand whether you need it or not.

this was my argument from the beginning. we had all the OTC at our disposal, why do we need to have prescription privilages for? the number of OTC grows every year. we really should not be complaining about not getting prescription privilages.

 

[babyruth]

I agree with one of the previous posts in that not all treatment modalities require a magic pill. This might be a problem if full prescription rights were given.

However, as the OP has reiterated over and over, the Rx would be under the supervision of the Dr. I know as a physician I would appreciate input about what prescriptions were the best for my pts. concerning new research, best buy, etc. I think Rx shouldn't be given prescription rights but be utilized more for a consultation purposes, and perhaps charge for those services.

 

[pikachu]

I don't think that giving pharmacists prescribing rights is about power or control. Do you feel the same way about PA's or NP's?? What makes them (after 2 yrs of school) experts in the same matter? I am an outsider here...neither a physician or a pharmacist, but am a health care professional (MPH) and work with almost ALL types of health care professionals. So, maybe I'm hoping I can give an unbiased response. I don't think all pharmacists should have prescribing rights. It depends on the practice site. Retail pharmacists have no need to prescribe. But I would think in a hospital setting, it would be beneficial. It would one allow the physician and pharmacist to WORK TOGETHER as a team and alleviate the work load on the physician. From my knowledge, most clinical pharmacists have to do a residency (anywhere from 1-2 yrs) and specialize just as a MD would. This in my opinion is great benefit to the health care industry. The point of any profession is to improve the quality of health for every individual. We, as an industry, cannot do that until ALL professions learn to work together and not want all the "power" to themselves. It has to be a team effort. And if that means allowing clinical pharmacists to have prescribing rights...I say go for it!

This scenario - of limited rights - never works out in practice. my mother was one of the first CRNP's trained in the country back in the 70's. The original role of NP was truly as a physician extender, where they would do health maintenance work and follow up of stable patients with chronic medical problems, under the supervision of a physician. Now NP's function essentially independently as primary care providers and in some places just like a junior resident. PA's have even less training than NP's; now they have essentially the same care rights as NP's. Once you extend prescribing rights to any pharmacist you will have people heading to the Rite Aid to see the "doctor," even if the original intent was to restrict prescribing rights to pharmacists in the immediate clinical setting (inpatient, clinic) alone. Unethical non-physician providers love to represent themselves as doctors. How many PA's have introduced themselves as "Dr. My First Name" to a patient of yours? And how many train wrecks then ensue? I recently went through the wringer with a family member of mine where a PA "Dr. Kathy" or whatever missed a flagrantly obvious DVT and told the patient that her leg swelling was due to a "side effect of Lasix"(!) Since our current health care system can't prevent this type of thing from happening with the current set of providers (bad doctors are certainly among this group), what we need is further and better regulation of who gets to prescribe medicine, diagnose and treat patients, not an expansion of providers. There are enough non-physician providers out there overstepping their bounds and screwing things up. And I'm not flaming pharmacists. They are better trained than PA's and NP's. Personally I wish every physician had a good pharmacist to back them up in terms of identifying interactions, titrating dose combinations, do teaching about taking the meds, etc., etc. There would be many fewer medical errors if physicians had more and better pharmacist back-up. If it's a compensation issue (as I suspect it may be), why not allow pharmacists to bill more extensively for this type of consultation service? I just don't understand why pharmacists have a need to actually prescribe medications, and why people are so focused on expanding the scope of people who can fill the traditional role of doctors, when it's so blatantly obvious that there are a lot of people out there who are clearly unqualified to fill this role. If people remain underserved, I think the answer is to train more doctors, not a bunch more not-really-doctors-who-are-trying-to-treat-patients-anyway, no matter what the consequences.

 

[J Lucas]

^^^This dude is a *****^^^^

Lets not forget the reason how the Pharmacist came to be in the 1st place. TO CATCH PHYSICIANS SCREW UPS! Physicians just arent cutting it. There are not enough of them to go around PERIOD and even then its really hard to find a GOOD Physician. This is the reason why all these other health profession ie PA,NP etc are trying and getting prescriptive privledges. Their is a demand for their services that is going unfilfilled. Pharmacist are being overeducated? I didnt even know overeducated was a word and if it is it shouldnt be. Are you telling me Physicians need to know half of that CRAP they learn in medical school that they forget 2 months after the exam anyway? Lets look at the big picture.. the patient...

 

[babyruth]

The barriers to good physicians are many. But that doesn't mean that we should just go ahead and give rights to people with less specific training. There are bad and good doctors, just like there are bad and good pharmacists, but I at least want someone who has the training beforehand.

We need to fix the barriers to having good physicians (i.e. like more help with education financing, restraints on insurance, fair reimbursement policies, incentives for family and rural medicine, etc.) instead of giving prescritpion rights to people that do not have the training. I appreciate Rx's and their training and as an adjunct/consultant, but they do not have the training or insight into medical problems.

 

[babyruth]

A comment was made about OTC medications and the problem with these is that they are and can be just as dangerous as prescription meds because people think they are "safe." Ask a nephrologist and they will tell you to put NSAIDS in the drinking water because it brings them business. We still need pharmacists there to keep people from using even OTC meds incorrectly.

Maybe you guys should get on the herbal/supplement band wagon and get "overeducated" about these since they will be and are an important aspect of both of our professions.

 

[awdc]

Pikachu and J Lucas bring up a good point about the proliferation of non-physician providers performing more and more traditionally physician services. Medical schools (or the lack of) simply has not supplied the demand. Obviously this has left the opportunity for other allied-health professionals to take up the slack and thereby an argument for expanding their scope of practice. It's kind of sad and annoying when I look at some of my classmates who are just as bright and dedicated as my U.S. med student friends (if not more) having to come here, a Caribbean school. And that no matter how good a physician they become, will always have the stigma associated with being a USIMG.

 

[kwakster928]

i think we established that general concense of pharmacist should not be given general prescription rights, am i safe to say that? it is definitely sad to see that scope of practice of MD are invaded by many other mid-level practioners, is it because the economics behind the healthcare? or is it just because we just dont have enough of them to go around?

 

[baggywrinkle]

As a CVS pharmacist i do not need to know how to read an EKG. period.
Its great that i know what drugs effect what aspect of the EKG so if someone has QT prolongation i can make a recommendation but i really don't care what it looks like on an EKG.....
i guess i'm going to be a bad retail pharmacist.



On another note... i do believe in collaborative practice agreements. I think if i build a relationship with a Dr. and they think i am qualified enough to give flu shots, monitor side effects, adjust existing dosing, or initiate smoking cessation plans i think that would be an excellent relationship.
I think most MDs know their limitations as I believe most pharmacists know theirs.

I think the only place for pharmacist prescribing is under a collaborative practice agreement in both acute and ambulatory care settings. Coumadin clinics & hospice care come to mind.

In the retail setting authorization of refills for existing maintenance meds would be very handy. Obviously, making sure the physician's office is informed
so they can update their records and veto further refills in some fashion
would be important. The critical point here is the physician must be comfortable with whatever goes on, and the pharmacist should be viewed as
an asset rather than a liability. Allowing the pharmacy free hand to manage
the details of drug therapy is a force multiplier allowing the physician to move
on to other things. I work with a physician who occasionally will write for a drug in the retail setting to be dosed appropriate for age and weight. It freaks my partner out but I enjoy doing it and it saves the physician time. Trust me on this point, seconds count. If you think you are busy now in school just wait until you are in practice....