Purpose of Pharmacy?

[hexonu]

Enlighten me, please..

[Orbea]

Allow me to enlighten you.

 

I'm not sure what area of health care your experience in the medical field has been, but I'm a little surprised that for someone who comes on a pre-pharmacy forum making statements that attempt to discredit an entire profession, 'how useless pharmacy really is,' that you are completely ignorant to what pharmacists actually do despite quite a bit of media coverage shedding light on the CLINICAL aspect of the profession, and the advantages to the health care system. Perhaps you don't read the news.

 

Think of pharmacists as 'medication specialists.' A pharmacist's training is mainly focused on that of complex medication management and certainly there is quite a bit of training on pathophysiology as well. In the current health care system patients are bounced around to various specialties/tertiary care, but coordination of complex medication regimens is often missed and that is where pharmacists play a vital role. Specialists will prescribe within their scope of practice (e.g. cardiology starts a beta blocker), but how does this affect their psychiatric medication? Their GI therapies? Anti-retrovirals? Multiply this through years of encounters with the health care system and as patients become more burdened by chronic disease and medications increases, the situation becomes even more challenging. Elimination systems (hepatic/renal) change over time as does a persons ability to absorb medication. Pharmacokinetics (absorption/distribution/metabolism/elimination) is a vital topic that only pharmacists get specific training in. I don't have the stats but something like 25-50% of ED visits are related to medication issues and comprehensive medication reviews can prevent a substantial amount of these. Bottom line is that a pharmacist looks at a patients complete medication profile for safety, efficacy, appropriateness, drug interactions (yes you got one), cost, adherence (do physicians realize how many of there patients are non adherent?) and many other factors. Also, take a look at medications that tend to be 'higher risk' or those with a narrow therapeutic index such as phenytoin. I recall many instances where physicians have completely inappropriately dosed this agent, chasing levels, until the patient went quite toxic. Digoxin, methotrexate, warfarin ... if you have patients on these medications your patients will no doubt benefit from a medication consult from your 'tolerable pharmacist.' Community pharmacists can, and are, doing these types of things as well.

 

If you're concerned that in your esteemed opinion you don't think pharmacists do this, should do this or are capable of doing this, ask yourself why the Alberta Government (and many many places around the world), have recognized the value of pharmacy involvement and are now paying pharmacists to do just that. I'm not sure where you get your information that pharmacists push the grunt work to techs and read magazines. Technicians are taking on a larger role to free up time for pharmacists to do clinical work. Yes pharmacists are clinicians, in fact pharmacists can prescribe, inject (yes - after training either in school or a course outside of school), and order labs. They have prac IDs so to be more accurate, they are PRACTITIONERS.

 

As far as prescribing, I'm not sure where you've found that pharmacists prescribe for 'minor ailments.' In Alberta pharmacists prescribe any medications that are not narcotic/controlled substances. These may be diabetes, respiratory, cardiac or many other types of medications. They do so in collaboration with physicians and the entire health care team. Make no mistake, pharmacists do not replace, nor do they want to replace, the PCP. Pharmacists augment the health care team in a very significant way. What this really means, is that medication decisions are being made by the most appropriate professional which may be the physician or pharmacist, and these decisions are made in a collaborative relationship. Pharmacists have an excellent understanding of the effect of medication on body systems and on other medications/OTC/neutraceuticals so they are in an ideal position to understand the implications of therapy changes and what monitoring needs to be done.

 

Right, a professions 'usefulness' is determined by the amount of malpractice they have. Despite the fact that I think this is a very ignorant statement, I think what you might be getting at is 'oh yeah, pharmacists make all these changes, walk away and take no liability.' Pharmacists have usually between 2-5 million in malpractice insurance. Having pharmacists prescribe is in fact shifting the liability away from the physician and towards the pharmacist in the first place, rather than the old situation where pharmacists would make a suggestion, but because the physician was the ultimate prescriber, the doc would take the liability even though it wasn't really their decision in the first place.

 

I hope this clears up your complete lack of knowledge about the pharmacy profession. It's been my experience that people who make blunt, uninformed statements like you have probably wont change, so I expect you might not get much out of this. But for those thinking about entering the profession, perhaps this has given you a bit more information about what pharmacist do.

[WtsupDoc?]

Thank you Orbea for a thoughtful, articulate and insightful response, all while not pandering to the inflammatory comments from the OP. I'm so tired of people discrediting pharmacists (or any health-care profession), because they have not idea what they are talking about. I've had the pleasure of working with several brilliant pharmacists that have unparalleled knowledge when it comes to PK/PD.

 

Just in addition to your response, if the OP is referring to pharmacists administering influenza vaccinations (i.e. giving injections) which has recently begun, there is no reason why they can't. An IM isn't particularly difficult (and they know make single dose intradermal injections of seasonal influenza vax that you can actually give yourself). An MD isn't required to give a vaccine; nurses do it all the time. It's a simple decision tree - do you have these contraindications? No, ok here's the vaccine (and have an epi pen close by incase of anaphylaxis).

[Orbea]

Exactly, thank you