For The Pharmacists

[sadhatter]

So, i am sure i have said this enough, but i am currently going through school with the goal of becoming a pharmacist.

That being said, i am having some trouble reconciling a couple of things we have been told.

One of the guiding principals of pharmacy is to protect those who are vulnerable. And this i can completely agree with, there are a lot of sections of society that can be harmed directly or indirectly by improper medicine practices. ( for those not in the know, this is usually aimed at the handicapped, elderly, children, or others who are in a position where abuse could take place. But is not limited to these groups.)

But we are also told that if a customer has a certain belief set ( i will get to specifics in a moment. ) that we are not to contradict it in any way shape or form. The reasons are fairly sound ( if you contradict silly beliefs , you are likely to push the person further away from real medicine. ) , but in certain situations, this seems to directly contradict the principal of protecting the vulnerable.

For example ( this is a situation i raised. )....

A person comes in with a fairly serious illness, and is taking homeopathic medicine as opposed to real medicine. ( not in addition, in the scenario i brought up.) This is having an obvious ill effect on the person. At this point we are supposed to simply ignore this.

That just doesn't make sense to me. In this situation a person who is vulnerable ( in this case gullibility.) is being harmed by a medical product. Yet it is made very clear we are not to attempt to dissuade them from the "treatment."

Another example ( one i hadn't thought of until it was brought up. ) , is that apparently there are certain cultures that view being obese as a sign of health and prosperity. And would avoid taking of medications for weight related problems. Again, from what we have been told, we are to simply ignore the issue due to it being cultural.

I am very conflicted, and not in a " i hate homeopathy/silly beliefs" way. I can see the reasoning for doing these things, but :

A) I can't help but think that the lack of saying " This works, this doesn't." isn't, in the long run harming the situation. If people in the medical profession are unwilling to tell a patient the truth, they are doing the next thing to endorsing what the person is doing. I can't tell you how many times i have heard people i know say " well the doctor said it couldn't hurt." and use it as an endorsement of an ineffective treatment.

B) I have a hard time seeing how these people are not vulnerable. They are being taken advantage of, whether this is cultural or not ( look into folk illnesses if your not familiar with the term. ) the fact remains someone is being given a medicine, or being told medical information that is ineffective or not correct. And this is leading to health harm.

Now, rules is rules, and when i practice i will be following them to the letter. But from a moral standpoint, i just can't wrap my brain around this.

So, for those in the profession, those that arn't, and whoever else. What are your thoughts? And specifically to those in the profession, any advice?

 

[Monketi Ghost]

Your job is to get what they have a scrip for, or what they ask for. Period. If a pharmacist has a moral problem with a scrip, they need to get a different job.

If they ask your advice, and people often do, then the floor is open... saying, "Oh, you can get the homeopathic stuff, but if you want something that actually works, try..."

But too much input from the pharmacist can be troublesome to your position. How do you decide a medicine isn't doing what the person needs? You aren't a doctor, and that's what doctors are for... my advice is to smile and fetch.

 

[John Jones]

A) I can't help but think that the lack of saying " This works, this doesn't." isn't, in the long run harming the situation. If people in the medical profession are unwilling to tell a patient the truth, they are doing the next thing to endorsing what the person is doing. I can't tell you how many times i have heard people i know say " well the doctor said it couldn't hurt." and use it as an endorsement of an ineffective treatment.

It could be an example of the MDs taking advantage of the placebo effect.

My doctor gives me prescriptions for Amitryptaline for chronic nerve pain. Newer antidepressants are supposed to work better, but they don't for me.

If my doctor says I can have it, and it helps (even if it's the placebo effect), then please don't stand in the way.

 

[marplots]

Now, rules is rules, and when i practice i will be following them to the letter. But from a moral standpoint, i just can't wrap my brain around this.

So, for those in the profession, those that arn't, and whoever else. What are your thoughts? And specifically to those in the profession, any advice?

I practiced for ten years. One of the things you don't learn very well in school but only later in your internship and working life, is that your resources are finite. Will you devote your time to a lecture on homeopathy or tracking down some doc on the phone who has misprescribed something?

People are often ignorant. This is to be expected. It is rare to find someone as well trained as you will be when it comes to pharmacology. You can do a bit to educate them, but in general you are competing in an environment of authority figures. You represent one authority, but there are others in their lives -- their best friend, some internet site, Prevention Magazine...

Part of your education has to do with evaluating evidence and making good decisions based on your evaluations. Do this and fight the battles you can win. Now, I worked at places that sold what we collectively lumped together as "herbal remedies" and I have been asked to recommend things in that niche. I broached the subject and if I could, swayed them toward a better product. But this isn't always possible. In a world where patients still believe that generics aren't as good as brand name items we are hard pressed and have to stick with those that can "hear" what we have to say.

Were I to own my own store I absolutely would not carry such stuff. But I was an employee, my license gave me a certain leeway, but it did not entitle me to ruin their business model. On the other hand, each of us is bound to our own ethics. You might consider a hospital job as one where you are less likely to run afoul woo.

I have known pharmacists who were uncomfortable with selling cigarettes and liquor at their stores. By extension, you could give the boot to a lot of other items as well. I'm not saying you should abandon your ideals, rather, seek a position that best fits how you want to practice. But understand that no matter where you end up, there will be ethical dilemmas. It is part of the job and part of being a professional.

 

[John Jones]

Part of your education has to do with evaluating evidence and making good decisions based on your evaluations. Do this and fight the battles you can win.

I endorse this.^^

Having said that, I was shocked to learn that Walgreens (in the USA) was selling homeopathic remedies. I was also shocked to learn that they expected me to pay $851 USD for one month's supply of Lyrica.

 

[Drachasor]

It could be an example of the MDs taking advantage of the placebo effect.

My doctor gives me prescriptions for Amitryptaline for chronic nerve pain. Newer antidepressants are supposed to work better, but they don't for me.

If my doctor says I can have it, and it helps (even if it's the placebo effect), then please don't stand in the way.

To be fair, a new drug that "works better" really is almost always a new drug that on average for a population works better. An old drug could easily work better for a particular patient.

 

[Drachasor]

Part of your education has to do with evaluating evidence and making good decisions based on your evaluations. Do this and fight the battles you can win. Now, I worked at places that sold what we collectively lumped together as "herbal remedies" and I have been asked to recommend things in that niche. I broached the subject and if I could, swayed them toward a better product. But this isn't always possible. In a world where patients still believe that generics aren't as good as brand name items we are hard pressed and have to stick with those that can "hear" what we have to say.

Good advice. Do what good you can, when you can, as best you can. When you can't talk someone into doing what's best, then consider it a victory if you can just talk them into doing something better than what they were doing.

 

[John Jones]

To be fair, a new drug that "works better" really is almost always a new drug that on average for a population works better. An old drug could easily work better for a particular patient.

I might agree with you except for this: The people taking amytryptaline after all these years report more effective relief from chronic pain than from the newer tricyclic antidepressant drugs, and apart from narcotics.

 

[xjx388]

In my practice (family medicine and bariatrics) I see a wide variety of woo.

I tell my patients that the product/treatment in question is not proven to work and is not endorsed by medical community. If its dangerous, i'm a little stronger in my warnings. I try to tell them the medical reasons why the treatment I'm recommending is superior. If they insist, I've done all I can do. I tell them that when the thing you are trying out fails, I will still be here to help.

I do have a problem with pharmacies selling quack products. If I were a Pharmacist, I would tell the patient that I can't tell them anything about the product other than what's on the box. I would say it's probably not going to hurt them but that if they have a medical problem they should talk to their doctor before they try it. After that, it's up to them.

 

[John Jones]

In my practice (family medicine and bariatrics) I see a wide variety of woo.

I tell my patients that the product/treatment in question is not proven to work and is not endorsed by medical community. If its dangerous, i'm a little stronger in my warnings. I try to tell them the medical reasons why the treatment I'm recommending is superior. If they insist, I've done all I can do. I tell them that when the thing you are trying out fails, I will still be here to help.

I do have a problem with pharmacies selling quack products. If I were a Pharmacist, I would tell the patient that I can't tell them anything about the product other than what's on the box. I would say it's probably not going to hurt them but that if they have a medical problem they should talk to their doctor before they try it. After that, it's up to them.

Are you an MD or a pharmacist?

 

[casebro]

I endorse this.^^

Having said that, I was shocked to learn that Walgreens (in the USA) was selling homeopathic remedies. I was also shocked to learn that they expected me to pay $851 USD for one month's supply of Lyrica.

Isn't Lyrica the newer gaba-sumthin? pre-gaba-sumthin? doesn't work any better than the old gabapentine, why pay the premiuim?

 

[John Jones]

Isn't Lyrica the newer gaba-sumthin? pre-gaba-sumthin? doesn't work any better than the old gabapentine, why pay the premiuim?

Yes, yes, no, and I didn't pay the premium.

I'm telling everyone who will listen that Walgreens tried to charge me $851 for a month's worth of lyrica, and it never helped me.

 

[quarky]

So, i am sure i have said this enough, but i am currently going through school with the goal of becoming a pharmacist.

That being said, i am having some trouble reconciling a couple of things we have been told.

One of the guiding principals of pharmacy is to protect those who are vulnerable. And this i can completely agree with, there are a lot of sections of society that can be harmed directly or indirectly by improper medicine practices. ( for those not in the know, this is usually aimed at the handicapped, elderly, children, or others who are in a position where abuse could take place. But is not limited to these groups.)

But we are also told that if a customer has a certain belief set ( i will get to specifics in a moment. ) that we are not to contradict it in any way shape or form. The reasons are fairly sound ( if you contradict silly beliefs , you are likely to push the person further away from real medicine. ) , but in certain situations, this seems to directly contradict the principal of protecting the vulnerable.

For example ( this is a situation i raised. )....

A person comes in with a fairly serious illness, and is taking homeopathic medicine as opposed to real medicine. ( not in addition, in the scenario i brought up.) This is having an obvious ill effect on the person. At this point we are supposed to simply ignore this.

That just doesn't make sense to me. In this situation a person who is vulnerable ( in this case gullibility.) is being harmed by a medical product. Yet it is made very clear we are not to attempt to dissuade them from the "treatment."

Another example ( one i hadn't thought of until it was brought up. ) , is that apparently there are certain cultures that view being obese as a sign of health and prosperity. And would avoid taking of medications for weight related problems. Again, from what we have been told, we are to simply ignore the issue due to it being cultural.

I am very conflicted, and not in a " i hate homeopathy/silly beliefs" way. I can see the reasoning for doing these things, but :

A) I can't help but think that the lack of saying " This works, this doesn't." isn't, in the long run harming the situation. If people in the medical profession are unwilling to tell a patient the truth, they are doing the next thing to endorsing what the person is doing. I can't tell you how many times i have heard people i know say " well the doctor said it couldn't hurt." and use it as an endorsement of an ineffective treatment.

B) I have a hard time seeing how these people are not vulnerable. They are being taken advantage of, whether this is cultural or not ( look into folk illnesses if your not familiar with the term. ) the fact remains someone is being given a medicine, or being told medical information that is ineffective or not correct. And this is leading to health harm.

Now, rules is rules, and when i practice i will be following them to the letter. But from a moral standpoint, i just can't wrap my brain around this.

So, for those in the profession, those that arn't, and whoever else. What are your thoughts? And specifically to those in the profession, any advice?

Sounds like you'll be a good pharmacist. You have concerns and questions.
You haven't become a robot.

 

[rjh01]

Are you an MD or a pharmacist?

This question means to me is can you diagnose a disease in a person? If a patient tells you that they have cancer and they need sugar pills to keep them alive, what you do? For a starter they may not have cancer. They may have been given the prescription to get rid of them. The cancer is nothing but an invention of the patient.

One thing you might be able to do is find out about the doctor. Is he a quack or a real one? If a real one then you can ask the doctor what the story is.

This is a problem I have with someone now. This person is getting treatment for a real condition that is not proven to work.

NB I have no medical qualifications.

 

[sadhatter]

Your job is to get what they have a scrip for, or what they ask for. Period. If a pharmacist has a moral problem with a scrip, they need to get a different job.

If they ask your advice, and people often do, then the floor is open... saying, "Oh, you can get the homeopathic stuff, but if you want something that actually works, try..."

But too much input from the pharmacist can be troublesome to your position. How do you decide a medicine isn't doing what the person needs? You aren't a doctor, and that's what doctors are for... my advice is to smile and fetch.

Did you read my post at all, i am confused at who you are replying to, or where you got refusal to sell a product from what i said. In fact i think that you simply skimmed a few sentences and made up your own post of mine.

Btw, can i assume that you are not in the medical field? Your knowledge of the role of a pharmacist seems sorely lacking, you are describing the role of a pharmacy technician, and even then an unregulated one. While i welcome your opinion, i would prefer one that is informed.

 

[sadhatter]

It could be an example of the MDs taking advantage of the placebo effect.

My doctor gives me prescriptions for Amitryptaline for chronic nerve pain. Newer antidepressants are supposed to work better, but they don't for me.

If my doctor says I can have it, and it helps (even if it's the placebo effect), then please don't stand in the way.

Placebo scripts are actually documented differently, ( and a separate issue all together. ) so that the pharmacist knows what he is dispensing and why. So that is not an issue.

I wonder if my wording was unclear, this is not an issue of contradicting what a doctor prescribes, doctors don't tend to prescribe homeopathic or folk remedies. And that was the issue in question.

 

[sadhatter]

I practiced for ten years. One of the things you don't learn very well in school but only later in your internship and working life, is that your resources are finite. Will you devote your time to a lecture on homeopathy or tracking down some doc on the phone who has misprescribed something?

People are often ignorant. This is to be expected. It is rare to find someone as well trained as you will be when it comes to pharmacology. You can do a bit to educate them, but in general you are competing in an environment of authority figures. You represent one authority, but there are others in their lives -- their best friend, some internet site, Prevention Magazine...

Part of your education has to do with evaluating evidence and making good decisions based on your evaluations. Do this and fight the battles you can win. Now, I worked at places that sold what we collectively lumped together as "herbal remedies" and I have been asked to recommend things in that niche. I broached the subject and if I could, swayed them toward a better product. But this isn't always possible. In a world where patients still believe that generics aren't as good as brand name items we are hard pressed and have to stick with those that can "hear" what we have to say.

Were I to own my own store I absolutely would not carry such stuff. But I was an employee, my license gave me a certain leeway, but it did not entitle me to ruin their business model. On the other hand, each of us is bound to our own ethics. You might consider a hospital job as one where you are less likely to run afoul woo.

I have known pharmacists who were uncomfortable with selling cigarettes and liquor at their stores. By extension, you could give the boot to a lot of other items as well. I'm not saying you should abandon your ideals, rather, seek a position that best fits how you want to practice. But understand that no matter where you end up, there will be ethical dilemmas. It is part of the job and part of being a professional.

I am actually currently trying to decide to go into a research based job, or an in store job ( i mean i do have a decent amount of time, lol. ). If i am going to be literally "behind the counter" i think i would almost have to own my own pharmacy. Following someone's business model that may not be putting the customer first ( though, obviously it should be. ) i couldn't do.

While i am perfectly willing to smile and ignore my urge to tell people that folk illness is woo, i will turn bright purple before i willingly sell any kind of useless medicine.

Though that is somewhat of a different issue for a different thread.

 

[marplots]

I thought a great deal of research (still do), until I did some. Research moves at a glacial speed and a lot of time is spend doing things that are ultimately dead ends.

On the plus side, the people you interact with are peers, which you shouldn't underestimate. You can get a decent level of professional interaction in a hospital as well, but in pharmacy as a business, the business side tends to swamp the professional aspects.

The really nice thing is that having the license opens the doors to a swath of opportunities. But you have to have the nuts to pursue them.

 

[sadhatter]

Sounds like you'll be a good pharmacist. You have concerns and questions.
You haven't become a robot.

That is one of the big things i intend not to happen with me. As much as i like the monetary aspect, i am joining the field in order to help, and to a lesser extent be in a field that gives me technical knowledge of a subject that i am interested in ( medicine.).

And from what i have been seeing , in the near future, in my province pharmacists will be taking over a good portion of the jobs currently done by the GP's. To me, this makes my ability to diagnose and give advice that is helpful and truthful all the more important.

But there is that fine line between being frank and being dick. And as to what side to err on, well from a moral standpoint, i don't quite know. It seems to me to come down to doing good, or being nice. And while i wouldn't say anything that would get my future license taken away ( the regulating body is very strict about how one can speak to a customer. ), dealing with someone who added some hp sauce to what i did say, is not a high priority.

 

[Emet]

And from what i have been seeing , in the near future, in my province pharmacists will be taking over a good portion of the jobs currently done by the GP's. To me, this makes my ability to diagnose and give advice that is helpful and truthful all the more important.

(bolding mine)

What country do you reside in? AFAIK, in the US, pharmacists can administer flu shots, and give very general health advice. But I don't believe they are either trained or permitted to diagnose anything. And they may run afoul of the laws governing the practice of medicine if they do.
(I may be wrong, of course)