For The Pharmacists

[Furcifer]

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?

I just have to point out that this is very sage advice, and it applies to just about everyone. It's very easy to run yourself ragged trying to fix all the wrongs that come your way, choosing your battles is key.

I imagine pharmacists fill scripts on a daily basis that they feel aren't necessarily "right". They may know a little more about the medications than the doctors prescribing them at times and may feel strongly about a newer or different one available.

At the same time they are dealing with very limited knowledge of why the doctor actually prescribed the medication in the first place. Maybe the doctor knows about different meds, maybe they don't, maybe they prescribed something for insurance reasons, maybe they prescribed a med because they plan on doing something that another med may interfere with.

I don't know much about medicine, but I do know a lot about second guessing someone, and more often than not, even when you're right, you're wrong. I would suspect that short of something causing an immediate danger to the customer, you're bound to end up with more headaches trying to do right than allowing someone to be wrong.

I've been the "middle man" more often than I'd like in my life, and I've always seen the pharmacist as the middleman between the patient and doctor. And let me tell you it can be a thankless job at times trying to go against the flow, even when you have the best intentions at heart. That's my 2 cents worth. Good Luck SH.

 

[marplots]

(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)

This is interesting because it is technically true. However, having a professional license (and malpractice insurance) gives pharmacists the necessary leeway to operate in a gray area. I say necessary because we are gatekeepers in many situations. When I practiced in an impoverished urban area I was often the first (and only) health professional patients saw.

We make recommendations all the time and these range from, "I think you can wait a day or two" all the way to "You need to see a doctor immediately." I had the advantage of some diagnostic training by way of the military, but by no means was I as skilled as a physician or even an experienced nurse. But again, the provisions of my license required me to self-evaluate and not tread in areas where I was likely to err.

The difference is often allowing the customer to make the final call. They usually want you to be a sort of "priest in a white coat" and tell them what to do, but the role is more likely that of giving them enough information that they can make a decision on their own. More of a waiter explaining a menu than a dietitian.

One of the jobs of a pharmacist is to make recommendations based on the public's self-diagnosis. This underlies the idea of over-the-counter medications and separates them from legend drugs. How far any pharmacist is willing to go without infringing on other medical disciplines is up to that individual pharmacist.

Sometimes the right answer, when put under the gun by a patient is, "I don't know." A trickier situation comes up when you are asked about a medication that has already been prescribed -- without knowing the doctor/patient relationship, it is hard to give customized advice. You risk inadvertently (or apparently) contradicting some understanding the patient has from their doctor. This is especially true when a medicinal is not being used strictly according to the package insert.

The gray comes up a lot. It is a reflection of medicine as art instead of a straight technical pursuit. There are often many answers and no clear winner. I'd propose this is one thing that distinguishes a profession from another type of career -- you are given a pool of knowledge and expected to base your decisions on it, rather than having concrete guidelines for every situation. They pay us, not so much for the hundred no-brainers we do in a day, but for the two that need some real thinking and maybe a bit of research.

Finally, it's important to remember that professional jealousies or internecine warfare is to be avoided. No one is out to battle a doctor or take the reins for patient care. Everyone involved wants (or should want) the same thing -- the best available care for patients.

 

[Emet]

Thanks for your thoughtful and informative post, marplots.

(My father, now deceased, was born in 1913 and was a pharmacist. I have several old, cool, weights and scales of his, used for compounding.)

 

[sadhatter]

(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)

Ontario Canada, as of right now, there are a few different situations in which a pharmacist can diagnose. In the near future ( by the time i get out of school, unfortunately i don't have my books near me so i can give an exact date. ) they will be taking over the lions share of the functions of GP's. Mainly this will be diagnoses, this very well may be completely different in your area, the reason we are doing it here is that GP's are completely flooded.

( and of course the poor techs get a lot of the jobs that used to be the pharmacist, and on down the line. )

But as of right now even, consultation in regards to medication is a huge part of the pharmacist's job. ( in fact as of right now,even a pharmacy tech cannot under any circumstances give an opinon on medication. ) And a good portion of it is " is **insert homeopathic crap here** going to help?".

 

[sadhatter]

Thanks for your thoughtful and informative post, marplots.

(My father, now deceased, was born in 1913 and was a pharmacist. I have several old, cool, weights and scales of his, used for compounding.)

Apperantly there used to be a decent amount of these around here, but they were stolen to be used in less legal drug dispensaries, lol.

 

[Gord_in_Toronto]

Ontario Canada, as of right now, there are a few different situations in which a pharmacist can diagnose. In the near future ( by the time i get out of school, unfortunately i don't have my books near me so i can give an exact date. ) they will be taking over the lions share of the functions of GP's. Mainly this will be diagnoses, this very well may be completely different in your area, the reason we are doing it here is that GP's are completely flooded.

( and of course the poor techs get a lot of the jobs that used to be the pharmacist, and on down the line. )

But as of right now even, consultation in regards to medication is a huge part of the pharmacist's job. ( in fact as of right now,even a pharmacy tech cannot under any circumstances give an opinon on medication. ) And a good portion of it is " is **insert homeopathic crap here** going to help?".

As you are in Ontario, you will not be selling cigarettes as drug stores as banned by law from doing so.

There are very, very few homeoquackic remedies in the mainstream (chain) stores. My local Shoppers has a homepathetic baby teething solution -- I suppose rubbing a baby's sore gums with distilled water may actually do something to help the pain -- but that's it.

Pharmacists are expected to monitor the drugs they dispense (a Ministry of Health drug interaction system is in the works (as it has been for a couple of decades)). Mine has phoned my family doctor on a couple of occasions to query what he has prescribed (Lipitor and Lipidel together for example) and my doctor has authorized changes in his prescriptions. If a doctor is too thin-skinned or full of himself to not listen to professional advice, he should not be in the business and would not be my doctor.

The OP should read the Code Of Ethics for Members of the Ontario College of Pharmacists at: http://www.ocpinfo.com/client/ocp/OCPHome.nsf/web/Code+of+Ethics and the other publications at that site. Forget what you are told and obey the Rules and Regs.

From the preamble to the Code:

All members of the College have moral obligations in return for the trust given them by society. They are obliged to act in the best interest of and advocate for the patient, observe the law, uphold the dignity and honour of the profession, and practice in accordance with ethical principles and their respective standards of practice.