I am Truly Disturbed

[Gav]

I think that jbirch has just gotten pharmacist confused with pharmacologist.

[dunastor]

I hope so.....

At least pharmacologists are usually doctors... (MD's that is...)

[Maeve_Mari]

That is certainly not the view of the Roman Catholic church. The following is from Familiaris Consortio (document of John Paul II which may be of interest to some here):

The Catholic church sees the unitive aspect of sex to be as important and inseparable from the procreative aspect: this should be read in the context of the Catholic view of love as itself creative and self-giving.

Sorry, don't know anything about the protestant views.

Yet, it continues with:

"When sexuality is separated from procreation, anything goes. And this is exactly what we are seeing in our society today: abortion, sterilization, cohabitation, multiple divorces, homosexual marriage, surrogate motherhood, therapeutic and reproductive cloning, abandonment and killing of new born babies, sexual exploitation of children, disrespect and degradation of women, and sexual perversion of every kind. The contraceptive mentality of separating sex from procreation is one of the root causes of our "culture of death," as it leads one not to respect the human dignity of another person, but to see another as an object to be manipulated for one's own ends.

In 1968, Pope Paul VI, a true prophet in Humane Vitae cautioned the world against four consequences of separating the procreative and unitive aspects of marriage: conjugal infidelity and the general lowering of morality, sexual exploitation and loss of respect for women, governmental control over people's lives, and human beings thinking they had unlimited dominion over their own bodies, turning the human person into an object.

It is interesting that Mahatma Gandhi, though not Christian, understanding the Natural Law, insightfully stated: "There is hope for a decent life only so long as the sexual act is definitely related to the conception of precious life. This rules out perverted sexuality and, to a lesser degree, promiscuity and to condoning if not endorsing natural vice" (10)"

[jBirch]

I think you are having too high an opinion of the pharmacist.
The doctor is by far more knowledgable about the effects and side-effects of the drug in the specific patient who he has proscribed the drug to.
The pharmacist only has knowledge about the pharmaceutical properties of the drug.
Diagnosing the problem and providing general therapy is exactly what the doctor is doing by prescribing medication. He is by far more suitable to chose the specific drug for his patient. The pharmacist doesn't have a clue about the medical history of the patient, and he shouldn't have.

That's the difference.

I've seen the kind of idiocy that Doctors prescribe and, frankly, feel way more comfortable with a pharmacist in charge of the drug therapy, thank you very much. Doctors are inundated with pharmaceutical information and tend to pick the drug that they are most comfortable with, not usually the one best tailored to your unique condition. And the only doctor in the whole system with a clue as to my unique medical history is my family doctor. Are you suggesting that only my family doctor should prescribe drugs for me? What about walk-in clinics, emergency rooms, and other elements of the health care system that are not my primary physician. And if there are other doctors handling your health then who is the medical individual with the best records of what drugs you're taking? Perhaps, the PHARMACIST??

Bullocks. As I said, there is only one person for a patient to diagnose a disease and chosing the right therapy for it, and that's the doctor. The pharmacist should keep his hands where they are, and not meddle with something he doesn't know anything about.

First, your assertion that the pharmacist doesn't know anything about drug therapy is just plain wrong. Second, your assumption about only one doctor is equally flawed.

This has nothing to do with evidence based medicine. Those doctors and pharmacists are nothing more than quacks. They do not adhere to professional guidelines, and should be subject to legal prosecution.

Hmmm... actually this has turned out to be a little bit of a rant...

They are registered, licensed MD's adhering to what they believe are their moral and ethical responsibilities. They simply refuse to prescribe BC for contraception, believing that pregnancy is not a disease in need of drug therapy. Don't see the quackery in that.

[scrapinpeg]

and how do you know what the language of the bill implies; have you read it? perhaps the wording sets up potential lawsuits/loopholes/etc.

Noodle, you should be more careful before saying such things. I am familiar with the language, and it is clear that Epee Pox and Jeff know what it says, and that you do not.

As Jeff suggested, perhaps you should actually read the article you linked to. It actually explains this detail pretty straightforwardly.

[dunastor]

I've seen the kind of idiocy that Doctors prescribe and, frankly, feel way more comfortable with a pharmacist in charge of the drug therapy, thank you very much. Doctors are inundated with pharmaceutical information and tend to pick the drug that they are most comfortable with, not usually the one best tailored to your unique condition. And the only doctor in the whole system with a clue as to my unique medical history is my family doctor. Are you suggesting that only my family doctor should prescribe drugs for me? What about walk-in clinics, emergency rooms, and other elements of the health care system that are not my primary physician. And if there are other doctors handling your health then who is the medical individual with the best records of what drugs you're taking? Perhaps, the PHARMACIST??

I will admit that not every doctor is flawless in his professional conduct or impervious to any influence by pharmaceutical companies.
This is not something we must accept, to let health care be based on other professions than doctors, but doctors should protect their independence and should be keeping up with the knowledge about drug therapy.
You are right about the primary care physician (PCP) having the best knowledge about your medical record. In the Netherlands, that's why, if you want to go to a specialist, you first have to go to your PCP to get a referral. The PCP will write a little note with his findings and your previous medical record, describing which drugs you use!! On the other hand, specialists and other doctors should ask their patients, even in emergency room situations, which medication someone is using. There lies also a responsibility with the patient, to be aware of which drugs he uses.
The pharmacist has a little list with the drugs you use, that's correct, but he doesn't know WHY you are using that drugs. For educated people it is sometimes easy to guess why, but he hasn't got the information the doctor has, nor is he able to provide drug therapy based on a specific patient and his disease. That is the sole terrain of the (primary care) physician.

First, your assertion that the pharmacist doesn't know anything about drug therapy is just plain wrong. Second, your assumption about only one doctor is equally flawed.

I do not believe I'm wrong about the pharmacist not knowing anything about providing therapy upon making a diagnosis. I don't want pharmacists making diagnoses. If you have unsurmountable evidence of the opposite, feel free to enlighten me.
The problem of multiple doctors I have addressed already.

They are registered, licensed MD's adhering to what they believe are their moral and ethical responsibilities. They simply refuse to prescribe BC for contraception, believing that pregnancy is not a disease in need of drug therapy. Don't see the quackery in that.

Quackery is a very strong term. My problem is that those MD's chose their own "comfort" (being their moral and ethical beliefs) over what is best practice with their patient. Anybody who doesn't has his patients best interest at the top of his priorities, is IMHO not a good doctor.
That has nothing to do with pregnancy being a disease or not....

[Inquartata]

The pharmacist has a little list with the drugs you use, that's correct, but he doesn't know WHY you are using that drugs. For educated people it is sometimes easy to guess why, but he hasn't got the information the doctor has, nor is he able to provide drug therapy based on a specific patient and his disease. That is the sole terrain of the (primary care) physician.

A) The pharmacist will very often call the doctor and consult with him or his nursing staff with regard to the prescribed drugs, so he may well know a lot more about an individual's overall health picture than you realize.

B) From http://www.aphanet.org/

Pharmacist teaching and monitoring of drug therapy in a group of African-American asthma patients reduced emergency department (ED) visits by over 70% and hospitalizations by 80%, compared with no significant reduction in ED visits and a 50% reduction in hospitalizations in a control group receiving "usual care from local physicians." (Kelso TM, et al, Am J Med Sciences, June 1996)
Asthma patients who are high users of hospital emergency departments experienced an 80% decline in ED visits after ongoing pharmacist counseling. [Pauley TR, et al, Annals of Pharmacotherapy, Jan 1995]


Geriatric consumers, who account for about 30% of drug use in the U.S., were able to reduce the number of drugs taken and achieve significantly better compliance with their drug regimen after counseling by pharmacists, with no increase in costs. [Lipton HL, and Bird JA, Gerontologist, March 1994].

Ambulatory patients used significantly fewer health services, saving over $640 a year in health costs per individual, as a result of comprehensive pharmacist counseling. [Borgsdorf LR, et al, Am J Hosp Pharm, March 1994].

Community pharmacists counseling patients identified and resolved problem drug therapy in ~2% of new prescription orders, with about 28% of these judged capable of causing "patient harm" if the pharmacist had not intervened. [Rupp MT, et al, Medical Care, Oct 1992].

Physicians accepted 83% of pharmacist recommendations for drug therapy changes in an ambulatory care clinic. In 80% of recommendations, "improvement or resolution of a patient's disease state" and cost reductions occurred. [Lobas NH, et al, Am J Hosp Pharm, July 1992].

Medicare would realize net savings of $280,000, 139 hospitalizations, and 63 deaths per 100,000 enrollees each year if it paid pharmacists to advise enrollees to be vaccinated for influenza, according to an estimate based on an experiment in North Carolina. [Grabenstein JD, et al, Medical Care June 1992.]

Adding a clinical pharmacist to a hospital-based geriatric clinic reduced the number of medications associated with an adverse drug reaction by 42% and produced direct cost savings of $54/patient within six months. [Phillips SL, Carr-Lopez SM. Am J Hosp Pharm May 1990]

Hypertensive patients who received pharmacist counseling were more compliant with their treatment, and achieved better blood pressure control, than a control group. [McKenney JM, et al, Circulation, Nov. 1973; McKenney JM, et al, Contemp Pharm Pract, Fall 1978]

Relative to a control group, diabetic patients who received pharmaceutical care were more compliant in keeping clinic appointments, made fewer medication errors, saw symptoms improve in 5 of 8 variables measured, and had a lower incidence of hospital admissions and "medical contacts". [Sczupak CA, Conrad WF, Am J Hosp Pharm, Nov 1977].

A clinical-pharmacist run anticoagulation clinic improved anticoagulation control, reduced bleeding and thromboembolic event rates, and saved $162,058 per 100 patients annually in reduced hospitalizations and emergency department visits. [Chiquette E, Amato MG, and Bussey HI, Arch Intern Med. 1998; 158:1641-1747]

Using a system integrating computers, pharmacists, and physicians, a total of 43,007 DUR alerts were generated. Rate of change to a more appropriate therapeutic agent was 24%. Except for the rate of change for beta blockers in patients with chronic obstructive pulmonary disease, all rates of change were significantly greater than the expected 2% rate of change. (Monane M et al, JAMA, October 14, 1998

And from
http://www.calmis.cahwnet.gov/file/o...e/PHARMCST.HTM

PHARMACISTS dispense drugs and medicines prescribed by doctors and dentists. They also supply and advise people on the use of non-prescription medicines. Pharmacists must understand the, composition, and effect of drugs and how they are tested for purity and strength. They often maintain patient medication profiles, and advise physicians on the proper selection and use of medicines.

Making a pharmaceutical agent by compounding ingredients to form powders,
tablets, capsules, ointments, and solutions is now only a small part of
Pharmacists' practice, since most medicines are produced by manufacturers in
the required dosage and form.

The practice of pharmacy is a vital part of total health care, requiring
today's Pharmacists to be very knowledgeable. Pharmacists use patient
profiles to insure that harmful drug interactions do not occur and to
monitor patient compliance with the doctor's instructions. Consequently,
Pharmacists are playing a more active role as they give more consultations
and have more direct contact with patients.

Pharmacists employed in community pharmacies may have other duties. Besides dispensing medicines, some Pharmacists buy and sell non-pharmaceutical merchandise, hire and supervise personnel, and oversee the operation of the pharmacy.

Pharmacists in hospitals and clinics dispense inpatient and outpatient
prescriptions and advise the medical staff on the selection and effects of
drugs; they also make sterile solutions, buy medical supplies, teach in
schools of nursing and allied health professions, and perform administrative
duties. In addition, Pharmacists work as consultants to the medical team in matters related to daily patient care in hospitals, nursing homes, and other
health care facilities.

This may also be of interest, as it seems to be the "wave of the future":


http://www.acponline.org/hpp/pospaper/pharm_scope.pdf

[dunastor]

I know I was little too bold.
Fact remains, the quotations use extensively the words counseling and consulting. Every decision a pharmacist makes in the drug regimen of a patient, should be known to the doctor. A pharmacist doesn't have the right to just meddle with the drug regimen on his own, because he has the attitide "the doctor is just doing stuff he doesn't know anything about..."

I would like to stress the importance of consultation, especially in health care providers.

The casus "sub judice" in this discussion, was a pharmacist who acted on his own, without consulting anyone. I hope I have made myself clear that I strongly condemn such practices.

[jBirch]

I know I was little too bold.
Fact remains, the quotations use extensively the words counseling and consulting. Every decision a pharmacist makes in the drug regimen of a patient, should be known to the doctor. A pharmacist doesn't have the right to just meddle with the drug regimen on his own, because he has the attitide "the doctor is just doing stuff he doesn't know anything about..."

I would like to stress the importance of consultation, especially in health care providers.

The casus "sub judice" in this discussion, was a pharmacist who acted on his own, without consulting anyone. I hope I have made myself clear that I strongly condemn such practices.

Absolutely. I agree totally with you on the assessment of this person's action as wrong. I agree totally with the concept of consultation and the total medical team. I disagree, however, with the assertion that this particular pharmacist was wrong solely because a doctor had already written the prescription and the pharmacist's only job is to fill the little bottles with the right stuff.

[jBirch]

I do not believe I'm wrong about the pharmacist not knowing anything about providing therapy upon making a diagnosis. I don't want pharmacists making diagnoses. If you have unsurmountable evidence of the opposite, feel free to enlighten me.
The problem of multiple doctors I have addressed already.

On this note, I think that we are talking at cross purposes. I never asserted (at least, I don't think I did) that a pharmacist should be seeing patients and prescribing drugs. I think that a doctor should provide a general regimen and the pharmacist should control the drugs. So the doctor doesn't prescribe 10mg of erthromycin twice a day, but rather says anti-biotics for an ear infection. The drugs are left to the pharmacist while the diagnosis and general prescription to the doctor.

Hope this clears up what I'm saying.

[dunastor]

I disagree, however, with the assertion that this particular pharmacist was wrong solely because a doctor had already written the prescription and the pharmacist's only job is to fill the little bottles with the right stuff.

I agree the job of a pharmacist goes (a little) beyond just filling bottles with the right stuff.
If a pharmacist sees a prescription with a certain amount of milligrams of a drug, and he has the opinion that the dosage is wrong, or that, in relation with other drugs the patient is taking, there is a chance of interactions, he may consult with the prescribing doctor to change the prescription to something else.
Anything more, and I believe the pharmacist goes beyond his professional boundaries.

[dunastor]

On this note, I think that we are talking at cross purposes. I never asserted (at least, I don't think I did) that a pharmacist should be seeing patients and prescribing drugs. I think that a doctor should provide a general regimen and the pharmacist should control the drugs. So the doctor doesn't prescribe 10mg of erthromycin twice a day, but rather says anti-biotics for an ear infection. The drugs are left to the pharmacist while the diagnosis and general prescription to the doctor.

Hope this clears up what I'm saying.

I understand, however, I don't agree.

I see no difference in a pharmacist seeing patients and prescribing drugs and providing specific antibiotics.

I think, now we're talking about antibiotics, that the doctor should be the one to choose the specific one. I know this is very hard, there are many possibilities, without even going into the discussion about even when to give antibiotics and when not.
The choice between them is based solely on the specific diagnosis of the patient, which was the terrain of the doctor.(the site of infection, the extent of infection, the microorganisms involved...)
I agree individual doctors may make mistakes. With complicated infections in the hospital I do internships, doctors consult with medical microbiologists, who are MD's, to tailor antibiotics to the specific microorganism at hand.
I do not see this consultation being possible between a town doctor and a town pharmacist.

[jBirch]

I understand, however, I don't agree.

I see no difference in a pharmacist seeing patients and prescribing drugs and providing specific antibiotics.

I think, now we're talking about antibiotics, that the doctor should be the one to choose the specific one. I know this is very hard, there are many possibilities, without even going into the discussion about even when to give antibiotics and when not.
The choice between them is based solely on the specific diagnosis of the patient, which was the terrain of the doctor.(the site of infection, the extent of infection, the microorganisms involved...)
I agree individual doctors may make mistakes. With complicated infections in the hospital I do internships, doctors consult with medical microbiologists, who are MD's, to tailor antibiotics to the specific microorganism at hand.
I do not see this consultation being possible between a town doctor and a town pharmacist.

See, now this is the situation that I think illustrates the best where a pharmacist can add real value to the system. In the scenario you mentioned, in both the hospital and the small town, the doctor works really hard to figure out what's wrong, getting the specifics as tight as possible. But when the decision to treat the problem with drug therapy comes along, I really do think that the pharmacist is the best one equipped to do that. What you end up having then is a local individual who is responsible for all elements of the drug therapy and another who is responsible for getting the diagnosis right.

But I guess from that you have to have someone who is able to tell whether the therapy is working or not, which means diagnosis. Hmmmmm. Maybe it's just a matter of increasing communication flow between doctor and pharmacist? With the doctor and pharmacist agreeing on the specific drugs and levels before either prescribes or administers them. So a prescription does not, de facto, mean that you get the drugs. It means that the doctor has diagnosed X and suggests to prescribe Y. The pharmacist can question Y but not X.

Make sense? On a related note, why do you think that pharmacists should not have any role other then filling bottles and acting as a simple sanity check on doctor's orders?

[Prometheus]

Make sense? On a related note, why do you think that pharmacists should not have any role other then filling bottles and acting as a simple sanity check on doctor's orders?

Because that is what a pharmacist's job is:

From m-w.com

Main Entry: phar·ma·cy
Pronunciation: 'fär-m&-sE
Function: noun
Inflected Form(s): plural -cies
Etymology: Late Latin pharmacia administration of drugs, from Greek pharmakeia, from pharmakeuein to administer drugs, from pharmakon magic charm, poison, drug
1 : the art, practice, or profession of preparing, preserving, compounding, and dispensing medical drugs.

A pharmacist can recomend a change in a patient's treatment plan to a physician, but changing that plan is practicing medicine without a lisence.

Similarly,

EMTs have to call the hospital before pushing drugs that are not on a list of standing orders.

A psychologist can refer a patient to a pschiatrist, but cannot prescribe or dispense medicaiton.

Consultants that work for biotech companies cannot legally install artificial joints, even if thier company created the product and they have intamate knoledge of it.

[jBirch]

Because that is what a pharmacist's job is:

From m-w.com

Main Entry: phar·ma·cy
Pronunciation: 'fär-m&-sE
Function: noun
Inflected Form(s): plural -cies
Etymology: Late Latin pharmacia administration of drugs, from Greek pharmakeia, from pharmakeuein to administer drugs, from pharmakon magic charm, poison, drug
1 : the art, practice, or profession of preparing, preserving, compounding, and dispensing medical drugs.

A pharmacist can recomend a change in a patient's treatment plan to a physician, but changing that plan is practicing medicine without a lisence.

Similarly,

EMTs have to call the hospital before pushing drugs that are not on a list of standing orders.

A psychologist can refer a patient to a pschiatrist, but cannot prescribe or dispense medicaiton.

Consultants that work for biotech companies cannot legally install artificial joints, even if thier company created the product and they have intamate knoledge of it.

So your argument then is simply because that's the way it has been defined? So they SHOULD not in the future have any role other then the way it is defined now, correct?

[dunastor]

See, now this is the situation that I think illustrates the best where a pharmacist can add real value to the system. In the scenario you mentioned, in both the hospital and the small town, the doctor works really hard to figure out what's wrong, getting the specifics as tight as possible. But when the decision to treat the problem with drug therapy comes along, I really do think that the pharmacist is the best one equipped to do that. What you end up having then is a local individual who is responsible for all elements of the drug therapy and another who is responsible for getting the diagnosis right.

As the therapy flows directly from the diagnosis, a forteriori with bacterial infections and antibiotics, because the nature of the bacterium is the basis for chosing an antibioticum.
As I said, in some cases the treating physician consults with a specialist in microbiology, also a doctor.
I do not see the same place for the pharmacist. Clearly you have another view of that, and I would be glad to hear your arguments as to why.

But I guess from that you have to have someone who is able to tell whether the therapy is working or not, which means diagnosis. Hmmmmm. Maybe it's just a matter of increasing communication flow between doctor and pharmacist? With the doctor and pharmacist agreeing on the specific drugs and levels before either prescribes or administers them. So a prescription does not, de facto, mean that you get the drugs. It means that the doctor has diagnosed X and suggests to prescribe Y. The pharmacist can question Y but not X.

That is exactly my point. As far as I know, the pharmacist doesn't have any knowledge about microbiology, relevant to the relationship between different strains of bacteria and the specific antibiotics to target them. Moreover because the pharmacist doesn't have any knowledge about which strain of bacteria is infecting the patient, he can't judge if that specific antibiotic is prescribed in error. He can only judge by the prescription itself whether the dosage and method of administration etc. are correct.
With any prescription, the pharmacist may have second thoughts about the dosage or the use of the drug, and then he may consult with the prescribing doctor. Like I said in my previous post, this is a healthy form of consultation, and it improves individual healthcare for the patients.

Make sense? On a related note, why do you think that pharmacists should not have any role other then filling bottles and acting as a simple sanity check on doctor's orders?

Again, I don't have a problem with sanity checks by pharmacists, but I would like the physician to keep on prescribing specific drugs (by name) to his patients. The pharmacist may have doubts, on which he can contact the doctor, but he mustn't be given the opportunity to choose drugs himself.

[jeff]

dunastor has it right. The pharmacist is not a doctor, hasn't studied disease, hasn't examined the patient (wouldn't know how to even if he had), doesn't know the patients history other than the drugs he or she has gotten, and all-around is not the person to prescribe medicine. That's the doctor's job.

What the pharmacist can do is act in a consultative mode that helps catch mistakes. He or she might know of a generic that is a clone of the prescribed drug and can be substituted with equivalent effect, or see from the patient's records that he's getting another drug (from another doctor) that has bad interactions with the prescribed drugs. Or, the pharmacist might be able to tell the doctor that the same patient has already gotten narcotics from 3 other docs (and maybe the patient is a junkie trolling different doctors for drugs so they can get high. Happens all the time)

Two roles, pretty much complementary, but very much different roles.

[Louweasel]

The medical profession is responsible for our medical welfare, That is their concern. They have nothing to do with our moral welfare, whatever their beliefes perception of it might be.

Like I said before (and some others I believe) if you have a moral objection to doing part of your job, you should choose another job. What I believe it boils down to, is: You don't have the "right" to do your job badly/incompletely. That's ridiculous.

I would have a moral issue with promoting smoking, so I wouldn't work for a tobacco company. I have a problem with racism, so i wouldn't work for for the BNP.

If I had a moral problem with banging on people's doors at 7am, or having long meetings in barristers' chambers, or writing things like "It is in the public interest, having regard to the benefit likely to accrue to the investigation if the material is obtained; and to the circumstances under which the person holds it, that the material should be produced or that access to it should be given", horrendously ugly and maladroit as it is, I wouldn't do the job I do.

Oh, I'll s0d off and stop repeating myself.

[jeff]

A valiant attempt by Louweasel to drag this thread back to its topic - well done!

I agree - if somebody has a problem dispensing the meds a doctor has prescribed, he or she should seek another career.

[jBirch]

But the issue is what is a doctor's mistake? Are there categories of mistake? If you prescribe high dosage narcotics for a microbial infection is that a mistake? How can a pharmacist catch that mistake if they don't participate in the diagnostic process? Who tells the doctor that they are prescribing the wrong drug? If the doctor is aware of the negative interactions between drugs yet insists on prescribing them anyway, is that a mistake? What role and what authority with that role does a pharmacist have?

My opinion on the matter is that a pharmacist really does know the most about the drugs being considered and is certainly able to leap from diagnosis to treatment. They may not know HOW to find out what organism is affecting a patient, but once they know what the problem is, they know pretty darn well what the drugs will do to that organism and so know which are the best to wipe it out. In that role, the doctor is responsible for accurately defining the problem and prescribing a drug therapy treatment. The diagnostic information then goes to the pharmacist who comes up with the best drug therapy.