This is obviously causing controversy:
But the plan, which pharmacists have talked about for a decade, has some physicians worried about patient safety. Other doctors have suggested it will create a conflict of interest because pharmacists could benefit commercially from the medications they prescribe.
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- Pharmacists sue over Plan B
- Retail clinics and conflicts of interest
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{ 22 comments }
everybody and their brother wants to script meds these days….. and dont you dare tell me they want to do it for the public good, they want to do it for one reason only: $$$$
where the evidence that pharmacists w/ script rights are just as good as medical doctors?
doesnt canada have plenty of NPs and PAs? Why add another cook to the kitchen. It doesnt make any sense.
If Canada has a problem with script providers, train more NPs, PAs, and MDs. Thats 3 different pathways to scripting meds. There is no reason to add yet another pathway.
What next, are we going to start allowing people with nurse assistant degrees to start scripting?
where does this madness end?
I wouldn’t trust a pharmacist to know the difference between peritonsillar abscess, viral URI and Lemierre’s syndrome. These would all be treated the same by the pharmacist (no disrespect to them). If someone isn’t trained to do something, why would they want to perform that task?
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In my state, the legislature has established a special program at the university for pharmacists, chiropractors, nurses, and just about anyone else who wants to prescribe medication. It’s called medical school. It’s pretty hard to get into, and hard to get through, but, boy, I sure learned a lot during my 4 years there.
So …
1. What are “basic medications” (that is the ones, that the pharmacists think they should be able to prescribe)? Antihypertensives? Insulin? Steroids? Last time I checked, there are plenty of medication errors and injuries to patients caused by physicians who prescribe these meds.
2. And pharmacists are going to keep medical records where? And how are they going to prevent duplications?
3. What is the malpractice coverage for a pharmacist?
4. And when Wal-Mart comes rolling through Canada (which probably has already happened), and your “neighborhood pharmacist” is transformed into another generic low-paid FTE (full-time equivalent) behind the counter, how exactly is that better than your regular physician?
Sigh.
I’m in pharmacy school right now, and I don’t really know what to think of all this. Sure it would feel good to have power, but my primary concern is and should be with the health and safety of my patients. It is true that level of training for new pharmacists is much higher than for pharmacists in the past, but I still am highly skeptical that it approaches anywhere near an M.D. I don’t believe that pharmacists should function simply as pill counters, but I don’t necessarily believe they should be prescribing either.
I think people are getting confused here. It’s not like pharmacists are going to diagnose, that is the job of MD’s. But when it comes to the choice of therapy for a diagnosed disease, pharmacists are definitely as good as or even better than MD’s. I believe pharmacists have the ability to assess progression of chronic disease (ex. diabetes and bp) and will definitely know when the patient requires a MD’s intervention. So, this relieves the pressure of pts waiting 3 hrs to get their refills of the same meds and allows MD’s to have time to accept new cases and make new diagnoses. This in mind, prescribing pharmacists will definitely go through extra training to get this right. Its not like they’ll jump into it right away.
I have a question. Just how much do GP’s know about advanced and atypical diseases? In these cases, wouldn’t you be referred to a specialist? I wouldn’t trust a regular GP with the diagnosis and management of any complicated diseases, thats what specialists are for. I would assume that community pharmacists are capable of handling diseases that a GP would normally encounter (chronic diseases). In special cases like peritonsillar abscess, it would be managed by a ENT specialist anyways and so community pharmacists would not need to do so. That aside, if the pharmacist knew which microorganism was involved AFTER the diagnosis, I wouldn’s see why they couldn’t recommend the appropriate therapy. (they would know the spectrum of activities of the anti-microbials/antivirals)
Talking about conflict of interest, when a surgeon recommends a specific surgical procedure to a patient, they can push for something expensive where they will make more money. Its the same argument with pharmacists. It all boils down to professionalism and patient choice. As surgeons have the obligation to provide the possible choices to the patients, so do pharmacists. Hence, I think this argument about conflict of interest is not valid based on this perspective. This probably opens a can of worms leading to the question of physicians dispensing based on these same principles. I say thats fine, if they go through another 4 years of pharmacotherapy, kinetics, and pharmacology. Remeber, diagnosis belongs solely to physicians while dispensing of appropriate medications belongs to the pharmacists. The act of prescribing does not actually solely belong to one health profession. I think as long as the diagnosis is made, anyone who has the qualifications and certifications to treat and manage the diagnosis should have the right to prescribe for the condition.
I’m very excited about this movement! If this comes to be, we’ll probably see dramatic changes in pharmacy curriculums across canada where there will be more focus on clinical pharmacy. As a result, future pharmacists will be much knowledgeable and will be able to finally apply all their knowledge and show the world their contributions to health care
I am currently a second year pharmacy student, and I think most of the ppl on this website are not clear on the facts of what a pharmacist prescribing would mean. First of all pharmacists have more training in the area of pharmacology and drugs than any medical student ever receives. Four whole years for pharm students vs. 1-2 courses for med students. Secondly, pharmacists would not be diagnosing, that would be the MD’s job. The pharmacist would optimize drug therapy, since they know more about drugs vs an MD who obtain their drug knowledge from drug reps (no conflict of interest there eh?). Lastly in terms of patient safety, the pharmacists who do prescribe would receive special upgraded training and be required to demonstrate their competency before being allowed to prescribe. In terms of why? It costs the health care millions of dollars a year, to pay for drug interaction related health problems. Obviously MD’s aren’t able to handle this area. One person can’t specialize in everything. Pharmacists are fully trained for FOUR years in the area of drugs, and should be given the right to prescribe.
First of all, retail pharmacists would not be doing the prescribing. Clinical pharmacists with advanced training would be doing it. It’s funny that all of these MDs don’t think clinical pharmacists have the knowledge to optimize drug therapy, but who do MDs turn to in the hospital for advice? Clinical Pharmacists!! It’s also intriguing to me that many medical schools employ pharmacists to teach their pharmacology and therapeutics courses, but think they are not capable of practicing what they teach. Anyway, after several years as a clinical pharmacist, I have found there are some really stupid pharmacists and some really stupid MDs. And to anyone that thinks medical school is a lot tougher than pharmacy school, I challenge you to take some pharmacology tests and therapeutics tests from a pharmacy school. The dean of my pharmacy school was also dean at a world renowned medical school. He said the only difference in pharmacy and medical school is the Gross Anatomy course. Yes, medical school’s anatomy course is much tougher.
And one post-thought. At my institution, pharmacists manage most of the Coumadin therapy. After 5 days, pharmacist dosed patients are therapeutic on Coumadin approx. 92% of the time. The physician rate lingers around 55%. And you say pharmacists are not capable of medication management? We have proven to be superior with warfarin management at my institution.
How many years of pharmaockinetics do they teach in medical school?
I am a new pharmacist, just out of school and I think there is a huge misconception as to what pharmacists actually do day to day. This misunderstanding is leading the belief that pharmacists do not know how to prescribe medications. We do know more about medications than physicians do and I often find myself educating physicians on labs that need to be monitored for the patient and ALMOST always end up prescribing drugs for the patient myself with physician approval. I think the public and healthcare professionals at large do not grasp the knowledge base that a pharmacist has. It’s quite upsetting actually! As for prescribing, I say bring it on. Afterall, if a nurse who can neither diagnose or write appropriate rxs can write prescriptions, then it’s a step up to give pharmacists the right to do so.
iam a new graduate of pharmacy in egypt
i was in shock after practicing the profession i love
alot of people consider us salesmen
and what is make me sad that i could go to med school if i wanted but i preferred pharmacy
i can assure that the pharmacist can prescribe without the need to practice
just like physician who take their knowledge from pharmacists
and benifeting from precribing is an issue that makes me worry if it came to physician not pharmacists obviosly
I am a fourth year pharmacy student at the University of Toronto. I find it upsetting that physicians and the public in general still do not realize how poorly utilized pharmacists are. We do not want to diagnose or order lab tests (although physicans wanting these results only for their eyes is laughable), we want more freedom to help patients AND physicians. If someone walks into their GP’s office with a malady beyond the physician’s scope of practice, they are referred to a specialist. If a patient comes into my pharmacy with a problem that I am not competent to ‘treat’, I will refer them to their GP. My college will hold me just as accountable for practicing outside of my area of competence as any doctor would be. And with all of this fuss about how patients will be hurt by their stupid pill-counters writing scripts, I find it almost comical that studies have shown that adverse drug reacitons are currently the third leading cause of hospitalization in Canada.
I don’t think most dentists knows the difference between peritonsillar abscess, viral URI and Lemierre’s syndrome either (no disrespect to them). Please do not be so short-sighted. Obviously, the scope of prescribing will be limited. Their case is: pharmacists prescribing SOME controlled medication which may assist in patient healthcare. My opinion… I think they should be able to prescribe some pharmaceutical drugs. For god sakes, their study is in Pharmacology.
Pharmacists should be allowed to prescribe, plain and simple. The physicians that say they are afraid of safety concerns are only worried about losing 1) Money and 2) Power. Pharmacists are fully qualified to safely prescribe over half the meds behind the pharmacy counter. Allegra? Naproxen 550mg? Give me a break. You don’t need an expensive office visit for that. Digoxin, Coumadin I do believe need to be monitored in a doctors office, but many drugs do not required extensive diagnostic/monitoring skills. Get over your status quo vision of health care. Its time to think outside the box.
The reason doctors disagree with pharmacists prescribing is NOT because they are concerned for patient safety. It is because of POWER and their fear of losing their prescriptive monopoly. The status quo is changing and pharmacist have displayed in numerous practice settings such as the VA that they CAN prescribe drugs both safely and effectively! Pharmacists are already allowed to prescribe in other countries such as the UK with great success. The one track mind that only a “doctor” can magically write scripts effectively is nonsense. You cannot tell me that a pharmacist is not capable of prescribing Allegra for seasonal allergies or nystatin for oral thrush for example. Yes, there needs to be limitations, but many meds that are Rx only do not necessarily need a doctor visit to treat.
Where is the outrage with NP’s being able to prescribe drugs autonomously without physician supervision. Pharmacists receive much more education with regards to appropriate drug therapies than NP’s. If I recall, many of the faculty that teach NP’s these courses ARE PHARMACISTS. Pharmacists will follow this trend because they can prescribe safely on a limited list and this will cut down on drug costs for patients AND the taxpayer. The last time I went to a general practitioners office with the flu, the physician just gave me shot gun antibiotics and Tamiflu. No “extensive” testing done AT ALL.
Lets all be honest with ourselves. Pharmacists know more about medications than any MD could ever hope to know. However…it should be a system in which the patient sees the MD and recieves a diagnosis, the patient then takes that diagnosis to their Pharmacists who writes a script and fills according to that diagnosis. Wake up people!! MD’s specialize in diagnoses while PharmD’s specialize in Drugs.
MDs and Pharmacists (and even pharmacy techs) are waaaay different things.
Lets say there are 3 different drugs to cure a patient with an illness who also happen to suffer from high blood pressure and diabetes. The pharm tech knows any of the drugs would cure the patient. Why? He has no idea other than the fact he has seen the Pharmacist dispense those in the past. For the Pharmacist, he knows because he understants the active components of those drugs and knows that any of the 3 drugs would work. While on the other hand, the MD knows that drug#1 could cure the patient's illness while aggrevating his BP & diabetes; drug#2 could cure illness and as well lower BP and aggrevate diabetes. You get the idea. Each of the jobs/professions completely have their own place in the food chain.
How do I know these? I used to be a pharm tech who later became a pharmacist and now an MD! To me, they are all honorable proffessions, it just depends on ones goals:-)
MDs and Pharmacists (and even pharmacy techs) are waaaay different things.
Lets say there are 3 different drugs to cure a patient with an illness who also happen to suffer from high blood pressure and diabetes. The pharm tech knows any of the drugs would cure the patient. Why? He has no idea other than the fact he has seen the Pharmacist dispense those in the past. For the Pharmacist, he knows because he understants the active components of those drugs and knows that any of the 3 drugs would work. While on the other hand, the MD knows that drug#1 could cure the patient's illness while aggrevating his BP & diabetes; drug#2 could cure illness and as well lower BP and aggrevate diabetes. You get the idea. Each of the jobs/professions completely have their own place in the food chain.
How do I know these? I used to be a pharm tech who later became a pharmacist and now an MD! To me, they are all honorable proffessions, it just depends on ones goals:-)
How can you say that a pharmacist does not know drug disease interaction when you went to pharmacy school.
Pharmacists know their pharmacology and how those drugs act on the body, side effects, drug-drug interaction, drug-disease interaction, drug-herbal interaction: most MDs would care less about these interactions.
MDs should diagnosis and PharmDs should prescribe!
It sounds like pharmacists would be good prescribers. It also sounds like doctors are afraid of how good pharmacists would be at prescribing if given the authority.
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