Doctors vs pharmacists in Canada

The battle about the pharmacists’ right to prescribe continues:

We believe any changes to the powers of pharmacists should be very limited, perhaps to allowing them to adjust dosages or renew a prescription without consulting a physician. We oppose giving pharmacists permission to assess what is wrong with a patient and then to prescribe medication. Pharmacists don’t have the diagnostic training of doctors.

Comments

Anonymous
I agree. I don’t think there is much question that a PharmD trained pharmacist cannot select an appropriate therapy for a patient’s condition, it is that they are not trained to diagnose the condition correctly in the first place. I would have no problem with a hypothetical situation in which the doctor diagnoses the disease and then a pharmacist prescribes accordingly, I just do not think that it is safe to allow them to evaluate and treat.
Anonymous
How do you feel about psychologists with the appropriate pharmacological and diagnostic training being able to prescribe psychotropic medication?
Anonymous
If by appropriate training you mean they have an MD, then I think it’s a great idea.
Anonymous
Of course, this hypothetical situation in which pharmacists prescribe medication is analogous to the original situation in which doctors sold medicine, and it brings up all of the same problems. When the person who prescribes the medicine also sells the medicine, then a lot of expensive and unncecessary medicine will be prescribed to increase the pharmacists earnings.
Anonymous
To be honest, it seems like pharmacy as a profession has already gone the way of the dinosaur and this initiative is a last-ditch effort to preserve some professional relevance. Pharmacists don’t actually need to have any graduate education, all they do is work a retail job.
I think that it would be nice to find some additional responsibilities for pharmacists so that we can preserve an ancient and historically presitigious profession, but capitalism and technology have all but stripped it all away and left faceless fillers of prescriptions with minimal decision-making authority.
Anonymous
Anon 7:45
Is the financial renumeration situation (not the relative training aspect) substantively different than an MD or DO being influenced by pharmaceutical reps via “gifts” to aid in the prescribing of their products?
Anonymous
The influence that drug reps have over doctors is grossly overrated. Sure my staff has received a half dozen or so free lunches provided by reps this year, but I think I only had the time to drop by for one. Usually the reps drop off the food in the back room and leave. I honestly don’t recall which drugs those reps carried or even which company they work for. As for their pens, pads, candy, mugs, cheap clocks, etc.- most of that junk gets tossed cause it clutters up the office. Quite honestly, most drug reps get on my nerves and are just one more nuisance I have to deal with during the day. The only reason I let them visit is because of the drug samples, which come in handy for a lot of my patients.
Honest to God, and I am not just saying this, I’ve never changed my prescribing habits because of a pen or sandwhich.
RJS
I think I should repost this to stave off some of the inevitable elitism and misconceptions that will come up in this discussion.
“I agree. I don’t think there is much question that a PharmD trained pharmacist cannot select an appropriate therapy for a patient’s condition,”
Judging by the rest of your sentence, I would say you probably meant to say “can” instead of “cannot.”
“I just do not think that it is safe to allow them to evaluate and treat.”
I completely agree. I’ve been asked numerous times what X was, and I always feel uncomfortable making basic diagnoses. Usually “simple” rashes and such — I’m not a dermatologist, and I don’t feel comfortable making that call.
“How do you feel about psychologists with the appropriate pharmacological and diagnostic training being able to prescribe psychotropic medication?”
Usually they’re NP’s with Masters degress in Psych, and as such, are allowed to prescribe. In federal institutions you will sometimes find MS Psych with PharmDs prescribing as well.
“Of course, this hypothetical situation in which pharmacists prescribe medication is analogous to the original situation in which doctors sold medicine, and it brings up all of the same problems. When the person who prescribes the medicine also sells the medicine, then a lot of expensive and unncecessary medicine will be prescribed to increase the pharmacists earnings.”
Just about all retail pharmacists are salaried, assuming they don’t own their own pharmacy. Volume really doesn’t have an effect on how much you make. Not in any meaningful way, anyway.
“To be honest, it seems like pharmacy as a profession has already gone the way of the dinosaur and this initiative is a last-ditch effort to preserve some professional relevance. Pharmacists don’t actually need to have any graduate education, all they do is work a retail job.”
That statement is so wrong, I don’t even know where to begin. I’ll just point out that a lot of pharmacists aren’t retail. In fact, there’s more non-retail pharmacists than retail RPhs.
Allow me to quote from my article linked above:
“A pharmacist’s education overlaps with a physician’s quite a bit, and even moreso vice versa. A physician probably knows more than a pharmacist does about physiology and making diagnoses. But in general, pharmacists know more about drugs than physicians do — for a reason: they went to school for it.”
Anonymous
“Usually they’re NP’s with Masters degress in Psych, and as such, are allowed to prescribe. In federal institutions you will sometimes find MS Psych with PharmDs prescribing as well.”
http://www.apa.org/practice/nm_rxp.html
Greg P
My experience with the advice that pharmacists give out suggests not such great knowledge about pharmaceuticals, but rather, good access to printed and online information. The typical comments from pharmacists more or less come straight from the PDR or similar sources.
The practical problem is that all drugs have potential side effects, placebos have side effects, but the issue for an individual patient is which are likely, which are worthy of serious consideration, and what the alternative approaches are.
This is not to say that pharmacists are not helpful in pointing out some interactions or precautions with drugs that I was not aware of or had overlooked. But this is more of a “many eyes on a situation” making it less likely that something important will be missed. A patient who has a copy of a PDR may do the same thing.
RJS
“My experience with the advice that pharmacists give out suggests not such great knowledge about pharmaceuticals, but rather, good access to printed and online information. The typical comments from pharmacists more or less come straight from the PDR or similar sources.”
Haha. If only we had good access to information. The information we have is decidedly piss-poor. Most everything comes from memory, or if it’s a technical question we’ll look at the package insert.
I’ve never looked in a PDR. I have looked in Thompson Micromedex (book version). Sometimes Drug Facts & Comparisons when someone writes for a wacky brand name drug that hasn’t existed in ages, and we need to find a modern equivalent.
More often than not, for real information, we’re looking at package inserts. I could be the minority, but I doubt it.
What is more likely is that you’re considering different aspects of a particular drug when you choose it. I know my mindset is probably different than a doc’s when it comes to thinking about various medications. This is why I think the discussion aspect is a good idea. Though it can be more time-consuming.
Another thing to consider is that a lot of pharmacists don’t “use it” nearly as much as your average doctor, and frankly, they’re not required to. Which I think is a bad thing. The amount of continuing ed stuff that an MD has to do as compared to an RPh isn’t comparable. I’d like to see RPhs required to do more (and more importantly) prove that they’ve learned and retained something.
Greg P
Considering that the PDR is just a compilation of package inserts, it amounts to the same thing.
Anonymous
Not long ago my pharmacist had alot more concern for me than what my own doctor did. I was temporarily on coumadin.
It was crazy the routine of it. Have blood work every Monday, only enough pills prescribed through Monday evening. Tues., no prescription called in, no coumadin, call Drs. office, on call doctor says, “I’m not telling you not to take any coumadin even for one night.” Ummm “Ok, then can you call it in for me?” “Well, I don’t have your blood work here and I don’t like calling in coumadin for another doc.” He had taken away all options, don’t not take it, and I’m not calling it in. What kind of s*** is that?
In the end the pharmacist gave me one for that night in the same strength as last script. which had stayed the same for several weeks.
Before you start asking why I didn’t call my doc’s office during hours that day. I did, at about 3:30 and talked to his assistant who said she would call it right in and didn’t.
This became more of the rule than the exception. My home health nurse finally gave me some she got from another patient whose dosage had been changed. I think its a shame when medical professional’s do their job so poorly that you force us to do something illegal to take a drug that you say we cannot go without.
I was taking 10mg at that point. I had previously been hospitalized with DVT.

Doctors vs pharmacists in Canada

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