Everyone can write prescriptions!
Its amazing how the medical community has 'evolved' in the past few years. Back when I started this profession, only Doctors (MD/DO/DDS/DVM/etc) and Nurse Practioners/PA's could write prescriptions. Everyone was happy, and the world was at peace.
Well some idiot decides to allow Certified Nurse Midwifes and Holistic Medicine (or some bullshit like that) to write prescriptions. Head, meet table.
When is the madness going to stop? Are janitors going to be the next ones to have prescriptive authority?
I went to college for 7 years, and I only have the ability to prescribe the morning after pill. Some idiot goes to a Career College, pops out a CNM in 5 months, and can write for anything (yes, I know they are under protocol, but thats not my point).
It makes my blood boil when I see these idiots churn out Rx's that look like this:
Amoxicillin suspension, 234.3 mg three times a day for 10 days.
Now that may look good to you, but any pharmacist will say "Hey! Amoxicillin suspension only comes in 125mg/tsp, 250mg/tsp and 400mg/tsp!".. Are we to have some mother who can barely wipe her own ass (but can pop out a kid) measure out 4.7372143 mL's? Hell no! Its fucking amoxicillin! You round up to the nearest strength! Its not rocket science! You could give the kid 2 grams of this shit three times a day and nothing will happen.
If you dont work in the profession, you may wonder where im going with this. Well its a fact of book learning vs common sense. Obvously a "real" doctor would use common sense and just dose said amoxicillin 250mg/tsp three times a day for 10 days and make it easy for everyone. However some CNM looks up in her little drug book (which is probably wrong) and uses her little calculator to do 20mg/kg/day (or something like that) and just blindly writes for whatever number appears as the result. Use your fucking head!
It doesnt end there, oh no!
I've seen them write Hydralazine for itching (supposed to be Hydroxyzine, whoops, you just killed someone). As well as give strengths for drugs that they obvously pulled out of their ass (Ultram 100mg when it only comes in 50's) as well as write for the latest and greatest shit not knowing that it costs 1000 bucks (Zyvox)..
Blah is all I have to say.. But of course because of them us pharmacists can never be replaced by machines.
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Vote for me!
Most CNMs have Master's Degrees...hardly career college.
I just read your entry on prenatal vitamins, and while I think much of your argument makes good sense, I find your references to blonde obstetric pateients in low cut shirts, pelvic exams and that reasoning with a pregnant gal is like reasoning with a turd are very offensive. And that's the opinion of someone with whom a pharmacist with good sense argument about what prenatal vitamin to take COULD reason. I have a feeling it might be hard to reason with you about a lot of things, too.
Damn! .. just found your blog .. can't quit reading it .. it really hits home!
I'm a pharmacist - used to work retail (7 years) - then couldn't stand the 2% assholes, and switched to the hospital scene.
This post hit one of my pet peeves - the resident that is a number hound! S/he whips out his trusty PDA for the dose - punches in the raw numbers and just writes the result! Or better yet, so lazy they don't even write it out - just write "Mannitol, 1.5 Gm/Kg - IVP over 3-5 min."
Had to call that last one back because her calculation would have resulted in a volume of about 500ML .. the equivalent of ten 50ml vials .. over 3-5 minutes?!!! WTF!
They are so STUCK on the NUMBERS without thinking of reality!! The doses listed in textbooks are approximations - not the bible! Many drugs are not distributed to the fatty tissues - so an obese person does not necessarily get 3x's the dose of a normal person! And how do you know the sensitivity of the damn bug you're treating? At least, not empirically - you need to do some sort of Culture/Sensitivity test.
I love the pediatric dosing of Zinacef(cefuroxime) ... (the usual ADULT dose is 750mg, Q8hr) - but, at the top suggested range of 150 mg/Kg/day for children, you can often get a result of 3Gm, Q8hr for a 5 year old!! They fail to read the end of the dosing paragraph that says ".. up to the normal adult dose." Mainly, because they have NO FUCKING IDEA of the NORMAL ADULT DOSE!
And the latest thing?! "Pharmacist to dose" Usually because it's a new patient that they haven't obtained the weight yet. But weight is not the only criteria!! Especially, an antibiotic .. "Levaquin, pharmacy to dose" .. what the hell am I treating!! I made one call just tonite to the nurse: "What are we treating? a UTI or pneumonia?", "Let's see, I have listed dehydration, chest pain and r/o MI .. nothing about an infection." Grrrrrrrr.
Well, have a beer on me after one of those days! Everything you mention has been said by me or a peer many times!
certified nurse midwives now have to complete a masters degree in order to get a license. They are usually on the same level as a nurse practioner. I date a pharmacist who discovered why he thinks pharmacists will never be able to write prescriptions.. Its because that would open up too much debate. As a consumers, I would not like the person who is filing my prescription to also be able to write my prescription. How do I know he has my best interest at hand and not the financial incentives from the pharmaceutical companies.
KJ:
That's a dumb argument:
"As a consumers, I would not like the person who is filing my prescription to also be able to write my prescription. How do I know he has my best interest at hand and not the financial incentives from the pharmaceutical companies."
The same could be said of the doctor/NP you see for your Rx. How do you know your doctor isn't in bed with the pharmaceutical companies?
Thank You
Have you researched OBGYNs and how screwed up they are? I'm sure midwives are able to prescribe things because of the fear women have of OBGYNs. My body can have a baby without drugs and all the crazy, unneccessary interventions a Dr. would perform. Have you read "The Thinking Woman's Guide to a Better Birth"? If a Dr. has high rates for C-section, epidurals, episotomies, induction, etc. - I'm determined to stay FAR from them. BTW - So far, being 6 months pregnant, the only thing my CNM has prescribed is hemroid medication...
hello. to all
i m from pakistan im doing Pharm-d.Can any body tell me can i do M.D after doing Pharm-d???
and which subjects will include and abut the duration of M.D After Pharm-D...thankss
By gosh, Jove, jiminy, cracky, and the NABP,why would I want to add prescriptive liability to my OBRA,HIPAA,CSA-corresponding, and pseudoepehedrine potential liability, and more?
As Bishop said in "Aliens," I may be a synthetic, but I'm not stupid.
I think that you need to get off your high-horse....Doctor's can be getting more done with other's (MA'S, LPNs) writing the prescriptions ...You just want to complain because you are a pharmacist, not a Doctor....Disappointed