Welcome to another installment of Ask The Angry Pharmacist, where the most famous pharmacist on the planet (heh) answers YOUR questions and concerns in a not-so-nice (usually) way!
This is a genuine question, so I won’t be burning her at the stake (much) For those of you new here, mail firstname.lastname@example.org with your questions and I’ll answer them on here. Be warned that the answer may end up making fun of you, but I wont publish who you are..
Dear Angry Pharmacist,
My husband and I, (physician and nurse practitioner, respectfully) recently found and subscribe to your blog. Wow. You really are one angry guy.
Before you go hating on us, if you knew us or worked with us peripherally, you would most likely put us in the category of “good guys”. We genuinely appreciate pharmacists who check dosages and allergies, and sincerely thank you if you catch a mistake on our part.
But humor me for just a minute and allow me to ask you something that Hubby and I have always wondered about. Please recognize this question comes from a combined total of over 18 years of higher education, and is meant with absolute respect and sincerity:
Just what is it that pharmacists DO?
We know you guys are smart…colleges don’t go around passing out Pharm D’s based on your looks. And from our own painful experience, we know there is more paperwork and red tape involved in your work than should be allowed by law. But I gotta tell you, from John Q. Public’s perspective, it appears that you guys have these huge bottles of pills in the back, count a few out, put them in a bottle, and put a label on it. Why does that require a doctorate and 7 years of college?
I’m being dead serious, not disrespectful. Oversimplifying it, yes, being jocular, yes, but I really am serious. Hubby and I are above average in intelligence. If we don’t know…and we actually WANT to know…then I am sure the docs with whom you regularly engage in sparring matches don’t have a clue. Even the ones with God complexes.
So, would you take the time to explain to us, and to your readers, what all you guys do? What you studied for 7 years? Maybe it would help them have a better appreciation for your intelligence and get that huge chip off of their shoulder.
(Who am I kidding? That chip is soldiered firmly onto said shoulder. But maybe some people would appreciate it…and you…more. We would.)
Thanks, TAP. Keep ranting.
Just The Nurse Practitioner
Well Nurse Practitioner, you partially answered your own question. How do you think we catch said mistakes and dosing errors and allergies without the 7 years of college? Most pharmacy computers marginally handle this (or go overboard with the interactions part) but almost all the time we do it off the cuff. Amazing isn’t it with all the drugs that are out there.
Let me run down for you what a typical Rx filling process goes like in retail:
1. Patient comes in with an Rx. We get the insurance information, personal information, allergies, etc.
2. Patient has 400 questions about OTC products, we answer those so they don’t bug you about if Tylenol will help their arthritis vs Ibuprofen.
3. We start to input the Rx into the computer. The computer, being a computer, spits back at us 900 drug interactions (99% which are theoretical and drug-food and drug-alcohol interactions) to which we blaze through sorting out the true interactions (warfarin and Codorone, Flagyl and Alcohol, etc) from the ones that are in the system because one idiot in Nebraska had it 30 years ago once. Knowing what is crap and what is a legit concern comes from the 7 years of college (however mostly experience).
4. We learn to find that the Rx is not covered. So we select the next best alternative that the insurance will cover and ask you to change.
5. We bill the insurance (to watch them reimburse us $3 over cost for all this work).
6. We tell the patient how to take it, as well as handle another 400 questions about if it will cause headache, diarrhea, anal seepage, hemorrhoids, when the next shipment of cards will be in, etc.
7. We send the patient on his/her way after a long discussion about how high the $1.05 copay is, and why he/she has to pay it.
8. We spend the next week getting phone-call after phone call from this patient about every little side effect that he/she is having claiming them to be ‘allergies’.
Now, this is if 1 person is bringing in an Rx. Most pharmacies have at least 3-5 (or more) of these processes going on at the same time with only 2 or 3 pharmacists to handle this. Add this with Dr’s and NP/PA’s calling at random times (which causes us to drop what we are doing and get the phone) and you have yourself quite a mess. We don’t get to shove people in rooms to wait and come around to them and work one on one. Imagine if you were seeing a patient in a big room, and someone just came in and tapped you on the shoulder derailing your train of thought. We shovel medical advice out the front door as the money is being spooned in through the window.
This doesn’t even touch on the clinical folks at the hospital who need to know what a patients renal or hepatic status is when selecting drugs. Try to give atenolol to someone with a GFR < 20 and you'll have quite a mess on your hands (hint: use metoprolol instead). Unless you're a specialty doc, we know as much (if not more) about drugs as you guys know about diagnosing stuff. Sure, any pharmacist can diagnose heart-failure, or diabetes, or hypertension just like any MD/NP/PA/etc knows the basic drugs to give, however when someone has no kidneys, or is in hepatic failure, or their insurance doesnt cover it, or how much Tylenol to give to a 4 month old baby, we don't have to look these up. Retail guys don't carry around PDA's or Tarascon (which is full of mistakes, be warned). Sure, we have Lexicomp or a Facts around for the weird stuff, but all the things that you have to look up we know off the cuff. Plus retail folk don't get their heads polluted with drug-company shit from the reps (which reminds me, I need to rag on the reps some more). Finally, (this is a big one), most (if not all) pharmacists have a uncanny ability to translate medical -> commoner. Doctors are notorious for using medical-speak to patients (which sound scary and just confuses them). We are the ones who get the “what does this word mean” when patients get the warning from their doctors about rabdo with statins. We are good at bridging the gap between a very precise big-latin-word based language to the language that is used by people with annoying song ring-tones on their cell phones.
I hope this answers your question, I’m sure that the commenters out there will add on what I leave out.
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