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Press Start: Lead an Empowered Life as a Clinical Laboratorian

I Want To Be a Pharmacist

Published October 24, 2010 7:09 PM by Glen McDaniel

I want to grow up to be  a pharmacist. Well, not really: let me explain. I recently ran across a woman who told me how her income had expanded exponentially in the last 3 years since she decided to become an immunization pharmacist. I am pretty up on healthcare matters, but I had never heard of such an occupation before.

I swallowed my pride and asked exactly what she did for a living.  She explained that she is contracted to an independent chain of pharmacies to provide vaccinations to walk-in patients at their retail pharmacists. She gives flu shots and immunizations-providing not just education and counseling, but administering the shots as well. She will sometimes visit homes or skilled nursing facilities and charges per vaccination administered. Pharmacists can do that??

Apparently many professional pharmacy associations with the support of the CDC agree that pharmacists have the knowledge and expertise to provide such a service.

They then make sure this right is written into local pharmacy scope of practice laws, making it legal to do so. Smart!

Over the years pharmacy organizations like the American Pharmacist Association (APhA)  and the American Society of Health System Pharmacist (ASHP) have advocated for an expanded role for pharmacists.

This orchestrated campaign started with making the entry level degree a doctorate. What was essentially a bachelor's degree was morphed into a PharmD using very innovative and creative ways to grandfather current practitioners when the change was made. Patients, physicians and healthcare colleagues started looking at pharmacists with renewed admiration. Who does not respect a doctorate?

It has become common practice for pharmacists in hospitals to do clinical rounding, monitor and manage patients on therapeutic drugs, antibiotics, pain medications, anticoagulants and so on. Not only do they use available lab data to adjust dosage, but in many cases they have been authorized to order the lab tests as well. The pharmacist is possibly the most respected individual on the hospital's pharmacy and therapeutics (P&T) committee.Doctors will ask for clarification or rationale, but rarely question the pharmacist's knowledge or veracity.

The Joint Commission and other regulatory agencies have written standards  indicating every medication order must be reviewed by a pharmacist. All medication in a facility are under the control of pharmacy and the pharmacists dictate what medications are available on the floors, in what form, and in what quantities.

In states like Georgia pharmacists have made a huge push to perform testing for glucose, cholesterol, pregnancy and so on in retail sites.

Pharmacists, quite rightly, have made a case for an expanded scope based on their education and training. This initiative has been a concerted effort by pharmacy organizations that incidentally have very strong lobbyists in state legislatures.

I have become a little queasy about some of their more aggressive efforts, but for the most part I admire them and wonder why clinical laboratorians are wiling to play shrinking violets rather than being more aggressive.

So, no, I don't really want to be a pharmacist; but I really respect and admire what they have done for their profession, scope of practice and patient care.




Before I was an MT I was, and still am, a registered pharmacy tech.  When an order comes to the pharmacy it is checked by the receiver and ultimately by the pharmacist.  If the instructions are not clear, seem ambiguous or downright wrong, or if it is suspected that the patient-Dr. relationship is at best, lacking; it is the duty of the pharmacy, to the patient, to double check.  This is in place not only for the protection of the patients health, but also for the protection of the overworked Dr./nurse that sent the prescription.  It is a system of checks and balances.  

When an order comes to the lab the same thing is done to a degree.  We don't usually know why the Dr. is ordering the test and it really doesn't matter; they want the results of the test they ordered and if we have enough specimen to do that test we are obligated to do so.  However, if we suspect that the test ordered is a typo or a reason for the test is stated and it doesn't match the test ordered; it is our duty to the Dr./patient/insurance company/lab to verify the order to prevent having to call the patient back in and cost the facility or insurance unnecessary monies.

While the two professions offer healthcare services, the outcomes may be very different.  If I dispense an inappropriate medication on doctor's orders, I may kill a patient.  Am I responsible?  Legally, no but if I suspected an error and didn't check it then yes, I had a hand in it.  If I do the wrong test on doctor's orders the likelihood of a patient dying because of that test is low.  The likelihood of a patient dying because I did not check something that appeared to be opposite of what was intended is slightly higher, but still, testing takes time and even a stat test is going to take a few minutes to days (depending on the test) and can be redone.

All this being said my point is not to downgrade the roll that the lab plays.  I think it is a fantastic thing that there are pharmacists who are able and willing to provide these services to patients and I think that the lab is still a Very important part of patient care as well.  As stated, it is the laboratorian's place to push for those powers, not the doctor's place to lift us up.  Also as stated, it does sometimes appear that we as the lab, have 'lesser roles' because of our inconspicuousness and it is up to us to bring ourselves out into the light and petition for a standardization.  As long as we allow the so called upper echelon to dictate how the lab is run it will continue to be so.  Just as the pharmacist has overseers so does the lab and even the pathologist.  Everybody has a boss but it is up to us to treat each other as colleagues and not employees and recognize that there is someone that knows more no matter what profession.  When everybody looks at the entire healthcare field as a collaboration, not as one-up-ment in the rungs of the ladder of hierarchy, only then will there be equality.

Cora Dimitt, generalist - MT December 4, 2010 6:47 PM
Nixa MO


Thanks for the comment. You make an interesting point about the influence of physicians on CLS and other professions. That is simply a matter of competition: few people will willingly cede influence and income to another group.

What's interesting is that although physicians have traditionally held a position of superiority over nurses, they (physicians) have not chosen to regulate nurses, dictate their practice or claim they can be legitimate substitutes for nurses.

Our (laboratorians') willingness to remain subservient to pathologists and to support pathology organizations that clearly state their opinion that laboratorians are simply "pathologist-helpers"  only empower those who do not support our interests.

It's interesting that pharmacists have aggressivley resisted the old "dispense whatever the physician orders"  and created the rule of "as the experts on medications we will review orders, make suggestions, point out errors before dispensing and in some cases change orders based on protocol." That change in paradigm was all the pharmacists' doing. It wasnt done by doctors.

That's what we have to learn and be willing to do.

Glen McDaniel October 30, 2010 2:44 PM

The main problem with the laboratory profession is that we do not have our own board. The ASCP does not advocate for the laboratorian, they are in it for the pathologist.

They will support the pathology assistant not the doctorate in clinical laboratory science.

The profession that have no MD influence like, pharmacy and dentistry are thriving.

The profession that have MD influences like physical therapy (they need a reference from a MD). Optometrist have limited scope of practice because of the Opthamologist they are struggling.

I see nursing reaching the level of pharmacy with the new DNP schools graduating students with the full scope in some states without MD influence.

This progression of our profession has to do with controlling our own profession, since we do not we will only move backwards. This is best illustrated by not having to be licensed in all 50 states and not having one conrete certification agency.

MT October 25, 2010 1:04 AM

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