Why are Pharmacists Practicing Medicine?
few days ago I was speaking to a physician, an ID specialist, who shared how
frustrated he was with, as he put it, “pharmacists telling us how to practice medicine.” He is
a member of a healthcare organization which, like many today, has a fairly specific
formulary. Physicians are restricted as to the medications available for
routine use. All off-formulary orders must be justified to various degrees.
have done a phenomenal job in driving better medication utilization. They serve
powerful roles on pharmaceutical and therapeutics (P&T) committees where
they not only offer guidance, but also critique on medication use. They have procedures and protocols meant to effect more efficacious use while controlling cost.
many organizations clinical pharmacists guide anticoagulation therapy and
direct therapeutic drug monitoring (TDM). In states like Georgia pharmacists order and
and in some cases even perform some laboratory tests. Lately pharmacists have taken to administering common vaccines
as well. Again in Georgia state law has been modified to increase the scope of
pharmacists who have a strong lobby (including pharmacy-legislators).
understood the frustration of my physician friend who, as he explained, was recently constrained
form ordering the expensive Zyvox for a patient with several gram positive
organisms showing resistance to the on-formulary medications. His latest outburst was prompted by a block from ordering Synercid for another patient.
thought immediately went from empathy for the ID doctor to a comparison of how far away from
controlling utilization the laboratory profession is right now. We do have small utilization projects
from time to time, but generally we are far from being able to dictate
laboratory test selection and interpretation. I have long advocated a laboratory formulary.
doctor probably had reason to be frustrated, but for the most part pharmacy
expansion of scope of practice has been accepted (and even welcomed) by the medical profession and by administration.
is a team sport and we all have to work together. That should mean drawing on
the expertise of each professional role. We have different bodies of knowledge and add value to the patient in a different way. Exerting influence should not mean overstepping your
expertise, but it also should not mean a physician with little a laboratory
training, overwhelmed by data dictating medical laboratory utilization.