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Press Start: Lead an Empowered Life as a Clinical Laboratorian

Why are Pharmacists Practicing Medicine?

Published August 30, 2015 6:31 PM by Glen McDaniel

A 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.

 

Pharmacists 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.

 

In 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).

 

I 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.

 

My 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.

 

This 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.

 

Medicine 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.

3 comments

Pharmacists know what to do. They limit access to pharmacy school to drive demand up. Then their professional organization comes up with more and more ways to expand their profession. People may kick and scream but eventually come to accept it. I can recall when pharmacists just counted pills. No more. I also remember when they made about $50K per year. I have high school class mates who are pharmacists. They went to school for  a year longer than me. Now because of licensure and a wider and wider scope they make upwards of $100K in many cases

Jermaine Taylor, CLS September 4, 2015 7:32 PM
Los Angeles CA

Very good article. Sha you might be joking by your atatement. But actually pharmacists have been suggesting that for some matters like changing medication dosages, managing some conditions like high cholesterol, then you should see a pharmacist.

They have made it clear pharmacists are THE experts on medication. They question doctor's orders, clarify anything they think is excessive and they have protocols. Some things they refuse to do.

In Georgia the state pharmacy board decided recently that some prescriptions should be electronic. They will not accept hand written scripts. Prescriptions that are printed must be done on special type of paper to prevent forgeries.  What do you think doctors did? They complained but as pharmacists refused handwritten scripts, docs came on board.

This is not to bash pharmacists and it's not to suggest that MLS should do the same. But I want to point out pharmacist set their agenda and make their demands, expand their practice and doctors just go along.

Butina T September 4, 2015 1:35 PM
Atlanta GA

Next  time  you  get  sick  don't  go  to  a  doctor ,  but  go  to  a  pharmacist .  If  they  can  over-ride  doctors  then  more  power  and  responsibilities  to  them  too .

sha malik September 3, 2015 2:25 PM

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