Our pharmacy practice roles continues to expand, registered technicians are taking on technical roles, and we are focusing more on our cognitive responsibilities. Some of our patients don’t necessarily understand these changes. I’ve started to hear this question or various shades of it like … “Isn’t that my physician’s job?” “Shouldn’t that be my Physician’s problem?” “Why do you need to know that, you are just a pharmacist?”
In the epic battle of what a physician can do, a pharmacist can do too vs. what a pharmacist can do a physician can do better, neither profession wins. It is the very essence of division of labor for maximum productivity in our society that individuals specialize and cooperate for the synergistic benefit of all. Many smart people have recognized this, I think, after Plato who wrote in The Republic
“Well then, how will our state supply these needs? It will need a farmer, a builder, and a weaver, and also, I think a shoemaker and on or two others to provide for our bodily needs. So that the minimum state would consist of four or five men…”
We view things from different perspectives to improve the overall outcome for our patients, and neither profession bears any characterization of higher intellect/ morals. The truth is, pharmacists are trained to know a whole lot more about medications than physicians, and I certainly was not trained to complete physical assessments or diagnose complex care cases. Yet, it is fascinating to me how physicians and some patients get their panties in a bunch over this topic.
Case in point, is a letter I received from a physician 3 years ago, when I had merely pointed out that our mutual patient had a significantly elevated blood ethanol level (despite denying any alcohol consumption) and was experiencing several episodes of post prandial hypoglycemia (about 3 hours after several meals every week) despite several attempts at dose changes. I had merely suggested a switch from Insulin Toronto to a rapid acting insulin, and asked the physician if he could speak to the patient about alcohol consumption (because, the patient was obviously not being upfront with me; I had hoped both I and the physician could intervene).
Instead of collaboration, I received this letter>>
Ps: This letter is now a part of the tools used to prepare my students for the worst case scenarios in attempting to collaborate with other healthcare professionals as they go about caring for our patients.
This patient spent another 2.5 years experiencing several bouts of hypoglycemia per week with hypoglycemic unawareness. At some point this year, another specialist recommended (as I had 2.5 years ago) rapid acting insulin with each meal. I am uncertain about his current alcohol consumption, but the number of hypoglycemic episodes dropped substantially.
As a side note about some of this particular physician’s comments:
On the comments about accessing Netcare: Our Standard of Pharmacist Practice actually requires that any reasonable Pharmacist would have, in this circumstance, considered appropriate information:
Standard 3.4 Appropriate information means the following information in relation to a patient: a) health condition to be treated and history of the condition; b) symptoms or signs to be treated; c) treatment history for the condition including drug therapy and outcomes; d) age; e) pregnancy or lactation status, if applicable; f) allergies or intolerances to drugs, excipients or other products that may affect drug therapy; g) other drugs or blood products being used; h) other health care products, aids and devices or other products being used that may affect the pharmacist’s decision; i) other health conditions that may affect the pharmacist’s decision; and j) any other information that a reasonable pharmacist would require to provide the pharmacist service.
Standard 3.6 When interaction with the patient or consideration of patient-specific information indicates that a pharmacist should review laboratory data and the data is not available, the pharmacist must:
a) order the appropriate laboratory test, or
b) contact an appropriate regulated health professional and request that the laboratory test be ordered.
On the comment about my inability to interpret lab data:
I am not entirely sure how else I could have interpreted a lab value of Blood Ethanol Level: 31 mmol/l and regular occurrences of FPG <4 several times in the week.
On the comment about Physician liability:
I am 100% liable for my decisions, actions, counseling, suggestions … etc. What I suspect is that many physicians do not recognize is that we are fully aware of the implications of our actions; we check and double check several studies and texts to back our suggestions up. The whole point of a pharmacist is essentially to mitigate medication risk to our patients and optimize pharmaceutical care, and we are fully aware about the implications of our interventions with regards to keeping our license.
Why are pharmacists so important?
Because, there is a good chance the pharmacist knows the time of onset, peak, duration and other such important pharmacokinetics as well as detailed mechanisms of action, interactions, clearance patterns etc about drugs. When pharmacists contribute such knowledge in their practice, it optimizes patient’s care for the best possible results. Pharmacists are here to provide great patient care in dispensing medications and optimizing pharmaceutical care through the various activities deemed now as our “expanded role” such as medication adaptations, prescribing, and medication assessments as advocates for our patients. This is our role: To dispense and manage medication use collaboratively for optimized patient care.
Can a physician do a pharmacists job?
First do no harm…
Asides from the obvious conflict of interests involved in having the diagnostician responsible for dispensing as well, pharmacists are the final check in the system to ensure that patients receive medications that are appropriate, safe and effective. We in addition, provide follow up counselling to ensure that medications are adhered to in order to reach treatment outcomes by monitoring our patients, and by being easily accessible to our patients. It is in fact impossible for physicians to do our jobs and ensure patient safety.
So, I thank you physicians who work with us collaboratively as we focus even more on our cognitive roles… and…
I beg the other physicians who currently do not understand us, do show us some love next time you receive our intentionally helpful messages. We really do not care for infringing on your territory, we just want to stay in our lane and optimize outcomes for our patients. Tis all!