Sunday, August 1, 2010

Patient counseling

While exploring the website the other day, I came upon an article from last December that quoted an article from JAMA. The article called for more pharmacist involvement in medical teams, specifically medical home teams. Sounds like a win for pharmacy.

But there was a quote that grabbed my attention. “Doctoral-level trained pharmacists would not count pills. They would counsel patients about complex polypharmacy regimens and spearhead interventions to eliminate medication errors...."

A couple things came to my mind. First, the author of the JAMA article basically says that all that pharmacists with bachelor's degrees can do is count pills. Blood starts to boil at this point. Maybe the JAMA author needs to spend a day shadowing a community pharmacist to see what we actually do.

Second, why can only doctoral-level pharmacists counsel the patient? Isn't the license granted to pharmacists with bachelor's degrees good enough? Did things change on me somewhere?

I will grant you that the pharmacists coming out today probably know more than I did when I graduated. That doesn't make them better pharmacists, it means that more is known about medications than there was known in the past.

But counseling patients isn't about your book knowledge. It's about communication skills. When you counsel a patient, your part of the dialogue must be tailored to the patient's level of comprehension.

To me it's interesting to see the difference in communication skills of the students who do their rotations at my pharmacy. I have had kids who could tell me the entire metabolic pathway of febuxostat (before it was even approved), but couldn't explain to a mother how to use an Aerochamber with her child's inhaler. I've had others who I wondered if they could pass the NABPLEX, but they could make our illiterate patients understand what each of their six medications was for and how to use them correctly.

To be an effective pharmacist, I believe that you do need to have contact with the patient at the retail level. Where you can see the patient's reaction to the price of their medication. It doesn't do Mrs. Smith any good if you can throw together a regimen of Coreg CR, Tekturna, Lipitor, Lovaza, and Januvia when she can't afford it. Sure, that may be the best regimen for her from a clinical standpoint, but she may only be able to afford carvedilol, lisinopril, lovastatin, and metformin.

In my opinion, an affordable treatment plan that the patient will take every day beats an expensive treatment plan where the patient skips doses every time. I don't think that it takes a doctoral-level trained pharmacist to do that.

It takes only one thing....a Registered Pharmacist.


Pharmgirl said...

You took the words right out of my mouth! Communication, education and problem solving are what we excellent pharmacists do best. How many times have you asked a patient what their medication was for and they had no idea? They were just given a prescription and told to take it. How many little old ladies have admitted to you that they take their expensive diabetes med every other day to try to avoid the donut hole? She will never admit that to her doctor. What you described is our exact ideal role in the health care system. And patients cannot take their medication properly unless they receive the right drug, at the right dose, at the right time. And for that, you need a dispensing pharmacist. I will NEVER be ashamed of "just" being a retail pharmacist!

Anonymous said...

Doctoral pharmacists not dispense? How are we going to keep up with the complexities of the job, as part of the whole realm of providing pharmaceutical services?

When I started BS pharmacy program in the late 70's our school made it desirable that not only profs had good research backgrounds, etc. but had RPh behind their name at some time in their career, and preferably kept up on that license.

I admit that I went back for the PharmD after several decades in institutions BEFORE actually picking up retail shifts, so I didn't have a lot of patient contact, though I did fill scripts in out-patient pharmacies. However, I find it reprehensible if pharmacists do not understand firsthand the nature of the beast in pharmacy, bringing pharmaceuticals, both drugs AND knowledge to the patient, as the DRUG EXPERT.

After all, our state boards do not license us as doctors, but registered pharmacists.

Katie said...

In defense of the newborn PharmD's... I've chosen a clinical path for myself-doing the whole residency thing. But I honestly find I miss some of the retail scene. Not the problems naturally, but my happiest intern days were when I could walk with a patient to the OTC aisle and help them. Or explain something until I saw the comprehension dawn on their face. While working in the hospital, I saw no problem hopping to our outpatient pharmacy and pulling some time there to cover a pharmacist who had to go home ill, take a dinner break, or just lend an extra hand.
But from the inpatient side of things, there have been several times that I can recall intervening with some prescribers with discharge Rx's. I remember a post-MI patient who I was talking to about compliance (since she had been previously non-compliant, and was relatively young for an MI) and bingo, cost was an issue. I look at her chart and everything was brand name. I intervened with the PA (grrr) and was able to talk everything but the Plavix into generic.

In my current residency, there is no staffing component. I was actually disheartened to realize this, because I do realize that one of a pharmacists' primary jobs is in the medication distribution processes. I miss this part of the job.
I acknowledge that any experienced pharmacist knows more than I do, in terms of real-world practice.

Maybe I am exception, but I really hope that most young pharmacists have a similar attitude to mine.