I know some people would argue that pharmacists answer questions for patients, but the two times I had very simple questions about common medications, the pharmacist told me to wait while they read the drug information sheet which is always stapled to the bag, and then said that the information sheet didn’t say anything about it. I already read it myself, what do I need the pharmacist for? They didn’t even have the prescribing information sheet that doctors have which gives more information. I had to go online to get my questions answered.
And it looks like neither patients nor doctors are consulting pharmacists even in a hospital setting. At http://talk.collegeconfidential.com/archive/index.php/t-3856.html
someone writes:
“I volunteered in a hospital pharmacy, and at least there, there was absolutely no patient contact and doctor contact was severely limited. The only contact with the rest of the hospital was when a pharmacist had a question about an order, and had to call (usually) the patient’s nurse or (less often) the doctor. If you are interested in having lots of patient/doctor contact, maybe nursing is more your thing?”
Some might argue that pharmacists can sometimes mix new medicines, and need the training for that. But according to this: http://www.dfw.com/mld/dfw/15158278.htm
such mixing is dangerous and widely discouraged (as I think it should be).
As far as checking all the patients medications to see if there might be any dangerous interactions, I’m sure this is all done by computer now anyway, with the computer alerting the pharmacist if there is a problem. This routine could be incorporated into the robot’s programming.
Finally, we have some pharmacists refusing to fill prescriptions they have an ethical objection to: http://www.cbsnews.com/stories/2005/03/29/earlyshow/health/main683753.shtml
The doctor and the patient want the patient to take the drug. Why do we need to run it past the ethics of a third party who has no business in the matter anyway? Using robots instead of pharmacists would eliminate the whole problem.
Finally a robot is less likely to give the patient the wrong drug, or the wrong amount. I once was supposed to get two pills a day for 30 days, and was only given 30 pills! And I’d started a road trip when I realized this, had to drive back, wait, and then set out again.
Healthcare already costs too much in this country. Why do we need to add to the cost by paying pharmacists? From:
“Nationally, the average pharmacist made $88,650 in May 2005.”
That is way too high for what mostly amounts to pill counting, and a robot could do it much cheaper.
The only reason pharmacists are employed now is likely because of laws requiring them. The laws should be changed to allow their replacement with robots.
I don’t have too much to add beyond saying that generally I found your OP to be relatively persuasive. I’m confident that someone from The Dope will be in to defend the current model of pharmacist-driven prescription filling shortly, but I’ll agree with you at this point in eliminating most pharmacists.
You seem to have cherry-picked a bunch of references to support your views on the usefulness of pharmacists. Contrary to popular belief, pharmacists are more than pill-counters. They know more about drugs than most doctors. They are a valuable sanity-check in the drug dispensing process.
And then there are those who refuse to dispense a drug like birth control pills because they have some kind of moral objection to it, thereby making it difficult or impossible for a female patient to obtain the most effective birth control that is reasonably affordable and non-invasive.
Or they could just be like the bionic moron who worked at the pharmacy where I went to get my birth control script refilled - the one who told me that I couldn’t get a refill on it until 30 days after the date it was last filled. Yeah right buddy, there’s 28 pills in a package and you don’t just skip two days. Skipping two days a month means you might as well not even take the damn things!
It took me and the female pharmacy tech twenty minutes to explain to the bionic moron pharmacist that you most certainly are not supposed to take 28 pills, wait 2 days, and then start again while he argued that ‘If you were supposed to take one every day, there wouldn’t only be 28 in the package’.
Also - are you sure you were addressing a pharmacist rather than a pharmacy tech? People frequently mistake one for the other because they’re both behind the counter, but there is considerable difference in training and knowledge. It’s not uncommon for the pharmacist to be in the back at work and the techs to be the ones handling customer interactions.
And that was a long-term grievance of my father when he worked in hospital pharmacy (for about 30 years). There were times when docs prescribed conflicting medications, or inappropriate doses, and he had to chase them down to clarify whether or not it was a handwriting error or a doctor being stupid about things.
The hospital pharmacist acts as a check on the doctors - he’s not to fill prescriptions that put the patient at risk, and is liable if he does, even under “doctor’s orders”
Hospital pharmacists have never had patients contact, not even in my father’s generation and certainly not since.
As a routine measure, when there are adequate commercially available products available, I’d agree. However, there are and will always be people who don’t fit the mold. My father also worked in this area and would custom mix drugs for people allergic to things like binding agents and dyes in commercial products. He mixed chemotherapy drugs for cancer patients (which, by the way, is hazardous to the pharmacist - chemo chemicals are highly toxic and he had to take great care to protect himself as well as the sterility of the medication) He also mixed medications for ophthamologists in the Detroit area, as there are concerns with eye medications. I will also emphasize that he did so under strict sterile conditions and great care - he wasn’t mixing custom-flavored cough syrup in the back room of a Walgreen’s, nor did he make large lots of anything or sell them for profit. He was compounding for medical reasons where there were no alternatives for the patients. We do need compounding pharmacists… but not as many as are currently trying to make a buck off the practice.
As a matter of fact, this is NOT routinely done by computer. I wish it was. It’s hard to get people to adapt to new systems, particuarly outside the major urban areas and teaching hospitals. A lot of medical record keeping and prescribing is still entirely paperbased.
You also have the problem of people seeing multiple doctors who don’t communicate with each other, and filling prescriptions at difference pharmacies. The computer won’t ask the patient “do you get any pills at another drug store chain as well as this one?” A human (I hope) would remember to do so. A human can also read a patient’s body language and facial expressions to determine if further questioning/explanation is needed. A machine can’t do that (yet). A human can also handle communication problems better than a machine. This goes beyond simply slurred speech from a stroke or a blind person unable to see a computer screen. People misprounce medication names, they don’t know how to spell them, sometimes they don’t even know what the pills they are taking do. Most computer programs along these lines I’ve seen/heard of operate under the assumption that people can spell correctly, know what they’re taking and why, and make no allowances for stress.
For all of the above, we stil need the human touch. Whether we need pharmacists for that I’m not sure, and could probably argue either way, but the point is that the automated systems aren’t perfect.
You see, computers/robots handle the routine stuff better than humans. And they’ll remember to ask “are you allergic?” every single time. But when you get oddball/unforeseen situations the humans still handle it much, much better. So what you really need is technology that complements human capabilities, relieving the human of the tedious and routine so he/she can handle the areas where humans excell - troubleshooting and odd situations.
And someone who can’t fulfill the duties of a pharmacist should lose their license. If that means we will have no Fundy pharmacists so be it.
Not if the robot was programmed by someone with ethical objections to the medication!
Which brings me back to my point that machines handle the routine and tedious much better than human beings.
Do you think computers and robots are free? How much do maintenance on those systems cost? How much will you pay the manufactuer and the technicians required to keep these machines functioning? How much to the inspectors who make sure the robot is dispensing correctly?
I worked for a methadone clinic that moved to automated dispensing of methadone. The system cost a LOT. It required regular inspections by government authorities (which we had to pay for) and maintenance. The up side was absolutely reliable dosing, the nurses no longer had to handle methadone directly (which they were happy about), we had much less spillage and loss (because people are human and any process loses some material), and the drug was much more secure. On the downside, it did malfunction occassionally, so we had to keep the old-style dispensing equipment on hand - you can’t ask people to simply wait two days for the repair guy to show up when they’ll be entering withdrawal in a day. That also meant you needed someone trained and licensed to dispense the correct doses. You needed humans to monitor the machine, troubleshoot it. It took methadone only in a standarized bottle - which, due to concentration and purity, had a street value in the six figures. What we saved in nursing costs we paid for in armed guards and security to transport the methadone - you couldn’t expect a middle-aged female nurse to carry that around without getting mugged, after all.
In the end, it saved us no money whatsoever. It did make things much more accurate and the methadone much harder to divert. All worthy causes. But it’s an example where moving to automation saved no money whatsoever. Personally, even if the dollars break even it’s worth it for better accuracy, safety, and security but those promoting these as “cost savers” aren’t accounting for all the upstream and downstream costs.
I’m always amazed when someone declares someone in another field “makes too much money”. How are they making that judgement?
Also, again - I’m not convinced that robots always result in overall savings.
There are no legal obstacles to using automated dispensing of medications NOW - the clinic I mentioned earlier was doing it back in the early 1990’s, fifteen years ago.
You do, however, need people to make sure the machines are functioning properly and accurately. You need people to handle the non-routine cases. You need people to provide backup when the machines stop working or the power goes out during some catastrophe. People don’t stop needing medicine when a hurricaine hits and the first floor of the hospital floods and you’re working with emergency generators and flashlights.
What I’d like to see is to move to where machines take over the grunt work/pill counting and the human pharmacists can work at the interesting stuff where humans do best.
As I’ve mentioned before, I deliver medicines for a pharmacy that serves nursing homes. I’ve become acquainted with several of the pharmacists who are employed there and I’ve learned more than I ever imagined about their role in health care. These men and women become very familiar with the medicines a given patient is taking; they are quick to spot inconsistencies and dangerous combinations. Before they will fill a suspect prescription, they will consult with the doctor and often point out drug interactions that a given doctor is unfamiliar with. Further, they monitor the work done by pharmacy techs; they physically verify that the specified medicine and dosage is being dispensed and they physically verify that all label information is correct. Plus, these people are responsible for maintaining inventory records and they are in absolute control of a lot of very heavy duty narcotics.
In short, they do a lot more than simply count pills from one bottle to another—and, in the pharmacy with which I’m familiar, the pharmacists regularly compound medications. I am regularly astonished at the amount of information they have at their finger tips; some of them have memories like tombstones. I wouldn’t want a computer to do what these people do.
This is the only sentence in an otherwise stellar post that I would disagree with; had you entered a “some”, I’d agree.
My second dad is a Pharm.D. Clinical Pharmacist (That means he has a Doctorate in Pharmacy) for the largest children’s hospital in Chicago. He is a stellar pharmacist - not only in compounding drugs - which he still does a lot of, and safely - but in patient and family education, nurse and doctor education and community education. He’s the kind of guy with the “Asimov/Hawking Gift”: he can take incredibly complex issues, involving all sorts of specialized knowledge, and explain it so that a reasonably bright 7 year old can get it.
(He also, when I was struggling with trigonometry in high school and wailed, “When am I ever going to use the stuff?!” smiled, pulled out his graphing calculator, and said, “Oh, this stuff? I use this everyday at work. Let me show you how neat it is.”)
He still has a lot of patient contact, although less than he had before his teaching duties got to be so much. He works a lot with the Neonatal Intensive Care, and those little bitties just don’t respond to medication like regular people much of the time. Everyone - doctors, nurses, pharmacists, therapists - are watching them like hawks to see what they’ll do next. As one of our nurse Dopers once said (I’m paraphrasing from memory): “I hate working with preemies. They feel funny and try to die when you give them a bath.”
He’s forever working out new regimens, finding new ways of compounding drugs to administer them to babies who can’t tolerate the premade stuff. If you weigh 600 grams, you can only tolerate a few cc’s of fluid every 12 hours. What if your patient needs 3 medicines which come in 5 cc doses to be given every two, four and five hours? That much liquid would kill a baby that size. His job is to figure out what to do about that.
In addition, his job is to learn about new drugs as they come out, and teach the doctors about them. I’d much rather my doctor was learning about new drugs from a neutral pharmacist than a drug company representative!
I think it’s probably fair to say that *some *job duties of *some *pharmacists could be fulfilled by automated machines. But not all duties, and not all pharmacists.
I <3 my Dad, and I’m very proud of the work he does.
My father is a pharmacist, and here are some of his job responsibilities:
[ul]
[li]Educate clinical staff about medications, particularly new ones or ones with new uses.[/li][li]Watch for not only interactions, but also possible over- or undermedication. Many of the patients his pharmacy serves are elderly, in whom overmedication or undermedication can severely affect quality of life.[/li][li]Ensure that all patients have regular bloodwork to detect certain side effects.[/li][li]Ensure that all medications that leave his pharmacy are correct for medication, dose, form, and label.[/li][li]Watch for possible drug diversion.[/li][li]Ensure that his pharmacy meets state and federal standards.[/li][li]Watch for unusual situations; for example, a drug that may not be appropriate for fertile women may be OK for a woman who is infertile.[/li][/ul]
Those are some of the things he does. He loves the robot pill-counters; they save him and his techs a lot of work. But no computer currently available can possibly substitute for human judgment. And with all the meds currently available, that’s more important now than it ever has been.
Oh, and catsix, my father does not put up with moral objections to things like birth control. He’s fired pharmacists for that.
On review, WhyNot and I could be sisters, but my father has never practiced pediatric pharmacy. Although he did drag out some of his pediatric dosing formula cheat sheets for his grandson.
Rather, he practices geriatric and hospice pharmacy, which has challenges of its own. There’s nothing like trying to explain to some doctor that you can’t crush this drug or that to put it through a feeding tube.
MsRobyn, thanks for sharing the other-end-of-the-lifeline perspective. I was pretty sure that hospital pharmacists are just as hands-on with other populations, but I only know the specifics of neonates.
My dad (and probably yours) always says that hospital pharmacy is nothing like drugstore pharmacy. I think maybe the OP is basing his opinions and arguments on drugstore pharmacy, which is understandable, as that’s the type of pharmacy most people see (or think they see.)
It’s always handy to have Dad to call when I need to give the baby some Tylenol, but she’s gained two pounds since we were at the doctor’s last - I know I could look it up myself or call the doc’s office, but I feel so much safer relying on his expertise. And, of course, when she was born 4 months preemie, he was a fantastic resource and reassurance for me (although she was in a different hospital). That’s when I really started to understand when he’d been talking about all those years.
He’s probably also smart enough not to tell a patient that she can’t have her refill until two days after her pill-pack runs out.
When the management of the store wouldn’t take the time to understand my complaint about him, I switched pharmacies completely.
BTW, it’s not an insurance thing either, since my ins. company will pay for the pill every 21 days to make sure that I don’t run out. Pills are cheaper than babies.
Actually, while all the other stuff mentioned by Broomstick, WhyNot, MsRobyn, and others is valuable, the most important reason why we need a human rather than a computer is that it takes a human pharmacist to go fight with the idiots at the insurance companies and Medicaid to get payment for legitimately prescribed drugs when some bean counter or bureaucrat has decided they can save a couple of pennies by putting barriers between the patients and ther funds for their medicine.
That, too. There was a story on NPR some time ago about a state’s Medicaid plan. It only covers five prescriptions a month. Period. If you get an infection and you’ve already used your five prescriptions that month, you don’t get antibiotics until the next month, when you decide which of your regular prescriptions you can do without (or can get samples for). (I think this is it.)
catsix, my father’s pharmacy deals with contraception very rarely, but it does come up. You probably dealt with either a newly-minted pharmacist or a tech. Still doesn’t excuse the stupidity, though.
Patient contact for hospital pharmacists is virtually nil. However, since we have automated, error rate has gone somewhat down, I believe…and costs have gone way up. Automation is not cheaper than using humans, even better-paid-than-I-am humans. (This was all pointed out by a previous poster.)
I am very busy, but not with dispensing medications anymore. I call nurses and doctors all night long. I deal with mistakes, errors, near-misses, wonky insulin doses, drug interactions, refiguring doses for patients in renal or hepatic failure, and all-around failure to communicate. I work at a teaching hospital, and the “baby docs” can’t be taught by robots.
In our system, we could theoretically take pharmacists out of the system entirely by having only technicians make the IV’s and do the compounding (with no checking by anyone with any education greater than a high school diploma and a few months of tech school), and by having doctors enter their own orders, which the nurses would then pull out of the machine. Noting the number of mistakes and problems I deal with every single shift, this would kill patients like flies. Untrained doctors + harried nurses (with widely varying levels of experience and knowledge) + undereducated technicians = huge error rate. The machines are only as accurate as the people who program and use them.
I’ve never worked retail, but the person who wouldn’t refill the birth control until 30 days were up is a complete moron. Sorry, but every field gets a few losers now and then. What an embarrassing dork.
A lot of people in my family are pharmacists (for some reason unknown to me, pharmacists tend to run in the family). All the ones in retail currently use machines to count pills and they almost never compound anything and they are constantly bitching about being treated like a cashier. The ones in a hospital setting make less work harder (they actually do make compounds) but they pretty much only deal with other medical professionals. I am somewhat familiar with the role that pharmacists play in health administration but I may miss something.
The most noticable role that pharmicists play is that of gatekeeper. They act as a check on doctors (check in the sense of “checks and balances” not in the sense of “check and make sure the doctor didn’t screw up” although that is also a vital role of the pharmacist). They detect phony prescriptions in a way that machines probably can’t. They also know more about drugs than just about any doctor and will notice interactions and misprescriptions.
There is a shortage of pharmacists so perhaps pharmacist wages are higher than they might be if we just let anyone be a pharmacist but my impression is that pharmacy is a 6 year degree and the admission criteria is competitive. My impression is that pharmacists catch a bad drug interaction (not necessarily fatal but a bad one one that can be avoided by using a different drug) several times a day and spend a lot of time convincing doctors to use the “new drug” that has only been on the market for 10 years. My impression is that they catch bad dosages every day. My impression is that they catch fake prescriptions or “doctor shopping” for prescription narcotics on a pretty regular basis.
Now most pharmacists also use machines for pill counting and spotting ineractions but interactions are about more than just spotting them, you have to call the doctor (because while the pharmacist might know the drug that “should” have been prescribed (heck my impression is that once the doctor diagnoses an ailment, the pharmacist is in a better position to prescribe the appropriate drug than the doctor is) that would breach the wall between the prescriber of medication and the dispenser of medication that is the “check” in the system). I think that most pharmacists are overqualified at places like CVS and retail drug chains have been leveraging the heck out of these pharmacists with pharmacy techs who do a lot of the grunt work but in the end, you want a qualified human being to look at stuff and put their license on the line and say everything is OK.
My brother is a hospital pharmacist for a large urban hospital. Part of his duties include rounding with the rest of the medical staff, where he makes significant contributions to the development of treatment strategies. I’m not altogether up on all the ins and outs of the rest of his duties, but it doesn’t strike me as reasonable to suggest that he could be replaced by a robot.
I’m sure that anyone could develop an argument that any professional could be replaced by a robot, if only they could be programmed precisely and machined to carry out any job-required movement. What is it that the OP does for a living?
