Given that AFAIK most retail pharmacists no longer compound or prescribe medicines themselves . . . why do they really need all that training?
The first (and last) answer I came up with was “Uh . . . drug interactions?” Okay, I’ll buy that. But that many years, to learn how to prevent interactions that (today) are also being screened for by the computer?
I’m putting this here because (without meaning to) I’m sure I will offend pharmacists, who will explain that their job consists of more than moving pills from big bottles to little bottles, and why all the training is necessary. And I’m happy to learn why that is. Apologies in advance.
The short answer is that the training provides pharmacists the necessary scientific background to understand how and why drugs work the way they do. I find that important because it enables them to explain and elaborate the warnings that come with many medications, but tend to be vague. For instance, many currently popular prescription drugs warn you not to drink alcohol while taking them…does that mean merely not to use a shot of Scots whiskey to wash the pill down, or does it mean you should abstain from alcohol if at all possible?
Pharmacists are also very helpful with questions about OTC products. As many products move to OTC status, that means more things they need to keep up on.
They’re more than just guardians of the controlled substances.
It’s good to have someone knowledgeable to put these questions to.
The simplest answer is that your “AFAIK” is simply wrong. Most pharmacists are not retail pharmacists, and most retail pharmacy is not pill counting and packaging.
Pharmacists require all that training simply because pharmacy school prepares us with the basics needed to work in ANY pharmacy environment. We need the medicinal chemistry (and by extension, it’s precursor organic chemistry) so that we understand how the chemical structure of two different drugs may affect how they work. We need biochemistry to understand the basic functioning of the body at a sub-cellular level. We need anatomy and physiology because we need to understand how the body is supposed to work under normal conditions. We need pharmacology to understand just what it is the drug is doing to the body. We need kinetics to understand what the body is doing to the drug (which is where your drug interactions usually come into play). We need statistics and training as to what constitutes good sources of drug information for obvious reasons. We need pathophysiology and therapeutics so we know what potentially went wrong in a disease state and what we can use to treat it–which includes both drug and non-drug therapy.
We use all that information to glean from your medication history, your prescription, and other information you’ve told us what it is that’s wrong, so if there’s a problem with the medication, we’re ready with an alternative (or two) for the physician. We’re trained to know what sort of questions to ask if we don’t have enough information.
Yes, the computer will alert us if the tech entered in an “allergy” to sulfa, but the computer can’t tell you if said allergy is clinically important or not (sometimes it isn’t, since often it isn’t a true allergy). The same holds true for drug-drug interactions. Or drug-disease state interactions. The computer tells us what the interaction is, but our training (should) tell us whether or not that interaction is significant.
In more hospital/clinical settings, we oftentimes are asked by the physician to dose a drug properly (taking into account kidney and liver function and other factors). We get asked for recommendations constantly, whether in retail or elsewhere, as to what drug/dose/length of therapy to use. We get asked all manner of questions about OTC drugs and nutraceuticals.
We act as a final safeguard to protect the public from things the physician might not have known or had missed. Or against mistakes a technician may make when inputting a prescription.
Our training gives us the tools necessary to do all of that. So yes, we really DO need all of that training.
(That’s not even mentioning the various board-certified pharmacy specialties requiring additional training after we finish pharmacy school that we can pursue, or the growing role in administration of vaccines pharmacists are playing)
I didn’t know this interesting fact. I thought, pretty much, the doctor always figured out the dose on his or her own.
Here’s another interesting fact that not even most pharmacists may be aware of: According to a book that I read long ago, the precursors to pharmacists in the Western tradition were the alchemists. As a necessary side effect (hah!) of all their futile tinkering to transmute metals and discover the Philosopher’s Stone, they actually discovered some useful chemistry and learned to handle lab materials properly. Physicians gradually began to consult the alchemists about drugs, and ask them to compound them.
It used to be that way. Nowadays, though, pharmacists are being trained to do the dosing and med students/residents are being trained to let the pharmacists do it–at least in the facilities I’ve been in.
One of my rotations this prior year was shadowing the clinical pharmacists who were in charge of monitoring all of the hospital’s surgical patients. They were in charge of adjusting the doses (independently of the physicians due to the hospital’s very progressive P&T policy) of antibiotics, anticoagulants, and other surgery-related drugs, and often were asked to dose them as part of the original orders rather the physician dosing.
Pharmacists are also increasingly being employed to dose warfarin (a very tricky anticoagulant to dose) under collaborative practice agreements with physicians and hospitals. During my NICU rotation, we dosed TPNs, antibiotics, and drugs used to treat common premature birth related conditions. Also, for two months, I worked in a pharmacist-run diabetes management clinic adjusting the doses of diabetes, hypertension, and high cholesterol medications in conjunction with physician oversight. And last but not least, for two months I rotated in a palliative care pharmacist consulting group, making recommendations as to drug choices and dosing for symptom management in terminal patients.
And that stuff is happening all over the country, not just here in Ohio. Retail pharmacy, honestly, is only one small aspect of what we can do.