Here’s a question for professional pharmacists-( “chemists” for Britdopers)
I dont want to besmirch your profession–but what exactly do you do, and how do you feel about it?
Every time I’ve ever had a prescription filled , the person standing behind that forbidding, elevated counter is nice and friendly. They smile.
Then they take a big bottle of pills off the shelf, count out 21 of them for me, and write “3 times a day for 7 days” on the label.
For this, you studied 5 years?
20 years ago, I actually had a pharmacist REFUSE to give me my pills. My doctor had written a perscription for 21 pills of 50 milligrams each. But the pharmacist only had pills of 25 mgs in stock. So I suggested," hey, if you give me 42 of the smaller pills, and I swallow 2 together each time, won’t I get exactly the same medical effect ?" But he told me that by law, he could only give me precisely what the doctor had written.
I wanted to ask him why he worked in a profession where he was not trusted to use his professional judgement in any way.
(I hope the laws have changed , now that generic drugs are more common.)
The Brits call the profession “Chemists”, probably because 75 years ago the pharmacist actually ground the chemical powders himself, using his knowledge to make the medicine.
But today, it’s all a matter of corporate brand names and insurance forms.Is this a rewarding career?
they also have an advisory role for people with medical questions relating to pharmaceuticals and they watch out for drug interactions.
I’m not a pharmacist, but my dad is. Its actually 8 years of university here in the states (4 year undergrad in chemistry, 4 years of graduate for a doctorate in pharmacology).
Actually, pharmacists are far more likely in some cases to catch drug interactions than doctors. People frequently have multiple doctors for various medical problems, but unless they’re scamming for abusable prescription drugs, they generally only have one pharmacy for all their prescriptions. People tend to forget to mention little, minor, piddly things like the three cardiac drugs they’re on to a new doctor, which can lead to scripts for things with major interaction potential. The pharmacist is in a much better position to catch that.
They can’t just go around changing scripts withou okaying it with the prescribing doctor for legal reasons. If you tinker with something and that tinkering leads to a negative patient outcome like, oh say, death, guess who’s ass is grass? If you okay the tinkering with the doc, though, negative patient outcomes are then the doctor’s fault, not yours.
Pharmacists also tend to advise people on side effects, what happens if you miss a dose or accidentally double dose, interactions with OTC meds or herbal supplements, etc. It’s quite a lot more comlicated than typing up a label and counting pills.
I know that they supposedly do give advice. But I’ve never seen it being done.Maybe it’s because I never have any questions to ask. I’m still young enough not to have to take 15 kinds of pills at once,so I dont worry about interactions. But as I understand the legal side, the pharmacist is not allowed to change the doctor’s instructions in any case.Legal responsibility is on the doctor, so I don’t see the pharmacist risking a lawsuit by challenging the doctor’s decisions.(and in the US,unfortunately, fear of lawsuits is more important than healing people).
nitpick.
The Brits do not call the profession “chemists”. It’s a slang term for a pharmacy, and refers to the shop and not the proprietor. As in “I’m going to get my pills from the Chemist”.
They study for a degree in Pharmacy, and are thus PHARMACISTS.
I work for a pharmacist, and they still do this to this day. You know those liquid antibiotics you get? I’ve seen them make those. I’ve also been present to witness several advisories and counseling sessions.
I would also like to second CrazyCatLady’s comments regarding pharmacists catching drug interactions, for all the reason she has stated.
And as far as I know (I am neither a pharmacist nor a lawyer) the law regarding changing prescriptions is still in effect, except for that the patient must be given a generic brand unless the doctor specifies no substitutions. I would appreciate any verification or correction regarding this.
Also, the dispensing of outpatient 'scripts at the corner Chemists or CVS (corporate megadrugstore in the USA) is only part of what the Registered Pharmacist/Doctor of Pharmacy does – it’s probably one of the most limited jobs available to the RPh
(BTW in the USA it used to be that you COULD take the 5-year course in one shot to become an RPh, but the schools spun it off long ago as a 3-year “first professional” degree, and by the late 80s, as happened decades earlier with Law, the degree was reclassified to a “professional doctorate”).
In hospital, the IV preparations – antibiotic minibags, TPN IV feedings, chemotherapy pushes – that do not come already prepacked are put together in a sterile lab in the pharmacy, by the pharmacists in the case of custom mixes, narcs and chemo, by the Pharm. Tech under the supervision of the pharmacist in the case of standard abtc or IV feeding mixes.
This is because RPh/PharmD, as mentioned, is authorized to “compound” i.e. actually make combination medications that do not come pre-made in standard dosages – and still does, very often.
Another aspect: The pharmacist needs to know, approximately, at least, what medicines treat which conditions. If nothing else, this is part of what enables a pharmacist to decipher doctors’ scrawl. When a guy comes in saying he’s got condition A, and the prescription he’s handing you looks like it’s for completely unrelated condition B, then maybe you need to give the doctor a call to confirm that.
My sister goes to Drake in Iowa and is studying to be a pharmacist. She went to school for 2 years at the comm college, the transferred into Drake where she has a total of 4 years to do there. The last 1.5 years or so is residency type work. When she is done she will be a pharmacist.
Suffice it to say that licensing boards thought several years of schooling about drugs and chemistry and diseases and treating patients made a good lead-in to smiling, counting, and typing.
"(and in the US,unfortunately, fear of lawsuits is more important than healing people)."
Boy you got that right. My mom’s doctor, a 3rd year resident, will not, under ANY circumstances, prescribe narcotic painkillers. Doesn’t matter what Mom’s MRI of her back says, doesn’t matter that nothing else non-narcotic has worked, she won’t do it … for ANY patient. Why? Because we live in West Virginia, where suing doctors is an actual hobby, up there with fishing and bowling.
A pharmacist is where the buck stops in the pharmachem industry.
All drugs for human use have their final release papers signed by a pharmacist.
The pharmacist is personally accountable for the safety of the drugs.
So if there was some sort of a mistake made in production resulting in drugs being released which are not correct, and the pharmacist signs the papers to release those drugs, then then the pharmacist is liable and can go to prison.
A very responsible job indeed. Not one I’d like
Some universities have a combine BS/DPharm. program, and you can graduate after 6 years (taking 2 years less than if you did them separate). It is very hard, of course, because you have to cram all the basic sciences in the first 2 years.
You don’t have to have a Pharmacy degree to count pills. I did work experience at a pharmacy and I counted pills. The pharmacist had to check what I had done and sign the label though. I couldn’t do the diabetic stuff, though, because it was too important.
I HAVE asked the pharmacist for advice in the past. I’ve also annoyed my doctor by asking for (travel) stuff on the pharmacists recommondation.
The pharmacy also has up to date info on side effects of drugs that doctors don’t always know
A buddy of mine is a “pharmacy technician”, IIRC the term.
From what I understand the person the OP describes politely handing out pills is probably not a pharmacist. There may be 6 people working behind the counter. A couple of them just regular store employees. A couple more that are pharmacy technicians. And one pharmacist who is in charge, and maybe another if they are a busy shop.
My friend is also in charge of making sure that the pharmacy meets all of the new regulations that have been put in place. At a large pharmacy, this paperwork could easily be a full time job for more than one person.
Pill-counters are not necessarily pharmacists. There is actually a shortage of real pharmacists in the USA. My wife worked as a “pharmacy technician” and is friends with someone who has been a pharmacy technician for years. Very often the large pharmacy chains (like CVS) will hire a real pharmacists to just rotate among stores in a region, usually putting in 60-hour or longer work weeks. CVS claims a shortage of candidates. I think there’s an unwillingness to pay for more qualified pharmacists.
More often than not, the person counting and dispensing pills at a pharmacy is a pharmacy technician, not a pharmacist.
The more schoolin’ they get, the better, IMO. A year ago, my father-in-law, newly diagnosed as mildly Parkinsonian, was prescribed a drug to counteract the effects of the disease–which, in broad terms, results from a shortage of dopamine in the brain. Unfortunately, the person who dispensed his meds (pharmacist or pharm. tech … don’t know which) accidentally gave him a drug with a very similar name, which is intended to treat schizophrenia–which, in broad terms, results from an overabundance of doapmine in the brain.
A few of the wrong pills = quick trip into advanced Parkinson’s disease. It wasn’t fun, and it was a good month before he realized what the cause of his worsened condition was.
In short–read those scrips, decipher that scrawl, and have a good idea of what the drugs are supposed to do before you count them out. The more school, the better.
Aside from the pharmacist being unable to change a prescription for you, there is sometimes a reason why a certain doseage of medicine is prescribed, and you can’t always double up on a lower dose to get the same effect. I don’t know what kind of medicine you needed, but it can depend on how the medicine is released. If a larger dose is released slowly in one larger pill it is different than taking 2 smaller pills that would be released more quickly.
Crushing or dividing pills can also affect the way they are released and is not recommended for some kinds of medication. Your pharmacist might have known something else about your medication. Just pointing out that 2 small doses is not always equal to one big dose.