Nope. I’d trust a human who has been trained to make judgment calls over a computer program programmed by a human.
A computer program could work in a perfect world, where everyone gets their drugs from one pharmacy, where dosages were constant across all populations, and where people are perfect in how they enter data.
However, there are LOTS of circumstances where a higher- or lower-than-normal dose is required. Drugs that don’t interact on paper may be okay if they’re to be taken at different times of the day. These are things that a computer may not pick up on and only a pharmacist can decide.
Even if a computer program were used, a human pharmacist would still have to double-check it, so there’s really no advantage to using one.
Which still defeats the purpose of a computer program.
There is already software in use that sends up these red flags. A pharmacist has to override the red flag, which they do a lot of the time. This makes more work for the pharmacist, who then has a computer to review when he could’ve done it himself.
In most places, techs already know enough to call a pharmacist. They’re not robots who fill any prescription blindly. In Texas, they have an associate’s degree and they have to pass a certification exam. Anyone who works as a tech develops enough knowledge and judgment to call in a pharmacist for anything that doesn’t seem right. The pharmacist then steps in, calls the prescriber, or okays it on his own based on the patient’s history or his own knowledge. A computer program merely puts in a roadblock where there may be no need for one. And if the computer is overridden too many times, humans get complacent and just override everything.
If people were exactly the same, and every drug had the same effect on everyone regardless of age, gender, weight, medical history, or any other variable, a computer program would make much more sense. But we’re all different and human judgment is an absolute necessity.
I’m not saying that a computer program is a bad idea. I’m just saying that it’s unnecessary. PharmDs aren’t overeducated pill-counters. They’re actually highly educated professionals with the training and judgment to make decisions based on any number of complicated factors. Just as I wouldn’t trust a computer to make any other complex decisions for me, I wouldn’t trust my life to one, either.
My oldest daughter is currently in Year One of pharmacy school at the University of Illinois-Chicago campus. This is after she completed two years of pre- pharmacy at the local community college, courses such as calculus, biology, and physics. She’s still got years to go. There’s a ton of math and science, which doesn’t let up–it’s not like getting a B.A. where you do your Math and Science Requireds and then you’re “done” with Math and Science–and it’s not cheap. Much loan money will be required before it’s all over, or a substantial scholarship. Being a pharmacist is not a career choice that one undertakes lightly just because one “couldn’t think of anything better to do”. It takes years to get there.
My son and I both work as pharmacy technicians at Walgreens. In Illinois all that’s required for the basic tech license is the $40 application fee and a record free of major felony convictions. However, if ya wanna go for the coveted “Certified Pharmacy Technician” licensing, which means extra money per hour plus the responsibility of, for example, making up compounded drugs (think “special acne creams”) under the pharmacist’s supervision, you have to attend a special class, take a special 3-hour exam, and pony up the extremely large fee for the test.
So Pharmacy Tech is something that “anybody” can do. But not pharmacist.
What do pharmacists do?
The pharmacist is the person with “The Buck Stops Here” tattooed on her forehead in flaming red letters. She is the person whose ass is in a sling if someone gets the wrong pills. That’s the bottom line, right there. She’s getting paid $90,000 a year to make sure that each and every one of the 700 or so people who get their meds at Walgreens every day–get the right pills. She is the Person Held Accountable. And it does happen–people do get handed the wrong bag with the wrong pills, and they go home and take them (yes, people are idiots). And it’s a miracle that more people don’t die from it, or at least sue Walgreens. Which they could, and in which case, it would be the pharmacist in deep shit. Not the pharmacy technician who may have actually put the pills in the bottle. The pharmacist’s ultimate job is called “Verification” at Walgreens, and it means simply that she has to open up every bottle of pills that the tech has filled, look at it, and “verify” that it is in fact the right stuff. Failure at this task means some very deep shit comes down.
So this, ultimately, is what pharmacists do. This is what’s worth $90,000 a year and six-plus years of grueling education. And they earn every penny of it.
Oh, and if that’s not enough–the pharmacist is also the buck-stops-here person for everything that happens in the pharmacy. Printer jammed? If nobody else knows how to fix it, or how to call Tech Support, the pharmacist is It. Weird insurance issue with a customer? Ditto it’s the pharmacist’s problem if nobody else on board knows what to do about it. A tech is typing a prescription into the computer and can’t read the doctor’s handwriting? Ask the pharmacist. She’s expected to be familiar with all the doctors’ handwriting in her area, especially their signatures.
Yesterday I witnessed the pharmacist spend 15 minutes on the phone talking to doctors, on behalf of a patient with no prescription insurance who had been bitten by a dog, and whose doctor had prescribed an antibiotic that she couldn’t afford. And this man isn’t some sort of saint; he’s basically a complete dick in real life. But that’s his job, to go to bat for patients who need an intermediary, between them and the doctor, between them and the insurance company, sometimes between them and Corporate Walgreens.
And it’s also his job to deal with doctors who screw up: I’ve only been there a few months, and already I’ve personally witnessed two occasions when a patient who was allergic to penicillins was given a prescription for penicillins. And it’s the pharmacist’s job to deal with that, when the mom picking up her son’s medicine for his ear infection says hesitantly, “Is this penicillin? 'Cause he’s allergic to penicillin, and I told the emergency room doctor that, but he wrote this anyway…”
And doctors write scrips for drugs that don’t come in the strengths specified, “Adderall 35 mg”, well, it doesn’t come in a 35 mg, so she has to call the doctor and deal with that.
Or else an addicted patient is cruising the Emergency Rooms and comes in with a prescription for Darvocet when we just gave her Vicodin two days ago; the pharmacist is going to notice, and say, “Hey, we just filled some Vicodin for you two days ago, and we gave you 30 pills. What gives?”
Software can’t do that.
And every time the pharmacist has to stop what she’s doing (verifying) in order to deal with a Problem, the whole workflow basically grinds to a halt, even if only for a minute or two. Then watch the orders pile up. Then the pressure really goes on, because all those people sitting in the waiting area have been promised their scrips by a certain time, and the computer knows it, and if they don’t get their stuff by the promised time, data will go back to Corporate, and the KPIs for Rx will be down–and it’s the Pharmacist who gets the flak, not the techs.
So after she deals with the jammed printer, she has to go back to Verifying, but this time under pressure, because we’re behind.
And every so often, one of the things she has to do under pressure is figure out how much medication to give a patient, because it’s “per kilogram” of weight, so she has to stop what she’s doing (again) and do math. Under pressure. How much does the kid weigh in pounds, how much is that in kg, how much of the drug to put in the bottle? If she gets it wrong, the kid could die.
What do pharmacists do? They do detailed, time-sensitive, math-oriented work under incredible pressure from all directions. Think “Bruce Willis defusing a bomb while also doing story problems, answering the telephone, and having Grandma pester him about her bowels.”
I’m a certified tech, too, and most retail pharmacists are like Duck Duck Goose describes above. But I’ve also worked with ones who, on slow days, sleep in the office for an hour or so, emerge to check the fills I’ve lined up for “non-waiters,” then go back to sleep.
If the pharmacist knows these things, then a computer can know these things. The computer can then be programmed to accept ranges(based on empirical evidence) and throw up red flags. I certainly don’t want to get rid of drug store pharmacists and I sure as hell wouldn’t soley trust a computer, but in my opinion, the only reason I can accept a pharmacist making 90k is because it’s their ASS on the line, not their intellectual workload(which the computer in my opinion should reduce).
This has always been a pet peeve of mine. I’ve never heard one good reason why a doctor’s handwriting has to be illegible, and a bunch of reasons why it shouldn’t. One doctor told me that it was because he was used to taking notes so quickly in med school, but I don’t buy it. I’m betting I took at least as many notes in grad school, and I can force myself to write twenty or thirty legible words if I have to.
This also includes using Latin abbreviations. It doesn’t take that much longer to write “three times a day” or even “3x/day,” versus “tid.”
This, I can comment on. Not only doctors use these abbreviations, but also nurses and staff in hospitals. I like the idea of these, because, as we know, hospital staff are often hurried. That, and this provides a standardized way of writing things in extreme shorthand.
Thing about it is, it is theoretically possible to make a smart computer program (an “expert system”) which could do everything a pharmacist could do and make exactly the same decisions.
The problem is, computer programs are written by software companies. Software companies have a strategic decision-making staff consisting of VPs who can’t even operate a pocket calculator, schedules that are laughably overagressive, U.I. designers who don’t know the difference between webpage design and real software, programmers who know nothing about the users they’re writing the computer program for or the arena in which the program is supposed to exhibit expertise, and software testers who lack an even basic understanding of what the software is supposed to do and who also rarely know enough English to write a useful bug report even when they do find something obviously wrong.
No way I’m trusting my life to something that came out of that process!
Both of my siblings and one of my in-laws are pharmacists and all of them have caught potentially fatal drug combinations given on valid prescriptions. Sometimes it’s not the doctor’s fault: one problem that comes up frequently is when people (especially older or sick people) don’t remember what all they’re taking and go to different specialists and doctors and Doctor A has no idea the patient is taking Drug X prescribed by Doctor B when he prescribes Drug Reacts-Badly-With-X. They also have all had six figure debts owed to them by drug companies and, especially, Medicare/Medicaid that tied up their own money until it was filled.
As far as the pill counting and bottle filling, most of that’s done by $10 per hour pharm techs.
On the subject of doctor’s handwritings, my doctor’s is so bad that she prints off the prescription on a computer and then signs it. I’m surprised more don’t do this.
I have to disagree with this, and with the whole “pharmacists are the last best line of defence” idea. My pharmacist has never seen me. (Not quite true–he’s seen me once, but not as a patient.) He doesn’t know my height, weight, medical history, or hair color. My prescriptions are mostly phoned in by a doctor and picked up by another family member (or my little sister’s babysitter, if she’s going there anyway). He doesn’t know the medicines I got at another pharmacy last weekend because his was closed, or the bottles of samples I got from my doctor this morning, or the over-the-counter drugs I take (even when I buy them from his store).
I have little doubt that he is capable of taking all these factors into account better than a computer program or an MD, and absolutely no doubt that he works extremely hard and does a very good job. He runs a very busy pharmacy because he offers better customer service and cheaper prices than anyone else in town (unfortunately not better hours, though). He’s also a very generous and active member of the community. (He filled prescriptions for hurricane victims completely free of charge, even when they could have paid him.) I certainly wouldn’t do a retail pharmacist’s job for the money they make, and I couldn’t do nearly as good a job as most of them do (especially this one).
Unfortunately, though, in our system, he simply doesn’t have the chance to second guess my physicians unless one of them makes a very obvious mistake, or he happens to discover it by chance (because I happen to take both of the relevant scrips to him, or happen to show up in person, or happen to mention what OTC I’m taking). A well-designed computer system (especially one that would acess data for all my Rx’s regardless of who filled them) could certainly go a long way to solving this problem.