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    Why healthcare's Rodney Dangerfield don't get no respect

    David StanleyDavid StanleyThe e-mail started out warmly enough. “Love the essays in Drug Topics. I have always been right there with you in my opinions and my despair at the state of my profession.” I have learned though, that when a letter starts out like that, there is always a “but...” on the way.

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    Sure enough: “But this month I gotta write a note ...Yes, pharmacists will move toward more of a provider status, for good or bad. But birth-control pills? Refills? I don't think so.” The letter-writer then went into the reasons he thinks it's not the best idea for pharmacists to prescribe hormonal contraceptives to women.

    Refreshingly, his reasons were professional and grounded in reason, unlike so much of the dogma and pseudo-science that has surrounded the issue over the last few years. I'll have to save my rebuttals for another column though, because this line caused my jaw to drop: “You ask if there's anyone with a pharmacy degree who doesn't feel equal to bringing someone's blood pressure under control. Heck yes, that would be me and many of my fellow pharmacists.”

    “Many?” How many?

    I have only one question for this letter writer and the “many” members of my profession he claims agree with him. What exactly did you do in college?

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    I certainly wasn't the best student in school, but I remember cramming years of chemistry, physiology, pharmacology into my head and topping them off with an intensive hospital rotation. I remember it being difficult. I remember that I knew a lot more coming out of the experience than when I went in. And I remember that everyone else who got a pharmacy license that year went through the same program I did.

    When I see guidelines from the American Society of Hypertension that say nonblack patients younger than 60 years of age with a blood pressure over 140/90 should be started on an ACEI or ARB with a thiazide or CCB as second-line therapy, and when I know exactly what that means, then so do you.

    No one has to translate those abbreviations for you or tell you the dosage of the recommended meds. They may look like alphabet soup to the average person, but you know all this, and you are perfectly capable of reading and understanding the rest of the ASH guidelines — better, I would submit, than some of the prescribers I see who still give thiazides and beta-blockers first-line to diabetic patients.

    What’s going on?

    So now I have to ask my correspondent: Why do you think so little of your skills?  Do you really think all the time, tuition, and training that went into you getting a pharmacy license qualifies you only to fax refill requests and follow orders?

    This same letter-writer drew an analogy between going to a pharmacist for a flu shot and going to Jiffy Lube for your taxes. Really?

    The year before pharmacists were allowed to give flu shots in California, I got mine from an LPN who spent a good five minutes trying to measure out 0.5 ml into her syringe, adding a little, squirting a little out, and repeating the process over and over. Even with zero immunization training at that point, I wanted to grab the vial from her and do it myself, and I would go to that letter-writer sight unseen for this year's shot before I would ever go back to that LPN.

    David Stanley, RPh
    David Stanley is a pharmacy owner, blogger, and professional writer in northern California. Contact him at [email protected]

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    • TomLaMartina
      Another issue concerning the direction of pharmacy is the lack of involvement among our graduates in the pharmacy associations. I attend local pharmacy meetings and functions and rarely see a new young face. I believe these new pharmacists do not understand that if they do not stand up and take ownership of their profession someone else will. Many are too tired from school, too much student debt, and work long hours for a company that expresses little interest treating the pharmacists the professionals they are. 30 year pharmacists such as myself will retire in the next decade, leaving the pharmacy's future in the hands of the insurance/mega corps or to active younger members who can lead pharmacy for a brighter future. But first they must step up and get involved.
    • Anonymous
      [url="http://www.bbc.com/"]bbc[/url] bbc
    • Anonymous
      Agree 100% with David Stanley and also Jose Lopez We must move forward clinically or our profession has no chance, but am extremely concerned that our workload will worsen......
    • Anonymous
      Agree 100% with David Stanley and also Jose Lopez We must move forward clinically or our profession has no chance, but am extremely concerned that our workload will worsen......
    • JoseLopez
      Totally agree with you, BUT :). I don't think the foundation for reimbursement is there. I don't think it will ever be there. The reason why optometrists, NP, PA, are prescribing is not because there's shortage of Drs. There's shortage of MDs because others are prescribing. The push for this is purely economical, by insurance companies. They got sick and tired dealing with Drs. The others, like RPh NP PA they can pay pennies on the dollar and abuse to the max. I totally agree with you that we are more then qualified to write Rxs for a whole range of disease states. But I strongly disagree that this will make any economical sense. We will be abused by third party payors even more then now. The only reason to dive into the abyss of prescribing is to save the profession. Because as it stands now we are just drug monkeys inside vending machines.
    • RLytle
      Agreed, don't dismiss our abilities. Or, confuse apprehensions about doing something you haven't practiced with not being able to do it or that we shouldn't. These days we have the knowledge and foundation to be involved in more than just the dispensing of this stuff. On a VA rotation I sat in on patient encounters with the internal medicine residents and with resident pharmacists managing hypertension, diabetes and cholesterol meds. My main takeaway was feeling that I could do that. I don't currently, but I could. Admittedly, I'd need some practice and to brush up on things like guidelines and lab tests but it's doable. I've done MTM sessions, screened for compliance and tolerability and made recommendations based on what I found - it isn't a huge leap beyond that. Does this mean a Dr does not need to be involved at regular intervals? No, but we could play a larger role.