Physicians are at the top of the ladder in our healthcare system. They train extensively for the practice of medicine and mastery in direct patient care. Utilizing their authority as leaders within our system, groups of physicians have written statements defining the scope of practice of other healthcare providers, including pharmacists.
One article was written several years ago by the American College of Physicians and American Society of Internal Medicine.
Another article has been put together by the American Medical Association, but it has not been made publicly available. There are a number of news articles and responses to this article, plus a list of recommendations from several pharmacy organizations.
One of the primary methods of expanding pharmacists' scope of practice is through collaborative practice agreements (CPA). To give you some background on what a CPA is, here is a link to an actual CPA from the North Carolina Board of Pharmacy and here is what the VA says should be included in a CPA for one of their pharmacists.
Consider this as you read through the articles and commentary:
Is it appropriate for physicians (or other healthcare providers) to define what other professions should be allowed to do?
Do you find the tone of the articles and papers insulting, complimentary, or neutral?
What are your thoughts about how the original article from the AMA must have looked?
We will initiate discussion of this in class on Wednesday. Thanks!
48 comments:
I feel like it is highly inappropriate for physicians to define the responsibilities and limitations of any other health profession. What gives them the right or requirement to do so? If each profession had to waste time detailing the restrictions of the others, there would be no concrete structure for those professionals to attain to. How would one determine their ranking of importance or which profession should have the greatest sway? Rather, there should be a collaborative effort between health professionals to advance the wellness of their patients. Outside of that, the roles of each profession in a patient's healthcare should be determined by the needs of the societal whole as prescribed by those who have expertise in that professional field and a connection with the changing roles in a developing sphere of healthcare.
Jesse R Alvarado
Like many people mentioned today in class, I think the most effective way to deal with this issue is to work as a unit to provide the patient with the best care. Both a pharmacist and a physician have specialized training that allow them to have more knowledge in certain areas. If both of these professionals were to use their abilities cooperatively, this would in turn provide the best outcome for the patient.
In just a short few days at my rotation I have seen a few instances where patients would come in to get a prescription, and as a courtesy the technicians would ask if they have any questions about the medications. Some of these patients would respond in an irritated manner something like "No, my doctor has already told me everything, thank you." This is an example of society's perception of physicians as much more advanced that pharmacists.
If somehow we could get rid of these preconceived notions about the scope of practice for each of these professions and combine the two skill sets, patient care and competition between the two healthcare systems would improve.
Obviously, as I think that we all agree, that no other healthcare professions have the right to determine our specific roles as healthcare workers. I believe that in a short amount of time, healthcare has changed drastically and that the roles that fit in with this ever-changing systems have been slow to develop with it. As someone said in class, many physicians have grown accustomed to the "God complex" and their ego's are not too willing to let this go. However, I do not want to categorize ALL physicians to this stereotype. I believe that it is this "type" of physician that contributed to the article. However, I'm sure that the majority of physicians are hesitant to "share the power."
However, in my personal experience, I feel that physicians treat pharmacists differently in different settings. For example, I have retail and hospital experience. My experiences in retail have always been that no one wants to talk to the doctor or deal with their offices. The majority of the time the doctors (especially in private clinics/offices) are impatient and have the mentality that their way is the right way and who is a pharmacist to question it. My pharmacist at Rite-Aid even received a voicemail from a physician that said the prescription and at the end added, "...and for me having to waste my time to call you and leave this message, you have successfully wasted 1 minute and 36 seconds of my time" However, I feel that in the hospital, pharmacists are much more respected in that the physicians see their expertise on a daily basis when they are dealing with inpatient situations. We have physicians calling and asking medication advice constantly. I feel that in the community setting, if the physicians got a change to interact with pharmacists first hand more often, there would be much more respect given, like I see in the hospital setting.
I noticed there's a lot of unspoken prejudice among groups of professionals. Generally speaking, nurses dislike doctors, scientists don't believe data generated by physician researchers, and physicians don't like pharmacists. Its mainly because we believe we can do each other's jobs better, but we can't. A physician is trained to diagnose, while a pharmacist is trained to recommend a treatment. They complement each other in the care of a patient. For this reason, the two groups need to develop better communication and teamwork.
--Irina Popovich
I noticed there's a lot of unspoken prejudice among groups of professionals. Generally speaking, nurses dislike doctors, scientists don't believe data generated by physician researchers, and physicians don't like pharmacists. Its mainly because we believe we can do each other's jobs better, but we can't. A physician is trained to diagnose, while a pharmacist is trained to recommend a treatment. They complement each other in the care of a patient. For this reason, the two groups need to develop better communication and teamwork.
--Irina Popovich
I think it is inappropriate for physicians to dictate the scope of practice for pharmacy. We each have our own specialties, and I think it is important that we do everything we can to the best of our abilities to help patients rather than worry about defining the other occupation's duties. Ted Agres pointed out in his article that physicians who wrote the AMA article "see danger in collaboration". I agree with this statement. When I read the AMA article it seemed as if they saw pharmacists as a threat rather than a team member. Collaboration should be an important aspect of how the healthcare system works. It is the most efficient way to care for the patients, which is out main goal.
Corrine Sharpe
I believe I may have found a link to the AMA article from 2008.
http://www.osteopathic.org/inside-aoa/advocacy/state-government-affairs/Documents/Pharmacists.pdf
The overview of the article on page 4 seems to make a quick comparison of the role of a pharmacist versus a physician. Basically, because a physician has spent more hours in a classroom and on clinical rotations, makes he/she more qualified to work directly with a patient. The article basically says that letting a Pharmacist take on increased roles puts patients at risk because of a lack of skill and knowledge in patient care.
While physicians certainly have a very important position in the diagnosing and caring of a patient, I feel that it is simply not right to let them define the scope of practice for pharmacists. I feel like there should be more team work within the healthcare field. There should be boards that include members that belong to all scopes of practice.
Elizabeth Patrick
This going along with our discussion in class about doctors and their egos.. I think doctors should realize their ultimate goal of helping a patient, and be appreciative they have pharmacists to help. Pharmacists and doctors should be working as a team to give patients the utmost care possible. Its frustrating when I witness pharmacists catching doctors' mistakes and them making excuses instead of thanking the pharmacist for double checking and catching the mistake. Both doctors and pharmacists want the same thing for their patients (hopefully) so should combine their brains and abilities to do their best practice as a team!
Jenna Picton
In continuation from class where we discussed doctor's egos. When I shadowed a clinical pharmacist this summer, we were going on rounds with the Doctor and med students, the pharmacist was telling me that the drug these doctors and med students were suggesting for the patient are sometimes not the best ones. He explained to me that he had to recommend a different drug that he thinks is more suitable without hurting the dego. I couldn't believe that when the Pharmacist was giving his professional advice, he still had to be conscious of the Doctor. I'm surprised that we have to be careful not to step on other professionals toes. You would think we would work hand in hand, and the fact that we are supposed to know more about drugs and less about diagnosing that we would make a good team. I sometimes wonder if the fact that doctor's go to school for a lot more years to get their Doctorate then we do affects their opinion of pharmacists. The fact that we are almost able to perform some of the same tasks as doctors with less schooling might be part of the reason for the articles. I hope eventually it will end in a direction that the doctors will appreciate our input since it would let them focus more on diagnosing and helping their patient.
Lora Steffner
From my own experience dealing with doctors, I have to say this: they are the MOST arrogant people on Earth! Once they made up their mind on something, that's it, it's over! So I'm not surprised by this very arrogant document written by one who is basically dictating to us pharmacists what to do and how to go about our daily business.
If it was written in a way that was constructive with suggestions, then that's one thing but please don't lecture us on things which we know a thousand times better than them. I regard this as a point of paramount arrogance.
Our education as pharmacist greatly differs from that of physicians, and as such I don’t think physicians have the knowledge or qualifications to determine our role in patient care. There is no arguing that the tone of this article is very insulting towards both to pharmacist and their growth as professionals. While I can understand some confusion or discomfort physicians may feel as they begin to collaborate with pharmacist more as equals and adjust their care plans, the idea that they would outright oppose the grow of our profession, especially in this manner, is not only unprofessional, but petty. Our duty as healthcare professionals is to provide the best care is to our patients, not competing for prestige or control of medicine.
Health care professionals should work together to utilize their knowledge to help patients in need. They shouldn't be an interference to one another. I think it's very unprofessional for a health care provider to critize and belittle another health care provider in a different field of studies.
Sandy One
The position that I see the most potential in is #2: "To improve patient safety and reduce medical errors, ACP–ASIM supports physician-directed pharmacist–physi- cian collaborative practice agreements..." This will do (and already has done) wonders for patients in the hospital setting: provide low-cost, efficient drug-therapy plans, lower readmission rates, and prevent miscommunication between providers (or lack there of). I cannot see, in any way, how a team of providers working together would do anything but improve the healthcare systems across the globe.
I think its pretty ridiculous that physicians are spending their time and energy on writing articles about what pharmacists scope of practice is. What these physicians need to do is spend their time and energy on thinking of ways that physicians and pharmacist can work together to better patients lives. When it really comes down to it its not about the physician or the pharmacist, its about putting the patients health at top priority.
Danny Salem
I do not believe that physicians should be allowed to define what services other health professions are allowed to perform. Physicians, although seen as leaders in the health care field, are not qualified to determine what other professionals are allowed to do, because most do not know the capabilities of various professions. Also, limiting the roles of certain professions could be seen as a detraction from health care as a whole. Qualifications should be issued by a board of each individual profession and regulated under a national accepted standard. I find the tone of the articles to be mostly complimentary, because they acknowledge the ability of pharmacists to expand in the health care field and perform more roles than they used to. However, there is a hint of insult in the articles, because it states that pharmacists are not qualified to diagnose and prescribe medication. Pharmacists, in many cases, have had a plethora of experience in diagnosing patients and are most likely more knowledgeable about medications than physicians due to the nature of the job.
Pharmacy has been changing into a more developed profession over the past few years. Pharmacists now have more training under their belt which carry greater responsibilities. In class, an idea was mentioned that pharmacists and physicians or other healthcare providers should incorporate each other when delivering patient care. They should work together to ultimately benefit the patient. I agree and somewhat disagree to this statement. I believe there are some things that should solely be done by the physician or pharmacist but other times when it is important to work together. As it may seem to most people that physicians and pharmacists learn similar subjects in school, this is not exactly true. The coursework required by a physician may be more rigorous in some subjects and pharmacy coursework may be more difficult in other classes. For example, as a physician goes through their didactic they only undergo 1-2 semesters of pharmacology based classes as opposed to a pharmacists whose entire education is based off pharmacology. With this in mind, I believe that physicians should stick to what they have learned and apply that to their patients and pharmacists should do the same especially when diagnosing . However, I also think at times it is important that healthcare providers work together. An example I can think of is when it comes to immunizations. Today, more and more pharmacies are administering flu shots and other immunizations that previously only could be given at the doctor's office. With immunizations, I think it is important to have that relationship between providers. Also, pharmacists are the most accessible healthcare providers to patients. If they do need to speak to someone regarding their health late in the evening or after the office is closed, pharmacists are available for help. If the physician and pharmacist have been working closely together they can go back and forth between the patient to relay the necessary information. Ultimately, patient care is the most important aspect of any healthcare profession.
I believe that all health care professionals should come together as a team for the benefit of the patient and the health care effort. We should all have the same ultimate goal in mind; the betterment of the patient. The health care world can no longer be a compilation of individual professionals, but more of a team. These professionals specialize in different areas; physicians in diagnosing and pharmacists in medication. If they collaborate with each other, the patient's well-being may have a more positive outcome. In the posted article, it states that when pharmacist's work with physicians, they "maximize the patients health-related quality of life, reduce drug related problems and improve societal benefits of pharmaceuticals." The same article also states that clinical pharmacy services have proven to yield lower hospital mortality rates as well as lower health care costs. These reasons, along with many others are why it is necessary to understand that the health care world functions better as a team.
Physicians have always and will always be extremely valued and highly regarded in our society. However, with the growing amount of medical information researchers are discovering, one group of professionals cannot physically become specialists in enough areas of medicine to dictate the roles of related medical professions. I understand if such articles were a reaction of insecurity. Many people have lost jobs in the last decade that we would never expect. Who is to say that we as pharmacists might not one day have a similar reaction to change concerning our profession. My point is that the whole medical field should work together to keep up with the pace of growing knowledge to better human life instead of boggling it down with technical difficulties.
-Yelena Panko
Healthcare providers shouldn’t be able to define what other providers can and can’t do. I feel this way because if we start letting other providers define certain providers job descriptions then we are giving them more power. This is like giving physicians’ power over the pharmacy profession, which could anger pharmacists and make them resent physicians. This is something that needs to be avoided because they all need to work together for the best possible care of the patient. Only government organizations should have the ability to define the scope of certain professions. This way a neutral organization is giving the exact scope that each profession should follow. After reviewing some of the responses to the AMA’s article, I generate the idea that the article was offensive for pharmacists. I get this idea from the statement, “According to Dr. Manasse, the report focuses on community pharmacists, questioning their education and training…” (From Ted Agres’s article). After reading this I feel like physicians are doubting pharmacists and their capabilities, which is a problem. Healthcare providers should work together and try to avoid doubting each other and causing controversy such as this. –Nicholas Locklear
I would like to know from the pharmacist mentors participating in our blog what types of experiences they have had with physicians (or other healthcare providers) regarding their thoughts on pharmacist scope of practice. In my experience at the pharmacy I worked, the doctors who had been practicing for 30+ years were more likely to be set in their ways and were sometimes rude if the pharmacist recommended a change in medication. However, the physicians who had recently graduated seemed more likely to ask for the pharmacist's input or accept recommendations. Does anyone have any particular experiences they'd like to share and/or any general comments? Also, I'm interested to know how you think it's best to handle situations where providers are "stubborn" in regards to pharmacist scope of practice.
Optimal patient care should be the number one goal of all health care workers. Therefore, when too much time is spent on analyzing who's job is who's, important steps in the patient's treatment plan may be forgotten due to one healthcare professional assuming another will take care of it. I believe healthcare professionals should work as a team, not as individuals. Although physicians deserve respect for their position, it should be the law that ultimately decides the responsibilities that come with a license in order to decrease bias opinions.
-Shannon Fennimore
I think that in order for us to reach optimum success with patient care, instead of defining each others roles and starting, for lack of better words, "turf wars", we should be working together. Physicians and pharmacists are both experts in their fields. While both professions do have some educational overlap, most of the academic process is tailored specifically to the job function of each profession. By working together as professionals, we will be able to optimize patient care and possibly make advancements in both fields.
While not all of the content I read was negative about pharmacy, some of the opinions and positions about a pharmacist were unfavorable. Physicians are trained to diagnose disease, illness, and injury. Pharmacists are trained to know how drugs interact with the body. Both professions are concerned with medication therapy. It seemed to me that some of the opinions on the physician side think of pharmacist almost as uneducated, saying that the physician is the only health professional responsible and knowledgeable enough to make patient-based medication decisions. If physicians with this opinion were able to see that a pharmacist could be of benefit for them and their patients they would understand that a pharmacist would be able to work in collaboration with treatment and drug therapy of the patient in order to offer the patient optimal care.
I read the article by the ACP–ASIM and was perplexed because it seems they are not aware of the volume and quality of education that go into education of the Pharmacist who have graduated with a PharmD degree.
It is assumed that the if a Pharmacist is given the responsibility of pharmaceutical care for patient, then the therapy of the patient will be modified by the Pharmacist without any reference to medical history or any other pertinent medical record of the patient. This is not what I am learning in Pharmacy school although I just started. The article seems to have a hidden agenda that needs further probing and so it is appropriate that the attention of all the Pharmacist associations have been drawn to it. Hopefully, the Physicians will understand that we need each other as complementary health care providers in a collaborative effort to benefit the patients and that the goal for pharmaceutical care is not just cost reduction.
- Vida Ohene Agyeman
I work in a pharmacist-nurse based chronic pain clinic in an Internal medicine clinic. We see patients, interview and evaluate their chronic pain. I as the pharmacist adjust, start, stop, or change all pain medications for these patients. This clinic then allows the PCP to focus on all other medical problems, except pain, like diabetes, hypertension, etc. The physcian is still responsible for signing the prescriptions as I do not have prescriptive authority. It is a challenge every day as these are complex patients with multiple other co-morbidities that must be factored in.
I wanted to share with you a different pharmacist opportunity, working in conjuction with physcians in a positive way.
Clark Lyda, PharmD
University of Colorado Hospital
I really appreciate Irina Popovich's comment about prejudices, and how we should work together. I feel that in order for the patient to recieve the best care these negative thoughts and words about different professions need to stop. Everyone can only see things from their perspective profession, but for the patient's benefit we need to try to see the other side of things. Instead of stereotyping each other or fighting a turf war, we should put our energy into helping the people we serve. Yes, maybe doctors dont understand the education we recieve or what we can do. However, we need to help them understand and not just throw negative, unhelpful comments back at them.
Having the ability to educate physicians on the abilities of pharmacists to help in providing overall healthcare for patients I believe is necessary. I understand that many physicians feel uncomfortable allowing pharmacists to be included in patient care and would like for more black and white guidelines to patient care. I read that the scope of practice for pharmacists has changed dramatically over the past ten years to include some new approaches to providing better healthcare to patients and many other healthcare professionals are worried that the education that pharmacists do not meet the requirements needed to provide a high level of clinical knowledge. My overall thought is to better educate other healthcare professional as well as patients on the many services and educational requirements that pharmacists have been trained in. I think that education is the best answer. The way that we can educate is to be involved in our profession and spread the word.
-Jilyan Austin
I don't mean to beat a dead horse here, but of course I have to agree with my classmates in saying that it's wrong for doctors to hold themselves on such high pedestals. Let’s be real, healthcare is a team sport where all professionals in the field need to come together and work for the patient. Why do doctors display such arrogance? Pharmacists have to go to school for four years, and are even required to complete residencies in certain situations.
I have always respected doctors because their job is difficult, but they need to show some respect as well. I think doctors forget to look at the bigger picture. Like I said in class, it has been improvements in public health that have made the biggest impact in life expectancy and mortality rates… not doctors! So my message to doctors and their grandiloquence is: Get over yourself and take a look at the what's important. We’re all here to help, not have a popularity contest.
Like so many of my classmates, I do not feel that physicians have the right to limit other health professions. Physicians and pharmacists go through two separate pathways in regards to education and training. Each heath care profession have their own area of expertise. Physicians are very knowledgeable about a lot of things,but they are not experts in every field. In my opinion, physicians and pharmacists need to work together to ensure the patient has the best treatment. Between the two professions, the patient would be better diagnosed and treated. Position 2 from the article mentions that physicians and pharmacists need to make a collaborative effort, but it's the job of the physician to direct and contact the pharmacist. So, physicians need to lose the ego and form better relationships with pharmacists. To the MENTORS: What are your thoughts about this? And, could you give some examples of how you and a physician interacted, either negatively or positively? Thank you!
-Curtis Austin
The article compares the roles of pharmacist versus physicians in an insulting tone. The paper basically concludes that based on fewer hours in training process and non required residency after graduation, pharmacist should be limited on direct patient care.
I definitely believe that it is not appropriate for physicians (or other healthcare providers) to define what other professions should be allowed to do. Physicians do not go through the whole training process of other professions to know what knowledge we have and thus what we are able to do. Physicians might look at the curriculums or attend some classes during training; however, that does not make them an expert and know what we are really doing. Therefore, they do not have the credibility to decide what other professions should be allowed to do.
Diep Phan
I believe that physicians should have a say, but not the ultimate say. There perspective should be considered but there should be an open discussion on the topic.
I don’t want to necessarily believe that physicians are writing these materials due to egotistical reasons. There may be a reason for why physicians are developing such a strong viewpoint on the matter.
If both sides were more education on this issue, educated more on the pharmacist’s education and what is going on in practice, we can come to a better solution. Physicians, themselves, should not have the right to determine what pharmacists/nurses/etc should be doing, what the scope of their role includes.
Physicians may play a major role in health care but they are not at the top of the food chain. This is why we have checks and balances, why there are boards and committees that may take their ideas into consideration and look at all aspects of the problems and come to a reasonable solution.
Physicians, pharmacists, nurses and all health care professionals alike have the very same priority in our every day jobs-providing a support system and help system for the patient. Any of us would feel offended by another area of health care encroaching on our area of expertise. In my mind it isn't a matter of one group telling the others where to fall in line, but rather working through the overlap collaboratively. We all need to rely on each other to give our very best to the patient. We have focused our studies on different areas and rather than being "threatened" by another area we should be looking to use their knowledge to help us. As pharmacist we are learning drugs and drug interactions, this knowledge is not extensive in a physician's study but it certainly overlaps their own area of study. We need to successfully work together not try to build rigid walls that make it hard to cross. I respect the amount of time it takes to become a doctor, specialized or not, and from these articles it would appear that not all doctors reciprocate that respect. Each area of health care is made up of specialized studies, I certainly cannot pretend to be a neurosurgeon, while I know areas of the brain I did not spend eight years studying it-I need their knowledge as much as I need mine when dealing with patients who are being prescribed medicine for this area. Cooperative practice is the key in order to care for our patients; it doesn't matter who is on top as long as our common goal is achieved-providing the best possible situation and outcome for our patients, our community.
I didn't find the tone of the article to be as demeaning as many of my classmates. (From what I can tell, the article that was not released publicly must have been much harsher...) However, in the ACP-ASIM article, much of the info detailed the benefits of joint collarboration between physicians and pharmacists, although it did stipulate it was typically in a hospital setting. The article said that collaboration also cut down significantly on medication errors and said physicians accepted 362 of 365 pharmacist recommendations.
In a community pharmacy setting, I can see collaboration goals as unreasonable and I think that's part of the article's point. Until pharmacists are trained to diagnose, do comprehensive physical exams, have access to all lab work, radiographs, and medical histories, physicians feel they are the main health care provider and have sole drug prescribing ability. I don't find that egotistical. Whether we as pharmacists are willing to alter our curriculums and trainings to expand our education to these goals is a seperate debate. As it stands now, joint collaboration is what both physicians and pharmacists should strive for, because that is what seems to help the patient most.
~Chris Pavero
In my opinion, physicians have no right to define the role of pharmacists. Both professions are essential to healthcare, but each has their own individual role. Both professions have their specialty; physicians are Doctors of Medicine and pharmacists are Doctors of Pharmacy, plain and simple.
I found the article written by the American College of Physicians and American Society of Internal Medicine a bit of a backhanded compliment. Although it acknowledges our education, it also undermines it. In one sentence is states, “…pharmacist expertise lies with pharmaceuticals.” A few sentences later, “Decisions about the most appropriate drug for a patient’s condition are often subtle and require a level of experience and training that is not provided in obtaining a PharmD degree.” Hmm, I thought that our “expertise lies with pharmaceuticals”.
Based on the responses to the AMA module on the scope of pharmacists, I would bet that the actual article was demeaning to our profession. It’s disheartening to see the AMA devaluing the education and skills of other healthcare professionals. What does that portray to the community? That we are divided, that we are not in this together. All healthcare professionals need to work in collaboration to ensure that patients are receiving the best treatment possible. Isn’t that the reason we all entered into the healthcare field?
I agree with what Diep was saying. I do not think that physicians should have a say in what other professions are allowed to do. Just because pharmacists do not always have to do the residency that is required for physicians, does not mean that pharmacy is an inferior profession. Both of these professions have their own training and they should stay in their areas of expertise. These professions are separate parts of the health care process.
Jeff Auten
After reading through the original AMA article that Elizabeth Patrick posted, I am curious about the difference between collaborative drug therapy management (CDTM) and a collaborative practice agreement (CPA). While it is understood that physicians and pharmacists collaborate together to manage drug therapy (CDTM), I did not know there was such a thing as a CPA where physicians get to “develop protocols defining the activities allowed in the management of patient medications, with a qualified pharmacist.”
To me, this is unnecessary. I believe that all health-care professionals should collaboratively work together (harmoniously) to provide the best patient care. That’s why we call it a health-care team. Physicians and pharmacist should both be understanding and considerate to each other when considering the other’s role in health care. No individual can know or control the knowledge and expertise another individual can bestow. We should simply work together like the professionals we have pledged to be.
The condescending tone from this article is what I have witnessed to be true in most cases while working as a technician in a hospital pharmacy. Physicians, in many cases are very arrogant, and unfortunately that only hurts the chances of pharmacists and physicians helping each other out as a team. There were some instances in which I have witnessed pharmacists and doctors taking advice from each other in order to find the best solutions for patient treatments. Since it is less common for this to work so smoothly, I see this sense of judgemental authority physicians tend to possess toward pharmacists as a problem that obviously needs some attention. The best response at this point is widespread education to other healthcare professionals to inform them of modern pharmacy education/training standards so the potentially expanding scope of practice for pharmacists can be more welcomed and accepted.
-Evan Palmieri
I appreciate Dr. Lyda's response regarding teamwork between physicians and pharmacists. It is best not to let individual articles or your own circumstances sway your view of the healthcare community as a whole. At my hospital, doctors call our pharmacists for advice on certain medications and ask for additional recommendations. Someone mentioned in class that education of a pharmacist’s scope of practice would ease tension between healthcare workers. When you work in an assembly line it is difficult to see the product you’re making, but when you know what happens before and after you, it makes the work you’re doing feel more significant.
-Amanda Lathom
I noticed there's a lot of unspoken prejudice among groups of professionals. Generally speaking, nurses dislike doctors, scientists don't believe data generated by physician researchers, and physicians don't like pharmacists. It’s mainly because we believe we can do each other's jobs better, but we can't. A physician is trained to diagnose, while a pharmacist is trained to recommend a treatment. They complement each other in the care of a patient. For this reason, the two groups need to develop better communication and teamwork.
Irina Popovich
From the few excerpts I read of the AMA article, I felt that there was a very condescending tone. Physicians should not have the power to determine things such as scope of practice, education requirements, and professional responsibilities. Pharmacists and doctors should work together to develop a treatment plan for patients, not bicker over who should help the patient more. Collaboration is the key to preventing errors during patient care. The goal of healthcare is to treat the patient in a way that will result in the best possible outcome for that patient. Personally, I do not see how that is possible when a physician thinks that it is their right to limit the scope of practice of pharmacy and other healthcare professions.
I felt like the tone of the physicians in the AMA article was quite condescending. Who are physicians to determine the education and scope of practice for all other healthcare professionals? I understand that they have significant schooling; however, I feel that their job is to diagnose and pharmacists are there to help with medication and treatments. The health of a patient should be a collaborative effort from all healthcare professionals. Arguing over who should perform what duties is in no way beneficial to that patient.
So far, we've only been talking about our feelings towards this document. But now is the time for ACTION, folks!!! What are we going to do to give doctors our piece of mind?
I suggest that we bring as many pharmacists as we can to a meeting to draft a formal paper of complaint that expresses our concerns and grievances. It will include a long list of all pharmacists across the country to show our strength and resolve. Afterwards, we will meet with the heads of various doctor organizations to present them with our paper and ask them to formally renounce this "Pharmacist Scope of Practice" nonsense.
It can be done, folks! If we don't take action, this arrogant attitude from doctors will continue to manifest its ugly head down the road.
I believe that a collaboration of all healthcare professionals is the best. I also realize the difficulty of making that a reality. We can't let doctors dictate what we as pharmacists can and can't do, but that goes both ways. The big issue here is each profession not truly understanding what the other is capable of.
I hear arguments about they aren't educated it that aspect, or how much education do they really receive on that topic? The problem arises that physicians don't really know what we learn, and we don't know what doctors really learn. The same goes for all healthcare professionals knowing the full education of each other.
We need to lay out each practice that will benefit our patients and sit together to talk about which profession is trained the best to deal with that issue. That is when you will be able to communicate all of your training and education with the other professionals and make sure you understand each others capabilities. That will produce the best patient outcome, and that is everyone's goal!
From a personal experience, as I grew up in Vietnam, I witnessed many pharmacists expand their scope of practice further by helping diagnose patient's symptoms, patient counsel, and medication recommendations. Since physicians are inaccessible in Vietnam, many pharmacists are actually have to go through the same amount of schooling and ultimately train in the clinical aspects such as direct patient care same as physicians. When I was younger, I remembered that my parents usually seek help through pharmacist instead of going to see a physician because it was more convenience to get diagnosed and get the medications as well at the same time.
I totally agreed with everyone in class that it is inappropriate for physicians to define the responsibilities of pharmacists. The two fields of study, at time, do overlap each other, but I don't think physicians have the ultimate saying in identifying the job descriptions of other profession. Better yet, physicians and pharmacists should collaborate with each other and put the patient's care at the most highest priority. Of course, this will depend on the setting of practice, such as hospital or community. However, to me it doesn't matter where a pharmacist practices his/her field of profession, they all receive the same amount of education and are fill with expertise and skills to care for a patient and that should be the ultimate goal.
- Tam Pham
It is not appropriate for physicians (or other healthcare providers) to define what other professions should be allowed to do. This would not be tolerated in other fields. The tone of the article and papers are insulting. They are assuming that Pharmacists do not have the education needed to provided these additional services.
The articles portray a group that is fearful of their own job security. Pharmacists are not trying to take away anything from Physicians we are trying to fill the gaps to provide better overall coverage to the public.
Natasha Allen
Based on what was discussed in class, I strongly agree with a majority of my classmates that physicians should not dictate or define what other healthcare professions should or shouldn’t do. As part of the health care system, I believe physicians, pharmacists, and other health care professionals should come together as one to provide the best care for all patients and decide certain decisions as a whole. Pharmacists and physicians have separate roles and duties from one another and therefore, one should not dictate the other. Instead, these professionals should work as a team in the healthcare process to avoid making large errors.
This topic reminds me of the discussion I had with my cousin who is currently a physician in Canada. Before she became a physician, she was a former pharmacist and one of the things she disliked about working in the pharmacy was that she didn’t feel she had enough freedom or power to treat her patients properly. She gave me an example of an incident where she knew the physician’s prescription was written incorrectly in which the dosage was too high. However, since she was not allowed to override the physician’s orders even after discussing it with the physician, she was forced to give the patient the higher dosage of the medication. Therefore, this patient was not treated properly. Due to the imbalance of authority between the pharmacists and the physicians, she decided to become a physician to be able to make her own judgments. Therefore, I do feel that there is a need for pharmacists and physicians to work as a team and not have one lead the other.
-Therese Nguyen
Considering the extensive schooling and experiential hours accrued by said physicians, they [in my opinion] to a degree reserve some right in guiding where the boundaries of other practices ought to stand and how those boundaries be set. It is, however, safe to say that said physicians are nowhere near as knowledgeable in regards to pharmaceutical practice, law, regulation, etc. as actual, practicing licensed pharmacists [and even veteran technicians]. With that said, noticeable airs of dissent among physicians and pharmacists are inevitable (e.g. Pharmacist Scope of Practice), but one thing -- at the very least -- can be agreed upon towards advancing improved patient care: Collaboration. Or Cooperation. Whatever the name, if all healthcare professionals would draw nearer to the concept of synergy when counseling patients, relaying [seemingly redundant] information from physician to pharmacist to patient, and so forth and so on, the possibility of even a ten-fold increase in quality of care wouldn't be so far-fetched.
-James Agtuca
Our health care system is a physician’s domain. We as pharmacists should not expect to gain more responsibility without a fight. There are several dynamics involved in playing a bigger role in health care. Automated systems may give us the time to venture in to these bigger roles. Technologies are here for our benefit. It is true that some may be affected, but it is our responsibility to the public to move our industry forward and into the twenty-first century. Only then will we be positioned to fill the gap in our nation’s health care. In time, it will become clearer what pharmacists are capable of doing.
Post a Comment