What can a Clinical Pharmacist Bring to the Table?
I feel like I’m always trying to educate folks what a clinical pharmacist can provide to patients, nurses, physicians, a healthcare team, institution etc. Since I was accepted into pharmacy school, I feel like I’ve been hearing about MTM(medication therapy management) and clinical pharmacy ever since, and when you talk to virtually anyone outside of the world of pharmacy, no one has a clue what you’re talking about.
Perceptions seem to be changing…slowly. I do work in rural areas, so maybe that does skew my experience. Maybe I’m not very good at selling our services? Or even worse maybe we pharmacists have a bad product? I’m biased but the second question isn’t true. A question asked by an administrator at an assisted living really got my frustrated, but it really did cause me to think. The question was simply – Why would we need someone else to review a medication list when the doctor and nurses already do that? In hindsight, it is a really good question and one I should’ve thought about a long time ago. When I put myself in the shoes of that administrator, the question is very legitimate and I feel like that is the giant hurdle I face every day in trying to prove the value of what I do. At the time, I had no response and ceded that she wasn’t interested in what I would provide. I could certainly list studies, case reports etc. that prove the value, cost savings, improvement of health related outcomes, satisfaction and on and on, but to be honest, that’s boring.
That question of what we do differently as clinical pharmacists has stuck with me for a few years now, and I’m finally gaining some perspective on that question. Just put yourself in the mindset of that administrator that knows very little about pharmacy and you will come to this conclusion – Pharmacists don’t do anything differently. (I’m sure all my pharmacist friends are up in arms right now!) Does the physician/nurse review the medication list? Does the physician/nurse review appropriate labs? Does the physician/nurse take into account patient concerns, objective and subjective information etc.? All the answers are yes which leads me to my conclusion that clinical pharmacist don’t do anything different than an attending primary care provider. Here’s the insight, while we don’t physically do anything different from a physician when reviewing medications, clinical pharmacists use a different tool. We have a different lens that we look through when assessing patients, and that’s the beauty of all of us working together. Let me explain. Where a Dr./nurse might see a patient failing in the end stages of dementia, I see an inappropriate increase in Dilantin causing toxicity. Where a Dr./nurse might see a new diagnosis of dry eyes, I see a patient on duplicate anticholinergic drugs. Where a Dr./nurse might see a patient with worsening CHF, I see a patient that was just recently started on Celebrex for pain. Where a Dr./nurse might see worsening symptoms of gout, I see that hydrochlorothiazide for blood pressure was recently initiated. Where a Dr. discontinues Rifampin for osteomyelitis, I see a very significant problem with abruptly discontinuing Rifampin without monitoring a patient’s (INR) Coumadin. Our pharmacist lens allows us to focus on medication related problems that put our patients at risk of adverse effects, poor outcomes, drug interactions, hospitalizations, or worse.
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