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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11 Comments

  1. Amy Herbranson

    Nicely put! I’ll have to remember this…

    Reply
  2. Pharm Osazone

    An enlightening piece…God bless you!

    Reply
    • chri1599

      Thanks so much, glad you enjoyed it – plenty more to come! – Eric

      Reply
  3. Karolina

    Dear Erik, I`d like to thank you for creating this website! I`ve been following it for a couple of months now and I`ve always learned something new and interesting so far! I am a pharmacy student in the last year of the master degree, I come from the Czech republic (Central Europe). 🙂 After the graduation I know that it is still a long way to go and that I will have to work really hard, but I want to become a clinical pharmacist. A good one. I think that there is a big big need of them all around the world and I would like to enforce their role in my home country at least. What I am missing are education materials for someone like me. There are very limited sources I found I could use for learning more on the clinical pharmacy issues. So I am very grateful for every experience shared by you guys! 🙂 Thanks! – Karolina

    Reply
    • chri1599

      I will keep rattling the cages of other clinical pharmacists to help provide you with the best clinical content…best of luck on your studies; with a great work ethic, you won’t just be a good one, you can be a great one!

      Reply
  4. John Joachim

    You have posted this a number of times, Ed, and I still re-read it. Every time. Some articles contain information that never dates. Thanks so much!!

    Reply
  5. Carol Bell

    Very well written! It’s a great way to explain clinical pharmacy! I’m in the process of developing my own pharmacy consulting business to help physicians give excellent care to Medicare patients, increase revenue, and meet or exceed quality measures. I will use this in my pitch to be hired. Thank you very much!

    Reply
    • Randi

      I guess we are on the same wave length because this is what I just posted on facebook about reissionthlpa: If there are things that you can't say for fear to end a relationship, then that's not a good relationship. I much rather say the truth and end the relationship, that fake a smile and carry on. I've been this way since I was 3 yo and I always will be. Life is too short to be surrounded by superficiality and fake people.

      Reply
  6. Ankita D Patel, PharmD, BCACP

    Eric, just wanted to thank you for sharing this. I really do appreciate what you do for us. Thank you for sharing your clinical experiences.

    Reply
    • Eric Christianson

      Comments like this help keep me going 🙂 – Thank you so much, glad I’ve been able to provide some education and experience!

      Reply
  7. Gopinath

    Thank you Eric. This is how pharmacist makes the difference in practice. Some where it’s working justification for the patients thereby our positions are elevated and chances to work close with patients and physicians to have a better outcome in healthcare. Agradable

    Reply

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Written By Eric Christianson

March 26, 2014

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