Hospital Pharmacy
Sunday, November 7, 2010
In my final year of pharm school, I promised myself I'd never work as a hospital pharmacist. It's not because I think it's unimportant, nor that Hospital pharmacists play an ineffective role in the health care team. It's because, for all thier skills at detecting errors and spotting interactions, there is just are three vibes that I find frustrating and counter to good patient care.
Firstly, Hospital pharmacists have been known to suffer a loss of perspective. Like the pharmacist who said that an antibiotic needed to be changed because it interacted (significantly) with the patient's statin. The patient is a late-septugenarian, and was unwell. They were to be on antibiotics for five days. The organism was only sensitive to this antibiotic. So, instead of holding the statin for the duration of anti-infective therapy and treating the infection, the pharmacist recommended a change to a less effective antibiotic. I've seen similar situations several times whilst on the wards, including in Intensive Care. Which leads me to my second beef;
Secondly, although this doesn't apply to all Hospital pharmacists, the sense of medicines-related arrogance and condescenion that I've been treated by a number of times is staggering. Notably, the same pharmacists have spoken to ICU consultants with similar disdain, so I don't feel as bad. But seriously, ICU consultants are freaking gurus. In this case, the doc concerned handed the pharmacist their ass on a plate, and deservedly. Good, well-read clinical Pharmacists know a cart-load of information about medications. what they're not so good on is the pathology, physiology and more complex situations. Hospital pharmacists play an essential part of the health team, but they're not the leading role and they're rarely on the same level of knowledge (medication or otherwise) as the specialists in their field. A little respect and understanding of the 'graded assertiveness' pathway would go a long way to improving the hospital pharmacist's face-to-face communication.
Thirdly, rigid thinking is generally unhelpful, particularly in the case of healthcare. Millions of reams have been printed on the importance of 'patient-oriented' care. If a doc writes 'tablets' and the medication only comes as capules, I've heard of hospital pharmacies not dispensing the prescription, or where the alternative is avaiable but not funded, charging a patient ten times what they'd pay for the intended formulation. Moreover, these pharmacists patronisingly note that prescriptions cannot be amended to fix these obvious errors. In community, these slips of the hand, especially for regular medications (think meloxicam caps instead of tabs), are regularly amended an the patient maintained on their exisiting formulation. But not in hospital.
But what was the final step to triggering this wee rant? Recently, a Hospital Pharmacist talked to the graduating crop of med students. She was patronising, absurdly impractical and took great pains to denigrate community pharmacy, along the lines of 'not caring' and 'have no idea'.
Pharmacy is a profession mired in tension - between healthcare and business, between evidence and outcome-based prescribing and bureaucratic penny-pinching. This pharmacist did nothing to assist this situation; Pharmacists need to see eachother for their flaws and strengths.
Sure, Community pharmacists might not have the impractically high knowledege of clinically irrellevant interactions of their hospital colleagues. But they see patients regularly, they know the finer points of how their patients live. Heck, the shop assistants might even visit the patient on a weekly basis. This is community caring; it's how life rolls outside the hospital.
I'm sure this reads as though I've a chip on my shoulder, so let me be clear - Hospital pharmacists save lives. Healthcare is built on knowledge, respect and effective communication between a myriad of health professionals and their patients. Community pharmacy, hospital pharmacy and doctors are on the same team. We need to work together, realistically , practically and with patient care as our focus for good individual outcomes.
Firstly, Hospital pharmacists have been known to suffer a loss of perspective. Like the pharmacist who said that an antibiotic needed to be changed because it interacted (significantly) with the patient's statin. The patient is a late-septugenarian, and was unwell. They were to be on antibiotics for five days. The organism was only sensitive to this antibiotic. So, instead of holding the statin for the duration of anti-infective therapy and treating the infection, the pharmacist recommended a change to a less effective antibiotic. I've seen similar situations several times whilst on the wards, including in Intensive Care. Which leads me to my second beef;
Secondly, although this doesn't apply to all Hospital pharmacists, the sense of medicines-related arrogance and condescenion that I've been treated by a number of times is staggering. Notably, the same pharmacists have spoken to ICU consultants with similar disdain, so I don't feel as bad. But seriously, ICU consultants are freaking gurus. In this case, the doc concerned handed the pharmacist their ass on a plate, and deservedly. Good, well-read clinical Pharmacists know a cart-load of information about medications. what they're not so good on is the pathology, physiology and more complex situations. Hospital pharmacists play an essential part of the health team, but they're not the leading role and they're rarely on the same level of knowledge (medication or otherwise) as the specialists in their field. A little respect and understanding of the 'graded assertiveness' pathway would go a long way to improving the hospital pharmacist's face-to-face communication.
Thirdly, rigid thinking is generally unhelpful, particularly in the case of healthcare. Millions of reams have been printed on the importance of 'patient-oriented' care. If a doc writes 'tablets' and the medication only comes as capules, I've heard of hospital pharmacies not dispensing the prescription, or where the alternative is avaiable but not funded, charging a patient ten times what they'd pay for the intended formulation. Moreover, these pharmacists patronisingly note that prescriptions cannot be amended to fix these obvious errors. In community, these slips of the hand, especially for regular medications (think meloxicam caps instead of tabs), are regularly amended an the patient maintained on their exisiting formulation. But not in hospital.
But what was the final step to triggering this wee rant? Recently, a Hospital Pharmacist talked to the graduating crop of med students. She was patronising, absurdly impractical and took great pains to denigrate community pharmacy, along the lines of 'not caring' and 'have no idea'.
Pharmacy is a profession mired in tension - between healthcare and business, between evidence and outcome-based prescribing and bureaucratic penny-pinching. This pharmacist did nothing to assist this situation; Pharmacists need to see eachother for their flaws and strengths.
Sure, Community pharmacists might not have the impractically high knowledege of clinically irrellevant interactions of their hospital colleagues. But they see patients regularly, they know the finer points of how their patients live. Heck, the shop assistants might even visit the patient on a weekly basis. This is community caring; it's how life rolls outside the hospital.
I'm sure this reads as though I've a chip on my shoulder, so let me be clear - Hospital pharmacists save lives. Healthcare is built on knowledge, respect and effective communication between a myriad of health professionals and their patients. Community pharmacy, hospital pharmacy and doctors are on the same team. We need to work together, realistically , practically and with patient care as our focus for good individual outcomes.
