JP's white paper

April 7, 2010

Doctors have no idea how much valuable knowledge resides in the brain of a pharmacist. If they did, they'd be on the phone a lot more often.

The doctor had just told me that he had not a clue what to prescribe for his patient's oral moniliasis. He had found Mycostatin pastilles (nystatin) in a book. "They didn't work, did they?" I asked.

"I didn't know that Mycelex (clotrimazole lozenge) came in a troche form. Thanks for the information. I would just have okayed a refill for the Mycostatin if you hadn't let me know."

There was a pause. "Hell, I don't know. I never considered calling a pharmacist, but it makes sense. Do you do that a lot?"

"Do what?"

"You told the patient to have me change the drug. Do you do that a lot?"

"When it's appropriate." I can't say that I do it a lot, but I have recommended what I consider to be a better choice many times during my career. I do not, however, call the doctor. You and I know all about the black hole that can consume you when you try to get a message to a prescriber. What I do is tell the patient. I write my recommendation down. Then it's the patient's move.

The doctor was intrigued. "I didn't know that pharmacists were that interested in the patients."

A microsecond after he hung up, I realized the opportunity I had missed. I coulda been a contender. I coulda told him all about pharmacists.

It would astound any doctor to know that at least one pharmacy student could have chosen medical school.

The other day I got a long e-mail from a kid in Los Angeles. He told me that he had gone three for three with his medical school applications, but he chose to attend pharmacy school instead. The evidence he presented showed that getting accepted into pharmacy school was harder than medical school.

He wrote that it was a no-brainer. He was a smart pre-med student and had loaded up on the requisites that could get him his PharmD in three additional years. He said that he could be in practice and making a good living while his med-school buddies, if they wanted to specialize, would be doing residencies forever. He mentioned the cost of malpractice insurance and told me that his research showed that a new primary care physician was likely to earn a lower wage than a new pharmacist working for a chain in Southern California.

I wish I had said to the doctor, "You know, pharmacists give immunizations now. You can give that chore up. I ask every single adult wound-care patient whether they've had a tetanus shot in the last 10 years."

Imagine the response. "Attaboy, Mister Pharmacist. I so commend you." Yawn. Sigh. "I suppose you're going to tell me that pharmacists are going to start doing brain surgery next." Yuck, yuck, yuck.

"They usually don't know, so I offer to give them a Td shot right then and there."

"Really?" A throat-clearing sound. "Don't you think that immunizations should be done in a doctor's office?"

"Most pharmacies that offer to administer vaccines can do it until nine at night. It saves your staff time. You won't have to deal with the insurance claims. How much do you think you make after expenses and rejected claims? Five bucks a shot, if you're lucky? And how much do you lose when you have to chuck a dose of Zostavax [Zoster Vaccine Live] because it wasn't used in 30 minutes after mixing it?"

"Zostavax has to be used in 30 minutes?"

"You are losing money, Doctor."

"You may have a point there."

"That's no way to run a business, Doctor."

So many doctors and so few pharmacists willing to spread the good news … PharmDs have so much more to offer than I do. They will call you. You are a contender.

JIM PLAGAKIS is a community pharmacist in Galveston, Texas. You can e-mail him at jpgakis@hotmail.com and cc us at drugtopics@advanstar.com
. You can also check out his Web site at http://jimplagakis.com/.