[giggles_giggles]

Exactly, the pharmacist is there to provide expert advice when you have a complicated prescription or combination of prescriptions. You can tell by these comments that the HN crowd leans young -- not enough people dealing with chronic illnesses who have seen the value in having a consult with the pharmacist when you pick up your medication.

My wife has a handful of chronic illnesses and I want her to be able to ask questions of someone who has been educated in the role, method of action, correct dosages, and possible interactions of her medications.

[tudelo]

Isn't that mostly the job of the doctor prescribing the medication? I could see value in having an expert at the point of pick up either way.

[MoodyTU]

In my experience, medication interactions are both solidly in the wheelhouse of physicians and taken quite seriously. As someone below pointed out, it's still a huge problem, and having more eyes and a distinct training/set of skills in the pipeline is a win for everyone.

I do not know this as a fact, but I don't believe US pharmacists are able to adjust dosing on the fly - though of course they can and do reach back out to physicians with questions.

I had an experience recently that really solidified my respect and appreciation for pharmacists though. I was standing in line behind a older gentleman who had maybe a 10 minute conversation with the pharmacist. I tried to mind my own business but couldn't help but hear the overall gist. He was very confused about what his medication was for and especially how to take it. The pharmacist clearly had a relationship with him and wrote down schedule based on the meds he was already taking. He thanked her by name and she told him she's give him a call later in the week to check in on how he was managing.

I was curious (and the last person in line) so I asked her about her work and how often she ends up so involved. Apparently she made lots of calls throughout the week to people, and people came in confused about their medications often enough. By percentage it sounded like a minority of the patients, but her assistance was obviously super important to a lot of people in the neighborhood.

I don't think I've ever asked a pharmacist for more info on my life, but I'm very grateful they exist as a resource. At the very least, I think it's important we don't think of pharmacies as counting factories that can be replaced by robots. And while I'm all for dropping the price of healthcare across the board, I hope the kind of value that kind of one-on-one interaction at least gets it's fair shake in any accounting done thinking about making a switch to tele-pharmacies and the like.

[unlinked_dll]

This sounds like the kind of problem where you want to take humans out of the loop, not add more.

[delfinom]

You realize there are reasons we have old people and computer tech support memes right? Replacing humans in the loop would do absolutely nothing to help.

[MoodyTU]

I'm not sure I understand, could you explain more?

[zachwood]

From what I've been told, physicians spend a relatively short amount of time actually studying the details of drugs while pharmacists spend several years and know considerably more about dosing, interactions, etc.

[eropple]

Doctors do not do a great job of balancing the behaviors of and interactions between prescriptions. You could say that they should do a better job--probably justifiably--but pharmacists do that for a living.

[CaptainZapp]

My doc, who's a great diagnostic, has a fantastic network and usually knows his shit prescribed a pain killer (Vimovo, which in addition to the pain killing compound contains a proton-pump inhibitor. The compound which reduces acid production in the stomach, so that the pain killer is much more gentle to it).

He advised to take it after food, which is true for any old pain killer (for example Ibuprofen), but not for such specific medications.

In fact it should be taken half an hour before a meal.

That's the reason why it's prescription only and deployed by a pharmacist, who immideately caught it an gave me correct advice.

[xkcd-sucks]

>He advised to take it after food... In fact it should be taken half an hour before a meal

Isn't that written down in the manufacturer's datasheet that comes with the drugs when you get the rx filled?

[delfinom]

The average human does not read said datasheet. Shit, I would say the majority don't.

[CaptainZapp]

Of course it is,

But usually doctors are very busy people, who may look it up in the compendium, but don't necessarily have time to dig into the details.

I don't fault him and that's exactly where the pharmacist comes in.

[wbl]

Two heads are better than one. The physician doesn't necessarily know all the new drugs outside of their specialty.

[nradov]

Physicians (and other prescribers such as dentists) don't even necessarily know what all medications a patient is taking. In theory they can check through the regional Health Information Exchange or Surescripts but in practice things fall through the cracks. This is a leading cause of preventable medical errors.

[cc439]

The unfortunate part of modern American medicine is that the pharmacy isn't likely to know all the medications the patient is on either. I'm currently going through a minor situation but have discovered that health insurance has, in some cases, switched to a model of partnering with specialized pharmacies for certain treatments. You're forced to use a specialized pharmacy for one specific condition while your day to day corner chain is completely excluded.

[tzs]

You can even get that without having some prescription that your insurance has made a special deal with. I currently have 3 prescriptions at Walmart and 1 at Safeway, all of them generics that I'm not using insurance for. I'm paying the cash price for the Walmart ones, and using GoodRx for the Safeway one.

It used to be all 4 at Walmart, and then something utterly ridiculous happened. For the non-US readers who won't believe this idiocy, I swear it is true. We really do put up with this nonsense.

One of them was for irbesartan. I'm supposed to take it twice a day, 150 mg each time. The prescription was written for 30 x 300 mg tablets, which I split in two (irbesartan comes in a rod shaped tablet that you can easily split it two by hand).

This is $9 cash at Walmart.

But then there were some irbesartan recalls (although not affecting the manufacturer of any tablets I had). There was a shortage of 300 mg tablets, and Walmart was having trouble refilling my prescription.

So we had my doctor change it to from 30 x 300 mg tablets to 60 x 150 mg tablets. The cash price for 30 x 150 mg is $9 at Walmart, same as 30 x 300 mg. (I'd guess that for this drug, most of the cost is in filler and binder, so that is probably not unreasonable). So I'd expect 60 x 150 mg to be $18.

Walmart filled that, and when I went to pick it up...it was something like $300. WTF!? So they double checked, and found out that it had actually been written as 180 x 150 mg. They redid it as 60 x 150 mg, which dropped the price to about $100. So, still a big WTF.

According to GoodRx it should be $24 cash (still a WTF...why not $18?). Since this is one that GoodRx thinks has a good cash price at Walmart, GoodRx does not offer a coupon for it there. I showed the pharmacist the listing in the GoodRx app, and he agreed to honor that price, so I got my prescription for $24.

GoodRx did have a coupon for Safeway, for 60 x 150 mg for around $13, so when it was time to re-fill that, I move it there. (That changed to about $18 next month).

I ran out of re-fills about 3 months later and so needed a new prescription, and by then 300 mg was readily available again so asked for 90 x 300 mg, which was $21 with a GoodRx coupon at Safeway.

[WhompingWindows]

Exactly, they are there for customer service, not for retail, which is a huge proportion of their duties.

[zachwood]

I mean this may be partially true for a retail pharmacy setting, but is much different in a clinical one.

Even in an place like Walgreens where customer service is a big part of the job, the idea that it's all a pharmacist does feels simplistic and reductionist and plainly wrong. There's lots of coordination with the patient's doctor and insurance and other pharmacies they might use.

It's like saying programmers just type into a keyboard.