Influence Intelligence

Further Thoughts on Who Should Prescribe: Could Nurses Be the Better Choice?

A few weeks ago, we raised the question as to whether or not it makes sense to separate diagnosing and prescribing powers between physicians and pharmacists. 

Let's add a third medical professional to the mix: nurses.

Perhaps they are ideally suited to prescribing medications. And why? Because they get far more face time with patients.

Today, more and more the patients don’t get enough quality time in front of their doctors. Insurance pressures and tight schedules mean that everyone is leaning on the pharmacist to be the prescription medication knowledge source.

Many times, however, the pharmacist is just fulfilling the script, pushing the generic based on the pricing pressures rather than what is best for the patient.  This happens to us all the time as patients. Many of us can attest to being prescribed a specific medication, only to have the prescription fulfilled by the pharmacist with a generic. Ask why, and they rightly claim that it costs less, and that insurance will cover it. A quick call back to your doctor, however, often reveals that the generic would not work as well as the original prescribed medicine.

How do we work around this unhealthy cycle? Nurses might be the answer. They see more patients, deal directly with medications, and can be far more emphatic about a patient following prescription specifics to the letter.

Are nurses the way to resolve the physician/pharmacist disconnect? 

 

 

 

Who Should Prescribe? Physicians or Pharmacists?

One of the more interesting aspects of health care is something many of us take for granted. When we visit the doctor, he or she will evaluate our health, diagnose any illness or condition, and then prescribe appropriate medication. And while the first two parts of this process make perfect sense, the third is actually somewhat curious when you consider the level of pharmacological training physicians have. Over the course of their medical education, doctors spend about six months studying pharmacology.

Contrast that with pharmacists, who spend six years in school learning not only about drugs themselves, but their deep chemical structure, near and long-term side effects, interactions, etc. That’s not to say physician don’t understand these at a fundamental level, but comparing six months of study with six years in any field pretty much speaks for itself.

Why, then, are the doctors the ones who prescribe medication, only to be filled by pharmacists? It could be very sensibly argued that doctors should be free to diagnose an illness, but the much more thoroughly trained pharmacist should be the one to prescribe the appropriate medication.

The reasons for the current state prescription protocol are rooted in generations of professional tradition. Centuries ago, the professional who evaluated your health might turn around and take the very medicine you need off the shelf right then and there. Physician and pharmacist were all but indistinguishable. Not so today. They are two very distinct skill sets, with two different educational paths. Perhaps that is why today physicians are not comfortable with drugs unless they are already very familiar with them. They stick with what is tried and true, hesitant to introduce innovations.

Is this role becoming too much for doctors? Perhaps pharmacists and physicians need to re-assess their relationship. It’s interesting to think about how care would be different if the responsibilities of diagnosing illness and providing ideal treatment were based more on experience and expertise, and less on tradition.

Of course, we'd be interested to hear what doctors and pharmacists think about the idea.