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THE BATTLE BETWEEN PHARMACISTS AND DOCTORS; MY ACCRA EXPERIENCE – PART 1 – PHARM. NKECHI OTI

THE BATTLE BETWEEN PHARMACISTS AND DOCTORS – PART 1

If you’re a pharmacist and you’ve had to work in close relation with a doctor, then I’m sure you can describe the experience in one word. I love doctors, I’m a huge fan of doctors. I respect them as professionals, but sadly some doctors don’t respect pharmacists as professionals (emphasis on some).

When I was doing my internship at a military hospital in Accra, I was excited. Imagine me fresh out of school, brimming with knowledge and waiting for the opportunity to show how much I knew. The interns were in charge of examining prescriptions and dispensing. One beautiful Tuesday I was given a prescription, as soon as I saw the prescription I knew my moment to be a hero and save someone had arrived. The prescription was Hydrochlorothiazide 25mg daily, metformin 500mg bd, and diclofenac 100mg bd. I was so excited, I had caught a prescription error. I felt “wow, this is what I have been trained for, my knowledge and learning will save the day”. I took the prescription to our supervising pharmacist. She looked at it and said, “Oh, okay… em… Change it to what it’s supposed to be”. I was surprised, I said “Pharm, I think we need to contact the doctor who wrote the prescription”, after all we were working in a hospital, and we could call the doctor or just walk to his office. She looked at me and said, “Okay, if you want to tell him, go ahead”. I didn’t expect that, I thought she was going to tell him herself. Regardless, I went to the doctor’s office. When I saw him I politely pointed out the error I had discovered. He looked at me and said, “I know what I wrote, that’s what I intended”. “But Doctor, thiazides are contra-indicated for diabetics, and the diclofenac is higher than the recommended daily dose, and also I don’t think it’s the best choice for a patient in her condition”. At this point he looked at me like I had insulted him. He told me that I should not question his prescription. I headed back to the dispensary thinking to myself, “maybe there are exceptions or special cases when this is allowed”, I just wished it could be explained to me, after all I was there to learn. When I got back to the pharmacy, our supervisor asked me how it went, and I told her. She told me not to worry, that she knows that doctor, his prescriptions are usually filled with errors and he is not easy to correct, so they usually just make the adjustments. In my mind I was thinking, “this is not right, what if there is a justification for this prescription” but at the same time should we blindly dispense what we have been given. Either way, the patient suffers it in the end.

The health care practice needs to be more integrated, there should be collaboration for the patient’s sake. We all make mistakes and we can learn from each other. I have always felt tension between pharmacists and doctors, even during ward rounds, most pharmacists just hover in the back like shadows, and we are the drug experts. We should be consulting on all things medication. We need to raise our standards, learn more, so we can contribute more. A lot of pharmacists just turn into dispensers who have refused to increase their knowledge, add value to themselves and improve their professionalism. So, when they are called upon they cannot contribute update information that can benefit their patients.

Pharmacists and doctors need to learn to put the ego aside and work together for the benefit of the patient.

Have you experienced working with a doctor, what was it like?

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15 comments

  1. The doctor was even cool to you. Their are some instances that when you approach them, they fight you all because of ego. I believe it’s inferiority complex but regardless of the situation pls make sure you school them if they won’t listen.

  2. I once had similar experience as yours. The doctor prescribed Diclofenac 100mg bd. I pointed out to her. The next thing was for her to raise her voice at me. I refused to dispense it. I wanted the case to go to management so they know what was happening. Sadly, most of our senior pharmacists don’t take issues of such to management. Thereby leaving younger pharmacists demoralize. If all doctors will respect pharmacists as pharmacists respect them, the work will be sweet for all. I thank God for humbles. I met one of the later-discssing with her was always fruitful as we learned from each other.

  3. I am sorry for the experience, but thiazides are not contraindicated in diabetics. I am a diabetic and a doctor and I am on the same ddiuretic but half that dose. I do agree though that the dose is too high. As per the diclofenac, maximum daily dose is 150mg but the doctor wrote 100mg bd which obviously exceeds that.
    No, it is not proper to change a doctors prescription, that would be over stepping your bounds and not safe for the patient especially since the pharmacist does not have the patients full history and no it is not proper for the doctor not to have paid attenion to your observation and at least explain his prescription, if not for the sake of the knowledge you both may gain, but for the fact that it’s the polite thing to do.

    • thats the problem we encounter in this our present day health system in nigeria. nobody wants to be corrected.
      on the medications listed above, thiazides are not contraindicated in diabetes mellitus, however there is the need to monitor blood glucose level for a diabetic patient as thiazide diuretics can increase blood sugar level. in the case of this patient, who is on metformin 500mg bd, blood glucose level should be monitored and the dose of the thiazide tapered if necessary.
      for the nsaid (diclofenac 100mg bd), it can diminish the antihypertensive effect of thiazide.
      Doctors should know that its a team and we can go far when we work together.

  4. Thanks for the article… @Dolly, thanks for ur comment also, but I must also say this.. Thiazide diuretics of which Hydrochlorothiazide is one may not be Contraindicated in diabetes but they increase blood sugar levels.. I am sure you must have heard of Thiazide-induced Hyperglycaemia.. The lowest effective thiazide dose should have been recommended.. Thank U!!

  5. Just thinking aloud……Can a pharmacologist function well in the absence of a pharmacist What could be the best possible reason why a pharmacologist cannot run a community practice. My reason for asking is that I have seen settings where a Pharmacist is always looking out to boss around a pharmacologist and also in the same setting, the pharmacist querying a doctors prescription to a patient without a knowledge of the patients history and diagnosis.

    • Well, a pharmacologist isn’t a pharmacist because he didn’t do all the required courses a pharmacist would have done in school eg dispensing, pharmaceutics, drug production and compounding etc. As for the bossing around of a pharmacologist by a pharmacist I am strongly against that….. And yes we do have a right to query a prescription as we are the drug expert , and the doctor has a duty to explain his decision to the pharmacist since it is a health team.

    • Issues issues issues

    • @Muyiwa,a pharmacologist is not a pharmacist,an average pharmacist is a pharmacologist but an average pharmacologist is not a pharmacist,pharmacology is simply 1/6 or 1/7 of pharmacy,that is why you see pharmacy as a faculty and not as a department.Courses like pharmacognosy,pharm microbiology,pharm chemistry,pharmaceutics and clinical pharmacy are alien to pharmacologists and even medical doctors,these 6 departments including pharmacology make a pharmacist understand drugs in and out beyond active ingredients that a pharmacologist might have studied,pharmacology is just one of the 6/7 departments of pharmacy.Running a community pharmacy goes beyond pharmacology,there are lots of drug information questions that pharmacology/medicine can not attempt,a doctor once approached me of his observation about differences in pharmacotherapeutic performance of two brands of cefuroxime in clinical setting,it only took combination of knowledge of pharmaceutics and clinical pharmacodynamics/pharmacokinetics to level his mountain but not pharmacology.Pharmacists take oath like doctors not to dispense anything they professionally perceived to be actually or potentially injurious to the patients,therefore there is a need for the pharmacists to approach the doctor with good communication skills which are thought in the course of their training and the doctor should accept the reality that pharmacy has clinically evolved as a care profession where collaborative contributions are required for the sake of the patients.Dr Sunday Olatunde,Associate Consultant,Clinical pharmacy.

    • As for the pharmacists querying doctors`prescriptions when he/she does not have the patient`s history,a pharmacist can take past and present medical history,past and present medication history etc by interacting with the patient when necessary,however the hallmark of pharmacists service today is to prevent drug therapy errors which could be actual or potential,if you are a pharmacist you will know that some errors could be detected without necessarily having the patients history.Thanks.

  6. Edaki Isioma

    The article is not educative.pharmacist should always do the right things first.

  7. Good to learn from.l have had experience with doctors a lot.concerning HCTZ, some of the research had shown that blood glucose level is raised only at high doses(above 25 mg).
    For diclofenac, the dose is above max daily dose hence an adjustment required! When a doctor insist, I just ask them to sign against the spotted error twice and that’s it.our approach really matters

  8. Generally to everyone,pharmacy is evolving,some dossage forms are available these days that are modifying the expected pharmacokinetic behaviours of traditional dossage forms,if the diclofenac in question is a modified or slow release dossage form,then the doctor`s dose of diclofenac in ecxess of maximum daily dose is permissible but not absolutely correct,the traditional peak plasma concentration might not be reached through out the day which is the one that determines the plasma half life,frequency of administration and therapeutic index.I know the doctor does not know all of these,mutual discussion would have sorted things out.