Friday, September 17, 2010

We Don't Realize How Much We Know

We forget sometimes that even a pharmacist with a below average knowledge-base knows much more than the average person. Concepts that seem so simple and easily understood to us can be very difficult for the average patient to comprehend.

How many times do we roll our eyes when a customer comes to us with a box of Tylenol and asks, "my doctor said to get Tylenol. Is this the right one?" We're thinking that it says Tylenol right on the box. What a stupid question. It doesn't take a pharmacy degree to read.

Have you ever wandered out into the aisle and just marveled at the variety of Tylenol Brand products there are (well, there were at least, considering Tylenol is still in short supply from the recall)? There's Tylenol Cold, Tylenol Arthritis, Tylenol PM, Regular Strenght Tylenol, Extra Strength Tylenol, Children's Tylenol Liquid, Infant Tylenol Drops, Tylenol Severe Congestion, Tylenol 8 Hour, Tylenol Rapid Release Gels, Tylenol Allergy, etc., etc.

If I didn't know a thing about medication (and why would I if I wasn't in a medical profession?), I'd be completely lost. The doctor just said Tylenol. He didn't say there were so many different options. Is Extra Strength OK? How do I choose?

It's simple to us. We know that Tylenol is acetaminophen. We know that you can take 2 Extra Strength Tablets up to 4 times per day without exceeding the maximum allowable daily dose of 4 grams. We know that store brand acetaminophen works just as well as Tylenol, so we can save money. Hell, we even know that weight based dosing of Tylenol is 10 to 15 mg/kg per dose, so we can tell someone the correct dose for an infant even though it doesn't say it on the box.

That information is right at the front of our brains because it's one of the first things we learn when studying to become pharmacists, and we use it often. However, it's kind of complicated for a regular person, and that's only one drug! We can tell people just about everything about other common OTC active ingredients such as ibuprofen, naproxen, pseudoephedrine, phenylephrine, dextromethorphan, guaifenesin, diphenhydramine, doxylamine, chlorpheniramine, meclizine, dimenhydrinate, ceterizine, loratadine, famotodine, ranitidine, omeprazole, lansoprazole, cimetidine, simethicone, clotrimazole, terbinafine, salicylic acid, and on and on and on...

I just rattled off 22 ingredients off the top of my head (23 if you count acetaminophen). I can tell you the drug class of each of them, indications, common dosing, side effects, and important drug interactions. Again... That's simple stuff. Every pharmacist can do this. The average person doesn't have a chance in the world of knowing all that stuff.

Then we move behind the counter, and we have ACE Inhibitors, ARBs, HMG Co-A Reductase Inhbitors, sulfonyureas, the different types of insulins, Calcium Channel Blockers (dihydropyridine and non-dihydropyridine varieties), bisposphonates, proton pump inhibitors, all the varieties of beta blockers, corticosteroids, diuretics, and so many more classes. We know multiple drugs in each category, and we know a lot about them.

The amount of information is staggering, especially when you really get down to the nitty gritty. For example, not only do I know that simvastatin is an HMG Co-A reductase inhibitor, I also know that it's one of the more lipophilic ones, and has a higher risk of muscle related side effects (myalgias, myopathy, and extremely rarely rhabdomyolysis) than less lipophilic statins like atorvastatin. It's extensively metabolized by cytochrome P450 3A4, and thus, a lot of clinically significant interactions can be seen when used in combination with 3A4 inhibitors such as verapamil, diltiazem, clarithromycin, amiodarone, and even grapefruit juice. Because of this interaction, it's listed as a contraindication in the package insert to use doses over 20 mg in patients concurrently taking verapamil. I know that simvastatin is available in 5, 10, 20, 40, and 80 mg dosages. And again... I know all this information off the top of my head, and so do most pharmacists.

That's one drug. I can do this with dozens, maybe even hundreds of drugs. It's amazing when you actually stop and think about it.

The point of all this is that perhaps the next time a customer comes to the counter and asks what you immediately think is a stupid question, just remember how much more drug information you know and understand than he does. Maybe cut him a little slack. He's not supposed to know this stuff, whereas you get paid to know it.

In addition, be proud that you have accumulated this massive drug information database inside your brain, and don't ever be afraid to use what you know to help other people. Whether you like the title or not, you are a drug expert. No other professional in the world knows more about a wider variety of drugs than a pharmacist, and this information is incredibly useful even when you're away from the pharmacy. Pharmacists never stop being pharmacists just like doctors never stop being doctors. Being a pharmacist is more than just counting pills, even though that may be what you do the majority of the time you're at work. If someone asks you a drug related question when you're away from the pharmacy, be happy to answer them. It really won't take that long, and the person will greatly appreciate it. If you are able to help the person, it will put pharmacists and our abilities in a good light.

You want to save the profession? Start by helping the people around you. Slowly but surely, the word will spread that these pharmacists are full of information and important to society. Let's face it, pharmacists alone appealing to their corporate masters are not going to change anything. However, if not only pharmacists but the people start demanding better care from their pharmacists, that will have an effect. If we want to play by the rules of capitalism, then we have to make the market decide that pharmacists are valuable.

This was a strangely upbeat post from me. I gave myself a flu shot yesterday. Maybe delusions of grandeur is one of the side effects.

1 comment:

m said...

Thank you so much for this post. I am a pre-pharmacy student. I aspire to be a considerate and understanding pharmacist like you one day.
The pharmacists I work with are so negative and cynical. I try to find inspirations online but most of the other pharmacist bloggers (at least the ones I have been following) are just as angry and snobbish. Why would anyone get into the health profession if they don't care about the well-beings of others? I understand their jobs are stressful and dealing with the public and the insurance can be frustrating sometimes. But where can you find a job that is stress-free?
Oops, I am getting negative like them with my complaints...