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Posts Tagged ‘collaborative practice agreements’

The Pastophor

Tuesday, August 19th, 2014

I’ve had my design thinking hat on this week about some other things…which had me thinking tonight about the following:

Why do physicians prescribe drugs?

The physicians are diagnosticians, from my understanding.  But why should they get to pick the “best” drug for a patient, when:
a. they don’t necessarily know what else the patient is taking, (and yes, there are some very fatal and very nasty drug-drug interactions out there to be worried about)
b. they didn’t have as much pharmacology training as an actual pharmacist, and
c. they typically don’t know what’s on the patient’s preferred formulary for their prescription benefit plan.

Common sense aside for a moment, I dug around history tonight to understand what the origins of this split between the physician as prescriber and the pharmacist as dispenser happened.

I’m still not totally sure, to be honest.  But, the one thing I stumbled upon was the pastophor.  This was, in ancient Egypt – a physician and pharmacist in one.  The pastophor diagnosed, treated and prepared medicine for the patient.  They were allegedly “highly respected” in society and pharmacy, or the preparation of medicine, was considered a specialty within medicine.  (I found that here, on page 25.)

Now, let’s flip over to NPR, where tonight, I also saw an interview with a cardiologist about his new book, basically about the problems with our healthcare system in the U.S., inter alia (and no, I haven’t had a chance to read the book yet).  Part of the interview talks about some docs (NOT ALL) ordering excessive diagnostic tests for patients.  Now, of course, we have a few laws called Stark and Antikickback that don’t allow docs to be vertical marketers anymore.

I guess through reading part of the first reference above, pharmacists in England couldn’t get their act together (meaning they didn’t have standards of education and experience established), which led to physicians making the call on drugs, and having licensed pharmacists (rather than snake oil salesmen or untrained chemists) fill the prescriptions instead.

Here’s my bottom line: I’m inconclusive here.  It kind of makes sense (at least from a design thinking perspective) that the doctor may be great a diagnosing the patient, then putting on paper or ePrescription the diagnosis – then handing the DIAGNOSIS over to the pharmacist INSTEAD of the drug, and letting the drug expert decide on which drug is best/cheapest/on formulary for the patient…?  Maybe? Perhaps?

There’s probably more history here that I’m missing.  But I still am haunted by the why.

However, if nothing else, we learned about the pastophor in this post.  Believe it or not, there are actually some pharmacist-physicians out there in the universe this very day.  Maybe THEY can shed some light on why physicians get to prescribe drugs, but pharmacists have no say in the best drug for the patient…?  When I run into one the next time, I’ll be sure to ask…*

(*OK, technically, pharmacists can prescribe a few drugs on their own, based upon different state laws.  Also, pharmacists may be able to prescribe through something called collaborative practice agreements.  This is a step in the right direction.  And I’m not saying that all physicians are terrible prescribers in this post either.  What I’m questioning is WHY the system is the way it is currently – and should it REMAIN that way?)