Why healthcare's Rodney Dangerfield don't get no respect

David StanleyThe e-mail started out warmly enough. “Love the essays in Drug Topics. I have always been right there with you in my opinions and my despair at the state of my profession.” I have learned though, that when a letter starts out like that, there is always a “but...” on the way.

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Sure enough: “But this month I gotta write a note ...Yes, pharmacists will move toward more of a provider status, for good or bad. But birth-control pills? Refills? I don't think so.” The letter-writer then went into the reasons he thinks it's not the best idea for pharmacists to prescribe hormonal contraceptives to women.

Refreshingly, his reasons were professional and grounded in reason, unlike so much of the dogma and pseudo-science that has surrounded the issue over the last few years. I'll have to save my rebuttals for another column though, because this line caused my jaw to drop: “You ask if there's anyone with a pharmacy degree who doesn't feel equal to bringing someone's blood pressure under control. Heck yes, that would be me and many of my fellow pharmacists.”

“Many?” How many?

I have only one question for this letter writer and the “many” members of my profession he claims agree with him. What exactly did you do in college?

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I certainly wasn't the best student in school, but I remember cramming years of chemistry, physiology, pharmacology into my head and topping them off with an intensive hospital rotation. I remember it being difficult. I remember that I knew a lot more coming out of the experience than when I went in. And I remember that everyone else who got a pharmacy license that year went through the same program I did.

When I see guidelines from the American Society of Hypertension that say nonblack patients younger than 60 years of age with a blood pressure over 140/90 should be started on an ACEI or ARB with a thiazide or CCB as second-line therapy, and when I know exactly what that means, then so do you.

No one has to translate those abbreviations for you or tell you the dosage of the recommended meds. They may look like alphabet soup to the average person, but you know all this, and you are perfectly capable of reading and understanding the rest of the ASH guidelines - better, I would submit, than some of the prescribers I see who still give thiazides and beta-blockers first-line to diabetic patients.

What’s going on?

So now I have to ask my correspondent: Why do you think so little of your skills?  Do you really think all the time, tuition, and training that went into you getting a pharmacy license qualifies you only to fax refill requests and follow orders?

This same letter-writer drew an analogy between going to a pharmacist for a flu shot and going to Jiffy Lube for your taxes. Really?

The year before pharmacists were allowed to give flu shots in California, I got mine from an LPN who spent a good five minutes trying to measure out 0.5 ml into her syringe, adding a little, squirting a little out, and repeating the process over and over. Even with zero immunization training at that point, I wanted to grab the vial from her and do it myself, and I would go to that letter-writer sight unseen for this year's shot before I would ever go back to that LPN.

The profession of “can’t”

That letter-writer's attitude is what has made pharmacy the profession of “can't.” We insult ourselves by saying an oil-changer knows more about the IRS code than we know about influenza immunizations. We meekly pretend we have no way of knowing whether losartan or reserpine is the better choice for a patient's blood pressure. A computer can print out an abnormal lab value in red, yet we claim it's beyond our ability to do anything about it.

“I can’t” isn't a sound strategy for survival in today's hypercompetitive economy - not to mention what a default setting like that does to your self-esteem.

If we want credit for being professionals we're going to have to start acting like professionals. Which means making decisions, using our best judgment, and stepping forward and solving problems more significant than getting a doctor to answer a fax. Otherwise we all might as well trade in our licenses for technicians’ certificates.

And don't even get me started on why we shouldn't be allowed to prescribe birth control.