osewalrus (osewalrus) wrote,

Why Nobody Cares What Pharmacists Think About Healthcare -- Which is a Real Pity.

I was at the America's Future Now conference yesterday attending a session on reforming healthcare. The woman presenting, an MD/MPH, had a slide of impressive figures for how much time is wasted dealing with insurance companies. Three weeks of productive MD time is spent dealing with insurance companies, six weeks of nurse time, and about three months of clerical time. Nowhere was there any mention of pharmacists.

This is not a fluke. Scan the newspapers or trades for discussions about electronic medical records (EMRS) and you will find lots of quotes from doctors, from vendors, from official spokescritters of commercial pharmacies like Walgreen's, from nurses, and -- very occasionally -- from patient advocacy groups (exception, privacy groups are reasonably well represented, but patient healthcare advocates are extremely rare). But representatives of pharmacist trade associations are non-existent, as are regular hospital or commercial pharmacists (unless they own pharmacies and are speaking as small business owners).

Granted I'm following at a distance. But from what I can tell the contribution of pharmacists to date on the rules governing electronic medical records (EMRS) is limited to the informatix section of the American Society of Health System Pharmacists telling its members to go make individual comments in various proceedings. Indeed, nobody seems to give a crap about what pharmacists think about healthcare policy at any level or on any issue. Even drug safety issue discussions are generally dominated by MD/PhDs and MD/MPHs (and, of course, vendors and insurers). To the extent the conversation is broader than MDs, it encompasses nurses and healthcare administrators. But pharmacists are noteworthy for their absence.

This is likewise reflected in JCOA. Inspection teams are generally MDs or nurses and do not include pharmacists. Consider this 2008 JCOA article suggesting that clinical pharmacists might actually have a role to play in direct patient care to reduce medication errors, not merely spotting potential adverse drug interactions.

What makes this oversight more ridiculous is that pharmacists have constant interaction with medical insurers, patient records, and new technology at every stage of the healthcare system. Patients are far more likely to see their pharmacist regularly when picking up prescriptions -- or at least have the opportunity to see their pharmacist if they want to talk to someone other than the tech at the counter. Why is the policy process so utterly blind to pharmacists?

Then it hit me: pharmacists are the computer nerds of the medical profession. Like computer nerds, pharmacists have an aversion to anything resembling organized "politics." This does not, of course, mean they lack for opinions. They simply have no desire to do anything about them. Which is why, as best as I can tell, their trade organizations have no interest in lobbying on policy issues outside of protecting their professional prerogative to compound drugs from being eliminated by the FDA.

Even if they wanted to organize, pharmacists face some significant battles in getting themselves heard. First, pharmacists are internally divided between retail pharmacists and non-retail pharmacists. when it comes to things like medical records and healthcare reform, the two groups are likely to have different perspectives. Also, the personal stake is lower. Pharmacist pay and their role in patient care is not in the least impacted by insurance compensation regimes. unlike Drs or nurses, they are not going to have their professional duties modified significantly by healthcare reform or by adoption of any electronic medical record rule. They may need to learn some new systems, but the change is not going to radically alter their regular routines, as it may with Drs and nurses (a result both groups of incumbents are busy trying to avoid -- whatever bullcrap they may say publicly about patient care. Trade orgs protect their members, and the consumer that forgets this is begging to be screwed).

Finally, pharmacists occupy a screwy place in the hospital hierarchy. Drs are not entirely comfortable with pharmacists, especially since they need to call so many of them Dr. Like ship captians and chief engineers, Drs are technically superior to pharmacists in hospital hierarchy but utterly reliant on them and their specialized knowledge. Drs may treat nurses as dirt beneath their feet, but they show a wary respect for pharmacists who are not only permitted, but required, to document doctors being idiots if the doctor decides to ignore a pharmacist's professional opinion.

Which also means that pharmacists are not particularly close to nurses either. Nurses, from my observation, tend to treat pharmacists with the same mix of outraged pride and secret inferiority that the average person feels when calling IT tech support. Pharmacists, for their part, tend to react to nurses in the manner of IT tech support people getting angry demands about why is the cupholder broken and why can't I get on the interwebs.

But nurses, despite the relatively low place in the hospital hierarchy, have far more policy impact because of their sheer numbers. There are tons of nurses as compared to the number of pharmacists. Further, many nurses go into allied professions because their familiarity with hospital practice and procedure makes them extremely well qualified for other hospital administrative work that may pay better -- particularly after acquiring another degree like MBA or MPH. That means nurses or former nurses are pretty much everywhere in healthcare policy land. Pharmacists, OTOH, tend to stay pharmacists.

The result is that we are on track to have healthcare reform and an electronic medical record system that sucks because a key constituency is going to remain virtually unconsulted until we get to actual implementation. This will also lead to a lot of pharmacists grumbling about the dumb ass system they have to implement. My sympathy for the pharmacists will be somewhat limited, because I am rather firmly of the belief that if you don't step up to get involved in policy you issue an invitation for others to do what they want to you for their own convenience. But I'm sorry my healthcare delivery system will suck, especially when it was avoidable.

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