The Pharmacist vs. the Air Traffic Controller (ATC)
Both professions primarily focus on one thing: keeping people safe. Pharmacists go through years of training learning about diseases, how to treat those diseases, and how those treatments interact with the body and other treatments. This is like ATCs training to learn air procedure, the difference in aircraft clearances, abilities, capacities, runways, and how the weather interacts with it all. ATCs use their training to get planes into the sky and back to the ground safely and without incident. Without them, runway collisions and even mid-air accidents would be far more frequent. No one would fly.
Similarly, pharmacists use this information primarily in the dispensing setting to make sure that the medications prescribed by a healthcare practitioner at a minimum do not harm the patient. Once that is ensured, a pharmacist has a duty to make sure that the ideal treatment is prescribed, not just an acceptable one. Making this decision requires information about the patient’s disease state, their other medications, their insurance and financial status, and their ability to comply with medication regimens. If the best treatment for a condition is drug X, but it needs to be injected with a needle, and your patient refuses to inject themselves, then drug X is not the best treatment for that patient.
This is where ATCs and pharmacists start to differ. ATCs have full access to the knowledge of the location, speed, altitude, etc of the aircraft in their zones of control. They also have the authority to issue commands that the pilots must obey. Pharmacists, on the other hand, are forced to watch as patients are prescribed suboptimal or even harmful treatments or combinations of treatments on a daily basis. When pharmacists report their concerns to prescribers, often they do not get a call back, or the provider gives it their blessing anyway. Sometimes, especially in the community pharmacy setting, this is because the prescriber has some important information that the pharmacist does not. Most pharmacists who have learned to live in the community pharmacy world rely on this assumption to maintain their sanity. Once they’ve done their part and called, they can move on with a clear conscience.
I could never do that. It wasn’t because I don’t believe that can be the case, but it’s because of the sheer volume of these types of interactions. It is IMPOSSIBLE for every patient to be the exception to the rule. Some providers simply don’t care about evidence based guidelines or drug interactions. If a dismissal of my concern was the exception rather than the rule, it would be much easier to believe that in those rare cases the decision made was correct.
