Robotic Pharmacy

April 13, 2005 1:11 AM

What is the need for a human pharmacist in this day and age?

I was reading the following thread about religious pharmacists refusing to dispense prescribed drugs that, for whatever reason, offend their moral sensibilities.

I am curious why the job of the pharmacist couldn't be replaced with an automated (robotic) operation, given a few observations:

• most if not all drugs, generic or otherwise, seem to be sold to stores in prepackaged dosages, eliminating the need for a pharmacist to mix products

• careless human pharmacists can make serious dosing or product errors and electronic prescription processes would further reduce interpretation problems

• nosy human pharmacists in an increasingly theocratic state seem prone to stick their business into others' private heathcare decisions

• drug stores would likely want to cut staff costs and reduce the likelihood of lawsuits from dosing or product selection mistakes or inappropriate decision making

Not that I want to put someone out of a job per se, but I'm curious what exactly are the roles of a human pharmacist today that can't otherwise be automated? What requires human intervention in this line of work?

posted by AlexReynolds to technology (18 comments total)

Just think of pharmacists as cashiers with slightly more to do, and note that regular cashiers are only in the very first stages of being phased out completely. These things take time.
posted by trevyn at 1:37 AM on April 13, 2005

I think a lot of pharmacists would be offended by the claim that they are "cashiers with slightly more to do". A pharmacist usually has around four years of training, and is qualified to give advice on health issues, such as recommending over-the-counter medicines. They're also handy for making sure that you don't end up taking weird and dangerous combinations of drugs.

In the UK, traditionally at least, the local pharmacist takes some of the pressure off the local doctors' surgeries, since they can be a first port of call for people with minor ailments.
posted by chrismear at 1:51 AM on April 13, 2005

A large part of what pharmacists do, in the US at least, is deal with insurance companies to get payment authorization. It would be possible to automate that, but first you have to develop an integrated system shared by a bunch of competing insurance companies. The insurance companies aren't eager to spend the millions to develop this system, since they wouldn't get the cost savings from eliminating pharmacists.

It's also more common than you think for pharmacists to have to compound (i.e., make) medicines.
posted by bac at 2:06 AM on April 13, 2005

The more i hear about the US system, the more it seems totally backwards. In the UK pharmacists dispense medicines and advice. In the US, pharmacists deal with insurance companies and refuse to dispense medicines. Don't you guys have a culture of care within your medical professions?
posted by handee at 2:17 AM on April 13, 2005

Pharm techs dispense drugs (count out pills), deal with insurance, and handle the cashiering. Pharmacists recommend OTC drugs, mix drugs (the liquid ones, the shots, etc), and provide consultations on side effects and drug interactions. I think the hardest to replace would be the drug interaction knowledge, which can get really complicated. Pharmacists often know more about drugs than the doctors who prescribe them.
posted by TheIrreverend at 2:29 AM on April 13, 2005

There are many, many reasons why human pharmacists are not being replaced anytime in the foreseeable future:

• Machines are fallible. I'm too lazy to come up with any citations (I think it was on RISKS Digest), but I believe there was a study of a hospital that switched to a mostly automated prescription-dispensing system. Medication errors actually increased. Modern pharmacies have pill counters, pill weighers, barcode scanners, etc. but none of these are perfect. There are numerous systems out there that allow pharmacies to operate with minimal staff.
• Pharmacists (and techs) have to validate prescriptions. Doctors still write out scripts, and those need to be interpreted and sanity-checked by the pharmacy staff. In many cases, the pharmacist will know more about a drug than the doctor will, and will contact the doctor to clarify the prescription. Automation cuts out this process (although it helps in other ways by warning about drug interactions, etc.). Computerization of prescription-writing is a step forward, though, mainly because doctors generally can't write for shit. :)
• Pharmacists often have to consult with patients and answer questions they may have.
• Pharmacists (and techs) do more than dispense pills. They mix creams, syrups, and IV solutions; triturate powders, etc. Automation would be prohibitively complex for these operations.
• Regardless of how a prescription is dispensed (whether by a tech, the pharmacist, or an automated system), the pharmacist still has to be the final point of accountability for any dispensing errors.
• As mentioned above, the U.S. healthcare system is an unholy mess. Pharmacy staff (especially in public "community" pharmacies) spend much (if not most) of their time navigating the minefield of insurance billing, formularies, allowed generics, patient coverage limits, co-pays, etc. Even with sophisticated computer systems and electronic billing, it's a tricky business. To use a specific example from my pharmacy-tech days: Almost 100% of the time, if a generic is available for a drug, the insurance plan will cover the generic and not the brand name. We had a patient who did not have her insurance information available at the time, but needed Cipro (an antibiotic) immediately. We filled it as ciprofloaxcin (the available generic), which she paid cash for -- we planned to rebill her HMO when she got her information, so she could receive a refund for the difference (cash minus copay). When we got the information, however, we discovered that the HMO (HealthPartners, I think) doesn't cover ciprofloaxcin -- they will only pay for brand-name Cipro! Why? Hell if I know.

(Um, in a nutshell, I guess what TheIrreverend said while I was typing this.)
posted by neckro23 at 2:48 AM on April 13, 2005 [1 favorite]

... on a similar note, why do I need a prescription with glasses/contacts? Is their some way to get high on them or OD that someone's not telling me about?

Seems like a trained tech could do give the proper testing... hell, i'm doing most of the work! "first one... no, second one... yeah..." and nurses do the serious disease testing.
posted by trinarian at 3:21 AM on April 13, 2005

I'm a hospital pharmacist and what I do is very different from practicing in a retail setting, but there are a few things I can think of that can't really be done by robots. First, the Omnibus Budget Reconciliation Act of 1990 mandated that pharmacists counsel Medicaid patients on their prescriptions. At that time, most states' pharmacy regulatory agencies mandated that all patients be counseled, so as not to create a dual standard of care. Second, despite the fact that some people think pharmacists are merely cashiers, they really are necessary to review and assess the appropriateness of prescriptions written by physicians. I know that a lot of people think that physicians are infallible, but here in the hospital, it is not at all uncommon that I receive orders for a medication at 100 times the normal dose, or a diabetes medication when the physician really wanted something for sleep. (I am guessing that this occurs in community practice as well.) Third, the paperwork and documentation required by the DEA for the distribution of controlled substances is not something that will be automated in this lifetime.

I found this link that also might help answer your question.
posted by mokujin at 3:28 AM on April 13, 2005

In some states pharmacists can dispense emergency contraception (also known as the morning after pill) without a prescription from a doctor.
posted by cushie at 3:55 AM on April 13, 2005

trinarian, if you're going to an optometrist, then you are going to a (very highly trained) tech, not a doctor. Ophthalmologists are the eye doctors. To complete the trifecta, opticians are the eye-care equivalent of pharmacists.
posted by bonehead at 6:28 AM on April 13, 2005

There are probably much better models for the provision of prescription meds, but meanwhile, an experienced pharmacist knows a lot more about drugs, dosages, compounding, interactions, etc., than physicians. They are a great resource to consumers, even/especially in the retail setting. In a hospital pharmacy, they are invaluable.
posted by theora55 at 7:09 AM on April 13, 2005

Doctors are fallible. A knowledgeable pharmacist once caught a serious (over-) dosage mistake on a prescription submitted by my Mom's old doc. I know most pharmacists are practically just cashiers, but this one was really good.
posted by Shane at 7:18 AM on April 13, 2005

Jeez, Shane. I had hoped that by reading some of the answers above, people would realize that pharmacists aren't just cashiers. Where I live, retail pharmacists generally make more than $100,000 a year. And around this time last year, Walgreen's was offering a 6-year/$1 million dollar contract. If you know of any cashiering positions that pay that well, please, sign me up.
posted by mokujin at 7:41 AM on April 13, 2005

I'd just like to ad that I believe pharmacists have even more responsibilities in the UK and Australia. I think they actually have the ability to prescribesome prescription drugs, in addition to filling prescriptions from doctors.

Please correct me if I'm wrong.
posted by croutonsupafreak at 8:03 AM on April 13, 2005

Don't you guys have a culture of care within your medical professions?

No.

sorry for the off topic...
Actually, I think this is an interesting balancing act that neither europe nor america has got right, yet. My mom moved back to London after being diagnosed with MS, & she gets great care there. They send over people to help her with tasks, to clean her place, to get her online, to help her do physical exercise; they send her to free yoga classes & call to remind her to check in with her doctor, etc. But they do not keep her up to date at all about new medications or treatments that might actually improve her condition. They care for her, but they don't try to make her better.

The problem is the opposite here - they dispense meds all over the place, have people on steroids, enroll people in trials for new treatments, etc, but they don't give a shit about the individual. It is very easy to get completely lost in the shuffle on this side of the pond, but you will almost certainly get some sort of prescription. People with MS that I talk to in america are always shocked to hear that my mom is not medicated at all in the UK. But they're equally surprised by the attention that is focused on her - in the US, you have to chase the doctors around and ask for stuff. If you don't, no one is going to do it for you, which is why lots of poor or uninsured people don't even know they're sick until it's basically too late, because they don't go to doctors, and doctors don't call them: they just go to the ER when something really hurts. But the culture of care can be a little too sluggish, and be more about nursing than doctoring...

Britain is patient and calm and hesitant and concerned; america is optimistic and adventurous and selfish and easily distracted.
posted by mdn at 9:15 AM on April 13, 2005

... on a similar note, why do I need a prescription with glasses/contacts? Is their some way to get high on them or OD that someone's not telling me about?

I'm pretty sure that's because there is more variation in eyeglass lenses than you'd think. Magnification, bifocals, astigmatism correction... most people need different prescriptions for their left and their right eyes, as well... there are just too many variations in eyeglasses to make them easily available off the shelf. Reading glasses, in very simple variations, are... I think the reason for the prescription is to get a pair of lenses that exactly match your ocular variations and correct them.

As far as getting high or OD'ing on them... I think the closest you'll come is frying ants. But that can be a bit of a high, no?
posted by salad spork at 10:48 AM on April 13, 2005

Sorry, but...

MetaFilter: adventurous and selfish and easily distracted
posted by dirtynumbangelboy at 2:35 PM on April 13, 2005

I know of a company that is trying to automate the drug dispensing business. They're a mail-order pharmacy trying to cut back on expensive pharmacist salaries, but as I understand it, even if they are able to automate completely, by law they'll still have to have a pharmacist sign off on every one of 3-million some prescriptions per year (poor soul). A lot of what is involved from what I gather, is image recognition of pills, and chemical analyzers to try to catch mistakes.
posted by jacobsee at 9:03 PM on April 13, 2005