What happens between my doctor sending a prescription to the pharmacy and me picking it up?
Does the pharmacy just have every single potential prescription sitting in the back and they count and portion it out as the order is received? Do they “make” any of the medicine on site? Seems unlikely for the pills with designated colors and markings.
And if a significant portion of the job is counting pills why do pharmacists require so much schooling?
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Pharmacies keep a lot of medications, but not all. If you’re prescribed something that they don’t have in stock they’ll have to order it, usually a quick process.
Doctors make mistakes and having a well schooled and well trained pharmacist keeping an eye on what medicines you take is necessary.
People also visit multiple doctors and many medicines cannot be taken with others. A trained pharmacist will also catch this.
Some pharmacies do offer compounding, which is making medication there, on site. Not all do this though.
In a nutshell, you want someone highly trained back there dispensing your medication.
I’ll answer the last question: pharmacists are the last check between the doctor and the patient for drug allergies and drug interactions.
This is especially critical as patients who are aging, or who have multiple conditions, and who are seen by different doctors. Just because my cardiologist puts me on Metoprolol, doesn’t mean my pain management doctor won’t prescribe Tizanidine, which is contraindicated.
In an ideal world, every patient carries a list of current prescription and OTC meds, and every doctor is familiar with every drug interaction. But it’s not a perfect world, so there’s where the pharmacist comes in. It’s much, much more than just counting pills.
Counting pills is actually a rather small part of the job, comparatively, and pharmacists themselves barely even do that in the first place. That job, and many others (insurance claims, customer interaction, basic record keeping, general pharmacy maintenance) falls on the technicians, for whom no schooling is required.
The primary function of the pharmacist is to A) make sure their techs don’t fuck up your prescriptions, and B) make sure your doctors aren’t unknowingly trying to kill you. That second part is where all the schooling comes in. You’d be surprised just how many doctors blindly send things in that can have severe adverse reactions based on your specific medical history, and the issue is only compounded when you have multiple doctors. Pharmacists are there to identify and prevent such occurrences, as well as provide more general medication counseling.
Also, yes, pharmacies tend to stock the most common medications regularly and dispense accordingly. There’s only so many drugs out there, after all. Everyone gets the same stuff.
Doctors and pharmacists have different specializations. Both hold doctorate degrees, as that’s the amount of knowledge you need to not kill people.
Doctors specialize in working with patients to determine what’s wrong with the patient’s body and setting a treatment or management plan. They are not drug experts; they oftentimes will learn that Drug Y is a treatment for disease X, but not how Drug Y works or its alternatives.
Pharmacists are the experts on drugs. They in general would know that Drug Y treats disease X…but aren’t trained to work with patients to determine what disease the patient has. So when the medical doctor sends over a prescription, the pharmacist will check their work; to make sure they sent over the right drug, right dosage, right quantity, and recommend a better drug or cheaper alternative if it’s suitable. They also check to make sure that Drug Y doesn’t interact with any existing diseases or other drugs. And they’ll also tell the patient how to take those drugs; what side effects they need to look out for, and answer any questions.
Lastly, the divide between the two also has a purpose. If a doctor could also dispense drugs or pharmacist write prescriptions, then there’s a single person that can create significant prescription drug abuse. With the divide, it takes two people working in two different practices in two different businesses to coordinate or look the other way. For example, if a dermatologist (skin doctor) keeps writing prescriptions for adderall (a psych med that a dermatologist has no business with) or pain killers, the pharmacist is going to think something is very suspicious. The two part system makes sketchy things like the opioid epidemic much less likely.
For the most part, yes. Pharmacies do stock the majority of medicines people are likely to have prescribed. They use decades of statistics to try to predict how much stock they need to keep of them. Part of how this works is pills just don’t take up a lot of space. A giant bottle with 5,000 of a pill isn’t *that much* larger than the bottle you get with 10-50 pills inside, and it can dispense up to 500 bottles.
Meanwhile, all of it is tracked, since we’re talking about drugs. The pharmacy has a more accurate count of every pill it has than any other part of a store. So it’s very clear when that 5,000 pill bottle is getting kind of low, and there’s plenty of data to tell the pharmacy when it’s low enough to reorder.
Also, chain pharmacies can move stock around. If one pharmacy needs to fill something they don’t have, but a pharmacy somewhere else in the city has it, they can either transfer the prescription or get the medicine delivered. This can cause a delay, but sometimes it’s fast enough patients don’t really notice.
That said, sometimes they’re just out. There have been a lot of medicine shortages over the last few years while people pretend everything’s fine. It’s left a lot of people with no real way to get the medicine from a local pharmacy at all. But even outside of shortages, I occasionally have to travel to a different pharmacy from my usual one because they indicate what I need is sort of “rare” and the other pharmacy is the only one that stocks it.
> And if a significant portion of the job is counting pills why do pharmacists require so much schooling?
Oh no. Not at all. “Counting pills” is just the tedious part of the job, it’s like arguing “all a doctor does is paperwork”.
The pharmacist is supposed to be well-trained in a VERY wide variety of medicines. Some doctors can specialize into certain kinds of drugs, but pharmacists have to study them all. They are supposed to know dosage requirements and interactions VERY well, and what they don’t have memorized they’re supposed to be able to look up and research very quickly.
The reason is sometimes a doctor doesn’t remember *everything* about a patient. Maybe the family doctor misses on the chart that a patient is taking something prescribed by a specialist. That could lead the doctor to prescribe a drug that interacts with the other one. The pharmacist is ONLY focused on, “What medicines are this patient taking, and why?”, so they’re less likely to miss something. They can notice, “Oops, your doctor probably didn’t mean this, let me call him and double-check.” Usually that results in the two hacking out an alternative, or in rare cases the doctor explaining they understand the risks but have a reason for this prescription.
Meanwhile the pharmacist is also supposed to understand the side effects and interactions the medicine your taking could have and is often required by law to explain them to you. My pharmacy’s policy will NOT let the employees give me a medication until the pharmacist scans their badge and speaks to me about the medications. They can’t even take my money without that.
That’s what the pharmacist is trained for. They are supposed to be at least as well-versed in ALL drugs as any doctor you see, because they are the last person who gets to double-check for safety issues. Even the “technicians” who work for the pharmacist require some degree of medical training just as an extra safety net. They aren’t trained *enough* to be *responsible* for the final decisions, but they are trained enough to catch big mistakes and to know better than to take the shortcuts people who get paid far less tend to be tempted to make.
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