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Comment by Overtonwindow | Hacker News Reader

Probably not a popular opinion, but I think we can do away with the vast majority of pharmacist. There are machines that can properly identify, sort, bottle, label, and provide prescriptions with little to no human intervention. All it seems the pharmacist does is pop bottles, fill prescriptions, file insurance claims over and over and over again.

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At least in the UK the pharmacist’s job is to check the prescription makes sense and isn’t going to poison the patient, and also to give crucial directions to the patient as they probably won’t read the leaflet. Seems like an important job.

It is the same in the US. The problem currently is the volume retail pharmacists (not hospital pharmacists) are asked to fill - it is harder to have time for interventions.

I think most pharmacists would welcome the chance to count fewer pills and apply their PharmD skills.

In the UK the vast majority of medications come in blister packs corresponding to a typical dose. So pharmacists are not counting individual pills, only trays. This seems like an obvious thing that the US could adopt.

So pre-record the instructions for taking the medicine in English / Spanish / Mandarin etc, stick ‘em in one of those booths like they have at the porn store and call it a day.

I had a doctor mistakenly up my dosage tenfold when doing a routine renewal. My pharmacist didn’t notice the change and filled it.

Surely an algorithm would have flagged this as suspicious (I’d been on the same dose for years).

Drug contraindications are automatically flagged though. In principle yes they have to do that, but rarely if ever in practice.

Drug contraindication flagging is not something a computer can do effectively. Garbage datasets on drug warnings, garbage data on patient conditions - it truly takes a highly trained human.

Maybe not for filling your 1 script - but for polypharmacy patients it saves lives.

My wife is a physician—she says that nearly every single drug she prescribes gets flagged by the computer for some kind of contraindication.

What types of contradictions fail in the computer but pass the doc ?

Why does this difference exist?

Drug interactions are complex, graduated, and probabilistic.

It’s generally not “drug A and drug B combined with definitely kill you” it more of “there’s a small study that shows that people who take drug A while taking drug B have a higher chance of experiencing side effect C”, or “patients taking drug A who have condition D, might experience problem E”.

It’s about managing risk, making judgement calls, and accepting responsibility.

There also just isn’t data for every possible drug combination or patient problem combination out there.

The computers flag many moderate contradictions and allow the human to decide.

Humans can ask questions or have information about the patient that the very rudimentary algorithms don’t.

> moderate contradictions and allow the human to decide

It's so much worse than that. The standard for side effects is pretty low and relies mostly on patient reports. So there ends up being a long tail of extremely rare or misattributed side effects.

Very true in retail and hospital pharmacy setting as well.

What are you even talking about? Drug data is very normalized. PDB does all of this already.

This is true, however a pharmacist is ultimately responsible (& legally responsible) for deciding actionable events after a discovery -- this is all logged and signed with electronic signature in case of mistakes and lawsuits.

Except in a few very rare cases, we don't really have that in the US. In the US, the job of the pharmacist is mostly to deny patients their prescription medicine on an insurance companies behalf, or to deny a handful of the most vulnerable patients their prescription medicine because of personally-held extremist political beliefs. (/s, but like, only slightly)

Very confidently incorrect. Doctors generally know very little about drugs and dosing - the pharmacist is the one protecting you from mixing inappropriate meds.

How can this be? Every prescription I’ve ever had was dosed by my doctor. How can you possibly prescribe a drug without knowing about drug dosing?

This has been my experience exactly.

I really like how the pharmacist who knows literally nothing about me, my diagnosis, life circumstances, family history etc... is supposed to be "the last line of defense" against all those silly doctors writing prescriptions that will kill their patients. It almost seems like the doctor might be the right person to decide what medications would work for me.

If I didn't know better I might think that pharmacists inflate their importance to try and maintain their comfortable position with a nice salary for a job that a fancy soda machine could do.

If you knew or read about retail pharmacists’ quality of life at work (and pay), you would know they are about as far from comfortable as possible. And their pay dropped precipitously over the 2010 to 2020 years when everyone else’s rise. And they get to work evenings and nights and weekends, and they get to deal with the general public, be on their feet all day, work without other professional colleagues, and work with unreliable minimum wage coworkers who are constantly changing.

See /r/pharmacy or sdnforum.

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