There is a joke:
What do you call the guy who graduates last in his class in medical school?
DOCTOR.
This is true for all professions. (However, my best friend in medical school was in the bottom 10%, largely due to test anxiety. She teaches medical students now, as well as having an amazingly successful practice. Everybody learns and tests differently.)
That being said, Babygirl scheduled herself at the local pharmacy for some vaccine updates. She needed her flu shot, a Covid booster and, since her last TDaP vaccine was in high school, one of those.
We arrived early for her 4 PM appointment and signed in. Then things got...interesting.
The pharmacy was busy, and I initially thought that the delay was just customers ahead of us being served. However, after about 20 minutes the pharmacist came out to have a conversation with Babygirl in the area behind the curtain.
I stood up, walked over and asked Babygirl if I could listen. The pharmacist then let me know that she was concerned about the fact that giving live vaccines to an immunocompromised patient is dangerous and contraindicated. I agree, absolutely, but she isn't getting any live vaccines today, right?
Well, the pharmacist informed us, the pertussis portion of the TdaP is live.
Historically there have been relatively few live vaccines. Smallpox - no longer needed. Polio - no longer given in live form. Monkeypox? I've no idea honestly. Chicken pox, absolutely. Measles/mumps/rubella? All three in one vaccine are live. Original shingles vaccine - live but no longer in use. To the best of my knowledge, there are no vaccines with a mix of live/not live components. And I will tell you I was ABSOLUTELY sure that Tdap is NOT a live vaccine.
I introduced myself. I don't typically play the "I'm a doctor so I know more than you" card. Most often if I'm informing a caregiver of my "status" it is to let them know that they can speak "medical" to me and I will generally understand it. But dang, this lady was unimpressed.
(Honestly, pharmacists have every right to question physicians. They are one of the last lines of defense between our errors and patient disasters, but...)
She called for back up. I think we passed the 50/50 elimination, the audience poll and were on the "phone a friend" portion of "Who Wants to Be a Millionaire" for about half an hour. Why she didn't just check the package insert I'm not entirely certain.
Final outcome: TdaP is, indeed, not live. Vaccines were given and the 10 minute appointment only took 50 minutes.
Babygirl still needs two more vaccines, but sensibly did not want to do 5 at one time. She thinks she will use a different pharmacy for those in a couple of months.
Why use a pharmacy for vaccines? Because doctors' offices carry flu shots, and if appropriate, pediatric vaccines. Most adult vaccines are not needed frequently enough to avoid expiration while in the doc's fridge, so pharmacies are the place to get them. The need for mass Covid vaccination led to most pharmacists learning to give vaccines, so they now can do all of the adult vaccines. Our hospital outpatient pharmacies don't carry them, so we end up in commercial pharmacies instead.
I've never really been concerned about this transition. Pharmacists are among the best trained and most trusted people on the medical team.
But what do you call the lady who graduated last in her pharmacy class?
Someone to avoid if possible.
DeeDee
PS Babygirl is otherwise fine. She recently had a cold, which triggered her asthma, and she handled the entire situation on her own like any grown woman should LOL.
