I’ve started thinking about this again, due in part to a comment made in the “Why do hospitals treat their employees like this?” thread by Qadgop the Mercotan.
If this really is the case, why have the Medical and Nursing associations pushed so hard (at least in Ohio) to prevent Pharmacists from limited prescribing, a greater role in immunizations (more than the 5 we can presently provide in Ohio, that is), and more of a patient care role?
Well, for one thing, people are already up in arms due to the fact that Pharmacists are refusing to fill legal prescriptions, (birth control, and the morning after pill) and some have even refused to give the patient back their script so they could go elsewhere. There has been more than one angry thread here about it. The people opposing giving Pharmacists more power might be thinking of this, and wondering how even handedly they will carry out their duties.
I’m all for it, but then again I’m all for broadening medical authority to those unlicensed and upfront about it. I don’t think “diagnosing” seasonal allergies (gee, you get congested and itchy eyes every May when that tree outside your bedroom window starts blooming? And it gets better during the day when you’re 50 miles away in a climate controlled building at work? Not rocket science here.) or other minor complaints really takes 10 years of schooling to do.
But I’m probably NOT the person you want on your side in this argument. I think all drugs, recreational and pharmaceutical, should be made available over the counter after a short quiz on the common uses and side effects. I’m pretty radical in my belief that a person should be responsible for their own health care decisions, and utilize pharmacists and doctors as educational tools in the process.
I see this as a Great Debate, rather than as a General Question. Moved.
samclem GQ moderator
And that would be a disaster for control of infectious disease. The overuse of antibiotics is already causing serious resistance problems. In places like Mexico where antibiotics are available OTC, multi-drug resistant strains are running even more rampant.
One person’s freedom to consume a substance needs regulation when said consumption impacts others to their detriment.
As for the OP, I’m leery. Most antihistamines are already available over the counter.
But is a pharmacist going to dispense warfarin without knowing the patient’s most recent INR results, or up the dose of methadone without having seen how wide their QRS complex is on their baseline EKG? Or know that the patient has already been on triple therapy for their elevated H. Pylori titers in the past, so there’s no sense in re-treating their GI upset with yet another course of antibiotics and acid blockers?
JayRx, I suppose you’re a pharmacist yourself. What are the boundaries of “limited prescribing…and more of a patient care role” that you would like to see? Do you see pharmacists becoming the same as nurse practicioners?
I’m sure I’m not the only patient who has pondered whether a sinus infection or a swollen finger warrants paying for an office call.
Pharmacists in Alberta have just started to be able to fill “emergency” refills on certain medication. I don’t know the full list, but I used that to get an refill on my asthma inhaler when I was running out recently.
I’m all about it. They can do this in NM. My Father actually wrote the legislation allowing them to do so. He’s pretty proud of it and so am I. The reasoning behind why he likes it is because in rural areas where it’s too difficult to get to Albuquerque or Santa Fe to see a Doctor, people can go see a Pharmacist for their basic needs. Pharmacists know more about the chemistry of the medicine than most doctors anyhow.
Doctors and nurses oppose giving pharmacists more of a role because doctors and nurses are seeking to protect the special privileges they have been given by the law. You see the same thing in a variety of different medical contexts – one group lobbies hard to prevent another group from having a wider scope of practice. It’s all about protecting their own turf even though they dress it up in “it’s best for the patients” language.
My initial reaction is no. Giving a pharmacist the power to prescribe something that he or she can then directly profit by selling to you creates an immediate conflict of interest.
Reactionary song and dance BS.
I get migraines. I’ve not found a doctor that will prescribe me anything that helps. So I use OTC rather than trying to fight, except one of my symptoms is that my sinus go absolutely haywire and I typically take sudafed, except the meth heads have made that a pain in the ass to be able to buy.
Doctors and nurses are overworked due to thunderous amounts of red tape from the government and the pain in the ass insurance companies.
A pharmacist who does not know my medical history can use his personal ethics to not fill a prescription given to me by my doctor.
Many americans (I am one) can not afford health insurance, fall above the guidelines for qualifying for any help, but below the level to be able to afford reasonable healthcare. Yes, we are at this moment trying to decide if we should drop health insurance for my daughter to help pay for our insanely expensive homeowners insurance, which is required by my mortgage company.
A customer had a shirt on the other day from a visit to Alcatraz. It said something along the lines of "You are guaranteed food, shelter and adequate medical care, everything else is a privilege. I wondered if I could get the same gig.
Insurance companies are driving people out of the medical field. Hence, less medical personell (There are counties that do not have ANY practicing OB/GYN’s) and less access for people for medical care, so we then have to expand the jobs of pharmacists to help cover this shortage, except that isn’t their job and I can’t fathom that the resultant malpractice suits would allow that to last long.
My father in law is an OB/GYN, his insurance went up $60k in one year, without him having a malpractice claim in 11 years.
We can complain about the apples, but we should note when the problem is actually oranges.
I once picked up a bad ear infection from a swimming pool in Lanzarote.
I went to a pharmacist and he reluctantly sold me some chlorine based eardrops
A cow-orker got exactly the same infection from the same place, his wife was a Registrar (mid range hospital doctor) she got him antibiotics - they did no good - I told him about what I had used - problem fixed.
Actually in a prior job I once visited a heck of a lot of Chemists (UK for pharmacists) and noted how they fell into three distinct categories - those running a sort of general hardware store, those running a cosmetics and fragrances store and those running a limited form of medical practice.
Even then, nearly 30 years ago, it looked to me as if it would be sensible to give them authority to prescribe moderately safe things.
Incidentally a friend of mine took her husband’s prescription to her local pharmacist, he looked it over and said that in conjunction with the other drugs he was taking, it was dangerous. My impression is that pharmacists know more about drugs than a lot of doctors - well GPs.
My experience with doctors has not been good, for minor ailments I would far prefer to amble into my local pharmacist than go to my GP.
Many medications I’ve been on over the years, once the prescription expired the doctor gave me a new one, didn’t do any diagnostic tests on me at all. For medications where the apparent norm is to just reissue the prescription without doing any periodic testing, I see no reason why the pharmacist shouldn’t be able to fill an expired prescription.
Personally I think the system is working out well enough as it is now. A pharmacist can’t know the results of all the patient’s tests, but often times it is the pharmacist and not the doctor that knows all the medications the patient is on and is able to prevent dangerous interactions (every doctor’s visit I’ve ever had, the system by which the doctor learned of what I was taking was him asking me and me telling him, anyone on a ton of medications or who has a poor memory can easily break that entire system down.)
I think this is definitely true. I think by trade a good pharmacist would have to know more about medications than a good doctor. A doctor (depending on what type, et cetera) in any given day may be doing a dozen different kinds of tests, performing minor in-office surgery, trying to diagnosis a wide range of ailments and et cetera. Whereas a pharmacist is working on pretty much the same thing during those hours, every day. I certainly wouldn’t want a pharmacist diagnosing me because they don’t have professional training or experience diagnosing illness, nor do they have professional training or experience in treating them.
Do pharmacists want the burden of malpractice insurance? Do pharmacists have the training to do the necessary diagnostics that lead to a prescription?
I can see where a pharmacist is qualified to “gut check” the appropriateness of a prescription, and to assess a prescription in terms of the patients total medication profile (in terms of avoiding adverse or suboptimal drug interactions). Moreover, in some cases, a pharmacist might be able capture a patient’s total medication experience.
A pharmacist should have limited authority to block a prescription, but only where there is a safety issue. I don’t see where a pharmacist has the resources required to perform the requisite diagnostics.
As a passing note, I believe that a lot of people rely on the advice of pharmacists to choose their OTC medications. The door is open at least that much. Wouldn’t that make grounds for a “malpractice” suit?
I don’t advocate pharmacists being able to prescribe sans any diagnostics from a physician. But I think for prescriptions which physicians routinely renew without performing any diagnostic tests on the patient, it would not hurt to allow the pharmacist to renew the prescription. The doctor could even write the initial prescription as one not requiring doctor renewal.
I think any pharmacist who gets into the business had better be ready to dole out whatever the doctor prescribes, within legal limits. If he’s got a religious hard-on with anything that might be prescribed, his time might be better spent in the pulpit than in the pharmacy. My rights trump his in EVERY case, as long as it’s legal. And any pharmacist who refuses to fill a prescription based on his personal beliefs should be stripped of his license immediately. No second chances.
Unfortunately, there’s not really a way to tell whether or not further diagnostic tests are desired by your doctor without asking them for refills. A prescription expires one year to the date it’s written (earlier for controlled substances) for that reason precisely, if you get a prescription for something it’s presumed that you’re going to use it within a reasonable time frame that the diagnosis has been made. Otherwise your diagnosis might be completely different.
Technically, a pharmacist can refuse to fill a prescription for any or no reason whatsoever. They aren’t bound by the word of the doctor, seeing how they have THEIR OWN license to protect. If they feel a medication is dangerous, or improperly prescribed, they should have every right to decide whether they want their initials to go on it or not.
The reason for this is because when people go back and sue doctors, they don’t just stop with the physician. They also include in the lawsuit the dispensing pharmacist. Case in point: the little boy who recently OD’d on clonidine because his parents were giving him too much. That’s not even really a dangerous medication at face value, it’s a blood pressure pill, but not only is someone going after the doctor for continuing to reissue prescriptions, they’re also suing the pharmacist for continuing to dispense what the doctor had issued, even after they were in contact with the office about the frequency of “lost” medication.
Actually, based on your prescription history, I’d say your pharmacist does actually know a lot about your medical history, considering he is legally responsible for ensuring that you aren’t taking medications that are contraindicated. Somehow he’s supposed to know everything and nothing all at once, how does that work exactly?
You think your doctor isn’t taking kickbacks from pharmaceutical reps? Puh-leeze.
Conflict of interest, my butt. We’re talking about more than just pens, here. Do you know how much time those people spend with your doctor every day convincing them that Coreg CR, even though it will cost you a higher tier copay, is so much better than the original? These people make their money convincing your doctor that they know better what kind of medication you should be on.
Well, moral objections aside, they do have a license to protect. You might feel entitled to demand whatever kind of medication you feel you should be on, but the bottom line is that their ass is exposed every time they verify any medication.
I am not supporting the pharmacists that refuse to dispense medication AND refuse to give the prescription back, and the reality of pharmacists prescribing is that they do have limited prescribing ability in most states (for certain types of medications) but the paperwork is such a pain in the ass that they usually don’t.
But I do know that things work a lot differently within the pharmacy than most of you seem to think. Not to seem combative, I’d be glad to englighten anybody on the inner-workings.
-foxy
I get that, but in most cases, they will not have enough information to make that decision; at least not without talking to the doctor. If they make the call to the physician and he OKs the prescription, what is the basis of their refusing it (barring an obvious error…oxycontin for tonsillitis or something equally bizarre)? Exactly what is the verification process and what situation would make a denial prudent, providing the doctor has been consulted?