Wednesday, October 3, 2007

Pharmacists and Scripts?

Today's FDA proposal was to have pharmacists write behind-the-counter scripts for patients who can't afford to see a doctor.

Doesn't that seem to be a bit of a conflict of interest for a profession that has not been trained to diagnose disease?

Another mind boggling idea from the FDA - Big Pharma's godfather!


Margie Pool said...

What is this world coming to? Pharmacists are NOT trained to recognize physical or mental disease symptoms, and why in the world would they want to take on that responsibility in today's litigious world?

Nancy Nurse said...

This reopens a can of worms and shines a whole new light on the issue of exactly who the government and the FDA think is really qualified to practice primary care medicine, since a large number of medical office visits end with the patient simply being handed a prescription for a drug by a doctor they saw for less than two minutes.

Ophthalmic Nurse said...


Many new concepts seem just too strange at first glance for those of us over sixty!

But, if basic healthcare for everyone is our goal, we must be realistic about the type of healthcare we will be able to provide with the funds we have available.

The fact is, there are not enough medical doctors to actually see (even for two minutes) the almost fifty million people in this country who are going without their basic healthcare needs being met, including vision care.

This idea could be a major boon for the supplement industry, since pharmacists study a bit more nutritional biochemistry than doctors do, so they might actually put more focus on disease prevention through nutrition and exercise - although I never see them just standing around when I'm in the drugstore, so it would seem that a busy pharmacy would have to have a number of pharmacists who just see patients.

So, doesn't it also make sense that the powers-that-be increase the type of scripts that experienced nurse practioners, optometrists and other allied healthcare professionals can write?

And doesn't it make even more sense that thirty percent of all medical continuing education credits focus on health maintenance and disease prevention for the next 10 years?

That's our only way out of the medical mess we have created, as I see it.

Anonymous said...

It's a mad, mad FDA controlled world!

James P said...

I totally agree with Margie. Pharmacists should not be able to write scripts since that is not what they are trained to do. For example, it will be much easier for people to get antidepressants when they really don't need it. I think this will cause much more harm than good.

Steve said...

You are looking good for an old gal over sixty. All those vitamins you take must be working!

Kathleen Coulter said...

Hey James,

It's so easy to get a medical doctor to write a script for antidepressents that many of us wonder why they don't just put presigned scripts in a basket or candy jar on their front counter - just like TUMS.

Think of all the time that would save stressed out soccer moms.

Marie said...

Love the cartoon - hate the concept of behind-the-counter anything!

Since it's so easy to get sleeping pills and antidepressents from any doctor, why can't we just eliminate the medical office visit fee and get these drugs from a vending maching in the ladies room.

We've come a long way baby and we don't want to discuss our sleeping pill and antidepressent drugs with our pharmacist any more than we want to discuss our condom purchases.

Kate said...

This is shocking! What about antibiotics? Bacteria is adjusting to it and getting stronger; especially when we're not taking the entire prescription OR don't have the bacterial infection in the first place! I've been to the doctor many times with what I could have sworn was strep, only to find out that it was a virus infection. Antibiotic-resistance bacterium is a huge problem and will only get worse if people starting handing out meds without a professional lab test.

Ellen Troyer, MT MA said...

Not to play the devil's advocate, but pharmacists might do a better job of holding back antibotic treatment until cultures have come back from the labs.

Or they might even recommend natural substances with both antiviral and antibacterial properties such as iron free lactoferrin.

But, I seriously doubt mainstream medicine will allow this to happen, so not to worry.

John Callahan said...

Pharmacist prescribing is a very real possibility. In the past there has been a schedule of drugs in some states that a pharmacist could give to a patient with a signature on a log and identification. Pharmacists daily and continuously are a first point contact for diagnosis and treatment every day, all day. Pharmacists are readily accesable to the public, and are asked continuously about this rash, this bump, this irregular spot, and so on. Pharmacists are now required to complete six years of school, only two less than a physician, and far more than nurse practitioners who do prescribe.

If a legend of drugs is added for pharmacist prescribing/dispensing, it will be with limitations. I doubt it would contain antidepressants or heavy narcotics, blood pressure medications or any other type of medications that alter mental capacity or have high degree of mental or physical addiction. (although the over prescribing of these medicatons is a HUGE problem in the USA, but a topic for another discussion)

If the legend is added for pharmacist dispensing it would most likely serve the public very well. Probably containing possibly a codeine cough syrup, select antibiotics, some topical creams/lotions for itch or rash, maybe a conjunctivitis drop, or similiar medications to quickly and effectively cure and treat common medical conditions that are easily recognized and treated.

This would unclog the physicians offices with mild cases and allow them to focus on severe cases with more time and not push people thru in abbreviated appointments, and allow more time for them to consult with each patient. Also small town America with the health care professional shortage would benefit as well.

Also this new schedule of medications, could have other limitatains. If a patient goes to a public health clinic and has a positive strep test on their throat, why not be able to get an antibiotic directly from a pharmacist?

We must act responsably as health professionals and help aid the average customer. Everything we do in life has liability, I choose to practice in such a way that serves the public and benefits the community in which I practice.

With the new $4 and $9 drugs lists at Walmart Pharmacy, I have actually seen people come to tears now that they can afford to eat AND take their live saving medications. Companies like WalMart have a plan to help bring down helath care costs for millions of americans. Many americans can benefit from a pharmacist prescribing schedule, insured or not.

Persoanlly I welcome the ability and responsibilty to increase my ability to serve the community as a health professional. Bring it on!

John Callahan R.Ph. Colorado Springs, CO

Ellen Troyer, MT MA said...

Pharmacist John,

Thank you so much for writing such a heartfelt reply to this blog.

I could not agree with a number of your points more, since I grew up in a small town with two doctor Busharts (father and son). Most people stopped by the locally owned drug store (with a soda fountain) to check with Joe, the only pharmacist, to see if they really needed to make an appointment with the doctors for whatever was ailing them at the time. Joe was most often right on the money with his assessment and when he personally called the doc, you got right into their office schedule.

Now that I think about it, Joe was a one man triage team for an entire community of 5000 people. The difference was, Joe personally knew a lot about most every person that came to him for advice, including their mental status, their health history and he also knew about every prescription they had ever filled.

Sad to say, but in today’s world, the big box pharmacies serve enormous populations and I doubt the pharmacist knows many of the people in the community they serve.

As far as the point you make about formal education almost being equal, you are forgetting that medical doctors also spend another two to six years doing hands-on internships and residencies after medical school, which is were they actually learn to diagnose and treat.

And all the nurse practioners that I know have a masters in nursing, as well as as a nurse practioner license from the state, so their formal education matches or exceeds yours; the difference being that they work under a medical doctor, and they see and examine patients every day, pharmacists don't.

Anonymous said...

Ellen, The AMA has a powerful lobbying association. They will quickly put an end to this nonsense.

Susan Chronin said...

The AMA is not nearly as powerful as they once were, so don't get your hopes up anonymous.

Isn't it true that Super Wall Marts will soon be adding Urgent Care (Doc in a Box) Centers to a number of their stores?

Isn't the goal to cut the cost of healthcare and to provide the best care the system can afford.

I like the idea of getting some of my regular prescription drugs directly from my pharmacist without having to pay for a visit to my doctor when it's not necessary.

AARP Lover said...

Hey John, Basic medicine is not rocket science, so don't let these folks make you believe you aren't qualfied to be a prescription drug decision maker for certain drugs, including Viagra. This will mean my sex life dependent relationship with my druggist has come, or mostly gone, full circle.

Anonymous said...

All we have to do is look at our VA hospital system to see that government run healthcare is almost worse than no healthcare.

I don't care who writes scripts if we can keep the decision out of George Bush's hands.

Maggie said...

I was impressed with Hillary's healthcare plan until I heard her use the VA Hospital system as a successful example of government run healthcare. That girl needs a reality check and she sure needs to spend some time at Walter Reed.

I know this has nothing to do with pharmacists and scripts, but I needed to say that.

Pam, RN said...

You know you're a nurse if...

You live by the motto 'To be right is only half the battle, to convince the doctor is more difficult.'

You can tell the pharmacist more about the medication they are dispensing than they know.

You notice that you are using more 4-letter words than you knew before you started nursing.

Your finger has gone places you never thought possible.

Your bladder can expand to the size of a Winnebago's water tank.

Did you hear about the nurse who died and went to Hell?
It took her two weeks to realize she wasn't at work!

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