Doctors want right to dispense medications - Tilted Forum Project Discussion Community

StanT · 06-27-2005, 07:45 AM

AMA: Physicians Charge Pharmacists With Interference in Medical Care

Quote:

CHICAGO, June 20-The American Medical Association's policy-making body voted today to press for state laws that would allow physicians to dispense medications when there is no nearby pharmacist willing to dispense the prescribed drugs.

The new AMA policy is an attempt to overcome what doctors say is a stampede of pharamacists who say they cannot in good conscience dispense certain medications. The issue of conscientious refusal was first raised when some pharmacists refused to fill prescriptions for the emergency contraception pill, called Plan B. Additionally some pharmacists refused to fill prescriptions for birth control pills.

But AMA delegates say the conscience-based refusals have now spread to psychotropic drugs and pain medications.

The new AMA policy states that doctors should be allowed to dispense medications when there is no "willing pharmacist available within a 30 mile radius." That change would require change in state laws regulating both doctors and pharmacists.

The AMA House of Delegates' action went beyond initiatives that had been discussed at reference committee hearings.

The doctors say that many pharmacists compound their refusal to fill prescriptions by not returning the unfilled prescriptions to patients, thereby stymieing efforts to turn to other pharmacists.

"It's not just contraceptives," said Mary Frank, M.D., a family physician from Mill Valley, Calif., during a discussion of the issue. "It's pain medications and psychotropics. And not only are the patients not getting prescriptions filled, but pharmacists are refusing to return the prescriptions and they are lecturing the patients about the drugs."

In response a coalition of medical specialty groups including the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Medical Women's Association, and the Michigan State Medical Society is asking the AMA to press pharmacists to follow ethical guidelines for delivery of healthcare.

The American Pharmacists Association has policy that recognizes an individual pharmacist's right to exercise conscientious refusal and "supports the establishment of systems to ensure patient's access to legally prescribed therapy without compromising the pharmacist's right of conscientious refusal."

Physicians say that language means that pharmacists must "refer patients to other pharmacists who are willing to fill the prescriptions" just as doctors are ethically required to refer patients they are unwilling to treat, said William Golden, M.D., a Little Rock Ark., internist. Dr. Golden pressed the case for AMA action Sunday during a reference committee hearing on the issue.

Several physicians testified that conscientious objection first became an issue with contraceptive prescriptions, especially prescriptions for emergency contraception; the so-called morning after pill called Plan B. But now, they said, the phenomenon has now expanded well beyond contraceptives.

And doctors say that pharmacists are winning support in state houses with 14 states already considering legislation aimed at protecting pharmacists' right to refuse to fill prescriptions based on religious, personal or moral grounds and nine more states in the process of enacting legislation that would allow pharmacists to refuse prescriptions "for any reason."

The AMA House of Delegates, the organization's policy-making body, is expected to vote today on a series of proposals that would require the AMA to mount a lobbying effort to "guarantee patients' access to legally prescribed and medically indicated therapy."

The American Pharmacists Association did not respond directly to the doctors' concerns. Kristina Lunner, director of federal government affairs, said the organization has received no complaints about pharmacists refusing to refer patients or refusing to return prescriptions that the pharamacist refuses to fill.

In a statement issued several weeks ago, however, in response to a critical editorial in The New York Times, the pharmacists' group said:

"Pharmacists, like physicians and nurses, should not be required to engage in activity to which they object. But supporting a pharmacist’s ability to step away from objectionable situations does not require a confrontation with the patient...

"Our organizations support the two-part policy stressing the need to assure patient access to legally prescribed, clinically appropriate therapy in a timely manner when a pharmacist steps away from working with a prescription based on personal beliefs. Pharmacists must not use their position to berate, belittle or lecture their patients -- our organizations oppose such action. Pharmacists must not obstruct patient access to therapy -- our organizations oppose such activity."

Ms. Lunner said pharmacists' organization has no mechanism to censure pharmacists who refuse to refer patients or refuse to return any prescriptions that the pharmacist concientiously objects to filling. She said such complaints are referred to the state licensing board.

It seems that the recent wave of pharmicist refusals to fill some prescriptions is having a backlash. Doctors are seeking the right to dispense "controversial" drugs themselves. Good idea or bad?

StanT · 06-27-2005, 07:49 AM

I've got mixed opinions on this issue. I have no problem with a pharmacy not stocking or refusing to dispense certain drugs. I do think they should be up front about it (like a sign that says "We don't do that"). I have a big problem with them not returning a prescription that they do not condone.

I'm also not comfortable with doctors handing out medications. On several occasions, a pharmacist has caught a mistake or side effect that the doctor didn't mention. Having a second set of eyes would seem to be a good idea.

astrahl · 06-27-2005, 07:59 AM

A pharmacist has no business choosing which prescription he/she decides to give out. This is a business of science, not philosophy. If they have moral problems with the work they do, they should find another profession.

I find it appauling that a professional would have the unmitigated gaul to tell me that they have a moral objection to BCPs or RU486 or ANY other drug that a physician, one who <b>knows</b> the circumstances, has prescribed.

I should not have to defend my need for the drug simply because the pharmacist is too short sighted to see the reason I need the drug(s).

Hardknock · 06-27-2005, 09:13 AM

Quote:

Originally Posted by astrahl

A pharmacist has no business choosing which prescription he/she decides to give out. This is a business of science, not philosophy. If they have moral problems with the work they do, they should find another profession.

I find it appauling that a professional would have the unmitigated gaul to tell me that they have a moral objection to BCPs or RU486 or ANY other drug that a physician, one who <b>knows</b> the circumstances, has prescribed.

I should not have to defend my need for the drug simply because the pharmacist is too short sighted to see the reason I need the drug(s).

Agreed. The religious fanatics have now gotten out of control. Now they want to mess with out health by saying that they can't dispense BCP's or morning after pills because of nothing more than it against their "good conscience?" Bullshit. They have no reason to not fill something that a doctor ordered. Period. They read the prescription and fill it. That's their job. Not to be the moral police.

I also have no problem with doctors handing out drugs. Who else knows your diagnosis and situation better that the doctor you just saw? I can't believe that StanT would not want his doctor telling him what medicine he should or shouldn't take. Whether the doctor hands you a bottle of pills or writes a note for you to take the pharmacy, what's the difference? I see none.

kutulu · 06-27-2005, 09:57 AM

I think this is great. Fuck the pharmacies, this is what they get for placing their personal belief system above the needs of another person.

Here is a hint - if you don't want to give out birth control don't become a pharmacist!

Remember, this is about towns like Crapville, Anystate where there is one place to buy groceries and one place to get your perscription filled. Not everybody has the means to drive 50 miles to get their medicine. One self-rightous bastard can effectively remove contraception from the whole city.

lindseylatch · 06-27-2005, 10:12 AM

i agree with astrahl. It rediculous that these pharmacist are getting away with this, I think we need to start focusing on them, rather than working around them (which will only encourage them).

And, BTW, docs already give out drugs in the form of sample. Obviously they can't give out narcotics, but BC pills can be, allergy medicine, arthritis medicine...all kinds of things.

My mother has actually made up some "morning after" kits to give to patients who can't get them at a pharmacy. It's a few BC pills and an anti-nausea pill.

StanT · 06-27-2005, 10:42 AM

Quote:

Originally Posted by Hardknock

I can't believe that StanT would not want his doctor telling him what medicine he should or shouldn't take. Whether the doctor hands you a bottle of pills or writes a note for you to take the pharmacy, what's the difference? I see none.

You may see more that one doctor, they don't necessarily know what the other doctor is prescribing. Even if they do, knowledge of drug interactions is generally the realm of a pharmacist, rather than an MD. I look at it as a checks and balances kind of thing, doctors do make mistakes.

That said, I'm fine with a pharmacist reviewing the medical aspects of a prescription. Leave the morality at home, or make it public, don't let me find out when I try to pick it up.

laconic1 · 06-27-2005, 10:44 AM

I'm pretty much with StanT on this one. I feel that a business, any business regardless of what type, has a right to not provide service to a customer for whatever reason, but they should not be able to do anything that would prevent the customer from receiving that good or service from a willing business. The second set of eyes is a good point that I didn't think about.

Ustwo · 06-27-2005, 10:52 AM

You people obviously have never had to deal with a quack doctor before.

As a doctor myself that can perscribe anything up to and including narcotics, I think this is a very bad idea.

There are checks and balances in any system, while you can whine about some pharmacist not perscribing an abortion pill, thats not what is really at stake here. What this does is give any doctor with a licence the ability to percribe any medication no matter how far out of their field it is.

For every 15 year old in some Georga town that gets to take an abortion pill because of this bill, there will be hundreds of screw ups, medical reactions due to multiple perscriptions, and outright quackery.

Paq · 06-27-2005, 11:49 AM

that's fine, ustwo, that there need to be checks and balances, but i really think the pharmacist should not be able to refuse to dispense a prescription or withhold the prescription so the person cannot get treatment.

Seriously, i have no idea what i would do if i were a woman and a pharmacist basically said, "Sorry, i'm Catholic and i cannot give you birth control pills and i am keeping this prescription as i cannot morally return it to you" I am afraid violence would ensue at that point. Makes me wonder what would happen if many pharmacists began refusing to fill Viagra/viagra type prescriptions bc it goes against her moral values. I ask that mainly bc it seems that birth related prescriptions are the most refused at the moment.

Basically, if they feel they can't morally do a job, they should really find another line of work. I'm certain there is something else that is more morally palatable.

That said, i do like the role of the pharmacist in tracking someone's prescription history, complications, issues, etc, plus, just being there for a 2nd set of eyes, but i do not believe they should be allowed to withhold prescriptions bc of moral issues.

Marvelous Marv · 06-27-2005, 12:11 PM

I think any business should have the right to decide what it will and will not do. However, the government usually interferes with that. Think of the cases where (usually elderly) rental property owners have been forced to rent to unmarried couples.

On the other hand, any pharmacist who wouldn't return my prescription would be explaining to a judge why he chose to interfere with my health care. If I didn't call the police and charge him with stealing it first. If he doesn't honor the prescription, he's not entitled to retain the written form.

StanT is correct. We are subjected to such a barrage of new drugs that health care practitioners can't keep track of their own fields and the new drugs as well. They also don't have access to records of prescriptions from other physicians, while pharmacists generally do.

EULA · 06-27-2005, 03:12 PM

On a related note, I think pharmacists should be able to dispense medicine without prescriptions. It would put a nice dent in the cost of healthcare.

Lead543 · 06-27-2005, 03:29 PM

Quote:

Originally Posted by kutulu

Here is a hint - if you don't want to give out birth control don't become a pharmacist!

AMEN!! My town has 3 Pharmacies, although about 4 years ago there was only one. If they'd refused to fill my prescriptions for BC I'd be hooped. It's a 30 minute drive to the next city, in other places I imagine it's worse. If the pharmacist is Catholic and thinks birth control is wrong that's fine, it's not their place to impose their beliefs on other people. I don't agree with abortion but you don't see me becoming an abortion doctor and then refusing to perform them. The pharmacist may have the right to refuse dispensing medications but the client also has the right to obtain medications they require in their own town/city.

Ustwo · 06-27-2005, 03:38 PM

Quote:

Originally Posted by EULA

On a related note, I think pharmacists should be able to dispense medicine without prescriptions. It would put a nice dent in the cost of healthcare.

Giving out pistols with one bullet in them would cut down on health care costs as well. That doesn't mean its even remotely a good solution.

guy44 · 06-27-2005, 03:48 PM

Yeah, I actually agree with Ustwo that allowing doctors to dispense meds may have many serious implications. A myriad of disastrous possibilities come to mind, including mistakenly giving out multiple prescriptions or a massive increase in the cost of medication as a side effect of having to include thousands of doctors in the medical dispensation process.

Remember when Rush Limbaugh went doctor shopping in order to find one who would prescribe hillbilly heroin? Imagine how much easier stuff like that would be if the doctor could just give him the stuff without going through a pharmacist.

I'm not saying this can't work, but I think it needs to be very well thought-out before it's implemented.

Ustwo · 06-27-2005, 03:55 PM

Oh and the big thing you are all missing.

A lot of doctors get PAID to perscribe certain drugs. (Something that should not be allowed)

They make money when they give you a perscription to X brand of whatever.

If you think this is so some kid can have an abortion pill, guess again, its about money.

MSD · 06-27-2005, 04:40 PM

Quote:

Originally Posted by Ustwo

Oh and the big thing you are all missing.

A lot of doctors get PAID to perscribe certain drugs. (Something that should not be allowed)

They make money when they give you a perscription to X brand of whatever.

Finally, someone in the medical profession comes right out and says it. This is absurd and needs to be stopped. I was puzzled by my doctor's insistence on one particular blood pressure medication until I noticed that every clipboard, pen, and notepad in the office had the name on it. It works, so I'm fine with that particular case, but this is a serious ethical problem.

martinguerre · 06-27-2005, 05:31 PM

ustwo...there is a fairly simple solution to the problem you rightly point out. self-interest, or lack of skill...whatever the problem may be, needs to be addressed.

but if a panel of three other doctors, selected locally by the AMA reviewed the case, and then signed the dispensation order...i don't see how that would produce ill results. interactions would be double checked, and the effort would guard against routine use of the system...it would be reserved for when it was really needed.

Elphaba · 06-27-2005, 07:26 PM

Pharmacies do not provide the necessary oversite in a hospital setting. Doctors Rx'ing emergency medication are not quack's, but another physician called in may Rx another drug without previous knowledge of the patient. He or she is also not a "quack."

My experience of my father's illness and death and the medical misjudgements that hastened it, is merely a personal story. I will save the expertise opinion to the dentist that straightens teeth.

pan6467 · 06-27-2005, 07:35 PM

I don't see what the issue is..... Doctors already give out "free samples" of drugs so what's the problem with them having a pharmacy within their office.

The Dr. does his job, prescribes the meds and you go to the on staff pharmacist and get it. BFD........ The doctor needs to make sure the patient isn't doctor shopping though...... but that happens whether it's a pharmacy or doctor giving out the meds.... just ask Limbaugh.

As for doctors selling out to med companies and being paid for what they prescribe, I believe the Doctor should inform you of that and offer you the choice of medications available.

It's not ethical and it's not right but until we regulate the medical, pharmaceutical and insurance industries, we will have this problem.

Elphaba · 06-27-2005, 07:48 PM

Pan, wouldn't it be ideal if we had a universal health plan? Naw, that could only happen if the two worst foes, Clinton and Gingrich would propose such a plan. Which they have.

Ustwo · 06-27-2005, 08:03 PM

Edit: Never mind its been said, no point in beating the horse.

lindseylatch · 06-27-2005, 08:33 PM

obviously there are a lot of problems with our health care system (as I imagine there are with ANY health care system, despite what you Canadians say

).
To address some points Ustwo made, "quacks" are the reason you can sue for malpractice. Of course, if you're dead from a bad drug combination, it doesn't do you much good. But that's why people should be alert when choosing a doc, and not just pick a name out of a hat. I've definitely seen a fair number of asshole docs that only care about the money they're making.
martin suggests a panel, but that would be WAY too expensive to set up for EVERY perscription being filled (I myself fill at least three a month). Even just for narcotics would be rediculous.
Now, as to docs being paid to perscribe drugs...that goes with the "quacks." They're obviously more concerned about money than patients, and you can usually tell the minute you meet them. And, MrSelfDestruct, just cause they have a lot of shit from one company doesn't mean they're in their pocket. Some drug companies give you that stuff no matter what. Maybe your doc just thought it was a great med. My mom used to take stuff from the drug companies, and then percribe what she thought was best for the patient. we got tickets to "Tony and Tina's Wedding" that way. I believe they aren't allowed to do that anymore, at least in Oregon.
Another point of Ustwo's, any doc can perscribe any med NOW, no matter how far out of their field it is. The pharmacists aren't checking that, as far as I know.
All that being said, I still think this is a bad idea. It's going to have consequences beyond those that it's intended to have (assuming it's actually aimed at pharmacists refusing percriptions, and not some ulterior motive). It's the wrong tool for the job, using a wrench to hammer in a nail. It might do the trick, but it's not optimum.

Ustwo · 06-27-2005, 08:38 PM

Quote:

Originally Posted by lindseylatch

Another point of Ustwo's, any doc can perscribe any med NOW, no matter how far out of their field it is. The pharmacists aren't checking that, as far as I know.

The good ones do, I forget the latin term for it.

Just because I can prescribe just about any drug in the book doesn't mean I should and a good pharmacist will pick up on it.

snowy · 06-27-2005, 11:18 PM

Well, provided you're a medically literate person with a functioning, intelligent brain, I don't see a problem with small-town doctors being able to fill prescriptions. The problem is that not everyone is medically literate (an incredibly low number of Americans are medically literate--by that I mean do they have an understanding of health information, information about their care and treatment, etc) so they cannot provide their own check (sadly, this happens quite often--my mom once had several different prescriptions and could not, for the life of her, understand why she was so tired...thanks to various resources I soon figured out that 3 of them shared fatigue as a side effect and when 2 were prescribed together they would increase drowsiness--this is what happens when you go to multiple doctors and multiple pharmacists). Pharmacists are in place because they provide a check.

However, in a small town where there are no other options, a doctor should have the ability to prescribe medications IF the town's pharmacist has a conscientious objection. Yes, I am suggesting this should be done on a case-by-case basis. After all, if we are discussing small-town America, then there shouldn't be that many cases of this happening (I certainly hope not). The state medical board and the doctor's professional association should be required to supervise filling of prescriptions somehow--some kind of oversight is necessary to prevent quackery. If we start off by allowing doctors to fill certain kinds of prescriptions--birth control, mifepristone and misoprostol, and Plan B, for example, then perhaps less oversight will be necessary. If it turns out that a certain town has a pharmacist who won't fill for narcotics, then that particular doctor can get approval from the state medical board to fill prescriptions for narcotics--with oversight. Someone has to provide a check, after all, and goodness knows most patients are incapable of doing so.

tecoyah · 06-28-2005, 01:39 AM

I would just like to thank everyone in this thread for great reading material. I will single out Ustwo for giving us all a bit of insight we likely would be missing without him. Excellent thread,

guthmund · 06-28-2005, 11:28 AM

Ideally, it would be nice to have pharmacists. It would be nice to get the prescription under another set of eyes and such. It's a nice buffer zone for the patient to have two educated minds looking over their prescriptions to make sure drug A and drug B play nice together.

However, if the pharmacist isn't going to fulfill their part of the doctor/pharmacist/patient triad then maybe we should get rid of the pharmacist.
If my mechanic won't work on my car because he thinks I should be observing the Sabbath, I find another mechanic, right? It seems like kind of the same thing to me.

Like the majority have posted, there would have to be some sort of oversight to make sure the power isn't used and abused, but it's certainly possible to do.

kutulu · 06-28-2005, 01:10 PM

Quote:

Originally Posted by Ustwo

Oh and the big thing you are all missing.

A lot of doctors get PAID to perscribe certain drugs. (Something that should not be allowed)

They make money when they give you a perscription to X brand of whatever.

If you think this is so some kid can have an abortion pill, guess again, its about money.

I know about that and it seriously pisses me off. It should be illegal for drug companies to give ANYTHING to docs. I'd almost want to take it as far as saying they should not be allowed to invest in drug companies because it presents a conflict of interest.

They should perscribe medicine based on the merits of that medicine that's it. Once money comes into play it makes it easy for them to say, "well this one is pretty much just as good" and take that kickback.

One day when my wife was pregnant and we were having a scheduled doctor visit we walk in and there is this drug rep sitting in the waiting room. We were early so she was able to come and go before our appointment. Surprise, the Dr had a different prenatal vitamin perscription that she wanted us to 'try out.' I lost a LOT of respect for her doc that day.

flstf · 06-28-2005, 03:27 PM

Quote:

And doctors say that pharmacists are winning support in state houses with 14 states already considering legislation aimed at protecting pharmacists' right to refuse to fill prescriptions based on religious, personal or moral grounds and nine more states in the process of enacting legislation that would allow pharmacists to refuse prescriptions "for any reason."

This is hilarious. I can just imagine going to get a prescription filled and having it refused and being told that prayer is the best medicine. Maybe getting our prescriptions filled from Canada over the internet will become even more popular.

kutulu · 06-28-2005, 03:46 PM

Quote:

Originally Posted by flstf

This is hilarious. I can just imagine going to get a prescription filled and having it refused and being told that prayer is the best medicine. Maybe getting our prescriptions filled from Canada over the internet will become even more popular.

Sure, but then you have to pay shipping charges, $15 extra if you want your antibiotics tomorrow!

Ustwo · 06-28-2005, 04:24 PM

Quote:

Originally Posted by kutulu

I know about that and it seriously pisses me off. It should be illegal for drug companies to give ANYTHING to docs. I'd almost want to take it as far as saying they should not be allowed to invest in drug companies because it presents a conflict of interest.

I think its one of those rules they never had a need to set in the past and now don't want to set. Whats funny is that if a doctor refers a patient to me as a specialist and I pay that doctor for the referral, I would lose my licence but if the same doctor gave that patient a prescription to brand X and gets money from the drug company that makes brand x, then its legal.

There is too much money going around out there for doctors to regulate this on their own. Their excuse is easy, since if they were going to prescribe you a blood pressure medication, what difference would it make if you get brand X or Y, and in most cases it wouldn't, but undoubtedly there would be cases where it would make a difference.

lindseylatch · 06-28-2005, 06:53 PM

Quote:

Originally Posted by guthmund

Ideally, it would be nice to have pharmacists. It would be nice to get the prescription under another set of eyes and such. It's a nice buffer zone for the patient to have two educated minds looking over their prescriptions to make sure drug A and drug B play nice together.

However, if the pharmacist isn't going to fulfill their part of the doctor/pharmacist/patient triad then maybe we should get rid of the pharmacist.
If my mechanic won't work on my car because he thinks I should be observing the Sabbath, I find another mechanic, right? It seems like kind of the same thing to me.

Like the majority have posted, there would have to be some sort of oversight to make sure the power isn't used and abused, but it's certainly possible to do.

Yes, I would find another mechanic, not get a gas jockey to learn how to fix my car.
We need to FIRE these pharmacist (or create laws that prevent them from doing this). If they don't want to despense these drugs, they can find another job.

Marvelous Marv · 06-29-2005, 12:41 AM

Quote:

Originally Posted by kutulu

One day when my wife was pregnant and we were having a scheduled doctor visit we walk in and there is this drug rep sitting in the waiting room. We were early so she was able to come and go before our appointment. Surprise, the Dr had a different prenatal vitamin perscription that she wanted us to 'try out.' I lost a LOT of respect for her doc that day.

You might have jumped to the wrong conclusion. The drug rep didn't necessarily buy the doctor off--they could have come in with some new favorable data from a well-respected researcher.

Marvelous Marv · 06-29-2005, 12:44 AM

Quote:

Originally Posted by lindseylatch

Yes, I would find another mechanic, not get a gas jockey to learn how to fix my car.
We need to FIRE these pharmacist (or create laws that prevent them from doing this). If they don't want to despense these drugs, they can find another job.

How do you fire someone who owns their own business?

I still say a business owner should be able to decide what they wish to do, and what they don't wish to do.

Just as a customer should be able to decide whether or not to patronize that business if they disagree.

Without creating more laws that dictate behavior.

kutulu · 06-29-2005, 08:48 AM

Quote:

Originally Posted by Marvelous Marv

You might have jumped to the wrong conclusion. The drug rep didn't necessarily buy the doctor off--they could have come in with some new favorable data from a well-respected researcher.

Yes but how am I supposed to know? That's the whole thing, the fact that doctors get kickbacks to perscribe certain meds erodes the trust I have in my doctor. There will always be a motive to perscribe an inferior med because of a payoff and there will be a motive to go with the more expensive med when they are equal.

Telluride · 06-29-2005, 10:13 PM

Quote:

Originally Posted by Lead543

AMEN!! My town has 3 Pharmacies, although about 4 years ago there was only one. If they'd refused to fill my prescriptions for BC I'd be hooped. It's a 30 minute drive to the next city, in other places I imagine it's worse.

I have to drive 30 minutes to buy clothes or a new car. I don't feel particularly oppressed.

Quote:

Originally Posted by Lead543

If the pharmacist is Catholic and thinks birth control is wrong that's fine, it's not their place to impose their beliefs on other people. I don't agree with abortion but you don't see me becoming an abortion doctor and then refusing to perform them.

Those who try to remove the control of goods and services offered by businesses from the business owner aren't trying to "impose their beliefs on other people"?

And the comparison to abortion doctors seems faulty. I'm pretty sure that most prescriptions filled are for medicines other than birth control, which means that even an anti-birth control pharmacist could still fill most of the prescriptions handed to him/her. I'm not familiar with how abortion clinics are run, but I don't see how an abortion provider who refuses to provide abortions would be able to perform his/her job in any capacity.

Quote:

Originally Posted by Lead543

The pharmacist may have the right to refuse dispensing medications but the client also has the right to obtain medications they require in their own town/city.

The owner of a private business has every right to choose which goods and services he/she will offer. Potential customers don't have a right to convenient shopping.

munchen · 06-29-2005, 10:38 PM

Quote:

I still say a business owner should be able to decide what they wish to do, and what they don't wish to do.

most business should have their own right to distrobute what they want but pharmacists are essential. People need their drugs you cant have someone denied drugs on principle. WHat if anti depressants are against someones beliefs? or worse? When you get into a proffesion of that nature you have to become a proffesional and check yourself at the door. If you have something against distributing drugs dont become a pharmacist

On a more productive note, maybe there is a comprimise somewhere in here. What if when presented with a prescription for say the birth control pill, the pharmacists hands back a written objection. This excuses the pharmacist from his duty. The patient can then give that objection to the prescribing doctor. The doctor can sign this then legally fullfil the prescription him/herself. Pharmacist doesnt go against his/her morals, patient gets medication, everybody happy.

Ustwo · 06-29-2005, 10:43 PM

Quote:

"It's not just contraceptives," said Mary Frank, M.D., a family physician from Mill Valley, Calif., during a discussion of the issue. "It's pain medications and psychotropics. And not only are the patients not getting prescriptions filled, but pharmacists are refusing to return the prescriptions and they are lecturing the patients about the drugs."

Another aspect people are ignoring is how prevalent is this and what are the circumstances?

Never trust a one sided story just because it gives you a soap box.

Ustwo · 06-29-2005, 10:52 PM

Apparently the pharmacists responded.

Quote:

FOR IMMEDIATE RELEASE CONTACT: Gail Street June 23, 2005 Public Relations Director 202-429-7558 Statement by John A. Gans, Executive Vice President and CEO American Pharmacists Association (APhA) Pharmacists & Physicians: Not Just a Matter of Conscience Despite the alarming headlines, pharmacists and physicians agree. Patients should receive their medications without harassment and interference. The American Pharmacists Association’s (APhA) two-part policy statement supports the ability of the pharmacist to step away from participating in activity to which they have personal objections—but not step in the way. The Association supports the pharmacists’ ability to choose not to fill a prescription based on moral or ethical values. But recognizing the pharmacist’s important role in the health care system, APhA supports the establishment of systems to ensure that the patient’s health care needs are served. Essential to APhA’s policy is establishing systems to assure patient access before the prescription ever reaches the pharmacist. Well-constructed systems are seamless; and often the patient is unaware of the pharmacist’s action. On this point, we agree with the AMA and welcome dialogue that will ensure this continued recognition of the need to serve patients and recognize the individual beliefs of pharmacists and physicians. Just as physicians are not required to provide all medical services, pharmacists should not be required to provide all pharmacy services. It is unfortunate that the conversation between the AMA and APhA did not take place before their House of Delegates action. But physicians and pharmacists collaborate every day to improve medication use and advance patient care—including navigating issues of conscience. We look forward to working with the AMA on this issue, much as our individual members are working together with physicians today. Just like doctors, pharmacists abide by a Code of Ethics for the delivery of health care. And yes, just like doctors, pharmacists make sure that patients are getting the prescriptions they need without interruption at the pharmacy.

astrahl · 06-30-2005, 06:29 AM

This is still the business of science. Morals and personal beliefs should be left at the door. And, for the record, I am AGAINST doctors being allowed to fill RX orders. A pharmacist has specific training that doctors barely even touch. It is like asking a podiatrist to do neurosurgery.

Witholding things like the morning after pill and BCP is akin to discrimination, and, last I heard, this country isn't about allowing discrimination.

06-27-2005, 07:59 AM	#3 (permalink)
astrahl Insane Location: You don't want to live here	A pharmacist has no business choosing which prescription he/she decides to give out. This is a business of science, not philosophy. If they have moral problems with the work they do, they should find another profession. I find it appauling that a professional would have the unmitigated gaul to tell me that they have a moral objection to BCPs or RU486 or ANY other drug that a physician, one who <b>knows</b> the circumstances, has prescribed. I should not have to defend my need for the drug simply because the pharmacist is too short sighted to see the reason I need the drug(s). __________________ Maybe it was over when she chucked me out the Rover at full speed. Maybe Maybe... ~a-Ha

06-27-2005, 10:12 AM	#6 (permalink)
lindseylatch Addict Location: Seattle, WA	i agree with astrahl. It rediculous that these pharmacist are getting away with this, I think we need to start focusing on them, rather than working around them (which will only encourage them). And, BTW, docs already give out drugs in the form of sample. Obviously they can't give out narcotics, but BC pills can be, allergy medicine, arthritis medicine...all kinds of things. My mother has actually made up some "morning after" kits to give to patients who can't get them at a pharmacy. It's a few BC pills and an anti-nausea pill. __________________ "Those who can make you believe absurdities can make you commit atrocities" "If God did not exist, it would be necessary to invent him." "It is dangerous to be right when the government is wrong." -Voltaire

06-27-2005, 10:52 AM	#9 (permalink)
Ustwo Pissing in the cornflakes	You people obviously have never had to deal with a quack doctor before. As a doctor myself that can perscribe anything up to and including narcotics, I think this is a very bad idea. There are checks and balances in any system, while you can whine about some pharmacist not perscribing an abortion pill, thats not what is really at stake here. What this does is give any doctor with a licence the ability to percribe any medication no matter how far out of their field it is. For every 15 year old in some Georga town that gets to take an abortion pill because of this bill, there will be hundreds of screw ups, medical reactions due to multiple perscriptions, and outright quackery. __________________ Agents of the enemies who hold office in our own government, who attempt to eliminate our "freedoms" and our "right to know" are posting among us, I fear.....on this very forum. - host Obama - Know a Man by the friends he keeps.

06-27-2005, 11:49 AM	#10 (permalink)
Paq Junkie Location: South Carolina	that's fine, ustwo, that there need to be checks and balances, but i really think the pharmacist should not be able to refuse to dispense a prescription or withhold the prescription so the person cannot get treatment. Seriously, i have no idea what i would do if i were a woman and a pharmacist basically said, "Sorry, i'm Catholic and i cannot give you birth control pills and i am keeping this prescription as i cannot morally return it to you" I am afraid violence would ensue at that point. Makes me wonder what would happen if many pharmacists began refusing to fill Viagra/viagra type prescriptions bc it goes against her moral values. I ask that mainly bc it seems that birth related prescriptions are the most refused at the moment. Basically, if they feel they can't morally do a job, they should really find another line of work. I'm certain there is something else that is more morally palatable. That said, i do like the role of the pharmacist in tracking someone's prescription history, complications, issues, etc, plus, just being there for a 2nd set of eyes, but i do not believe they should be allowed to withhold prescriptions bc of moral issues. __________________ Live. Chris

06-27-2005, 03:48 PM	#15 (permalink)
guy44 Somnabulist Location: corner of No and Where	Yeah, I actually agree with Ustwo that allowing doctors to dispense meds may have many serious implications. A myriad of disastrous possibilities come to mind, including mistakenly giving out multiple prescriptions or a massive increase in the cost of medication as a side effect of having to include thousands of doctors in the medical dispensation process. Remember when Rush Limbaugh went doctor shopping in order to find one who would prescribe hillbilly heroin? Imagine how much easier stuff like that would be if the doctor could just give him the stuff without going through a pharmacist. I'm not saying this can't work, but I think it needs to be very well thought-out before it's implemented. __________________ "You have reached Ritual Sacrifice. For goats press one, or say 'goats.'"

06-27-2005, 07:49 AM	#2 (permalink)
StanT © Location: Colorado	I've got mixed opinions on this issue. I have no problem with a pharmacy not stocking or refusing to dispense certain drugs. I do think they should be up front about it (like a sign that says "We don't do that"). I have a big problem with them not returning a prescription that they do not condone. I'm also not comfortable with doctors handing out medications. On several occasions, a pharmacist has caught a mistake or side effect that the doctor didn't mention. Having a second set of eyes would seem to be a good idea.

06-27-2005, 09:57 AM	#5 (permalink)
kutulu Junkie	I think this is great. Fuck the pharmacies, this is what they get for placing their personal belief system above the needs of another person. Here is a hint - if you don't want to give out birth control don't become a pharmacist! Remember, this is about towns like Crapville, Anystate where there is one place to buy groceries and one place to get your perscription filled. Not everybody has the means to drive 50 miles to get their medicine. One self-rightous bastard can effectively remove contraception from the whole city.

06-27-2005, 10:44 AM	#8 (permalink)
laconic1 Junkie	I'm pretty much with StanT on this one. I feel that a business, any business regardless of what type, has a right to not provide service to a customer for whatever reason, but they should not be able to do anything that would prevent the customer from receiving that good or service from a willing business. The second set of eyes is a good point that I didn't think about.

06-27-2005, 12:11 PM	#11 (permalink)
Marvelous Marv Cunning Runt Location: Taking a mulligan	I think any business should have the right to decide what it will and will not do. However, the government usually interferes with that. Think of the cases where (usually elderly) rental property owners have been forced to rent to unmarried couples. On the other hand, any pharmacist who wouldn't return my prescription would be explaining to a judge why he chose to interfere with my health care. If I didn't call the police and charge him with stealing it first. If he doesn't honor the prescription, he's not entitled to retain the written form. StanT is correct. We are subjected to such a barrage of new drugs that health care practitioners can't keep track of their own fields and the new drugs as well. They also don't have access to records of prescriptions from other physicians, while pharmacists generally do.

06-27-2005, 03:12 PM	#12 (permalink)
EULA Crazy Location: Bowling Green, KY	On a related note, I think pharmacists should be able to dispense medicine without prescriptions. It would put a nice dent in the cost of healthcare.

06-27-2005, 03:55 PM	#16 (permalink)
Ustwo Pissing in the cornflakes	Oh and the big thing you are all missing. A lot of doctors get PAID to perscribe certain drugs. (Something that should not be allowed) They make money when they give you a perscription to X brand of whatever. If you think this is so some kid can have an abortion pill, guess again, its about money. __________________ Agents of the enemies who hold office in our own government, who attempt to eliminate our "freedoms" and our "right to know" are posting among us, I fear.....on this very forum. - host Obama - Know a Man by the friends he keeps.

06-27-2005, 05:31 PM	#18 (permalink)
martinguerre whosoever Location: New England	ustwo...there is a fairly simple solution to the problem you rightly point out. self-interest, or lack of skill...whatever the problem may be, needs to be addressed. but if a panel of three other doctors, selected locally by the AMA reviewed the case, and then signed the dispensation order...i don't see how that would produce ill results. interactions would be double checked, and the effort would guard against routine use of the system...it would be reserved for when it was really needed. __________________ For God so loved creation, that God sent God's only Son that whosoever believed should not perish, but have everlasting life. -John 3:16

06-27-2005, 07:26 PM	#19 (permalink)
Elphaba Deja Moo Location: Olympic Peninsula, WA	Pharmacies do not provide the necessary oversite in a hospital setting. Doctors Rx'ing emergency medication are not quack's, but another physician called in may Rx another drug without previous knowledge of the patient. He or she is also not a "quack." My experience of my father's illness and death and the medical misjudgements that hastened it, is merely a personal story. I will save the expertise opinion to the dentist that straightens teeth.

06-27-2005, 07:35 PM	#20 (permalink)
pan6467 Lennonite Priest Location: Mansfield, Ohio USA	I don't see what the issue is..... Doctors already give out "free samples" of drugs so what's the problem with them having a pharmacy within their office. The Dr. does his job, prescribes the meds and you go to the on staff pharmacist and get it. BFD........ The doctor needs to make sure the patient isn't doctor shopping though...... but that happens whether it's a pharmacy or doctor giving out the meds.... just ask Limbaugh. As for doctors selling out to med companies and being paid for what they prescribe, I believe the Doctor should inform you of that and offer you the choice of medications available. It's not ethical and it's not right but until we regulate the medical, pharmaceutical and insurance industries, we will have this problem. __________________ I just love people who use the excuse "I use/do this because I LOVE the feeling/joy/happiness it brings me" and expect you to be ok with that as you watch them destroy their life blindly following. My response is, "I like to put forks in an eletrical socket, just LOVE that feeling, can't ever get enough of it, so will you let me put this copper fork in that electric socket?"

06-27-2005, 07:48 PM	#21 (permalink)
Elphaba Deja Moo Location: Olympic Peninsula, WA	Pan, wouldn't it be ideal if we had a universal health plan? Naw, that could only happen if the two worst foes, Clinton and Gingrich would propose such a plan. Which they have.

06-27-2005, 08:03 PM	#22 (permalink)
Ustwo Pissing in the cornflakes	Edit: Never mind its been said, no point in beating the horse. __________________ Agents of the enemies who hold office in our own government, who attempt to eliminate our "freedoms" and our "right to know" are posting among us, I fear.....on this very forum. - host Obama - Know a Man by the friends he keeps. Last edited by Ustwo; 06-27-2005 at 08:05 PM..

06-27-2005, 08:33 PM	#23 (permalink)
lindseylatch Addict Location: Seattle, WA	obviously there are a lot of problems with our health care system (as I imagine there are with ANY health care system, despite what you Canadians say ). To address some points Ustwo made, "quacks" are the reason you can sue for malpractice. Of course, if you're dead from a bad drug combination, it doesn't do you much good. But that's why people should be alert when choosing a doc, and not just pick a name out of a hat. I've definitely seen a fair number of asshole docs that only care about the money they're making. martin suggests a panel, but that would be WAY too expensive to set up for EVERY perscription being filled (I myself fill at least three a month). Even just for narcotics would be rediculous. Now, as to docs being paid to perscribe drugs...that goes with the "quacks." They're obviously more concerned about money than patients, and you can usually tell the minute you meet them. And, MrSelfDestruct, just cause they have a lot of shit from one company doesn't mean they're in their pocket. Some drug companies give you that stuff no matter what. Maybe your doc just thought it was a great med. My mom used to take stuff from the drug companies, and then percribe what she thought was best for the patient. we got tickets to "Tony and Tina's Wedding" that way. I believe they aren't allowed to do that anymore, at least in Oregon. Another point of Ustwo's, any doc can perscribe any med NOW, no matter how far out of their field it is. The pharmacists aren't checking that, as far as I know. All that being said, I still think this is a bad idea. It's going to have consequences beyond those that it's intended to have (assuming it's actually aimed at pharmacists refusing percriptions, and not some ulterior motive). It's the wrong tool for the job, using a wrench to hammer in a nail. It might do the trick, but it's not optimum. __________________ "Those who can make you believe absurdities can make you commit atrocities" "If God did not exist, it would be necessary to invent him." "It is dangerous to be right when the government is wrong." -Voltaire

06-27-2005, 11:18 PM	#25 (permalink)
snowy Kick Ass Kunoichi Location: Oregon	Well, provided you're a medically literate person with a functioning, intelligent brain, I don't see a problem with small-town doctors being able to fill prescriptions. The problem is that not everyone is medically literate (an incredibly low number of Americans are medically literate--by that I mean do they have an understanding of health information, information about their care and treatment, etc) so they cannot provide their own check (sadly, this happens quite often--my mom once had several different prescriptions and could not, for the life of her, understand why she was so tired...thanks to various resources I soon figured out that 3 of them shared fatigue as a side effect and when 2 were prescribed together they would increase drowsiness--this is what happens when you go to multiple doctors and multiple pharmacists). Pharmacists are in place because they provide a check. However, in a small town where there are no other options, a doctor should have the ability to prescribe medications IF the town's pharmacist has a conscientious objection. Yes, I am suggesting this should be done on a case-by-case basis. After all, if we are discussing small-town America, then there shouldn't be that many cases of this happening (I certainly hope not). The state medical board and the doctor's professional association should be required to supervise filling of prescriptions somehow--some kind of oversight is necessary to prevent quackery. If we start off by allowing doctors to fill certain kinds of prescriptions--birth control, mifepristone and misoprostol, and Plan B, for example, then perhaps less oversight will be necessary. If it turns out that a certain town has a pharmacist who won't fill for narcotics, then that particular doctor can get approval from the state medical board to fill prescriptions for narcotics--with oversight. Someone has to provide a check, after all, and goodness knows most patients are incapable of doing so. __________________ If I am not better, at least I am different. --Jean-Jacques Rousseau

06-28-2005, 01:39 AM	#26 (permalink)
tecoyah Illusionary	I would just like to thank everyone in this thread for great reading material. I will single out Ustwo for giving us all a bit of insight we likely would be missing without him. Excellent thread, __________________ Holding onto anger is like grasping a hot coal with the intent of throwing it at someone else; you are the one who gets burned. - Buddha

06-28-2005, 11:28 AM	#27 (permalink)
guthmund big damn hero	Ideally, it would be nice to have pharmacists. It would be nice to get the prescription under another set of eyes and such. It's a nice buffer zone for the patient to have two educated minds looking over their prescriptions to make sure drug A and drug B play nice together. However, if the pharmacist isn't going to fulfill their part of the doctor/pharmacist/patient triad then maybe we should get rid of the pharmacist. If my mechanic won't work on my car because he thinks I should be observing the Sabbath, I find another mechanic, right? It seems like kind of the same thing to me. Like the majority have posted, there would have to be some sort of oversight to make sure the power isn't used and abused, but it's certainly possible to do. __________________ No signature. None. Seriously.

06-30-2005, 06:29 AM	#40 (permalink)
astrahl Insane Location: You don't want to live here	This is still the business of science. Morals and personal beliefs should be left at the door. And, for the record, I am AGAINST doctors being allowed to fill RX orders. A pharmacist has specific training that doctors barely even touch. It is like asking a podiatrist to do neurosurgery. Witholding things like the morning after pill and BCP is akin to discrimination, and, last I heard, this country isn't about allowing discrimination. __________________ Maybe it was over when she chucked me out the Rover at full speed. Maybe Maybe... ~a-Ha