6 ms·

There are better ways to go about this. As others have noted, there must be a mechanism for a continual prescription to be easily filled, e.g. insulin, metformi

There are better ways to go about this. As others have noted, there must be a mechanism for a continual prescription to be easily filled, e.g. insulin, metformin, etc. I could see a long term prescription that has to be renewed each year and is good at any pharmacy. For the short term prescriptions though, cutting the doctor out of it makes people much more susceptible to marketing (instead of 'ask your doctor if you need X' we'll get 'You need X if you have any of a, b, and c...get it now before it's too late'. Also, the doctor is aware of your health history and can spot reasons you specifically shouldn't take a drug, or better alternatives. Maybe you are overweight and one diabetes drug would work for you, but this other one will also help you lose weight. Maybe you have a loss of kidney function, and shouldn't be taking metformin. Your pharmacist should catch drug interactions, but they can't catch problems that would result from your past medical history. For me this is big pharma getting their way, at our cost, in more ways than one.

gaius 8y ago
Also, the doctor is aware of your health history Your doctor skims your notes in the 20 seconds between the receptionist calling your name and you entering her office, in handwriting she can barely read herself, and has forgotten you before you’re even back in the waiting room after spending 5 minutes talking to you while she’s really thinking about the new Audi. That’s as far as the awareness goes.
- tptacek 8y ago
  That is not at all the experience I have with my doctor, where the intake NP does a whole litany of the past several years worth of doctor visits before I’m seen. I’m ok and I think glad that pharmacists don’t even have access to that information.
  - WillPostForFood 8y ago
    On your first visit or every visit thereafter? I think the issue is the overhead of unecessary repeat visits.
    - tptacek 8y ago
      Every visit thereafter.
      - gaius 8y ago
        Not sure how your anecdata is any more or less valid than mine...
        tptacek 8y ago
        I never said it was! My point was just that a pharmacist probably couldn't replicate the routine experience that the large health provider chain my doctor works in provides for patients.
- aesclepius 8y ago
  Thanks for speaking for the entire medical profession. That is in fact what a terrible physician does, and not what myself or other newly trained physicians aspire to do.
  - thatcat 8y ago
    If you live in a location that has poor selection of GPs then it should be your choice to opt out without denying yourself access necessary medication.
    - panzagl 8y ago
      If you don't go to a doctor, how do you know it's necessary?
      - WillPostForFood 8y ago
        If you’ve been taking the same medication for 10 years, then on day 1 of year 11 you need a refill, pretty good chance you know it is necessary. I wouldn’t claim you never need to see a doctor, but it is equally absurd to suggest you always need to see a doctor. My experience has been that I ask for refills, and my doctor unquestioningly gives them. It would save the whole system money and time if I could just refill them myself.
  - phil21 8y ago
    You may not aspire to it, but you likely will have to do it if you want to remain employed in many areas. I have multiple friends who made it all the way through residency and have since stopped practicing within years of "graduating. The OP describes the profession much better than you do, as a whole. Double booking patients, requiring certain revenue targets, massive amounts of useless paperwork, etc. Considering the varying ranges of where they took up residency I'd say this is endemic industry-wide. Also jives with my personal experiences with the medical field.
    - adrr 8y ago
- throwaway-hn123 8y ago
  I'm guessing you go in with that attitude and then whine when you get treated like shit.
- hansthehorse 8y ago
  I sit with my primary care doctor at least a half hour each visit, but then I'm lucky. I live very close to a first class VA medical center. I don't believe the west palm beach center can be beat.
thatcat 8y ago
It's a trade off since Doctors have a habit of using their prescription power to force you to schedule unnecessary visits to boost profits and they are not immune from marketing pressure.
- 394549 8y ago
  > It's a trade off since Doctors have a habit of using their prescription power to force you to schedule unnecessary visits to boost profits and they are not immune from marketing pressure. Citation needed. I'm sure are a few doctors out there who do that, but I have a hard time believing that's so widespread that it's a "habit" of "doctors." For instance, my doctor will reissue my long-term prescription if I call him, the next I hear of it is when the pharmacy sends me a notification saying it's ready. That said, I'm sure there are prescriptions that actually do require regular long term medical monitoring by a professional, even if a lot of people are annoyed by that and therefore think it's unnecessary.
  - nanagull 8y ago
    For just one example: 33% of doctors always require a pap smear and pelvic exam to renew a birth control pill prescription. This is despite the fact that the WHO and ACOG both advise that the pills can be safely prescribed without the exams. 33% certainly counts as more than a "few" in my book. Citation: https://www.reuters.com/article/us-birth-control/women-seeking-birth-control-get-unneeded-pelvic-exams-idUSTRE6AL67X20101122 https://www.reuters.com/article/us-birth-control/women-seeki...
    - ams6110 8y ago
      Well, birth control pills aren't really safe. I guess they're safe compared to a pregnancy, but they do have potentially serious side effects. It seems reasonable to have periodic checks for those, if you're taking them.
      - astura 8y ago
        As the GP pointed out, pap smears and pelvic exams are not medically necessary prerequisite to a birth control prescription and adding those procedures don't make prescribing birth control pills safer. They are an artificial barrier to access birth control. Pap smears (when done at the recommend intervals - most doctors overtest) are extremely beneficial screening tool and they save lives, but they have nothing to do with birth control - the purpose of a pap smear is to screen for cervical cancer. In fact, the current recommendation is to wait until a women turns 21 before starting pap smears, yet many (most?) women will require contraceptives before 21. It's also false that "birth control pills aren't really safe." - "potential to have serious side effects" is not even remotely the same thing as "not really safe." Oral contraceptives are not more dangerous than NSAIDs like ibuprofen. Both The American College of Obstetricians and Gynecologists [1] and The American Academy of Family Physicians [2] recommend over the counter access to oral contraceptives based on the availabile evidence [1] https://acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Over-the-Counter-Access-to-Oral-Contraceptives https://acog.org/Clinical-Guidance-and-Publications/Committe... [2] https://www.aafp.org/about/policies/all/otc-oral-contraceptives.html https://www.aafp.org/about/policies/all/otc-oral-contracepti...
jdietrich 8y ago
For what it's worth, the UK has had a three-tier system of medicine licensing (prescription-only, pharmacy-only and general sale) since 1968. In 2006, pharmacists with additional training gained the right to independently prescribe any prescription-only medicine within their clinical competence. Repeat prescriptions can be requested online and sent electronically to a pharmacist of the patient's choice. Obviously YMMV. https://www.nhs.uk/common-health-questions/medicines/what-is-the-law-on-the-sale-of-medicines/ https://www.nhs.uk/common-health-questions/medicines/what-is... https://www.pharmacyregulation.org/education/pharmacist-independent-prescriber https://www.pharmacyregulation.org/education/pharmacist-inde... https://www.nhs.uk/NHSEngland/AboutNHSservices/pharmacists/Pages/eps.aspx https://www.nhs.uk/NHSEngland/AboutNHSservices/pharmacists/P...
- Lazare 8y ago
  NZ has done something similar. Seems to work quite well; I recently went to a pharmacy looking for an OTC solution for a mild infection (it didn't seem worth seeing a doctor over, and I didn't have time anyhow) and ended up with a prescription from antibiotics written by the pharmacist, which was super useful and convenient. Also in the case of oral contraceptives, a change recently went through here (last year I believe) making oral contraceptives OTC as long as the purchaser had been prescribed them within the last 3 years. Bit of an odd compromise, but a nice stepping stone towards greater liberalisation if it doesn't end up causing issues.
_bxg1 8y ago
I'd also be concerned it might exacerbate the opioid epidemic.
- dkasper 8y ago
  Opioids would not be part of this change. This is for stuff like high blood pressure, cholesterol, migraines and asthma (according to the article).
- hrygolis 8y ago
  ... because physician prescribing did so much to prevent that epidemic? Not trying to be snarky--I understand the argument--just pointing out how absurd that seems to be to some.
ohbleek 8y ago
This situation perfectly illustrates how underutilized pharmacists are in the health care system. A few states are passing laws that will allow pharmacists to prescribe certain medications but it’s happening slowly due to the typical pressures of lobbies and insurance companies.
wahern 8y ago
> Your pharmacist should catch drug interactions, but they can't catch problems that would result from your past medical history. They can and do. See, e.g., https://www.sciencedirect.com/science/article/pii/S131901641300039X https://www.sciencedirect.com/science/article/pii/S131901641... Pharmacists in the U.S. are highly trained medical professionals. A Pharm.D is a professional doctorate. Their expertise extends beyond chemistry, and more importantly are trained well enough to know when to seek the advice of, or refer a patient to, an M.D. It's not that pharmacists aren't trained well enough to do these things. The real issue is that most electronic medical records are locked behind proprietary walled gardens. Outside HMOs and similar vertically integrated medical systems, pharmacists don't have reliable access to medical histories. This is a solvable problem, though.

gaius 8y ago

Also, the doctor is aware of your health history Your doctor skims your notes in the 20 seconds between the receptionist calling your name and you entering her office, in handwriting she can barely read herself, and has forgotten you before you’re even back in the waiting room after spending 5 minutes talking to you while she’s really thinking about the new Audi. That’s as far as the awareness goes.

tptacek 8y ago
That is not at all the experience I have with my doctor, where the intake NP does a whole litany of the past several years worth of doctor visits before I’m seen. I’m ok and I think glad that pharmacists don’t even have access to that information.
- WillPostForFood 8y ago
  On your first visit or every visit thereafter? I think the issue is the overhead of unecessary repeat visits.
  - tptacek 8y ago
    Every visit thereafter.
    - gaius 8y ago
      Not sure how your anecdata is any more or less valid than mine...
      - tptacek 8y ago
        I never said it was! My point was just that a pharmacist probably couldn't replicate the routine experience that the large health provider chain my doctor works in provides for patients.
aesclepius 8y ago
Thanks for speaking for the entire medical profession. That is in fact what a terrible physician does, and not what myself or other newly trained physicians aspire to do.
- thatcat 8y ago
  If you live in a location that has poor selection of GPs then it should be your choice to opt out without denying yourself access necessary medication.
  - panzagl 8y ago
    If you don't go to a doctor, how do you know it's necessary?
    - WillPostForFood 8y ago
      If you’ve been taking the same medication for 10 years, then on day 1 of year 11 you need a refill, pretty good chance you know it is necessary. I wouldn’t claim you never need to see a doctor, but it is equally absurd to suggest you always need to see a doctor. My experience has been that I ask for refills, and my doctor unquestioningly gives them. It would save the whole system money and time if I could just refill them myself.
- phil21 8y ago
  You may not aspire to it, but you likely will have to do it if you want to remain employed in many areas. I have multiple friends who made it all the way through residency and have since stopped practicing within years of "graduating. The OP describes the profession much better than you do, as a whole. Double booking patients, requiring certain revenue targets, massive amounts of useless paperwork, etc. Considering the varying ranges of where they took up residency I'd say this is endemic industry-wide. Also jives with my personal experiences with the medical field.
  - adrr 8y ago
throwaway-hn123 8y ago
I'm guessing you go in with that attitude and then whine when you get treated like shit.
hansthehorse 8y ago
I sit with my primary care doctor at least a half hour each visit, but then I'm lucky. I live very close to a first class VA medical center. I don't believe the west palm beach center can be beat.

thatcat 8y ago

It's a trade off since Doctors have a habit of using their prescription power to force you to schedule unnecessary visits to boost profits and they are not immune from marketing pressure.

394549 8y ago
> It's a trade off since Doctors have a habit of using their prescription power to force you to schedule unnecessary visits to boost profits and they are not immune from marketing pressure. Citation needed. I'm sure are a few doctors out there who do that, but I have a hard time believing that's so widespread that it's a "habit" of "doctors." For instance, my doctor will reissue my long-term prescription if I call him, the next I hear of it is when the pharmacy sends me a notification saying it's ready. That said, I'm sure there are prescriptions that actually do require regular long term medical monitoring by a professional, even if a lot of people are annoyed by that and therefore think it's unnecessary.
- nanagull 8y ago
  For just one example: 33% of doctors always require a pap smear and pelvic exam to renew a birth control pill prescription. This is despite the fact that the WHO and ACOG both advise that the pills can be safely prescribed without the exams. 33% certainly counts as more than a "few" in my book. Citation: https://www.reuters.com/article/us-birth-control/women-seeking-birth-control-get-unneeded-pelvic-exams-idUSTRE6AL67X20101122 https://www.reuters.com/article/us-birth-control/women-seeki...
  - ams6110 8y ago
    Well, birth control pills aren't really safe. I guess they're safe compared to a pregnancy, but they do have potentially serious side effects. It seems reasonable to have periodic checks for those, if you're taking them.
    - astura 8y ago
      As the GP pointed out, pap smears and pelvic exams are not medically necessary prerequisite to a birth control prescription and adding those procedures don't make prescribing birth control pills safer. They are an artificial barrier to access birth control. Pap smears (when done at the recommend intervals - most doctors overtest) are extremely beneficial screening tool and they save lives, but they have nothing to do with birth control - the purpose of a pap smear is to screen for cervical cancer. In fact, the current recommendation is to wait until a women turns 21 before starting pap smears, yet many (most?) women will require contraceptives before 21. It's also false that "birth control pills aren't really safe." - "potential to have serious side effects" is not even remotely the same thing as "not really safe." Oral contraceptives are not more dangerous than NSAIDs like ibuprofen. Both The American College of Obstetricians and Gynecologists [1] and The American Academy of Family Physicians [2] recommend over the counter access to oral contraceptives based on the availabile evidence [1] https://acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Over-the-Counter-Access-to-Oral-Contraceptives https://acog.org/Clinical-Guidance-and-Publications/Committe... [2] https://www.aafp.org/about/policies/all/otc-oral-contraceptives.html https://www.aafp.org/about/policies/all/otc-oral-contracepti...

jdietrich 8y ago

For what it's worth, the UK has had a three-tier system of medicine licensing (prescription-only, pharmacy-only and general sale) since 1968. In 2006, pharmacists with additional training gained the right to independently prescribe any prescription-only medicine within their clinical competence. Repeat prescriptions can be requested online and sent electronically to a pharmacist of the patient's choice. Obviously YMMV. https://www.nhs.uk/common-health-questions/medicines/what-is-the-law-on-the-sale-of-medicines/ https://www.nhs.uk/common-health-questions/medicines/what-is... https://www.pharmacyregulation.org/education/pharmacist-independent-prescriber https://www.pharmacyregulation.org/education/pharmacist-inde... https://www.nhs.uk/NHSEngland/AboutNHSservices/pharmacists/Pages/eps.aspx https://www.nhs.uk/NHSEngland/AboutNHSservices/pharmacists/P...

Lazare 8y ago
NZ has done something similar. Seems to work quite well; I recently went to a pharmacy looking for an OTC solution for a mild infection (it didn't seem worth seeing a doctor over, and I didn't have time anyhow) and ended up with a prescription from antibiotics written by the pharmacist, which was super useful and convenient. Also in the case of oral contraceptives, a change recently went through here (last year I believe) making oral contraceptives OTC as long as the purchaser had been prescribed them within the last 3 years. Bit of an odd compromise, but a nice stepping stone towards greater liberalisation if it doesn't end up causing issues.

_bxg1 8y ago

I'd also be concerned it might exacerbate the opioid epidemic.

dkasper 8y ago
Opioids would not be part of this change. This is for stuff like high blood pressure, cholesterol, migraines and asthma (according to the article).
hrygolis 8y ago
... because physician prescribing did so much to prevent that epidemic? Not trying to be snarky--I understand the argument--just pointing out how absurd that seems to be to some.

ohbleek 8y ago

This situation perfectly illustrates how underutilized pharmacists are in the health care system. A few states are passing laws that will allow pharmacists to prescribe certain medications but it’s happening slowly due to the typical pressures of lobbies and insurance companies.

wahern 8y ago

> Your pharmacist should catch drug interactions, but they can't catch problems that would result from your past medical history. They can and do. See, e.g., https://www.sciencedirect.com/science/article/pii/S131901641300039X https://www.sciencedirect.com/science/article/pii/S131901641... Pharmacists in the U.S. are highly trained medical professionals. A Pharm.D is a professional doctorate. Their expertise extends beyond chemistry, and more importantly are trained well enough to know when to seek the advice of, or refer a patient to, an M.D. It's not that pharmacists aren't trained well enough to do these things. The real issue is that most electronic medical records are locked behind proprietary walled gardens. Outside HMOs and similar vertically integrated medical systems, pharmacists don't have reliable access to medical histories. This is a solvable problem, though.