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Not really disagreeing that a pharmacist might know more about the drugs than a doctor. I wasn't warned about the potential side effects of Ciprofloxacin once,

Not really disagreeing that a pharmacist might know more about the drugs than a doctor. I wasn't warned about the potential side effects of Ciprofloxacin once, just told it was an "antibiotic" by the specialist I saw, and the pharmacist did clue me in about some side effects, which I promptly had some of the worst ones after a single pill. I might not have made the connection it was a bad reaction to the pills without their warning, at least not so quickly. I continued to have side effects off and on for years afterwards. I learned my lesson and now do my own research before just taking any medicine a doctor wants to prescribe now. But I still don't think pharmacists should be able to just override the decision of a doctor. Make sure the person is fully informed of potential dangers, side effects and correct usage, sure, but not override the doctor. The doctor has had an opportunity to examine and talk to the patient at length, multiple times over multiple visits, and know their history and specific needs, the pharmacist doesn't know any of that background and are most likely just making assumptions. I mean if it's literal rat poison or a dose guaranteed to kill the person is being prescribed, maybe they can hold off on fulfilling it and alert authorities, but otherwise? Opioids are a major problem, as there are addicts that cycle doctors to get multiple prescriptions so some doctors might not realize it's being overprescribed, but that's a matter of addiction and abuse and I don't know how a pharmacist is expected to know when it's being abused or not, unless they're getting them all filled at the same pharmacy. Again, they're not spending enough time with these people to know what their situation is. The most interaction I have with my pharmacist is "Picking up a prescription." "Verify your address please?" "My address." "Okay this has these side effects and you should only have it after a meal." "Okay thanks." Yeah that's totally enough for them to make a medical decision on my behalf. /s If anything, I think them deciding when to withhold medicine could make them MORE liable, not less, because they're inserting themself into the decision process. What if their withholding fulfillment of a prescription results in that person dying? If the doctor said yes and they said no, that seems to open up room for litigation to me.

ashtonkem 5y ago
> But I still don't think pharmacists should be able to just override the decision of a doctor. You’re free to believe that, but understand that this is well in the “wishes and hopes” territory more than a factual understanding of how doctors, patients, and pharmacists actually interact. Personally I believe the idea that we’d spend a huge amount of time and effort as a society training a whole class of specialists and then declare that they must abide by the decisions made by a generalist to be quite odd. Your personal doctor isn’t able to override your oncologist, so why should they be able to override the experts on prescribed medicine? > If anything, I think them deciding when to withhold medicine could make them MORE liable, not less, because they're inserting themself into the decision process. I’m sorry, but that’s clearly motivated reasoning and completely unrelated to the actual law. Pharmacists are subject to medical malpractice laws just like every other type of doctor, there’s no magical “I didn’t insert myself into the process therefore I’m not liable” clause.
- cableshaft 5y ago
  > “My experience is enough to determine for everyone else” is a really bad look. Let's put it this way, I haven't seen any evidence based on what I've seen that this isn't the normal interaction with a pharmacist after decades of seeing pharmacists myself, or sitting waiting for my parents to get medicine filled, or watching other users interact with pharmacists while I've been waiting in line, etc., across multiple pharmacies in multiple cities. If there's a more personal and intimate pharmacist reaction that you see as common (or even uncommon), please share those details for me. I would love to have an example otherwise.
  - deleted 5y ago
    [deleted]
- cableshaft 5y ago
  > You’re free to believe that, but understand that this is well in the “wishes and hopes” territory more than a factual understanding of how doctors, patients, and pharmacists actually interact. I made a good faith effort in researching this, and here are some examples of interaction you might be alluding to: 1. The doctor made an obvious mistake in dosage or a might not be aware of safer alternatives and the pharmacist contacts the doctor to verify that there wasn't a mistake on the prescription or mention those alternatives and see if they can persuade the doctor to change the prescription. Great, no issues with me. Everyone makes human mistakes. I do it in software also. 2. Something obvious they can see about the patient gives them some information that contradicts the prescription (i.e. an obviously pregnant women being given a drug that's dangerous to pregnant people). Again, they contact the doctor to inform and verify. Again, no issues from me. 3. Patients sometimes see other specialists and get prescriptions from them without informing their PCP (sometimes on accident), whereas a pharmacy probably sees all of these prescriptions, and can catch when two prescriptions could have dangerous interactions that a PCP or specialist might not realize they were causing because they weren't aware of the other prescription. Again they contact the physician and verify. Again, no issues from me. 4. The pharmacist has a religious reason not to want to fulfill a prescription. Some states that's allowed, some they aren't. In those where it's allowed, most pharmacies have a policy that they must allow another pharmacist at the facility to fulfill the prescription or help transfer the prescription to another doctor. Fine with me. Note that for the first three, they generally contact the doctor and verify/try to persuade, not outright override and refuse. They help catch problems, not generally cause them. It looks like there are several states where pharmacists are actually required to provide medication[1], although that link mentions specifically personal beliefs, so I don't know if it applies for the other three issues as well. If that's all you mean, then I don't think we disagree actually. But it doesn't look like it's as clear-cut legally as you were suggesting before, and I'm far from alone in thinking that pharmacists can't just decide never to fulfill a prescription without a damn good reason (i.e. it's definitely going to kill the patient). [1]: https://www.nbcnews.com/news/us-news/can-pharmacist-legally-deny-patient-prescription-it-depends-n894871 https://www.nbcnews.com/news/us-news/can-pharmacist-legally-...

ashtonkem 5y ago

> But I still don't think pharmacists should be able to just override the decision of a doctor. You’re free to believe that, but understand that this is well in the “wishes and hopes” territory more than a factual understanding of how doctors, patients, and pharmacists actually interact. Personally I believe the idea that we’d spend a huge amount of time and effort as a society training a whole class of specialists and then declare that they must abide by the decisions made by a generalist to be quite odd. Your personal doctor isn’t able to override your oncologist, so why should they be able to override the experts on prescribed medicine? > If anything, I think them deciding when to withhold medicine could make them MORE liable, not less, because they're inserting themself into the decision process. I’m sorry, but that’s clearly motivated reasoning and completely unrelated to the actual law. Pharmacists are subject to medical malpractice laws just like every other type of doctor, there’s no magical “I didn’t insert myself into the process therefore I’m not liable” clause.

cableshaft 5y ago
> “My experience is enough to determine for everyone else” is a really bad look. Let's put it this way, I haven't seen any evidence based on what I've seen that this isn't the normal interaction with a pharmacist after decades of seeing pharmacists myself, or sitting waiting for my parents to get medicine filled, or watching other users interact with pharmacists while I've been waiting in line, etc., across multiple pharmacies in multiple cities. If there's a more personal and intimate pharmacist reaction that you see as common (or even uncommon), please share those details for me. I would love to have an example otherwise.
- deleted 5y ago
  [deleted]
cableshaft 5y ago
> You’re free to believe that, but understand that this is well in the “wishes and hopes” territory more than a factual understanding of how doctors, patients, and pharmacists actually interact. I made a good faith effort in researching this, and here are some examples of interaction you might be alluding to: 1. The doctor made an obvious mistake in dosage or a might not be aware of safer alternatives and the pharmacist contacts the doctor to verify that there wasn't a mistake on the prescription or mention those alternatives and see if they can persuade the doctor to change the prescription. Great, no issues with me. Everyone makes human mistakes. I do it in software also. 2. Something obvious they can see about the patient gives them some information that contradicts the prescription (i.e. an obviously pregnant women being given a drug that's dangerous to pregnant people). Again, they contact the doctor to inform and verify. Again, no issues from me. 3. Patients sometimes see other specialists and get prescriptions from them without informing their PCP (sometimes on accident), whereas a pharmacy probably sees all of these prescriptions, and can catch when two prescriptions could have dangerous interactions that a PCP or specialist might not realize they were causing because they weren't aware of the other prescription. Again they contact the physician and verify. Again, no issues from me. 4. The pharmacist has a religious reason not to want to fulfill a prescription. Some states that's allowed, some they aren't. In those where it's allowed, most pharmacies have a policy that they must allow another pharmacist at the facility to fulfill the prescription or help transfer the prescription to another doctor. Fine with me. Note that for the first three, they generally contact the doctor and verify/try to persuade, not outright override and refuse. They help catch problems, not generally cause them. It looks like there are several states where pharmacists are actually required to provide medication[1], although that link mentions specifically personal beliefs, so I don't know if it applies for the other three issues as well. If that's all you mean, then I don't think we disagree actually. But it doesn't look like it's as clear-cut legally as you were suggesting before, and I'm far from alone in thinking that pharmacists can't just decide never to fulfill a prescription without a damn good reason (i.e. it's definitely going to kill the patient). [1]: https://www.nbcnews.com/news/us-news/can-pharmacist-legally-deny-patient-prescription-it-depends-n894871 https://www.nbcnews.com/news/us-news/can-pharmacist-legally-...