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> 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 i

> 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
  Pharmacists can refuse to fill prescriptions they believe will harm the patient. The law does not restrict it to the narrow circumstances you have listed. “You are giving a deworming medicine for Covid as an off label use. No, I believe that this will harm the patient” is 100% within their legal right. My state explicitly states that every pharmacist should consider whether an act is “consistent with the licensee or registrant’s education, training or practice experience” even if it is not expressly forbidden by the bylaws. This is much more expansive than you’re implying. Legally in my state they must refuse to fill prescriptions they believe were not created by a proper doctor patient relationship, which includes a lot of these Ivermectin phone doctors. But that’s a slightly different issue.
  - cableshaft 5y ago
    I'm not going to go down the Ivermectin research hole as I've mostly been avoiding it myself. But Ivermectin is not just a "dewormer" as the media has been running with to sensationalize things and try to throw shade at Joe Rogan for taking, and is known to have antiviral and anti-inflammatory properties, and is known to be safe in proper doses because it's been prescribed to humans for quite some time. Dr. John Campbell is a highly respected doctor that, since the beginning of this pandemic, has been going over medical studies and data and making them understandable to the general public (I do watch a good handful of his videos, but I've been skipping the Ivermectin ones up until tonight). The very first video[1] of him going over Ivermectin has a peer-reviewed meta-study that gives moderate-certainty level evidence that when clinicians have given Ivermectin to patients it's resulted in a 62% reduced risk of death compared to not taking it. And honestly that surprised me, up until I watched that tonight I was certain he was going to say it may have had a very mild positive effect and that's all. [1]: https://www.youtube.com/watch?v=3j7am9kjMrk https://www.youtube.com/watch?v=3j7am9kjMrk I also know my friend highly respects this guy and watches his videos a lot as well. Probably why he was seeking the prescription in the first place, was after seeing the information from these studies, instead of just "well the FDA hasn't approved it therefore it's poison". Again I'm not going to dig deeper than that right now, I've already spent most of my limited free time this evening doing this instead of other productive things. But yeah, sure looks like a pharmacist could potentially be doing harm by preventing these prescriptions from fulfilling. I don't even care about this drug specifically (I've been actively avoiding reading up on it and just threw it in with Hydroxychloroquine as a non-drug up until now). It just bothered me to learn that pharmacists were refusing to fill a prescribed drug. And after listening to my friend provide his reasoning for wanting to take it in small doses, I figured he had researched this a lot more than I had up to this point and was willing to give him the benefit of the doubt.

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
Pharmacists can refuse to fill prescriptions they believe will harm the patient. The law does not restrict it to the narrow circumstances you have listed. “You are giving a deworming medicine for Covid as an off label use. No, I believe that this will harm the patient” is 100% within their legal right. My state explicitly states that every pharmacist should consider whether an act is “consistent with the licensee or registrant’s education, training or practice experience” even if it is not expressly forbidden by the bylaws. This is much more expansive than you’re implying. Legally in my state they must refuse to fill prescriptions they believe were not created by a proper doctor patient relationship, which includes a lot of these Ivermectin phone doctors. But that’s a slightly different issue.
- cableshaft 5y ago
  I'm not going to go down the Ivermectin research hole as I've mostly been avoiding it myself. But Ivermectin is not just a "dewormer" as the media has been running with to sensationalize things and try to throw shade at Joe Rogan for taking, and is known to have antiviral and anti-inflammatory properties, and is known to be safe in proper doses because it's been prescribed to humans for quite some time. Dr. John Campbell is a highly respected doctor that, since the beginning of this pandemic, has been going over medical studies and data and making them understandable to the general public (I do watch a good handful of his videos, but I've been skipping the Ivermectin ones up until tonight). The very first video[1] of him going over Ivermectin has a peer-reviewed meta-study that gives moderate-certainty level evidence that when clinicians have given Ivermectin to patients it's resulted in a 62% reduced risk of death compared to not taking it. And honestly that surprised me, up until I watched that tonight I was certain he was going to say it may have had a very mild positive effect and that's all. [1]: https://www.youtube.com/watch?v=3j7am9kjMrk https://www.youtube.com/watch?v=3j7am9kjMrk I also know my friend highly respects this guy and watches his videos a lot as well. Probably why he was seeking the prescription in the first place, was after seeing the information from these studies, instead of just "well the FDA hasn't approved it therefore it's poison". Again I'm not going to dig deeper than that right now, I've already spent most of my limited free time this evening doing this instead of other productive things. But yeah, sure looks like a pharmacist could potentially be doing harm by preventing these prescriptions from fulfilling. I don't even care about this drug specifically (I've been actively avoiding reading up on it and just threw it in with Hydroxychloroquine as a non-drug up until now). It just bothered me to learn that pharmacists were refusing to fill a prescribed drug. And after listening to my friend provide his reasoning for wanting to take it in small doses, I figured he had researched this a lot more than I had up to this point and was willing to give him the benefit of the doubt.