Choose Your Pharmacist as Carefully as You Choose Your Doctor

Choose Your Pharmacist as Carefully as You Choose Your DoctorIn the US, prescription drugs are big business. In 2008, Americans spent close to $4 billion on prescriptions, a twelve percent increase over 2004. What’s more alarming, however, is the type of prescriptions that Americans buy. The most lucrative prescription for drug companies in the United States is Vicodin, an extremely popular and addictive painkiller that combines hydrocodone with acetaminophen. Almost twice as much money was spent on Vicodin in 2008 ($124 million), than the next closest prescription drug, Lisinopril ($75.5 million), a high blood pressure medication.

Aside from drug companies, pharmacies are benefiting from the increase in demand on drugs. However, like doctors, the number of licensed pharmacists has not risen enough to adequately serve all patients who need to fill prescriptions. These days, pharmacists are just as busy as doctors, possibly more so. In addition, pharmacists who fail to fulfill their role of prescription drug counselor can be as dangerous as an incompetent doctor.

Unless administered in the hospital by competent medical staff, the taking of prescription drugs is also one of the most dangerous forms of medical treatment available today. More dangerous than brain surgery, you ask? Absolutely.

In order to be the most effective, an the least dangerous, a prescription drug needs to be taken as directed by a doctor – a doctor who is aware of all other medications a patient is taking and which other medications, if any, the patient is allergic to. However, studies have shown that outpatient compliance with prescription dosing instructions is abysmal and, thus, many drugs are not taken precisely as directed. Further, it is now a rarity for one doctor to be aware of a patient’s current prescription drug catalogue.

In a perfect world, each patient would see only one doctor and obtain prescription medications from only one pharmacy. However, at least in the US, these scenarios are less and less common. Even if a patient sees just one primary physician at a time, he or she may also be prescribed medications by a specialist or, if the regular doctor is unavailable, a clinic or emergency room. These substitute professionals rely on patient testimony in order to determine allergies and possible dangerous interactions. Unfortunately, not all patients are able to accurately report the details of their current prescriptions. Some simply fail to remember a particular drug when under the pressure of an unfamiliar medical setting or emergency situation. Others may decline to reveal information if they are addicted to certain drugs and are seeking a fix.

Proper prescription drug information does not flow just from patient to doctor. Upon prescribing a drug, a doctor would ideally describe to the patient potential side effects, dangerous drug interactions, dosing instructions and contingency plans, such as what to do if a dose is missed. Given the current state of medical care in the United States, doctors rarely take the time to accomplish these goals today.

Instead, doctors are relying more and more on pharmacists to fill the role of prescription drug counselor that. Doctors not only accept the fact that pharmacists will handle patient notification, they now expect it to happen and rely on the fact that it will– a dangerous practice indeed.

It is commonly believed in the medical community that experienced pharmacists are better qualified than doctors to inform patients of essential information regarding prescription drugs, given the sheer number of hours spent studying drug effectiveness and applying interaction formulas. Because of this, many states now require pharmacists to offer prescription drug counseling sessions when patients purchase prescription drugs. However, despite these regulations, more and more patients experience serious side effects or actually overdose from the interaction of incompatible medications. Given the regulations, how can this be possible?

The simple fact is that many patients to not receive even the most basic prescription drug counseling. Although pharmacists are required to offer counseling, most do not approach the customer and offer to discuss the prescription. Instead, a clerk or cashier typically asks the customer if they have any “questions” and, when they don’t, instructs the customer to sign a form that confirms that counseling was offered. A recently study found that 50% of patients in California over that age of 65 waive their right to receive counseling on prescriptions. Further, written information distributed with the prescription is typically inadequate, failing to address all potential side effects, dangerous interactions, and contingency plans.

A study conducted by the University of Florida and recently published in the Archives of Internal Medicine revealed that customers who filled prescriptions for lisinopril (blood-pressure) and metformin (diabetes type 2) were woefully underprepared by pharmacists before taking the drugs. Further, the study found the written information given to customers, such as dosing instructions, to be inadequate or too complicated for the layperson to understand. Approximately 5% of pharmacies didn’t give any written information at all.

Before bringing a prescription home from the pharmacy, all patients should ask the pharmacist about (not a clerk or cashier) what medication they are being prescribed (including the generic name, if any), what the medication is used to treat, how the medication should be taken (with food, sitting down, on an empty stomach, etc), when the medication should be taken, how the medicine is supposed to work (to prepare for side-effects and to be able to recognize effectiveness), what to do if a dose is missed, when to stop taking the medication (i.e. when it’s gone, on a particular day, or take only as needed), issues surrounding improper or premature stopping of medication, potential side effects, potential interactions with other medications, and proper storage and disposal.

Even if a pharmacist properly counsels a patient on the dosing instructions, side-effects, and potential interactions of a particular drug, many states have not yet developed a system to provide pharmacists with a list of all other drugs a patient is taking. If a patient obtains prescriptions from more than one pharmacy, and fails to notify the pharmacist of any other medications he or she is on, the pharmacist will be unable to properly identify all potentially dangerous situations.

Given the important role pharmacists now play in prescription drug counseling, choose your pharmacist wisely. If your pharmacist does not personally approach you to offer individualized prescription drug counseling, you should find another pharmacist.

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