Have you ever read the little piece of paper you sign at the pharmacy when you're picking up a prescription? Most people think they are confirming receipt of the medication. If you have read it, you'll know you've just confirmed that you didn't want to speak to the pharmacist for counseling.
Frankly, they're too busy counting pills.
I wonder why my wife, who is obsessive enough to count the pills from every prescription she receives, only ever finds that she has been short-changed. She has never once been the beneficiary of an error in her favor.
The FDA is holding hearings about allowing pharmacists to dispense medications currently available only by a physician's prescription. Pharmacists already dispense good advice about medications, direct people about over-the-counter drugs, and control a new class of controlled drugs that do not require a prescription. Specifically Plan B, the morning-after contraceptive, and many cold medicines, are kept behind the counter, to be sold only on a pharmacist's recommendation. This is the way many medications are sold in Europe, and they're healthier than Americans, right? It improves access for patients, so it has to be a good thing.
Presumably the college drop-out who manages and evaluates the retail pharmacist's performance, also gets to supervise the professional acceptability of behind-the-counter sales. Of course, the corporate chain retail pharmacies will be responsible enough to temper the incentives to sell as much product as possible, with some sense of quality control. The right of a pharmacist to refuse to provide any medication will be protected by a recognition that these pharmacists are independent and responsible professionals who know exactly what they're doing. Since counseling takes time, I am certain that retail chains and supermarkets will hire additional pharmacists to ensure the best possible advice for their customers.
I personally have no objection to psychologists, physical therapists and other paraprofessionals prescribing and being responsible for medications. I am quite certain they are capable of ordering lab work to detect liver and kidney abnormalities and examine patients to make sure the medication is working effectively.
OK, I will stop the sarcasm for a second right here...
In fact, allied health professionals are NOT specifically trained to monitor patients for side-effects and effectiveness. All they can do is dispense. I will not treat the side effects produced by another professional's decisions, except in an emergency. It is bad medicine and both the patient and the physician deserve the continuity of information. This is how we learn, even in the absence of a mistake.
Let's not forget the patients. My clinics dispense free medication at our $30 sliding scale visits. I cannot tell how often patients show up only wanting the medication and refusing to pay $30 to see the doctor, despite the fact that they are not under control and it has been 3 or 6 months or more since they were last seen.
Finally, let's make sure the trial lawyers are safe. After all, they have easy pickings with primary care physicians and drug companies when things go wrong. By shifting the responsibility to patients and pharmacists (whose liability coverage is not as rich as physicians), trial lawyers could find themselves out of significant contingency fees.