Question about asking a pharmacist for drug information

[rougemarie]

Last week, my godson was sick and I had a question about possible drug complications-interactions. I called the pharmacy where I got his meds from, but they were super busy, so I called another pharmacy, because I needed to give his meds right away. My question got turned down by the pharmacist in charge on this other location because, he mentioned, that this is not the prescribing pharmacy.

Is there a new rule that as a pharmacist, you can only counsel those patients who filled out the prescription there? I thought I can just ask any pharmacist at any location for possible drug interactions, esp. since I have the name, dosage, etc. on hand. Any thoughts on this? Many thanks.

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[bananaface]

There is no specific rule about this. Some pharmacists may consider prescription drug counseling a service offered to their patients only, since it's supoosed to be offered in connection to medication purchases. If one is really busy, it might be reasonable to put one's own patients in front of someone else's. But, one should always make time for one's own patients.

 

[sdn1977]

Last week, my godson was sick and I had a question about possible drug complications-interactions. I called the pharmacy where I got his meds from, but they were super busy, so I called another pharmacy, because I needed to give his meds right away. My question got turned down by the pharmacist in charge on this other location because, he mentioned, that this is not the prescribing pharmacy.

Is there a new rule that as a pharmacist, you can only counsel those patients who filled out the prescription there? I thought I can just ask any pharmacist at any location for possible drug interactions, esp. since I have the name, dosage, etc. on hand. Any thoughts on this? Many thanks.

No...no rule really, but I could see there might have been complications for the second pharmacist which I'd would influence his/her decision. First is the whole confidentiality thing....he is your godson - not your son. Now, if I was the dispensing pharmacist and I knew you had picked up the Rx or knew of your family situation, I'd have no trouble giving you the info you might need (the child's age would influence me). Second, depending upon what the medication was...ie was the dispensed medication different strength from the ordered medication...that could cause complications for someone not familiar with the dispensing history. This could also come into play if some part of the rx had to be clarified. Third, if the question had to do with an interaction with another medication the child was taking & I had no dispensing history for that child (which also gives me a history of reaction problems with medications), I might be hesitant to give out info which may or may not be accurate. I actually feel the second pharmacist gave you good advice - you might have been given inaccurate info which is worse than no info, IMO. Most busy pharmacists are happy to call you back if you leave your name & number and most medications can wait an hour or two to give so you can get all your questions answered (remember, if urgency is that critical, the child would never have left the prescriber's office, although I do understand how difficult that is to remember when you have a crying, feverish child). We really do want patients & their caregivers to understand what & how to take medication prescribed. I can understand and appreciate your desire to have your question answered RIGHT NOW and hopefully, this gives you some insight into the times we might be hesistant to answer patient specific cold questions when we are not the dispensing pharmacy.

 

[rougemarie]

No...no rule really, but I could see there might have been complications for the second pharmacist which I'd would influence his/her decision. First is the whole confidentiality thing....he is your godson - not your son. Now, if I was the dispensing pharmacist and I knew you had picked up the Rx or knew of your family situation, I'd have no trouble giving you the info you might need (the child's age would influence me). Second, depending upon what the medication was...ie was the dispensed medication different strength from the ordered medication...that could cause complications for someone not familiar with the dispensing history. This could also come into play if some part of the rx had to be clarified. Third, if the question had to do with an interaction with another medication the child was taking & I had no dispensing history for that child (which also gives me a history of reaction problems with medications), I might be hesitant to give out info which may or may not be accurate. I actually feel the second pharmacist gave you good advice - you might have been given inaccurate info which is worse than no info, IMO. Most busy pharmacists are happy to call you back if you leave your name & number and most medications can wait an hour or two to give so you can get all your questions answered (remember, if urgency is that critical, the child would never have left the prescriber's office, although I do understand how difficult that is to remember when you have a crying, feverish child). We really do want patients & their caregivers to understand what & how to take medication prescribed. I can understand and appreciate your desire to have your question answered RIGHT NOW and hopefully, this gives you some insight into the times we might be hesistant to answer patient specific cold questions when we are not the dispensing pharmacy.

Nope, he declined to even hear the question before I mentioned anything (even the question itself). All he asked was, "Was the prescription filled here? If not, I cannot counsel you."

Honestly, I've seen several pharmacist dispensing advice about simple medication interactions. I can understand his hesitation, though. In retrospect, perhaps it's his attitude that I do not appreciate. I am a future pharmacist myself, and I will treat every patients who comes to my window as if they are my own family member and will give advice within my professional judgement and information that I have. It won't take a few minutes to hear my question before he can decide whether or not he can answer it. I'm just wondering if there are such law that would limit him from doing that.

 

[ultracet]

Well I personally would have probably declined b/c of the HIPAA laws as well as professional liability...

if he was not my patient i cannot answer the question to the best of my ability

 

[sdn1977]

I agree attitude makes even an answer you don't want to hear easier to take. You had an unfortunate experience & I'd offer my apologies on behalf of my colleague. Its a good lesson for all of us that we often see patients at their worst & after they have already waited to see a prescriber and can be worried or concerned. I hope you carry this experience and can remember to empathize even when you have to give out "no" as an answer when you become a pharmacist. I appreciate your reminder!

 

[Aznfarmerboi]

There is no new rule that as a pharmacist, you can only counsel your patients. A harmacist does not have to provide any counseling except for medicaid/medicare patients where the law requires so for new prescriptions are a change in dosage. If I was the 2nd pharmacist, I would decline to counsel too since there are so many factors that I do not know.

Last week, my godson was sick and I had a question about possible drug complications-interactions. I called the pharmacy where I got his meds from, but they were super busy, so I called another pharmacy, because I needed to give his meds right away. My question got turned down by the pharmacist in charge on this other location because, he mentioned, that this is not the prescribing pharmacy.

Is there a new rule that as a pharmacist, you can only counsel those patients who filled out the prescription there? I thought I can just ask any pharmacist at any location for possible drug interactions, esp. since I have the name, dosage, etc. on hand. Any thoughts on this? Many thanks.

 

[rougemarie]

I see that we have pretty much a consensus across the board that we won't counsel the patients who do not fill the prescription in our pharmacy due to liability. I understand that.

Let me offer you a twist: suppose your uncle A asked you about the medications he has during one of those Thanksgiving dinner, you don't know him very well, only saw him once a year. Would you counsel him, knowing that he does not fill the prescription in your pharmacy, only saw him occasionally? Or how about your church friends? social friends from your local club you belong to? can you trust that they won't sue? would you still say, "sorry I cannot counsel you, you better check with your pharmacist?"

If so, I believe there's a double-standard here going on.

 

[rougemarie]

I agree attitude makes even an answer you don't want to hear easier to take. You had an unfortunate experience & I'd offer my apologies on behalf of my colleague. Its a good lesson for all of us that we often see patients at their worst & after they have already waited to see a prescriber and can be worried or concerned. I hope you carry this experience and can remember to empathize even when you have to give out "no" as an answer when you become a pharmacist. I appreciate your reminder!

This is exactly my point. I'm working as a tech now and the pharmacists in my place always dispense advice within their means (we've got quite a bit of Katrina evacuee for a while who have no idea where to ask for things and some with tons of diabetic meds), even if all they can say is, "I'm sorry, without knowing any other meds, info, etc. I cannot answer your question. Why don't you contact your prescribing doctor/pharmacy and explain your situation." or even tell them what questions to ask them.

 

[alwaystired]

I see that we have pretty much a consensus across the board that we won't counsel the patients who do not fill the prescription in our pharmacy due to liability. I understand that.

Let me offer you a twist: suppose your uncle A asked you about the medications he has during one of those Thanksgiving dinner, you don't know him very well, only saw him once a year. Would you counsel him, knowing that he does not fill the prescription in your pharmacy, only saw him occasionally? Or how about your church friends? social friends from your local club you belong to? can you trust that they won't sue? would you still say, "sorry I cannot counsel you, you better check with your pharmacist?"

If so, I believe there's a double-standard here going on.

I am a lowly P1 and have not take Pharmacy Law yet, but if it is allowed by law, and I think I can safely answer the question, then I plan on answering the question. So far I have learned that the State Board grants pharmacists the ability to make judgement calls that are in the best interests of the patient (at least that is my understanding thus far).

I will be taking good notes in Pharmacy Law----that I guarantee.

 

[Sosumi]

I know several pharmacists who don't believe they should be giving advice for medications received at another pharmacy. If they bought the medicine at a certain pharmacy, that pharmacy should give them the service there. Pharmacists are too used to giving away their knowledge for free, so the public is used to it and don't value it as much as other professions. Lawyers and physicians guard their knowledge and can therefore charge a lot for theirs. However, our pharmacist and I usually give out advice regardless of where you usually go (we work in an medically underserved area and sometimes, as one of my professors said, you never know that you might get new business from that person).

There's also the liability issue as previous posters have eloquently mentioned. For instance, this patient had received eye drops from another chain and was asking us if she should take it. She went back to her doctor and the nurse told her that it's okay for her to take pilocarpine eye drops for her dry mouth. My pharmacist wouldn't tell her if it was okay or not and made her go back to her original pharmacy to ask them since they had the original prescription. Our pharmacist wouldn't tell her that we suspected that the original pharmacy made a mistake and dispensed pilocarpine eye drops instead of pilocarpine tablets.

 

[lnn2]

There's also the liability issue...

That's the point. "Never Treat A Stranger"
If you didn't dispense the med then you shouldn't counsel them. Period. You don't know their med hx nor any other information regarding this patient. What if the doc Rx the wrong med, dosage. What if the other pharmacist dispensed the wrong med, dosage...who knows!
Save yourself a malpractice lawsuit and refer them back to their doc or the pharmacist who dispensed the med (that's what the patient should have done in the first place anyway)

 

[sdn1977]

I see that we have pretty much a consensus across the board that we won't counsel the patients who do not fill the prescription in our pharmacy due to liability. I understand that.

Let me offer you a twist: suppose your uncle A asked you about the medications he has during one of those Thanksgiving dinner, you don't know him very well, only saw him once a year. Would you counsel him, knowing that he does not fill the prescription in your pharmacy, only saw him occasionally? Or how about your church friends? social friends from your local club you belong to? can you trust that they won't sue? would you still say, "sorry I cannot counsel you, you better check with your pharmacist?"

If so, I believe there's a double-standard here going on.

Ok....I've actually been in this situation - UNFORTUNATELY!!!! I actually thought about posting this as a ethical "what if" question. So...I'll post it now....I had a very good friend - my husband was a best man in their wedding, we had children at similar times, we had a 20 year friendship. For whatever reasons (we could go on and on and on.....) she developed a mental illness (or it was finally manifested....) and her marriage began collapsing. My husband and I, friends with them both, provided all the support friends do. However, a complication developed - she attempted suicide - was unsucessfull. She was treated and after a few months into therapy (enough for the medications to become fully therapeutic) she sought me out, not just for friendship and support, but also for professional advice. Now.....WOW!!!!! - big complications for me. Had I posted this, I would have asked the current pharmacy students and pharmacists - what would you do.

I'll add - she at this point identified her OB-GYN as being not complete in the monitoring of her medication - he was the one who initially prescribed. However, assume, as in the case of the stranger who would have been you in your case, I might not have known this. Now...the empathetic friend may have given pharmaceutical advice. But, I knew she was not yet stable (a patient 6 months after a suicide attempt, altho in pharmaceutical steady state is not yet healthy mentally) - again - I knew her - not you, as a stranger. I chose, both professionally and personally, to refer her to her psychiatrist who could better assess her concerns.

I discussed this situation with my husband, another health professional (dentist). I could not be held professionally liable since I was not the dispensing pharmacist. However, I was very concerned about civil liabilities and we pursued how extensive our umbrella liability policy was (sufficient) in case I had inadvertently given advice or she later claimed I had. She wanted to sue the OB-GYN.

The final outcome was, unfortunately, her second suicide attempt was successful. I will forever remember this very difficult personal and professional situation. So...my not so brief answer is - no....I would not give out information to my Uncle A, church friend or otherwise. I will always refer them to the professional they use. I feel strongly it would otherwise impinge upon the medical/pharmaceutical relationship which is very important in continuity of therapy.

I apologize for the length.....but, IMO there is no double standard and as I replied to you previously, I would hope and I believe I did exhibit a greater degree of empathy than you infer we have!

 

[ooscubaoo]

what about patients who have their medications dispensed at multiple pharmacy and not just ONE single pharmacy? I mean I know plenty who transfer their medication from one pharmacy to another all the time. Who would these patients ask for drug related interactions if they don't have a primary pharmacy they go to? Also, I thought most pharmacist answer drug related questions whether patients get their medication filled at their pharmacy or not.

 

[sdn1977]

what about patients who have their medications dispensed at multiple pharmacy and not just ONE single pharmacy? I mean I know plenty who transfer their medication from one pharmacy to another all the time. Who would these patients ask for drug related interactions if they don't have a primary pharmacy they go to? Also, I thought most pharmacist answer drug related questions whether patients get their medication filled at their pharmacy or not.

As the dispensing pharmacist for the one of the medications, I would answer their question "guardedly". I'll give you an example....say I filled their levothyroxine (this is a real example). She calls me later & asks about an interaction with lisinopril. Well, I give her general info about levothyroxine & lisinopril interactions & tell her openly this is general info only and I cannot provide more specific information because I don't know her history of her lisinopril use & her use of antihypertensives in general. When she asks more questions...which she does....I refer her back to her prescribing physician (which is more than one MD, btw).

There is an assumption by many of us in medicine, that some patients will not tell you the "whole" story and this is actually borne out by studies. MD's have a difficult time taking accurate drug histories because many patients are not complete about what they take. I'm happy to give drug information in a general sense, but I'd rather it be at my place of business - not at a party or at the neighborhood park - just as a physician would. In addition, liability limits what patient specific advice I would give unless I am clear I know the patient well. However, most folks want to know if they can give their child the amoxicillin suspension with food - I don't need much info to give and an accurate & specific answer to that, so depends upon the question.

 

[rougemarie]

Thanks to sdn1977 for sharing her story. It reinforces my understanding, I guess, between the fine line of empathy and sympathy.

 

[SClENCE]

Well he/she probably doesn't have time to give free advice to other people's patients while inheriting liability at the same time.

Plus they know nothing about you... including condition information, current medication list, allergies, etc

 

[Dred Pirate]

I agree with most of the posters here, as far as the attitude, I am guessing this pharmacist was a hurried pharmacist in a busy store who doesn't feel like giving out advice for free. You would not call a different physician to get advice and expect it for free?

 

[owlegrad]

Impressive bump!

 

[Dred Pirate]

Impressive bump!

just noticed that - who goes back 8 years to pull up threads????

 

[BidingMyTime]

Why do you think another pharmacist would give you free information? I won't answer prescription questions from people who don't fill their prescriptions with me 1) it takes valued time away from the patients who DO pay me to fill their prescriptions and 2) experience tells me that half the time the information people give me over the phone doesn't match the information on the profile, so I am uncomfortable answering questions without having documented information.

Bottom line, if your pharmacy is too busy to provide you full service, than you should pay (ie take your business) to a pharmacy that can.

 

[BidingMyTime]

Ha, I fell for the necrobump. How do people even find these old threads? I can't imagine scrolling back 100 pages (??? how many pages would one have to go back to to find 2006 posts?)

 

[owlegrad]

Ha, I fell for the necrobump. How do people even find these old threads? I can't imagine scrolling back 100 pages (??? how many pages would one have to go back to to find 2006 posts?)

I assume they use the search function and decide they have something to contribute, lol.

 

[lcow2004]

If the prescription was not filled at my pharmacy, I always just tell them to go see their doctor who prescribed it.

 

[FarmD711]

I do not consult for patients that don't fill at my pharmacy or for prescriptions not filled at my pharmacy. Period. If you have a question the first question I ask is your name and DOB so I can look at the profile. If you won't or can't provide this you will not have questions answered by me.

 

[SClENCE]

The thread showed up at the bottom of the page in "Similar threads"... my bad lol.