Is ADHD within scope of practice for an Ob gyn?

[Carboxide]

I think it depends on the state. Some states a DPM is legally allowed to call themselves “Podiatric Physicians”. This makes sense, as a physician is someone who diagnosis, treats, and manages health and illnesses, DPMs do this, just on the foot and ankle. If they are allowed unlimited prescribing rights, I’m not sure.

DPMs do a lot of things to mimick MD/DO education, some schools even have the DPMs and DO take the same courses. They also have a 3 year residency.

It doesn't matter. They still are limited to specific areas of the body. It is outside of reasonable expectation to say that podiatrists should ever be treating diabetes or HTN. No reasonable person would say that falls under limitations to foot and ankle.

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[Old Timer]

Medical doctor." An individual who has acquired one of the following licenses to practice medicine and surgery issued by the board:
(1) License without restriction.
(2) Interim limited license.
(3) Graduate license.
(4) Institutional license.
(5) Temporary license.
(6) Extraterritorial license.
"Medical service." Activity which lies within the scope of the practice of medicine and surgery.

Pennsylvania Medical Practice Act of 1985

I can't speak for other states. In Pennsylvania a physician is licensed to practice medicine and surgery and they can prescribe whatever they want. Specializing or increasing your training does not limit your ability to practice, it expends it. It is clear and unequivocal. In Pennsylvania is licensed to practice medicine. There is no license based on specialization.

 

[GypsyHummus]

Unreasonable for a foot doctor to adjust diabetes medication? Someone with a high A1C will have slow healing foot ulcers. That would fall under a DPM's jurisdiction if they were treating slow healing ulcers, wouldnt it?

Would you expect a Orthopedic surgeon to prescribe diabetic medication?

It doesn't matter. They still are limited to specific areas of the body. It is outside of reasonable expectation to say that podiatrists should ever be treating diabetes or HTN. No reasonable person would say that falls under limitations to foot and ankle.

 

[Sine Cura]

Would anyone dispense scripts for "psychotropic" drugs by dentists under the delusion that treating their mental health will help them take better care of their teeth?

Then again I work in a state where the dental board doesn't give a **** about dentists violating the Medical Practice Act by practicing medicine without a license.

 

[CetiAlphaFive]

Another thing that's being ignored is this:

If a doctor is prescribing something that is wildly outside of their specialty, it probably means that their script pad got stolen

 

[Old Timer]

Unreasonable for a foot doctor to adjust diabetes medication? Someone with a high A1C will have slow healing foot ulcers. That would fall under a DPM's jurisdiction if they were treating slow healing ulcers, wouldnt it?

Would you expect a Orthopedic surgeon to prescribe diabetic medication?

A foot doctor could not adjust diabetic medication.
An orthopedic surgeon could prescribe diabetic medication.

Would anyone dispense scripts for "psychotropic" drugs by dentists under the delusion that treating their mental health will help them take better care of their teeth?

Then again I work in a state where the dental board doesn't give a **** about dentists violating the Medical Practice Act by practicing medicine without a license.

No a dentist cannot prescribe Adderall.

I love these *****ic posts that twist the argument into a pretzel on steroids......

This is really simple. It is a legal question. Ask one of your lawyer friends.

• A physician's license is not controlled by his specialty.
• A physician DOES not lose privileges of his license because he gets additional training.
• A physician may prescribe any drug or perform any procedure that his license permits.

A pharmacist has the right and the duty to make sure the therapy is correct and appropriate. It is the duty of the pharmacist to question any prescription they see fit.

 

[W19]

A foot doctor could not adjust diabetic medication.
An orthopedic surgeon could prescribe diabetic medication.

Why not? I am assuming pod physicians study DM extensively in pod school since it's something they deal with (e.g.., diabetic foot ulcers) on a daily basis.

 

[Rouelle]

There’s a simple solution to all this:

Refuse to fill any CNS stimulant written by any prescriber practicing in any setting. No better way to exercise corresponding responsibility than blanket refusal.

Ditto for opiates.

And benzos.

 

[Carboxide]

Unreasonable for a foot doctor to adjust diabetes medication? Someone with a high A1C will have slow healing foot ulcers. That would fall under a DPM's jurisdiction if they were treating slow healing ulcers, wouldnt it?

Would you expect a Orthopedic surgeon to prescribe diabetic medication?

I do think it's unreasonable, because diabetes does not PRIMARILY or ACUTELY affect the foot. It is a systemic disease.

Orthopedic surgeons prescribe diabetic meds all the time inpatient, and on discharge. I would not expect to see an rx for insulin provided regularly by one, and I would not recommend to any patient to have an ortho manage their diabetes, but it is still within their scope of practice because they are actual true physicians and their scope of practice is 'the human body.'

I'm genuinely not sure why this is so hard to understand.

 

[Carboxide]

Why not? I am assuming pod physicians study DM extensively in pod school since it's something they deal with (e.g.., diabetic foot ulcers) on a daily basis.

As I stated above, because diabetes does not primarily or acutely affect the foot. Even diabetic foot ulcers require long-term close management - not short-term fixes. It is a systemic disease with a variety of ill effects spread across the body.

 

[GypsyHummus]

Dieseases of the foot are usually symptomatic of other problems in the body. DPMs need to know about the whole body to treat the foot and ankle.


Are you an older pharmacist? That would make sense then why you wouldn’t view DPMs as doctors. The education has evolved, DPMs graduating today are not DPMs of the 80s.

I do think it's unreasonable, because diabetes does not PRIMARILY or ACUTELY affect the foot. It is a systemic disease.

Orthopedic surgeons prescribe diabetic meds all the time inpatient, and on discharge. I would not expect to see an rx for insulin provided regularly by one, and I would not recommend to any patient to have an ortho manage their diabetes, but it is still within their scope of practice because they are actual true physicians and their scope of practice is 'the human body.'

I'm genuinely not sure why this is so hard to understand.

 

[W19]

As I stated above, because diabetes does not primarily or acutely affect the foot. Even diabetic foot ulcers require long-term close management - not short-term fixes. It is a systemic disease with a variety of ill effects spread across the body.

I think pod students do a 4-6 wks IM rotation in 3rd year and spend their first 2 years taking classes alongside med students...

 

[nlax30]

I think pod students do a 4-6 wks IM rotation in 3rd year and spend their first 2 years taking classes along med students...

While that exposes them to some of the concepts of these systemic diseases such as DM, it in no way makes them, or anyone with just that experience competent in managing those.

A family practice or IM physician would have had at least a handful of internal medicine rotations over their 3rd and 4th year of med school and then 3 additional years of residency where we actually learn the "art" of practicing medicine.

 

[Carboxide]

Dieseases of the foot are usually symptomatic of other problems in the body. DPMs need to know about the whole body to treat the foot and ankle.


Are you an older pharmacist? That would make sense then why you wouldn’t view DPMs as doctors. The education has evolved, DPMs graduating today are not DPMs of the 80s.

Nope. I've been practicing for four years, and I work with podiatrists sometimes. That's one way I know what they're qualified to manage. Besides, it's not about your opinion. It's about the law. If you think a podiatrist can treat DM and HTN then there's very few things you would see outside their scope - where does it end?

 

[Carboxide]

While that exposes them to some of the concepts of these systemic diseases such as DM, it in no way makes them, or anyone with just that experience competent in managing those.

A family practice or IM physician would have had at least a handful of internal medicine rotations over their 3rd and 4th year of med school and then 3 additional years of residency where we actually learn the "art" of practicing medicine.

This. Would you want someone who has done 4 to 6 weeks of a student rotation managing your diabetes independently? God help you if the answer is yes.

 

[Rouelle]

This. Would you want someone who has done 4 to 6 weeks of a student rotation managing your diabetes independently? God help you if the answer is yes.

Agreed.

I had classes with med students when I was in pharmacy school. I had rotations with med students. This does not make me a physician.

 

[owlegrad]

I'm genuinely not sure why this is so hard to understand.

It's not hard to understand. Either we are being trolled or that poster just enjoys playing devil's advocate.

 

[GypsyHummus]

Pods rotate through Family Med and IM. Granted, I do not think that DPMs should be managing diabetic medication, or heart medication, but I think it’s weird how Pharmacist would fill a script for a Dermatologist prescribing liver medicine while they wouldn’t fill the same script for a DPM.

While that exposes them to some of the concepts of these systemic diseases such as DM, it in no way makes them, or anyone with just that experience competent in managing those.

A family practice or IM physician would have had at least a handful of internal medicine rotations over their 3rd and 4th year of med school and then 3 additional years of residency where we actually learn the "art" of practicing medicine.

 

[Charcoales]

It doesn't matter. They still are limited to specific areas of the body. It is outside of reasonable expectation to say that podiatrists should ever be treating diabetes or HTN. No reasonable person would say that falls under limitations to foot and ankle.

I'd say diabetes would definitely fall under podiatrists scope, diabetes can cause severe complications to the foot.

 

[owlegrad]

Pods rotate through Family Med and IM. Granted, I do not think that DPMs should be managing diabetic medication, or heart medication, but I think it’s weird how Pharmacist would fill a script for a Dermatologist prescribing liver medicine while they wouldn’t fill the same script for a DPM.

The question is not "would a pharmacist fill a prescription for liver medication from a Dermatologist". The question is "is the liver in the scope of practice of a dermatologist". And the answer to that is yes, the scope of practice of a dermatologist is determined by their license, which is that of a physician and so the scope of practice is "unlimited". A prudent pharmacist (with too much time on their hands) would investigate why a dermatologist is prescribing a liver medication but nothing in the law forbids or prevents said prescribing.

The scope of practice for a DPM is determined by their license and is explicitly confined to the feet, although I suppose there might be states that are more liberal in their definitions on scope of practice, I certainly do not pretend to know the laws of all 50 states. So in this example there is nothing for the pharmacist to investigate - it would be illegal for the pharmacist to fill a medication meant to treat the liver written by a DPM.

Would it help if we developed a little school house rock song to make it easier to understand?

 

[confettiflyer]

Unlimited scope of practice. If the script is appropriate in all facets of pharmacy prudence, fill the damn thing.

That’s like me questioning my ICU attending (pulmonologist) for initiating someone on an SSRI in the unit.


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[GypsyHummus]

I think scope of practice is determined by state as well. If a Pod can justify it affecting the foot, cant DPMs write for it?

Again, I dont think DPMs should be writing out Rx for heart meds, but it seems that anything can be justified if it affects the foot. DPMs are "Podiatric Physicians" in many states. High blood pressure is going to limit perfusion to the foot, therefore why cant a DPM write for Blood Pressure medication. In practice, most pods dont wanna deal with drug interactions, and part of the fun of Podiatry is working with your hands.

The question is not "would a pharmacist fill a prescription for liver medication from a Dermatologist". The question is "is the liver in the scope of practice of a dermatologist". And the answer to that is yes, the scope of practice of a dermatologist is determined by their license, which is that of a physician and so the scope of practice is "unlimited". A prudent pharmacist (with too much time on their hands) would investigate why a dermatologist is prescribing a liver medication but nothing in the law forbids or prevents said prescribing.

The scope of practice for a DPM is determined by their license and is explicitly confined to the feet, although I suppose there might be states that are more liberal in their definitions on scope of practice, I certainly do not pretend to know the laws of all 50 states. So in this example there is nothing for the pharmacist to investigate - it would be illegal for the pharmacist to fill a medication meant to treat the liver written by a DPM.

Would it help if we developed a little school house rock song to make it easier to understand?

 

[VA Hopeful Dr]

I think scope of practice is determined by state as well. If a Pod can justify it affecting the foot, cant DPMs write for it?

Again, I dont think DPMs should be writing out Rx for heart meds, but it seems that anything can be justified if it affects the foot. DPMs are "Podiatric Physicians" in many states. High blood pressure is going to limit perfusion to the foot, therefore why cant a DPM write for Blood Pressure medication. In practice, most pods dont wanna deal with drug interactions, and part of the fun of Podiatry is working with your hands.

Chiropractors are often "chiropractic physicians", doesn't change anything.

Interestingly in my state there is a specific point in the Podiatry Practice Act that addresses the point you're trying to make, where treating systemic problems that have manifestations in the foot is prohibited.

 

[owlegrad]

Chiropractors are often "chiropractic physicians", doesn't change anything.

If I call myself a “pharmaceutical physician” can I write whatever I want as well?

And here all this time pharmacist thought they needed to have Pharmacy laws changed. Turns out we just had to work physician into our title and we could do whatever we want! Awesome!

 

[Old Timer]

Pods rotate through Family Med and IM. Granted, I do not think that DPMs should be managing diabetic medication, or heart medication, but I think it’s weird how Pharmacist would fill a script for a Dermatologist prescribing liver medicine while they wouldn’t fill the same script for a DPM.

OK, so either your are playing dumb for the sake of argument or your understanding of law is limited...... A dermatologist is an MD. He or she went to college and got a degree. Then they went to medical school and got an MD degree. Then they completed whatever post MD school training required to be licensed as a Medical Doctor. At this point they are allowed to write a prescription for liver medicine. Now, they complete additional training that allows them to become a dermatologist. As soon as they get that, they lose all privileges of their MD license? And this makes sense to you? A Medical Doctor has license that is unrelated to any additional specialization he/she might acquire after they get their MD degree. Unless your state has licenses based on specialization, they are an MD and they can write anything any other MD can write for.

A Podiatrist can only treat disease of the foot an ankle. Even though they are podiatric surgeons, they can't do knee replacements, even if the damaged knee is effecting the ankle. Chiropractors have their own scope of practice that does not include the privilege to prescribe medication. It doesn't matter what the person calls themselves, it matter what the law calls them and what the law allows them to do. Any Medical Doctor can prescribe anything they want.

 

[GypsyHummus]

Well I think technically MDs can practice any type of medicine that they want to legally, but they need a residency to be reimbursed by insurance or government. So like a PCP could open up a heart surgery shop or do total knee replacements but it can only be cash based.

OK, so either your are playing dumb for the sake of argument or your understanding of law is limited...... A dermatologist is an MD. He or she went to college and got a degree. Then they went to medical school and got an MD degree. Then they completed whatever post MD school training required to be licensed as a Medical Doctor. At this point they are allowed to write a prescription for liver medicine. Now, they complete additional training that allows them to become a dermatologist. As soon as they get that, they lose all privileges of their MD license? And this makes sense to you? A Medical Doctor has license that is unrelated to any additional specialization he/she might acquire after they get their MD degree. Unless your state has licenses based on specialization, they are an MD and they can write anything any other MD can write for.

A Podiatrist can only treat disease of the foot an ankle. Even though they are podiatric surgeons, they can't do knee replacements, even if the damaged knee is effecting the ankle. Chiropractors have their own scope of practice that does not include the privilege to prescribe medication. It doesn't matter what the person calls themselves, it matter what the law calls them and what the law allows them to do. Any Medical Doctor can prescribe anything they want.

 

[Old Timer]

Well I think technically MDs can practice any type of medicine that they want to legally, but they need a residency to be reimbursed by insurance or government. So like a PCP could open up a heart surgery shop or do total knee replacements but it can only be cash based.

hey want to legally, but they need a residency to be reimbursed by insurance or government. So like a PCP could open up a heart surgery shop or do total knee replacements but it can only be cash based.[/QUOTE]

This has nothing to do with anything. Who cares about insurance reimbursement? Are they legally allowed to do something or not. That is the question at hand. Can and OB/GYN prescriber Adderall? The answer is yes. In PA, a GP could not do heart surgery unless they were trained for it, so no, they couldn't........ It's the exact opposite of what is being discussed here. Does getting more training limit you, the answer is NO. Stop bringing non-sequiturs to the table.....

 

[catalyzt]

I think everyone forgot the main gist of the question which is does this Rx fall in the prescriber's *usual course of practice.* - not the scope of practice which has the obvious physician can write for anything answer.

 

[Old Timer]

I think everyone forgot the main gist of the question which is does this Rx fall in the prescriber's *usual course of practice.* - not the scope of practice which has the obvious physician can write for anything answer.

NO, NO, NO, NO
​

The title of the thread is:

Is ADHD within scope of practice for an Ob gyn?
​

They are two totally separate questions. The doctor can legally prescribe whatever they want. As for usual course of practice, they are not practicing OB/GYN, legally they are practicing medicine. If the pharmacist things something is amiss, they can call for clarification and refuse to fill if they want.

 

[GypsyHummus]

I was reading the laws in a couple states and looks like DPMs have unlimited prescribing privlages while other states don’t. So I suppose it really depends on the state you live in.

If I call myself a “pharmaceutical physician” can I write whatever I want as well?

And here all this time pharmacist thought they needed to have Pharmacy laws changed. Turns out we just had to work physician into our title and we could do whatever we want! Awesome!

 

[owlegrad]

I was reading the laws in a couple states and looks like DPMs have unlimited prescribing privlages while other states don’t. So I suppose it really depends on the state you live in.

Which states did you find DPMs have unlimited prescribing privileges?

 

[Carboxide]

Which states did you find DPMs have unlimited prescribing privileges?

Go ahead and post a link too, please.

 

[GypsyHummus]

Well, we can take a state with a pod school in it, Ohio.

Lawriter - ORC - 4731.51 Defining practice of podiatric medicine and surgery.

"A podiatrist may treat the local manifestations of systemic diseases as they appear in the hand and foot, but the patient shall be concurrently referred to a doctor of medicine or a doctor of osteopathic medicine and surgery for the treatment of the systemic disease itself"

So it seems like Pods can prescribe medication for diseases if they affect the foot as long as they are also consulting with a MD/DO. If I am reading correctly, a DPM can prescribe anything that they want to, but it has to deal with foot issues. Example: Patient comes in with high A1C and diabetic foot wound, DPM can adjust Diabetic medication for treatment of a foot wound and consult MD in the meantime while wound heals.

So, pods can prescribe anything they want to as long as they can tie it back to the feet?

I am happy to be corrected if I am wrong.

Which states did you find DPMs have unlimited prescribing privileges?

 

[Old Timer]

Well, we can take a state with a pod school in it, Ohio.

Lawriter - ORC - 4731.51 Defining practice of podiatric medicine and surgery.

"A podiatrist may treat the local manifestations of systemic diseases as they appear in the hand and foot, but the patient shall be concurrently referred to a doctor of medicine or a doctor of osteopathic medicine and surgery for the treatment of the systemic disease itself"

So it seems like Pods can prescribe medication for diseases if they affect the foot as long as they are also consulting with a MD/DO. If I am reading correctly, a DPM can prescribe anything that they want to, but it has to deal with foot issues. Example: Patient comes in with high A1C and diabetic foot wound, DPM can adjust Diabetic medication for treatment of a foot wound and consult MD in the meantime while wound heals.

So, pods can prescribe anything they want to as long as they can tie it back to the feet?

I am happy to be corrected if I am wrong.

I must say, you lack reading comprehension skills. The law states:

A podiatrist may treat the local manifestations of systemic diseases as they appear in the hand and foot, but the patient shall be concurrently referred to a doctor of medicine or a doctor of osteopathic medicine and surgery for the treatment of the systemic disease itself"

So, in Ohio if there some problem of the hand or foot caused by diabetes, they may treat the local condition but they are required, hence the word shall, to refer the patient to a physician to treat the systemic condition itself.

 

[CetiAlphaFive]

NO, NO, NO, NO
​

The title of the thread is:

Is ADHD within scope of practice for an Ob gyn?
​

They are two totally separate questions. The doctor can legally prescribe whatever they want. As for usual course of practice, they are not practicing OB/GYN, legally they are practicing medicine. If the pharmacist things something is amiss, they can call for clarification and refuse to fill if they want.

It's important to note that you should call for clarification, but the pharmacist can refuse to fill without making any call at all.

 

[Old Timer]

It's important to note that you should call for clarification, but the pharmacist can refuse to fill without making any call at all.

You can do whatever you want. But a blanket refusal makes no sense, legally or otherwise.

 

[CetiAlphaFive]

You can do whatever you want. But a blanket refusal makes no sense, legally or otherwise.

Please elaborate with something specific

 

[Old Timer]

Please elaborate with something specific

I hate to repeat myself. They are legally allowed to write it. You don't have to fill anything you don't want to. But since this is Adderall and no harm could come from missing this drug, it's just an inconvenience,. Bit if this was for lets say a seizure medication from an OB/GYN and you refused with no call and they had a seizure, you would be calling your liability insurance. You harmed them by refusing a legal order for no good reason and if you try scope of practice as a defense, you will lose as I have pointed ad nausea um this is a legal with the scope of their medical practice.

 

[confettiflyer]

It's important to note that you should call for clarification, but the pharmacist can refuse to fill without making any call at all.

I mean, I suppose I can poop in a toilet or in the middle of a crowded sidewalk...because I’m an adult, and I do what I want.


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[CetiAlphaFive]

I hate to repeat myself. They are legally allowed to write it. You don't have to fill anything you don't want to. But since this is Adderall and no harm could come from missing this drug, it's just an inconvenience,. Bit if this was for lets say a seizure medication from an OB/GYN and you refused with no call and they had a seizure, you would be calling your liability insurance. You harmed them by refusing a legal order for no good reason and if you try scope of practice as a defense, you will lose as I have pointed ad nausea um this is a legal with the scope of their medical practice.

Ah, I see. The old seizure meme.
What you're arguing is that all pharmacists have an "assumed duty" to dispense.

We do not.

 

[Charcoales]

Ah, I see. The old seizure meme.
What you're arguing is that all pharmacists have an "assumed duty" to dispense.

We do not.

Maybe if we ask the obgyn why they are doing what they are, and if they give us the old 'I'm an MD just do it' then boom we can refuse since that is literally not a medical reason, its just an appeal to authority...

 

[CetiAlphaFive]

Maybe if we ask the obgyn why they are doing what they are, and if they give us the old 'I'm an MD just do it' then boom we can refuse since that is literally not a medical reason, its just an appeal to authority...

Here's a good example of why we should not kowtow to "scope of practice":

18yo female shows up to my pharmacy expecting to pick up Claravis. Nothing in system.

Minutes later, MD with California area code calls in Rx. Other Rph takes the call.
I look him up; he's an inpatient surgeon.
No ipledge number, weird md from out of state?
I don't have time for that. Refused.

Fast forward a month.
She's back, and this time MD calls it in with ipledge number.
It works and the Rx is good to go.

I sit on the Rx for a minute until girl shows up and ask if she went to his office.
At first she says no, then later says she had a pregnancy test done.

I refuse it again.

I call the MD and start asking questions.
He swears up and down that they did the pregnancy test and starts threatening to report me if I don't fill it.
"There's no way my daughter is Pregnant!"
Last names were different, so this is just a cherry on top.
Finally, he hangs up.

I then look up his office and call to tell him to stop calling and give him a blanket refusal for all of his prescriptions.

Instead, the person who answers tells me that they can't give him any messages because he's been in Iran for 3 months and won't be back until next month.

This was about 45 minutes worth of time I'll never get back.

He tried again a few months later.
I just hung up on him as soon as he identified himself.

 

[Carboxide]

Here's a good example of why we should not kowtow to "scope of practice":

18yo female shows up to my pharmacy expecting to pick up Claravis. Nothing in system.

Minutes later, MD with California area code calls in Rx. Other Rph takes the call.
I look him up; he's an inpatient surgeon.
No ipledge number, weird md from out of state?
I don't have time for that. Refused.

Fast forward a month.
She's back, and this time MD calls it in with ipledge number.
It works and the Rx is good to go.

I sit on the Rx for a minute until girl shows up and ask if she went to his office.
At first she says no, then later says she had a pregnancy test done.

I refuse it again.

I call the MD and start asking questions.
He swears up and down that they did the pregnancy test and starts threatening to report me if I don't fill it.
"There's no way my daughter is Pregnant!"
Last names were different, so this is just a cherry on top.
Finally, he hangs up.

I then look up his office and call to tell him to stop calling and give him a blanket refusal for all of his prescriptions.

Instead, the person who answers tells me that they can't give him any messages because he's been in Iran for 3 months and won't be back until next month.

This was about 45 minutes worth of time I'll never get back.

He tried again a few months later.
I just hung up on him as soon as he identified himself.

Reasons to deny that:

1. He didn't follow the law.
2. He did not have a legitimate patient-prescriber relationship with the patient.

Not reasons to deny that:

1. Surgeon

 

[CetiAlphaFive]

Reasons to deny that:

1. He didn't follow the law.
2. He did not have a legitimate patient-prescriber relationship with the patient.

Not reasons to deny that:

1. Surgeon

How do you know that?
He explicitly claimed that he did.
He also did all of the iPledge paperwork.

You guys have to be out of your minds if you're that willing to gamble with your licenses.

"B.. Bu .. But they're still doctors!"

Yeah, and so are the family medicine doctors that we all stop from killing patients in their usual setting and course of practice every single day.

Would you fill chronic pain management prescriptions from a surgeon?
No? That's weird.

You're going to trust an MD who, for whatever reason, is doing something unusual that they haven't done in regular practice in __ number of years?

Why?
So you don't get dinged on a customer service survey?

This is just an example of pharmacists buying into the MD mythos.
There's no reason a specialist wouldn't forget knowledge that doesn't get used regularly.
It's legal, but it's stupid.

 

[W19]

Ah, I see. The old seizure meme.
What you're arguing is that all pharmacists have an "assumed duty" to dispense.

We do not.

What if the patient has been taking that medication for months or years and the obgyn was doing her a favor by providing 1 refill because the patient for whatever issue had problem seeing her neurologist etc...

It's more prudent to call the prescriber instead of blanket refusal...

 

[Old Timer]

Ah, I see. The old seizure meme.
What you're arguing is that all pharmacists have an "assumed duty" to dispense.

We do not.

Are you really are just ****** and flunked reading comprehension in 1st grade or just like to argue or just refuse to admit you are wrong. This is really simple. You are combining two things. They are totally separate. The first is scope of practice. Is the prescriber legally allowed to prescribe this medication. The second is the duty of the pharmacist to exercise his corresponding responsibility to assure the therapy is correct and appropriate. They are totally separate. Any MD can write for any drug regardless of their degree of specialization. They are NOT licensed as a specialist, they are licensed as a Medical doctor. It is inappropriate to refuse to fill a legal order. If you as the pharmacist have any question about the order, you have not just the right, but the duty to question the prescriber and based on his/her response either to fill or refuse to fill. A simple refusal to fill an order from an OB/GYN is inappropriate. Any doctor has the legal right to prescribe:

• Vitamin-D 50,000 iu daily.
• Motrin 800 mg q4h
• Gemfibrazole and Simvastatin
• Cipro and Tizanidine

They are legal orders and I wouldn't fill any of them.

I don't understand your argument. It is illogical. Your deal with the Claravis is also silly. So, you are the pregnancy police now. As long has he got I-Pledge to approve, what the hell do you care? You will have ZERO liability. In Pennsylvania a prescriber may prescriber for himself or his family as long as he keeps medical records. They even have a special license in PA for retired doctors. The license only allows them to prescriber for themselves or their family. They can keep their license w/o Malpractice insurance and CE. It's called active - retired. You just seem to be on a big power trip with nothing to back you up. You may get through your career just fine, protecting the world from Claravis abuse while refusing to fill legitimate rxs and causing inconvenience or suffering based on your unfounded assumptions.

 

[Old Timer]

How do you know that?
He explicitly claimed that he did.
He also did all of the iPledge paperwork.

You guys have to be out of your minds if you're that willing to gamble with your licenses.

"B.. Bu .. But they're still doctors!"

Yeah, and so are the family medicine doctors that we all stop from killing patients in their usual setting and course of practice every single day.

Would you fill chronic pain management prescriptions from a surgeon?
No? That's weird.

You're going to trust an MD who, for whatever reason, is doing something unusual that they haven't done in regular practice in __ number of years?

Why?
So you don't get dinged on a customer service survey?

This is just an example of pharmacists buying into the MD mythos.
There's no reason a specialist wouldn't forget knowledge that doesn't get used regularly.
It's legal, but it's stupid.

Your arguments totally lack logic.

• There is no gamble with your license in the Clarvais issue. None. If the order is legal and the dose is appropriate and I-Pledge approves, how could your possibly violate the pharmacy act of your state?
• The family doctor who writes something incorrectly has the write to prescribe it and you have the right to question it. This does not affect his right to prescribe.
  
• Would I fill chronic pain medication from a surgeon? Maybe. But a call would be in order. Maybe they were just discharged from the hospital s/p surgery and the surgeon prescribed all of their discharge medications. I would fill the pain pills along the with BP meds and the anticoagulants.
• So now, I have to assume they forgot stuff they learned years ago because they don't see it regularly. Does that mean they can't treat someone with pheocromacytoma because they haven't seen it in 30 years and they forgot how to do it. That's what CE is for to keep you refreshed and up to date. Does that mean you can't dispense drug X because it's old and hardly used? Where is this in the pharmacy act?
• My closest friend is presently in the hospital s/p cardiac arrest. His GP does not go to the hospital so all of his care is being managed by the cardiologist. When he get's D/C'D from the hospital I will fill all of the rxs written by the cardiologist including the Omperazole, the Finasteride, the Synthroid and not refuse because the cardiologist forgot everything he learned on his GI/Urology/Endocrine rotations.

Your arguments are totally and completely without logic, merit or basis in law. It's just crap you made up because you feel like it. That's fine by the way, just own it....

 

[CetiAlphaFive]

Are you really are just ****** and flunked reading comprehension in 1st grade or just like to argue or just refuse to admit you are wrong. This is really simple. You are combining two things. They are totally separate. The first is scope of practice. Is the prescriber legally allowed to prescribe this medication. The second is the duty of the pharmacist to exercise his corresponding responsibility to assure the therapy is correct and appropriate. They are totally separate. Any MD can write for any drug regardless of their degree of specialization. They are NOT licensed as a specialist, they are licensed as a Medical doctor. It is inappropriate to refuse to fill a legal order. If you as the pharmacist have any question about the order, you have not just the right, but the duty to question the prescriber and based on his/her response either to fill or refuse to fill. A simple refusal to fill an order from an OB/GYN is inappropriate. Any doctor has the legal right to prescribe:

• Vitamin-D 50,000 iu daily.
• Motrin 800 mg q4h
• Gemfibrazole and Simvastatin
• Cipro and Tizanidine

They are legal orders and I wouldn't fill any of them.

I don't understand your argument. It is illogical. Your deal with the Claravis is also silly. So, you are the pregnancy police now. As long has he got I-Pledge to approve, what the hell do you care? You will have ZERO liability. In Pennsylvania a prescriber may prescriber for himself or his family as long as he keeps medical records. They even have a special license in PA for retired doctors. The license only allows them to prescriber for themselves or their family. They can keep their license w/o Malpractice insurance and CE. It's called active - retired. You just seem to be on a big power trip with nothing to back you up. You may get through your career just fine, protecting the world from Claravis abuse while refusing to fill legitimate rxs and causing inconvenience or suffering based on your unfounded assumptions.

You don't seem to understand liability, the word "duty" in the legal use and context, or how lawsuits work at even the most basic level.
"ZERO liability" lol. Thanks for the laugh.

I have absolutely no incentive to put myself even at the most minuscule amount of risk in order to avoid inconveniencing a prescriber or patient that I don't know.

Also, since you seem to be unaware of how the disciplinary process works, here's a very basic breakdown:
An event takes place. For instance, a girl gets pregnant from Claravis after the pharmacist dispenses the medication despite a few red flags.
She delivers a mutant Claravis baby with the head of a wildebeest.
The patient then sues the pharmacist and submits a complaint to the state board.
The state board then investigates and makes a ruling.

I'm not sure why so many BPharms think that writing "OK to fill per Dr. ____ 01/01/2011" totally absolves them of any civil liability or any responsibility whatsoever.


I think the difference between us that you're unaware of is this obsequious attitude you seem to have towards prescribers.
You consider CYA to be a "power trip"? What a joke.

You're hung up on the fact that any MD is legally allowed to prescribe anything.
If you'd please go back and read my posts, you'd see that I never contradicted this.

Also, well done. You totally side-stepped the fact that you were objectively wrong about the pharmacists "duty" to dispense seizure medication.
You're still charging ahead, citing "logic" and what not.

I think what you mean to say is "I think I'm right because that's what I feel"

 

[BidingMyTime]

"Scope of practice" is not that hard to understand. Can an orthopedic surgeon retire and decide to run a concierge family medicine practice or to moonlight in an urgent care? Yes, absolutely yes, they can. (Of course, they probably would never do this, but that is besides the point.) So, is there any reason the orthopedic surgeon can't write family medicine type RX's while they are practicing as an orthopedic surgeon? No, there is no reason why they can't (provided they are keeping records per legal requirements.)

Now, can a dentist or a podiatrist decide to retire and run a concierge family medicine practice or to moonlight in an urgent care? No, they absolutely can not. Therefore, they can not write family medicine type RX's while working as a dentist or a podiatrist.

With all the talk about collaborative medicine, pharmacy schools should be doing a better job at teaching students these basic concepts.

 

[CetiAlphaFive]

"Scope of practice" is not that hard to understand. Can an orthopedic surgeon retire and decide to run a concierge family medicine practice or to moonlight in an urgent care? Yes, absolutely yes, they can. (Of course, they probably would never do this, but that is besides the point.) So, is there any reason the orthopedic surgeon can't write family medicine type RX's while they are practicing as an orthopedic surgeon? No, there is no reason why they can't (provided they are keeping records per legal requirements.)

Now, can a dentist or a podiatrist decide to retire and run a concierge family medicine practice or to moonlight in an urgent care? No, they absolutely can not. Therefore, they can not write family medicine type RX's while working as a dentist or a podiatrist.

With all the talk about collaborative medicine, pharmacy schools should be doing a better job at teaching students these basic concepts.

This is exactly right.

For low risk meds, who cares?