Offering Consultation

[aznshy2]

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Currently, I am working at a CVS chain store as a first year intern pharmacist. Today, a patient came in person to pick up his prescription. It is a refill prescription, not a new medication. Part of the procedures was to put down his "receipt sticker label" onto a log sheet, and obtain a signature from him.

There are two boxes for him to choose from to sign. One says, "No, I would not like to speak with a pharmacist," and another says, "Yes, I would like to talk to pharmacist, blah blah." Since the med is not new, the convention is to just have him sign the "No" box. So before letting him sign it, I asked, "Would you like consultation?" He said, no, so I told him to sign the "No" box. We then proceeded with everything else and he left. This is overseen by my preceptor.

My preceptor later told me that as a tech (I am actually not a "tech," but officially an intern pharmacist. But CVS treats us as "techs.") I cannot legally ask the question "Would you like consultation?" I was just asking and was in no way going to do it myself as a 1st year student. I simply have not enough knowledge myself. I know that very well. 😉 He, my preceptor, said that this is actually against the Board of Pharmacy's policies, and I should NEVER ask that question. Otherwise, my license may be revoked and he can be cited.

Now, my question is, is that really true? Can I not ask "Would you like consultations?" It seems to conflict with what I have learned in class. Asking that simple question really is against the law? (A licensed pharmacist in practice can ask this question with no problem, of course, right?) I don't want to jeopardize his and my own license, but I also want to make sure I don't force the patients to sign the "No" box every single time without letting them know what the boxes mean.

(I probably will not be asking the same question ever again as it is more respectful to follow my preceptor's directions. I am under the supervision of his guidance, after all, and I value that over the insistence of asking this one, same question. However, I just want to ask for knowledge sake.)

And if it is true, do you think I can use the question, "Do you have any questions about your med?" instead? And if they say yes, I would just direct them to my preceptor and have them sign the "Yes" box. Would that be better?

Thank you for reading a length post. 👍

 

[dgroulx]

My techs all ask, "Do you have any questions for the pharmacist?". If they say yes, then they send them to the consultation window.

If I have flagged a med as "consultation required", then they have to come and get me in order to sell it.

 

[SGPharmD]

My techs all ask, "Do you have any questions for the pharmacist?". If they say yes, then they send them to the consultation window.

That's what we do too.

 

[Old Timer]

It probably depends on the state, however in Pennsylvania, anyone can "offer" to counsel, but only the pharmacist may perform the duties.

 

[Aznfarmerboi]

I think your pharmacist probably told you that because he/she misunderstood you. When offering consulation, you have to say "Do you have any questions on your medication for the pharmacist?". The key words are medication and pharmacist.

Interns are also not treated like techs unless they do not have an intern permit. If you do, you can rightfully in a respectful way tell the pharmacist that you are an intern, and can counsel under his/her supervision. A pharmacist intern (at least in NYS) can practice pharmacy under a pharmacist as long as he is capable to. If you do not have a pharmacist intern permit though (which is what I suspect since this is your first year), then yes. . . you are a tech.

 

[genesis09]

In Illinois, a tech can ask "do you have questions for the pharmacist?" The law just states either a tech, pharm student, or pharmacist must ask for every new and refill prescription, would you lilke to talk with the pharmacist. Since they are in the process of rewriting all the rules, there is a movement to change the rule from offer to consul to requirement of it.
Only a pharmacy student or pharmacist can give the actual consultation though.

 

[pharmacogenomic]

I guess California is the outlier again.

Each new rx Must be counseled by a pharmacist if the pt or the pt's guardian is picking it up (exceptions are friends picking up for friends, spouses, adults for other adults, etc....) Thus, the signature on the log, sig cap or other device recognizes both the acceptance of consultation if parameters are met and receipt of the actual product. If it is the actual patient or parent picking up the med, the pt doesn't even have a chance to not get counseled - its automatic & the techs must not let any new rx out without consultation. Depending on the level of training my intern has, I let the intern counsel.

If the rx is a refill, the signature only indicates the receipt of the medication. Counseling cannot be offered (since it had already been done with the original rx). Thus, those "boxes" have been removed. So - in
CA, a tech or intern can't offer counseling. It will either be done or not & that is not the patient's choice.

The concept is you cannot deny what you don't know you might NOT know. It sounds convoluted, but the complete consultation must always be done on the first dispensing. That then covers all the pharmaceutical & legal issues surrounding the dispensing.

If you offer something, then later an adverse reaction develops, either related to the medication or not, and the pt remembers....he/she could interpret the offer as something which should have been disclosed anyway, thus should be automatic. Just like it is with the original.

The only other time a consultation is required on a refill is when something new is added or removed when we dispense - med guides for all antidepressants for example.....even refills required counseling until everyone went thru a "cycle" of fills - 90 days or so.

A bit crazy....but,heh - its CA!

 

[HaleyRX]

That's very odd. In Louisiana we are required to make the offer to counsel (I'm just a tech.) and then arrange for a pharmacist to meet with the patient if needed.
To be honest, the offer is hardly ever made. When I see a new Rx going out, I try to ask "do you need to talk to the pharmacist about this medicine?" and the person ALWAYS panics and says "Oh gosh, what's wrong? Should I not be taking this? What happened?" and I say "I'm just offering, since it is a new Rx." People never look at what they're signing on the pick-up sheet, so if they sign by "yes" then I say "the pharmacist will meet with you in a moment" and they say "what for? what happened?" and I point out what they signed and they say "oh, I didn't notice that." 🙄 sign your life away...

 

[confettiflyer]

In CA, I'm instructed to make the assumption that the pt wants a consult for a new Rx. I don't believe we're allowed to ask anything that ends in a question mark, so I get around this by making a statement of fact: "This looks like a new prescription, I can have the pharmacist go over it with you if you would like."

I don't even know if that's legal, I don't get much guidance at work.

 

[soyroger]

I guess California is the outlier again.

Each new rx Must be counseled by a pharmacist if the pt or the pt's guardian is picking it up (exceptions are friends picking up for friends, spouses, adults for other adults, etc....)

If the rx is a refill, the signature only indicates the receipt of the medication. Counseling cannot be offered (since it had already been done with the original rx). Thus, those "boxes" have been removed. So - in
CA, a tech or intern can't offer counseling. It will either be done or not & that is not the patient's choice.

I used to think that only the pt or guardian could be counseled on a new Rx, but CA law says that any agent of the pt picking up the Rx should be counseled. Once the pt authorizes a person to be their agent and pick up their Rx they can legally be counseled. (refer to 1707.2 of the Code of Regulations, 2007 CA Lawbook)

Patients also have the right to request consultation in any care setting, even if it's a refill. Perhaps some hospitals or pharmacies have policies that are different, but they definitely can request it according to CA law. Pharmacists can also offer counseling for a refill when it's warranted in their professional judgment.

Of course, the idea above that a pt needs to know what may hurt them is vital.

 

[aznshy2]

Thanks for all the responses so far; they have been very helpful.
Just to clarify, I am an intern pharmacist with a valid license in California.
It's actually been photocopied and posted on the board inside the pharmacy also.

In school, I was instructed that I can do everything that a pharmacist in practice can do except:
1. I must be supervised by the preceptor
2. I have to act within reasons and knowledge

After reading, it's best that I just don't say anything from now on since it's a refill, those 2 boxes are somewhat equivalent anyway, according the above post made regarding CA laws. Thanks!

 

[GaPharmGirl09]

Georgia law states that a tech, cashier, etc. CANNOT ask if the patient has any questions for the pharmacist. Also, the RPH/Intern CANNOT just say "Do you have any questions about your medications?". From the GA BOF website...

Patient Counseling
Georgia law, O.C.G.A. §26-4-85, requires that each
patient receive an offer to counsel by a licensed pharmacist
or a pharmacy intern operating under the
direct supervision of the pharmacist, not a technician,
banner message, cashier, recorded message, or by any
means other than a personal conversation with a pharmacist
or an intern. Such discussion shall be in person,
whenever practical, or by telephone and shall include
appropriate elements of patient counseling, based on the
professional judgment of the pharmacist. The question,
“do you have any questions about your medication,” is
not sufficient and is not patient counseling. The intent
of the law is that when a patient leaves the pharmacy
he or she has the necessary information to receive the
maximum positive outcome and be aware of major adverse
effects that might come as a result of taking his
or her medication. As we all know, professional judgment
applies in counseling, just as it does in everything
that we do as pharmacists. The bottom line is that you
need to talk to each patient or caregiver about each
prescription, both new and refills. A patient can refuse
counseling, but it must be offered.

 

[museabuse]

Georgia law states that a tech, cashier, etc. CANNOT ask if the patient has any questions for the pharmacist. Also, the RPH/Intern CANNOT just say "Do you have any questions about your medications?". .

That is the same law as in az. If the rx is new... meaning the pt never had the medication at your pharmacy before or anything changed on the rx, like dr, quantity, direction, ndc... a pharmicist must counsel. At my store the tech tell pt that the pharmacists needs to speak with you, and then yells counsel for me to come over. If the pt then says I don't want to speak with the pharmacist they can do that and I have to write refused on the log. THe tech can't ask if they want a cousel or if they have any questions. AZ board thinks that is leading them to say no, which I think is true.

 

[BMBiology]

Most pharmacists are scared of their own shadow.

 

[pharmacogenomic]

I used to think that only the pt or guardian could be counseled on a new Rx, but CA law says that any agent of the pt picking up the Rx should be counseled. Once the pt authorizes a person to be their agent and pick up their Rx they can legally be counseled. (refer to 1707.2 of the Code of Regulations, 2007 CA Lawbook)

Patients also have the right to request consultation in any care setting, even if it's a refill. Perhaps some hospitals or pharmacies have policies that are different, but they definitely can request it according to CA law. Pharmacists can also offer counseling for a refill when it's warranted in their professional judgment.

Of course, the idea above that a pt needs to know what may hurt them is vital.

Ahhhh - they key here is the pt must authorize the agent! Most people don't authorize the person who is sent to the pharmacy to pick up the rx. Your real issue here is perhaps giving consultation to someone who the pt has not authorized (.....see here BMBiology's being afraid of one's own shawdow...) We usually don't take the time to contact the pt to see if the husband or daughter is an "authorized" agent.

But, in CA case law, there are significant cases where parent's have been counseled on an "adult" child or a spouse has been counseled on the other spouses' medication which might disclose a condition which causes conflict - HIPAA violations.

However, you can "cover" your *ss by just calling the pt & giving counsel over the phone.

It normally is not a dicey problem, but can be if there are family issues. If you know the family, its not a problem.....but, as a floater - you can get caught in a morass.

I agree with BM - most pharmacists just love hiding behing "laws"!

 

[soyroger]

Ahhhh - they key here is the pt must authorize the agent! Most people don't authorize the person who is sent to the pharmacy to pick up the rx. Your real issue here is perhaps giving consultation to someone who the pt has not authorized (.....see here BMBiology's being afraid of one's own shawdow...) We usually don't take the time to contact the pt to see if the husband or daughter is an "authorized" agent.

But, in CA case law, there are significant cases where parent's have been counseled on an "adult" child or a spouse has been counseled on the other spouses' medication which might disclose a condition which causes conflict - HIPAA violations.

However, you can "cover" your *ss by just calling the pt & giving counsel over the phone.

It normally is not a dicey problem, but can be if there are family issues. If you know the family, its not a problem.....but, as a floater - you can get caught in a morass.

I agree with BM - most pharmacists just love hiding behing "laws"!

Yes, but an agent is anyone that the pt asks to pick up their drug (ie. wife asks husband to pick up her prescription at Safeway while he's getting milk and butter). He is then the patient's agent and can be consulted for a new Rx. Again, the pharmacists professional judgment applies, especially in the case where privacy issues may be a big concern.

What we have here by law is that anyone the patient asks to pick up their new Rx can be consulted, anyone can indeed decline being consulted on a new Rx, and anyone can request consultation on a normal refill (all in CA). Now, I'm just talking law so far and not liability. Even when acting within the law a pharmacist may be sued b/c they are still liable for whatever problem they could have prevented. Hence CA case law examples, which is why BMBiology is right about pharmacists being afraid of their shadows. Professional judgment should of course always guide, such as when a pt declines consultation on a new antibiotic and they're obviously in the dark about their new Rx. I'd just keep informing them on how to take it before handing the Rx over, even if the pt was getting upset and wanted to just leave with it and no consultation.

As far as the OP's concern, he hasn't done anything wrong b/c an intern can do anything a pharmacist can do while being supervised by the pharmacist. I highly doubt that the preceptor was anywhere near the truth when he said the Board of Pharmacy is against what the intern did, that his license was in jeopardy, and that the preceptor could have been cited.

 

[pharmacogenomic]

Yes, but an agent is anyone that the pt asks to pick up their drug (ie. wife asks husband to pick up her prescription at Safeway while he's getting milk and butter). He is then the patient's agent and can be consulted for a new Rx. Again, the pharmacists professional judgment applies, especially in the case where privacy issues may be a big concern.

What we have here by law is that anyone the patient asks to pick up their new Rx can be consulted, anyone can indeed decline being consulted on a new Rx, and anyone can request consultation on a normal refill (all in CA). Now, I'm just talking law so far and not liability. Even when acting within the law a pharmacist may be sued b/c they are still liable for whatever problem they could have prevented. Hence CA case law examples, which is why BMBiology is right about pharmacists being afraid of their shadows. Professional judgment should of course always guide, such as when a pt declines consultation on a new antibiotic and they're obviously in the dark about their new Rx. I'd just keep informing them on how to take it before handing the Rx over, even if the pt was getting upset and wanted to just leave with it and no consultation.

As far as the OP's concern, he hasn't done anything wrong b/c an intern can do anything a pharmacist can do while being supervised by the pharmacist. I highly doubt that the preceptor was anywhere near the truth when he said the Board of Pharmacy is against what the intern did, that his license was in jeopardy, and that the preceptor could have been cited.

No - in CA, the agent is that individual who has been designated by the pt PRIOR to the receipt of the medication. It is not just anyone who is picking up the rx along with the milk and bread.

You should go back to the clarifications of 1707.2, which are not in the law book of 2007, but in the CA state board's clarifications as well as what you should have learned in your class as CA's recognition of the "learned intermediary" rules. Likewise, you might find review of case law with regard to counseling cases in CA - the phen-fen cases as well as some addiction cases.

There are on two situations in which absoute counseling (non-discretionary) must occur in CA - those in which taking the drug could potentially cause problems with alcohol and/or which driving or operating machinery. These situations cannot be declined (hence - non-discretionary).

This is the basis by which you place those cautionary stickers on the bottles. CA has recognized that by placing those stickers, you have given the patient warning, in writing, even if the pt himself/herself did not pick up the actual prescription. Thus, even if the pt says they don't want to be counseled and you, as a pharmacist, say ok....you've still done it in writing, which is what the law requires. However, a technician or intern cannot offer to have it be declined.

You run a far greater risk of giving instructions to a friend or family member by counseling and having the instructions or cautions relayed incorrectly than by telling that friend or family member to have the patient call you if there are any questions or concerns about the medication.

The most recent clarifications by the board on this regulation were this summer when they came up with the specifics related to the automated delivery devices located in some retail establishments. Those circumstances require the pt to sign a written consent to comply with all the restrictions & requirements placed on them & one of them has to do with counseling. It is also up to the pharmacist's discretion whether to place a medication in that device or not.

You might want to be really informed of this particular part of CA law. I think it is covered on the CPJE.

 

[thepianocian]

I am a pharmacy ancillary so my experience with this may not be very... experienced. However, like someone stated above, I am required to say "I'll have the pharmacist go over this medication with you" or something to that effect, but never in question form. If the patient says they've had it before and deny the consultation, then the would sign the deny box. I'm also from California if that makes any difference.

 

[bananaface]

Most pharmacists are scared of their own shadow.

Boo!

(just testing)

As stated by above posters, it's an issue of state law. One thing to keep in mind is that even if you may be allowed to do things under state law, you should still follow the discretion of your preceptors and do things as they are comfortable. If you live in a state where you can do alot more than your preceptor will allow you to as you grow in your abilities, you may need to find a new site to work at. It sounds as if you may have gotten one of those preceptors who is never going to want you to do anything beyond technician duties. I guess you'll just have to wait and see what happens.

 

[littleaznpharm]

It depends. I'm from NY. NYS law requires an offer of consultation made for every prescription (refills too). The offer of consultation could be made by anyone (pharmacist,tech, or intern.)

But the consultation must be done by the pharmacist or intern. If your pharmacist is as lazy my pharmacist. Then dude....your stuck doing the consultation.

I only remember this cuz I took the MPJE today.

HOWEVER.....Consultation is REQUIRED for
1. New prescriptions
2. New patients
3. Change in dose form/strength/directions

 

[haokiet]

consultation should also be given during refills
to determine if the drug is effective.. if after taking
the drugs and the patient say its not helpful, the
symptoms persist, then the drug should be discontinued,
or change dosage..

 

[Old Timer]

Most pharmacists are scared of their own shadow.

Which causes them to invent regulations they feel they have to follow even if they don't exist.....

 

[pharmacogenomic]

Which causes them to invent regulations they feel they have to follow even if they don't exist.....

Amen to that!

Pharmacy = one of the most "regulated" professions which exists!

 

[Old Timer]

Amen to that!

Pharmacy = one of the most "regulated" professions which exists!

I had a pharmacist refuse to fill and RX for methadone from a pain management doc (a real one not a croaker handing out scripts for money) because it had to say it was for pain on the script.

The trouble is the DEA regulations DO NOT require this. It's just another invented regulation from the people who as you pointed out are the most regulated profession in the universe....

 

[soyroger]

No - in CA, the agent is that individual who has been designated by the pt PRIOR to the receipt of the medication.

That's one way to become an agent, but when the pt requests that another person pick up their prescription, even after they've seen their MD, they are then the patient's agent. I just asked our law professor specifically about this today in addition to our discussion of it last week. He's a JD as well as a PharmD (has his MBA too, but that's besides the point) so I usually trust what he says with a high degree of confidence. If I'm wrong on this point then perhaps he didn't understand what I was asking during class and I was misinformed. I'll seek more info about this since after all that's why I'm a student.

Concerning what you've said regarding pharmacy practice, where the rubber meets the road so to say, I totally agree. What I originally disagreed about was what you said regarding people (ie, spouse, friend, etc.) picking up the new Rx being an exception to being counseled, and counseling not being the patient's choice (especially in the case of a normal refill).

Again, let me repeat that I'm talking about what the law states and not saying that I'm always going to straightway council anyone who is picking up their spouse's/brother's/friend's prescription. I totally agree that it's best to call the pt or find some way to get the information to them directly yourself.

What first sparked my interest in who can be the agent and when they can be counseled is when my wife and I returned home in June with our baby girl. She naturally asked me to pick up her prescriptions and the pharmacists went ahead and clicked on the the "NO" box when it asked if I wanted to be counseled, and my understanding at the time was in accordance that I couldn't be counseled in that situation. However, I now know that I was indeed acting as her agent and had the right to consultation.

Now that I've read through some more posts and thought about the OP's original concern I'll have to seek more info about 1727(e) since it indicates that an intern can do all the functions (including consultations?) a pharmacist can do while under the pharmacists supervision. More food for thought for me.

 

[pharmacogenomic]

That's one way to become an agent, but when the pt requests that another person pick up their prescription, even after they've seen their MD, they are then the patient's agent. I just asked our law professor specifically about this today in addition to our discussion of it last week. He's a JD as well as a PharmD (has his MBA too, but that's besides the point) so I usually trust what he says with a high degree of confidence. If I'm wrong on this point then perhaps he didn't understand what I was asking during class and I was misinformed. I'll seek more info about this since after all that's why I'm a student.

Concerning what you've said regarding pharmacy practice, where the rubber meets the road so to say, I totally agree. What I originally disagreed about was what you said regarding people (ie, spouse, friend, etc.) picking up the new Rx being an exception to being counseled, and counseling not being the patient's choice (especially in the case of a normal refill).

Again, let me repeat that I'm talking about what the law states and not saying that I'm always going to straightway council anyone who is picking up their spouse's/brother's/friend's prescription. I totally agree that it's best to call the pt or find some way to get the information to them directly yourself.

What first sparked my interest in who can be the agent and when they can be counseled is when my wife and I returned home in June with our baby girl. She naturally asked me to pick up her prescriptions and the pharmacists went ahead and clicked on the the "NO" box when it asked if I wanted to be counseled, and my understanding at the time was in accordance that I couldn't be counseled in that situation. However, I now know that I was indeed acting as her agent and had the right to consultation.

Now that I've read through some more posts and thought about the OP's original concern I'll have to seek more info about 1727(e) since it indicates that an intern can do all the functions (including consultations?) a pharmacist can do while under the pharmacists supervision. More food for thought for me.

Good example!

You thought you were being the good husband/dad, etc - picking up the ibuprofen/vicodin rx. However - your wife should have called the pharmacy & said my husband is picking up the rx. We then would have counseled her over the phone, noted you were not the pt & then would have just have you signed that you received it & told you we had spoken with your wife. The counseling would have been noted on the rx.

As for your daughter (congrats, btw!!!)...you are her agent until she reaches 18 (well...in CA, it could be as low as 13 in some cases - another thread!).

But, now ..... not that this would happen to you, but what if your wife had asked you to pick up methergine & you had never known she had been pregnant. Yeah - not so smart as a wife, but it happens. Or if your daughter, god forbid had that called in & you picked it up Or think about the many other things your daughter might seek out in the next 16-18 years (depending on the state), which might become "dicey" issues and ones best dealt with within the family, privately and most definitely not at the pharmacy counter at 6PM!

Or.....what if your daughter or wife had an rx called in for Serafem & we filled it for fluoxetine, oral contraceptives, etc and counseled you on antidepressant use, contraceptive intractions, time to effectiveness, etc...when really is was used for menopausaul issues, acne, stress - any number of issues which you may not be fully aware of. Welcome to parenthood!

See where this leads? To no good in most cases.

Law professors are all good - one of my classmates became a JD after becoming a PharmD & he said its all about the law. But, in our real life, its all about what we tell pts & the repercussions of that.

Who knows how many people have been told their parent has a seizure disorder when they are really being treated for post herpetic neuralgia with gabapentin. There are no seizures & the poor parent is now being forced to give up the driver's license by the well-meaning, but poorly informed adult child.

It becomes a pandora's box & one you want to open cautiously.

Use good judgement & not a blanket one size fits all rule.

After all - we are a profession, which means we can exercise good judgement on the behalf of our patients.

 

[pharmacogenomic]

I had a pharmacist refuse to fill and RX for methadone from a pain management doc (a real one not a croaker handing out scripts for money) because it had to say it was for pain on the script.

The trouble is the DEA regulations DO NOT require this. It's just another invented regulation from the people who as you pointed out are the most regulated profession in the universe....

Pain management = one of the most poorly taught subjects in pharmacy school, to the detriment of patients and their providers.

I have one patient who uses 3700 mg oxycodone per month. Yep! 3700!

He is dying of cancer and has no insurance & this is the cheapest alternative.

Can you imagine the nonsense some pharmacists would put up over this???

Sorry 3700 tablets of 5mg each! - not 3700mg. Do the math!

 

[soyroger]

Good example!

But, now ..... not that this would happen to you, but what if your wife had asked you to pick up methergine & you had never known she had been pregnant. Yeah - not so smart as a wife, but it happens. Or if your daughter, god forbid had that called in & you picked it up Or think about the many other things your daughter might seek out in the next 16-18 years (depending on the state), which might become "dicey" issues and ones best dealt with within the family, privately and most definitely not at the pharmacy counter at 6PM!


Use good judgement & not a blanket one size fits all rule.

After all - we are a profession, which means we can exercise good judgement on the behalf of our patients.

Thanks, I try to do my best. As for the situations you mentioned, my law professor took the same line of thought and gave me an example that nearly parallels yours (ie, underage daughter asks mom to pick up new Rx, but she's on something for postpartum hemorrhage and there's potential interactions). He mentioned that as an example of when it's best to tell mom nothing speak to the daughter only.

I agree, I definitely don't want to just use the cut and dry version of the law as a one blanket fits all rule. That's why I try to be careful to note the differences between law and liability. It's interesting to see where liability applies even when legalities are not compromised and how much of a role professional judgment has in practice outcomes. This has been a good discussion; gets my nose in the books more than when I'm just reviewing for class. Now that my study session is over it time for 😴

 

[Orthonut]

Just a thought from the other side of the counter-I WISH I could get someone to counsel me... They usually just go "Oh, Orthonut, this is an XYZ agent, you know what those do right?" and Orthonut says "yes" but her internal monologue says "IN HORSES! Not people!" but because they're so busy, and my pharmacist is so nice, and Orthonut doesn't want to look like an idiot....Orthonut crumbles to her own internal monologue/imagined peer pressure and doesn't say "um, no....could I get a consult?"

So please, don't assume that the DVM doesn't need or want a consult, I do! really! (maybe my pharmacist is reading this)

someday I'll get up the courage, in the meantime I've got a PDR a NACAP and a Plumb's

 

[aznshy2]

As stated by above posters, it's an issue of state law. One thing to keep in mind is that even if you may be allowed to do things under state law, you should still follow the discretion of your preceptors and do things as they are comfortable. If you live in a state where you can do alot more than your preceptor will allow you to as you grow in your abilities, you may need to find a new site to work at. It sounds as if you may have gotten one of those preceptors who is never going to want you to do anything beyond technician duties. I guess you'll just have to wait and see what happens.

My preceptor said I can start to do counseling when I am a 2nd year student, so he is a pretty understanding mentor. I think he will let my abilities grow when the time is right, so that is not my utmost concern.

I am just wondering, like I posted in my original post, to see if there are any specific questions or things that I shouldn't be saying. And I guess, in the end, no matter what the law is out there, following what my preceptor says is the best decision to make. He is, after all, my guide to the pharmacy career, and I am still very, very new.

Thank you for all the responses. I enjoyed reading all of them. 👍

 

[humira49]

Just a thought from the other side of the counter-I WISH I could get someone to counsel me... They usually just go "Oh, Orthonut, this is an XYZ agent, you know what those do right?" and Orthonut says "yes" but her internal monologue says "IN HORSES! Not people!" but because they're so busy, and my pharmacist is so nice, and Orthonut doesn't want to look like an idiot....Orthonut crumbles to her own internal monologue/imagined peer pressure and doesn't say "um, no....could I get a consult?"

So please, don't assume that the DVM doesn't need or want a consult, I do! really! (maybe my pharmacist is reading this)

someday I'll get up the courage, in the meantime I've got a PDR a NACAP and a Plumb's

interesting Orthonut!

Its funny you say that you don't want to "look like an idiot", yet you want counseling.

When I had my first child (sdn1977's first child was MSIII -- mine too - funny!), anyway, when I met the pediatrician for the first time, before she was delivered, I told him expect me to know absolutely nothing about children or drugs. Tell me everything because my emotions will get in the way of any logic I have. I am an idiot when it comes to my family.

Likewise, at about 32 weeks gestation with MSIII, my ob asked my husband & myself about anesthesia choices, etc. I immediately told him to make the choices himself given my medical condition at the time. I felt that I was not in any way able to make a rational decision (& I knew drsnd couldn't - he's waaaay to emotional!!!). So - we just let the ob choose & in hindsight, the choice was right.

Some of my best patients are pharmacists & physicians....they ask questions & want explanations. Now...some of my worst are the same. There is no generality.

But, don't be afraid - you're not a horse, a tiger or a snake - ask away!!!!

 

[tussionex]

Which causes them to invent regulations they feel they have to follow even if they don't exist.....

a big hearty thumbs up to that!👍👍👍

god forbid someone tries to think creatively...most pharmacists are too afraid of the white-gloved inspector or the JCAHO guy with the clipboard to actually assert themselves and make creative decisions!

 

[humira49]

a big hearty thumbs up to that!👍👍👍

god forbid someone tries to think creatively...most pharmacists are too afraid of the white-gloved inspector or the JCAHO guy with the clipboard to actually assert themselves and make creative decisions!

👍👍

again hiding behind "rules" - what rules?????