"Walgreens pharmacist denies woman miscarriage medication due to his beliefs"

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Indications absolutely matter in pharmacy, whether or not they practice medicine.
Whether it's safe and the indications match the med matter. They're not the ones that should be picking and choosing who gets what so long as it is safe in the eyes of the medical community

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Again, how does this not also apply to physicians?
Because, again, their function is the same thing regardless of medication. They verify safety and dispense. They might provide some counseling. They make sure the dose entered was correct. That is the same regardless of medication. We, as physicians, have already determined something is necessary for our patients, and, so long as it is not in error, their job is to make sure the orders all line up and the patient is getting the right thing, not to second-guess our judgment if we're prescribing a medically necessary medication in an approved manner with no interactions at an approved dose to a patient we believe should be getting it. I'm not asking them to provide a new service, I'm asking them to not discriminate in the service they are already providing, because ultimately this is discrimination with regard to women's reproductive services.
 
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Because, again, their function is the same thing regardless of medication. They verify safety and dispense. They might provide some counseling. They make sure the dose entered was correct. That is the same regardless of medication. We, as physicians, have already determined something is necessary for our patients, and, so long as it is not in error, their job is to make sure the orders all line up and the patient is getting the right thing, not to second-guess our judgment if we're prescribing a medically necessary medication in an approved manner with no interactions at an approved dose to a patient we believe should be getting it. I'm not asking them to provide a new service, I'm asking them to not discriminate in the service they are already providing, because ultimately this is discrimination with regard to women's reproductive services.
Again, how does this not also apply to physicians?

A D&C is a D&C is a D&C.

Or a medical abortion is done exactly the same as managing a miscarriage medically speaking.

Why do we allow OBs to refuse to perform the literal exact same service but not the pharmacist?
 
Again, how does this not also apply to physicians?

A D&C is a D&C is a D&C.

Or a medical abortion is done exactly the same as managing a miscarriage medically speaking.

Why do we allow OBs to refuse to perform the literal exact same service but not the pharmacist?
Procedures are procedures, each has different indications, counseling, etc. They are different services, even if they are functionally the same. A pharmacist would not describe their dispensing of one medication versus another as a separate function. This is a completely stupid example that fails every aspect of, you know, common sense.
 
Procedures are procedures, each has different indications, counseling, etc. They are different services, even if they are functionally the same. A pharmacist would not describe their dispensing of one medication versus another as a separate function. This is a completely stupid example that fails every aspect of, you know, common sense.
Really? Seems like an easy way to figure this out.

Local pharmacists, what say you?
 
Procedures are procedures, each has different indications, counseling, etc. They are different services, even if they are functionally the same. A pharmacist would not describe their dispensing of one medication versus another as a separate function. This is a completely stupid example that fails every aspect of, you know, common sense.
Clearly one pharmacist thinks that dispensing two meds are very different things
 
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Procedures are procedures, each has different indications, counseling, etc. They are different services, even if they are functionally the same. A pharmacist would not describe their dispensing of one medication versus another as a separate function. This is a completely stupid example that fails every aspect of, you know, common sense.

For fun, let's see if this statement works when we substitute "medication" for "procedure" and "prescriber" for "pharmacist":

Medications are medications, each has different indications, counseling, etc. They are different services, even if they are functionally the same. A prescriber would not describe their prescribing one medication verses another as a separate function. This is a completely stupid example that fails every aspect of, you know, common sense.

All the statements still seem to be true!
 
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Given that the teratogenicity if Absorica is taken during pregnancy is so high that birth defects are all but assured, a highly undesirable outcome, and that fetal loss is the desired outcome of misoprostol, I can see exactly why a REMS doesn't exist. Misoprostol has had 21 recorded deaths worldwide when used for abortion, compared to 1,500 accidental deaths for Tylenol in the United States alone. Something with that low of a risk profile has no need for any counseling on the part of pharmacists unless the patient requests it.
This just in, the raw amount of people who die of an extremely common medication is higher than that of a rarely used medication.

Whether it's safe and the indications match the med matter. They're not the ones that should be picking and choosing who gets what so long as it is safe in the eyes of the medical community

False. Every pharmacy act that I'm aware of requires a DUR for each and every prescription

Because, again, their function is the same thing regardless of medication. They verify safety and dispense. They might provide some counseling. They make sure the dose entered was correct. That is the same regardless of medication. We, as physicians, have already determined something is necessary for our patients, and, so long as it is not in error, their job is to make sure the orders all line up and the patient is getting the right thing, not to second-guess our judgment if we're prescribing a medically necessary medication in an approved manner with no interactions at an approved dose to a patient we believe should be getting it. I'm not asking them to provide a new service, I'm asking them to not discriminate in the service they are already providing, because ultimately this is discrimination with regard to women's reproductive services.
You're really kinda trivializing what physicians do with this post.
Pharmacists can and do manage and prescribe for some disease states.

The magic word that's on a pedestal is "diagnosis", not everything that follows.

If FM were so magical, a person wouldn't be able to do it after a short PA program
 
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For fun, let's see if this statement works when we substitute "medication" for "procedure" and "prescriber" for "pharmacist":

Medications are medications, each has different indications, counseling, etc. They are different services, even if they are functionally the same. A prescriber would not describe their prescribing one medication verses another as a separate function. This is a completely stupid example that fails every aspect of, you know, common sense.

All the statements still seem to be true!
I mean, I don't really care about any arguments made in this thread to be perfectly honest, reproductive rights should be a universal guarantee
 
We've reached the point of circular discourse, so I'm just going to exit the thread, it's pretty pointless
That's a funny way of saying "I tried to assume something about pharmacists and they showed up and proved me wrong", but OK
 
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That's a funny way of saying "I tried to assume something about pharmacists and they showed up and proved me wrong", but OK
I still stand by my point as backed up by law in nine states, but I don't have all damn day to be arguing about a topic we will never gain ground on. I'm conceding that my time is worth more than this thread
 
I still stand by my point as backed up by law in nine states, but I don't have all damn day to be arguing about a topic we will never gain ground on. I'm conceding that my time is worth more than this thread
That's just crazy talk, as an intern your time has no value :)
 
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False. Every pharmacy act that I'm aware of requires a DUR for each and every prescription

This and corrrsponding responsibility are the two facets of pharmacy that most people seem completely unaware of.

I keep seeing people on social media saying our job is to dispense what the doctor prescribes and it isn't our place to question them. Meanwhile, the reality is we are legally required to question every prescription we process. Failure to successfully fullfil this duty leaves us legally liable for any harm that occurs.

I feel gross arguing this point due to this case because I absolutely do not support denying care for "ethical" reasons. Our responsibility is to the patient. I have refused med orders that are dangerous, and that is where it should end.
 
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It's sad when people outside our profession try to tell us how to do our job. They are so clueless. (@Mad Jack )
 
Yeah, but pharmacists aren't offering each individual medication as its own service. They offer the general service of dispensing medications. Just like a person that prescribes, say, AEDs for seizures isn't going to prescribe them for bipolar disorder. Indications matter in medicine, pharmacists don't practice medicine.

No, we practice pharmacy, and it's actually been both a common law and historical tradition as well as inscribed into statute that pharmacies are free to keep (or not keep) whatever their clientele requires and the pharmacy is comfortable dispensing. Remember, until the late 00s, uniformed pharmacies in MTFs did not ordinarily carry even standard birth control (and still it's situational).

Unlike medicine, because pharmacy is declared to not be a profession, it actually is not bound in the public health "necessity". A patient drops down in my pharmacy, I call 911 like anyone else. I don't have any duty to dispense anything to anyone, and I'm actually protected on that matter (even on things like a patient having an asthma attack and I refuse to dispense albuterol until payment is rendered). I know pharmacies that used to proudly advertise that they were in compliance with Catholic Healthcare Association standards, which were an obvious ringer for "we don't do any reproductive health services" and actually Title 42 specifically has provisions about the matter that exclude Catholic Healthcare, the hospital of the handshake (Shriners), and other organizations from those matters. This is not nice, but it is the reality.

In practice, until the precedents change and actually are enforced, pharmacists and pharmacies have no ulterior public health duty to do anything unlike medicine. If you want that changed, you're going to have to change the distribution method. Either stand up a pharmacy that more or less exclusively does that work (as Planned Parenthood laudably does in metropolitan areas), cut the pharmacist out of the equation by making Plan B OTC, or just directly administer to the patient from the prescriber themselves (again, another good Planned Parenthood practice).

(As written above, I have no impediment to dispensing anything. I'm just pointing out that you're not arguing something achievable, if you want a change, you're going to have to explicitly force it, but as of right now, there's not much you can do to that incompetent pharmacist which is a shame.)

One last point, laws mean nothing if not enforced. The professional boards for pharmacy and medicine historically let their membership get away with fairly stunning incidents. Changing public opinion to do something is going to be the way this has to resolve, but we're all too entrenched in our own special interests to allow change to come to us.
 
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Yeah I know what you're doing with your free time you lucky bastard
Which will make its absence all the more painful. But I'm going to make the best of residency, and hell, home isn't that far away and I've got a few beds to crash in when I've got free time, so maybe things won't be so bad
 
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Which will make its absence all the more painful. But I'm going to make the best of residency, and hell, home isn't that far away and I've got a few beds to crash in when I've got free time, so maybe things won't be so bad

Eyebrows.gif
 
I'm late in this post, but I will say....assuming the patient's side of the story is 100% true (which is most likely is not), then the whole situation is appalling. Especially since it likes the pharmacist was already filled, their were technicians who could have done the physical selling, and if only counseling was required wouldn't it be possible for the pharmacist to call a willing pharmacist in the same chain to do the counseling? This really seems like a situation that should never have happened. Even so, I agree with others about the public thoughts, even of doctors here, that pharmacists should fill every prescription period.

Am I required to tell a pharmacist what im using an RX is for? What is the legal/HIPPA on that?

No you aren't required to tell me what you are using an RX for....but I'm not require to fill your prescription either.

That's the thing though, the Bible says a whole lot more that people don't follow. Shouldn't they not dispense birth control or pde5 inhibitors?
You can't pick and choose from the Bible.

There are independent pharmacies that do not carry any birth control (I don't know about PDE5 inhibitors....I've never heard of people making a moral issue about that....although I'm sure there are rare individuals out there who would) It is literally impossible for an pharmacy to carry every drug, if a pharmacy doesn't want to carry an entire class of drugs, well it's probably not a wise business decision, but it should be there decision to make.

And within those groups a number wouldn’t use it thenself but would dispense

I count myself in this group. As someone who strongly leans liberatarian, I'm not going to tell someone else what they should or should not be doing. I guess this also shores up with my religious beliefs, as I believe God often tolerates sin or less then ideal behavior, as we are all still learning. Just like a parent's expectations for a 2 year old's behavior are far different than they are for a 16 year old's behavior (or at least they should be!), similarly I also believe that God has different expectations for each person's behavior based on their religious/spiritual age. I can't, nor should I try, to teach algebra to a 2 year old, nor should I be trying to impose my religious beliefs on anyone else (as I have no idea what their religious/spiritual age is.) *IF* there is a sin involved, then it will be on them.

So the pharmacist picked one thing from the Bible? Doesn't should very Christian. Sounds like it's ok to not follow anything.
That's the thing though, the pharmacist didn't take the time to find out what was going on here either. He just blanket refused it.

Here is the GREAT thing about the 1st amendment....it gives "freedom of religion" to ALL religions (yeah, yeah, I know atheism is a hair color in the same way that bald is a hair color, but I think we can agree that atheist's beliefs are protected under the 1st amendment.) There is NO requirement that a religion be logical. People have greatly differing interpretations of the Bible, and that is their right in the US. You even have religious groups, like B'Hai or Mormons who believe the Bible is correct, but that later religious writings are more important in understanding/interpreting/superceding the Bible (just like Christians believe about the New Testament.) So, while you may think it's religiously wrong for a pharmacist to pick one thing from the Bible and only believe that (and this is most likely not true at all), but even if it were, that is a valid religious belief in the US. Most people agree that religion can't be "proven" in a scientific lab, so whatever someone says is their religious belief, is indeed a valid religious belief....for them.

Per the ruling in Stormans, Inc v Wiesman, in states that require dispensing such as WA, pharmacists have no Constitutional right to decline. This doesn't apply in this case, but it is to say that pharmacists do have to dispense in some states

I extremely doubt that is true. Illinois has a law that pharmacists can NOT deny prescriptions for moral/ethical reasons, but in Illinois pharmacists absolutely can and do deny prescriptions for medical reasons. Now, it appears there was NO medical reason to deny the prescription we are talking about here, and I'm sure that is the kind of cases that WA law is saying is illegal. But medical reasons? Absolutely.

If it was you or a member of your family that couldn't get this medication because that pharmacist decided you/she were lying about why they needed it (miscarriage vs abortion), would you still think this is their right?
I can't even wrap my head around anyone thinking this was ok to deny for "religious reasons".
Can I just say "religion" and get away with anything?!

Yes (in their personal life) and no (in their public life.) I completely agree with you, as do probably all religious people, excepting those who think taking any drug is wrong. Maybe the patient was lying, but why wouldn't the pharmacist think that the sin was on the patient for lying? It hasn't been that long ago that misoprostol was used to induce labor for healthy pregnancies (rarely done these days because of bad outcomes....), just pointing out that misprostol is far more than an "abortion drug", and it is poor practice for the pharmacist to assume the patient is using it for abortion, instead of assuming it is being used for other indications.

, but all pharmacists in retail chains provide the service of dispensing medication.

Nothing requires a pharmacist to dispense all medications, and it is literally and physically impossible for any pharmacy to stock all medications. And it's not unheard of for pharmacies to deny filling a prescription because of cost (a small pharmacy is not going to order a exorbitantly-priced brand name bottle of #100 tablets, for a person with a 1x prescription for #20 tablets....they will tell that person they don't stock the medication and they will have to get it else where) Another example, where I highly doubt that WA law would require pharmacists to fill such a prescription that would cause a great monetary lose to their pharmacy.

Because, again, their function is the same thing regardless of medication. They verify safety and dispense. They might provide some counseling. They make sure the dose entered was correct. That is the same regardless of medication. We, as physicians, have already determined something is necessary for our patients, and, so long as it is not in error,

Wrong, wrong, wrong. What pharmacists should never do is 2nd guess the DIAGNOSIS that a doctor has made, but we absolutely have the right, and duty, to determine appropriateness of a medication based on the diagnosis, and/or other medications that the pt is on, and/or other diagnoses that the pt may have. Now, 95% of doctors, will be quite reasonable when a pharmacist calls and explains the issues with a medication that the doctor had prescribed (oh, did I write methimazole for my newly diagnosed diabetic patient, I don't know what I was thinking, I meant metformin. I know bad example because the dosing is totally different, but let's ignore that for the sake of discussion.) And many times, there are times there is additional information that the doctor has, and then the pharmacist will totally understand the reasoning why it was prescribed (ie the patient doesn't really have diabetes but has dementia, but thinks they must because "diabetes runs in their family.") I have, unfortunately, talked to doctors who will never admit they made an error, no matter how egregious it is, and pharmacists have every right, indeed duty, to document and refuse to dispense such a medication.
 
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