A middle aged woman came up to my pharmacy counter and asked for my supervisor. She wanted to report the nurse practitioner who works in the Minute Clinic adjacent to my pharmacy for not prescribing her antibiotics. According to the customer, this was the second time she had been to the clinic in one week with complaints of a persistent cough. Both times, the nurse practitioner followed protocol and deduced that the patient did not have a bacterial infection, and therefore did not need antibiotics. The patient, already having her mind set on receiving antibiotics, stormed to a nearby urgent care clinic that is notorious for corralling patients in and out with a Cipro prescription, and came back about an hour later to pick up her antibiotics. According to the urgent care, the patient had walking pneumonia, which they had determined without doing a chest x-ray, blood test, sputum test, or any kind of diagnostic measures to tell if the patient even had a bacterial infection, let alone which kind of bacteria.
As the patient continued to complain to my pharmacist while we filled her prescription, it was obvious that the pharmacist doubted the validity of the diagnosis as she informed the patient that the antibiotics were probably not necessary, and that a treatment for cough would likely do the trick. My pharmacist, being the treatment expert, knew the exact requirements for diagnosis and treatment of walking pneumonia, yet dispensed the prescription anyway because that's what pharmacists do.
In this instance, had the pharmacist had more discretion over the situation, the patient would not have received the unnecessary antibiotics, and that would have been one less person contributing to antibiotic resistance and putting herself at risk for secondary complications and readmittance to a clinic. There are countless other cases where a pharmacist's knowledge has the potential to prevent a patient from receiving an unnecessary or harmful drug, and in most institutions, especially in the outpatient or community setting, pharmacists simply do not have the power to intervene with or override the decisions of a doctor. This is why the full potential of a pharmacist needs to be recognized, accepted, and implemented in all pharmacy practice, The push for provider status is at least a legal step closer to this, but I believe that an additional component needs to be considered; that is that the clinical knowledge and drug expertise of pharmacists should be regarded as equal to that of a medical doctor, and that community pharmacists should have the power to refuse to dispense any prescription that they believe is not in the best interests of the patient without first having a thorough, logical discussion with the prescriber and the patient.
This partly is a challenge due to the legal implications of a dispensing pharmacist's duties, but is also largely related to a pharmacist's own perceptive on his or her job, and the unfortunate business and corporate need to use community pharmacies purely as a revenue-generating resource. Individually, community pharmacists should realize that their value as a health care provider is much more than someone to simply bag and sell prescriptions (after all, are we really going through four years of pharmacy school just to count pills and follow alerts on a screen?). With this realized, a pharmacist can use his/her clinical knowledge to the extent that a doctor does, and could truly make an impact of treatment choices as a double check for the doctor. From the corporate vantage point, more large businesses should shift their focus from the money involved with prescription counts to the importance of time and energy spent on patient care. Companies need to allow their pharmacists time to really analyze each prescription in order to determine its appropriateness and safety, rather than just automatically verifying each one to be sold.
Medicine is a powerful field. With great power, though, comes great responsibility, and in the community setting, I believe that pharmacists and health care companies have a responsibility to dedicate time and knowledge to each patient in order to get the right drugs to the right patients for the right reasons, and to know when to intervene and not dispense a prescription as well.
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