I read about it in the papers, just as you may have. A Milledgeville pharmacist recently declined to fill a patient’s prescription for an off-label use of a medication. Some of those quoted by the media seemed genuinely surprised pharmacists could legally do that. “It’s not pharmacist’s place to question the physician,” they insinuated. A patient’s condition is between the patient and doctor, they said; it’s none of the pharmacist’s business.
That reaction deserves some perspective.
First, Georgia law does, in fact, permit a pharmacist to refuse to fill any prescription based on either his/her professional judgment or moral beliefs. So do the laws in most other states. In the Milledgeville incident, according to media reports, the pharmacist declined to fill the prescription not because of a moral objection, as some have assumed, but because the medication and dosage indicated were “off-label” – that is, not FDA-approved for treating the condition for which they were prescribed.
And second, I suspect those who suggest pharmacists should unquestioningly fill whatever prescription is presented to them, for whatever medication at whatever dosage, may not have thought through the implications of such a suggestion.
As health care professionals, pharmacists serve as gatekeepers to prescription medications. More broadly, they are experts and advisers on improving medication use to ensure patients get well — and stay that way. In fact, pharmacists are licensed by the state and have a legal duty to protect the public. One important way they do that is by relying on their extensive training to make sure the right medications in the right dosages make it into the right hands.
Pharmacists’ knowledge of pharmacology often exceeds that of physicians. That’s not meant as a slap at physicians. Just as physicians have training and expertise that pharmacists do not, pharmacists have training and expertise in the usage and effects of medications that physicians often do not. Each brings a necessary, complementary skill set to patient care, and they collaborate to achieve the best possible health outcome for the patient.
Getting the medication and dosage right means the pharmacist does need to know the patient’s story. It means the pharmacist must make judgments based not only on a patient’s medical history, but also on pharmacology, observation and common sense.
Would you fill a prescription for hydrocodone for a patient who is clearly intoxicated?
Would you dispense a script for an elderly patient if you know there is potential for a negative interaction with his other medications?
Would you instruct a patient to take a suppository orally because that’s what is (mistakenly) indicated on the prescription?
Would you not question a prescription for a dosage that is out-of-sync with FDA guidelines?
Every day, pharmacists catch medication and dosage errors, potentially deadly drug interactions, bogus prescriptions and other serious problems. And when those arise, pharmacists should discuss any concerns with the patient; that’s why the relationship works best when patient and pharmacist know one another. They also should — and routinely do — call the physician to verify and discuss the intended use of a medication before proceeding. That’s teamwork. That’s proper patient care.
That’s also why Georgia pharmacists may sometimes refuse to fill a prescription as written. Their training, licensure, ethics and humanity require them to take such care, to do no harm. It may occasionally be inconvenient at the pharmacy counter, but on a daily basis, lives are saved because of it.
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