Vicious Rants of an Angry Yellow Man

Couple of authors wrote into the LA Times supporting the idea that pharmacists should be able to prescribe medicines. They say that pharmacists know more about pharmacology than physician assistants and nurse practitioners who are allowed to prescribe. The flaw of this reasoning is that pharmacists don't examine the patient. Making the right diagnosis is the most important part of prescribing treatment. I don't know how you can make the right diagnosis without examining the patient. They point to the morning after pill which someone can purchase without a prescription just by talking to the pharmacist. According to them the next logical step would be to allow medicines for migraines and cholesterol to be sold behind the counter. This does not seem logical to me. If a woman comes in and say that she needs emergency birth control, there is no need to examine her to see if she really had sex last night. But over the years I have had many patients who come in and tell me that they have migraines but upon further questioning and examination, I found that the cause of their headache was not migraines. Treating cholesterol requires ordering and interpreting test results. This is not something pharmacists are trained to do.

It is legal for doctors to dispense medications. I choose not to do so for two reasons. First I believe that pharmacists play a very important role in assuring the safety of the patient. Just like any human being, I make mistakes. When I make a mistake on my prescription a pharmacist usually would point it out to me. If I dispense the medicine myself, this layer of protection is lost. So if a pharmacist prescribes and dispenses, wouldn't that layer of protection be lost? The second reason is that it gives an appearance that I may prescribe more to make a greater profit. Most of the doctors who dispense and most pharmacists who would prescribe are probably honest. But some would be dishonest. If the government and the patients think that one step shopping is the best way to go, then I guess I may have to dispense as well to keep up with the times. I hope it won't come to that.

The authors of the article are economists. While I understand that economics teach us that free market usually works the best, it is not the case here. When the person who provides the product is able to tell the buyer what and how much to buy, free market forces are not at work. More people prescribing and dispensing will lead to higher and not lowe healthcare costs. Believe me if you can walk into a pharmacy and get medicine without being examined, you will see more advertising by pharmaceutical companies to encourage people to do so. These companies will also pitch to the pharmacists who unlike most doctors who only prescribes will have more incentive to sell more. With more medicine taken, more complications will certainly follow and there will be more healthcare spending. So the economic calculations by these authors are totally wrong.