Really, why bother being a pharmacist?
This story bugs the shit out of me.
I come into contact all the time with patients that make choices different from mine. But those choices are theirs to make. So long as the patient isn't giving me a prescription that will result in overdose or seriously conflict with other drugs they take, then I'll fill it and counsel them on it. I may not be happy about the choices they make (yes, I think you should taper off those benzos if you've been on them 3x a day for 10 years, I think long term you're screwing yourself to go to a non-university teaching hospital for cancer care, and I don't like dealing with IV drug users) but my official duty is to provide you with safe health care. I can't tell you what I'm thinking, and I can't deny you health care based on my beliefs. I have to smile and do your bidding unless it imperils your safety.
Why be a health care provider if you can't leave your personal opinions at the door? At that point, you're no longer a nurse, a doctor, a pharmacist. You're a judge, a priest, a pusher, something more than your patients bargained for.
And here's something else--if this wasn't about birth control, let's say it was a Scientologist pharmacist refusing to dispense mental health meds--then would this even be up for argument? Or would people see through this bullshit once and for all?
I come into contact all the time with patients that make choices different from mine. But those choices are theirs to make. So long as the patient isn't giving me a prescription that will result in overdose or seriously conflict with other drugs they take, then I'll fill it and counsel them on it. I may not be happy about the choices they make (yes, I think you should taper off those benzos if you've been on them 3x a day for 10 years, I think long term you're screwing yourself to go to a non-university teaching hospital for cancer care, and I don't like dealing with IV drug users) but my official duty is to provide you with safe health care. I can't tell you what I'm thinking, and I can't deny you health care based on my beliefs. I have to smile and do your bidding unless it imperils your safety.
Why be a health care provider if you can't leave your personal opinions at the door? At that point, you're no longer a nurse, a doctor, a pharmacist. You're a judge, a priest, a pusher, something more than your patients bargained for.
And here's something else--if this wasn't about birth control, let's say it was a Scientologist pharmacist refusing to dispense mental health meds--then would this even be up for argument? Or would people see through this bullshit once and for all?
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2 years ago I interviewed at a Catholic university for a post-doc position in their counseling center. I was told that if a student came in and told me they were pregnant, I was not allowed to talk to them about that. I had to refer them two outside pregnancy-counseling services, and one of the referrals had to be a pro-life organization. Once they decided what to do about their "situation" I could then work with them after that. Which I thought was completely absurd. I didn't ask if I was allowed to talk to gay students. I think it's ridiculous to say you can't talk to your psychologist about things the church doesn't believe are "right."
So, yeah, I get it. On the other hand, I kind of prefer that they're putting it out there that they're a Catholic pharmacy that only sells things approved by the church. You know that going in, right? It's on the door, essentially, if you know enough to figure out that your Divine Whatever pharmacy with the saints hanging on the wall probably won't fill your script for Plan B.
What I find more unconscionable is when you go to a regular pharmacy expecting to get whatever med your doctor prescribed and having THAT pharmacist turn you away. I have many more problems with that that someone setting up their own shop based on their beliefs. Also, it's in No. Va. I would also have a problem with it if it were in some rural area where that was the only pharmacy. But if it's just one option among many, and they're upfront about what they're doing.... I can live with that. Just like I can live with "pastoral counselors" or "Christian counselors." If you're upfront about what you're selling, that's cool. But I wouldn't want someone I knew going to a psychologist they thought would be neutral or supportive on certain issues and then be hit with a religion stick.
This story is over on feministing.com right now. Not sure if you regularly read that site or not.
I don't know why I feel like I always have to clarify my comments, but re-reading my comment just now....I don't think it came across that I DO think this is ridiculous... it just doesn't anger me as much when the pharmacy refusing to fill certain scripts is the only pharmacy around, leaving folks with no options, etc. But of course I think all pharmacists should fill all prescriptions, and I would probably go nutty on a pharmacist that tried to pull that crap with me. :) Especially given that birth control is often prescribed for other reasons, like reducing the symptoms of endometriosis.
To clarify my problem with it, and hence the title of the post--I feel that if if you're not going to fill all viable prescriptions, then you're not living up to your oath as a pharmacist. Personally, I don't feel that this place should be called a pharmacy. It's more like Divine Soul Drug Shoppe. We as a clinical discipline need to have more standardization on what is and what isn't a pharmacy, and we don't have that in community pharmacies (and is why I can't stand most of that part of ambulatory care practice).
What also cracks me up is that people argue that with all of the signs, it'll be clear what kind of pharmacy this Divine Drug Shoppe is. People walk into the prosthetics store next to the pharmacy I'm at *all* the time and ask for the most random stuff. They walk into our pharmacy and ask for the most random stuff. IV chemo? You can't walk out with a bag of that anywhere. But patients see pharmacy and that = prescription filled in their minds.
In Washington State, the new legislation (in response to the shitstorm over Plan B) is about pharmacists having to stock medications under reasonable expectations that their population will use, to be willing to refer/order medications if not in stock (most meds you can get in 24 hrs if they're not in stock), and to fill legally written, safe prescriptions. People argue that you should be able to have discretion as a small business owner. I think that if you want to be a small business owner with discretion on what you can sell, then you be a pharmacist. You should go into floral arrangements, selling soda, selling candy, selling cars. Then, sell whatever the hell you want. If you want to be a pharmacist, and be called a pharmacy, then you should sell and stock medications that are legal and safe to dispense (and yes, BCPs are one of them). Don't mess with inventory that in turn affects people's health care. What is between a patient and their doctor has nothing to do with what's between you and your God. If you can't separate that out, then you shouldn't be a pharmacist, and if you can't sell everything that a fully accredited, licensed pharmacy sells, then you shouldn't be able to hang a shingle on a place and call it a pharmacy.
To clarify on that last paragraph--if you want to be a small business owner with discretion on what you can sell, then you shouldn't be a pharmacist. That is what I meant to say, and no, no slips meant. I was editing out the cuss words, because this makes me so angry.
Lol. Yeah, I understood what you meant. I get that. I guess I just think of it in terms of my own field, where it is acceptable to practice in a limited way as long as you're very clear with your clients about that. Like, if you have some particular issue that you know you can't be unbiased about, it's perfectly acceptable and even expected that you would refer those clients to someone who can provide effective, ethical care to them. Like, if you can't tolerate drug dealers because you think what they're doing is so horrendous... you refer them to someone who can work with them effectively. I guess I was viewing this in a similar manner, but maybe that's not appropriate in medicine. Do they talk about this in your coursework? I'm sure you probably have ethics classes or that ethics of your profession are weaved into your program in some way. What is the general consensus in your field?
I'm with you, Cara! And, I might add, that when I was working for PP we had staff and volunteers calling up pharmacies to ask about EC and the number of pharmacists and techs who didn't know/realize there was a difference between EC and RU486 made us so mad. You're a pharmacist/pharmacy tech! Isn't it your job to know about the medications you are dispensing and to not hide behind this b.s. about "morally objecting" to the dispensation of either drug?!? It still makes me mad.
Last week at trivia, one of the questions was "what is the name of the "morning after" pill?" I put down Plan B. They had RU 486 as the answer. I argued and they gave it to us, too, but still reported the answer as RU 486. Grr.
My anatomy & physiology textbook said the same thing! An f'ing medical textbook! I had to point it out to my professor who was using the notes provided by the textbook publisher and he was shocked that he had missed it when he edited the notes before giving them to us. It's no wonder so many people are ill-informed.
OK, will you tell me the difference between EC and RU486? I don't know it.
Also, that article made me want to tear my hair out. I wish I could claim high-minded ethical principles, but it's really just a visceral reaction to hearing other people make rules and judgments about what's best for me. I am so tired of the "compassion" that the right wants to show us poor dumb women who can't worry our pretty little heads making choices about our own damn lives.
I agree with Alissa that if this is in a heavily populated area that has other options, I don't really care what the religious whackjobs do. No, they shouldn't really be allowed to call themselves pharmacists if they're going to be nitpicky about what they will and won't fill. But if people can just go to the Walgreen's or Rite Aid down the street and get their birth control there instead, then... meh.
Gwen: I'm sure the pharmacist and nurse can answer this better, but my understanding is that Plan B (the morning-after pill) is basically several birth control pills that you take at once to prevent conception from happening immediately after an "accident" - so like within 72 hours of unprotected sex, I think? Plan B sort of forces your period to happen so you can't get pregnant. A friend of mine had to take it after she was raped, that's how I learned about it. RU-486 is the drug that forces an abortion after you already ARE pregnant, hence why it's much more controversial.
Wow. This is the website for the group that "certifies" the pro-life pharmacies. These people are ridiculous. Their whole website is about "Barrie Hussein" (Obama) and not so much about the sweet little nunnies that I envision stocking the shelves with Ivory soap at the local pro-life pharmacy.
http://www.pfli.org/
Correct me if I'm wrong, but my understanding is that Plan B prevents ovulation and implantation, but has no effect if implantation has already occurred, which is why you need to take it within 72 hours. RU-486 is an abortifactant that can be taken during the first couple of months. Although, I think RU-486 can also be used as emergency contraception when taken in a smaller dose within 72 hours of sex, but Plan B is what is usually prescribed. (Am I right on that, pharmacist lady?)
Hello all! Sorry I've been away from the blog for a few days.
Here's a bit of info on the mechanism of action (hereafter MOA) for the drugs.
RU-486, also known as mifepristone, is categorized as an abortifacient. Progesterone is needed to maintain a pregnancy; that's why if you're undergoing fertility treatments you use progesterone supplements, and it's why you see a progesterone spike in pregnant women. Mifepristone's MOA is to compete with progesterone at progesterone receptor sites. This in turn leads to a decrease in progesterone, and the uterus can no longer support the embryo/fetus, depending at the stage in which it is used. The labeling for mifepristone is through day 49 of pregnancy, or up to 7 weeks.
Plan B, on the other hand, is a high dose of birth control pills. With Plan B, you take 1 pill followed by a 2nd pill 12 hours later. But what people don't realize is that you can duplicate the same effect with other BCPs. Depending on the BCP, you can take anywhere from 2-20 pills a dose and get the same effect. I don't know why there's such a frickin' hullabaloo around Plan B, when duh, if you are on the pill and you haven't been adherent and are concerned about pregnancy, you can call a pharmacy friend :-) or look up the algorithm and then take a proper dose. It's just a form of birth control pills, people, so stop yer bitchin' about Plan B!!
But back to MOAs--the way birth control pills work, they are usually a combo of estrogen and progesterone. The combination works to suppress gonadotropins overall. This in turn: a) hinders ovulation; b) changes the cervical mucus (thickens it and changes the pH so sperm have trouble entering the cervix); and c)changes the endometrial lining so that if a egg is fertilized, it doesn't implant.
Whew. Now, c is the big problem with a lot of folks and is why they don't like BCPs and see them as a form of abortifacient. Now, if you argue that life begins at fertilization, I have a hard time swallowing that argument, because there are plenty of times that an egg can be fertilized but doesn't implant for different reasons, ranging from chromosomal abnormalities to being fertilized too far up the Fallopian tubes to make it down to the uterus in time for a viable implantation. I'll leave the carry out of that argument to the reader, but you can see where I'm going with it.
Now, with regard to timing of the drugs--Plan B can prevent implantation, yet some fertilized eggs can implant within 72 hours, so it doesn't always work. However it can be effective after 72 hours, it's just that its efficacy decreases. The other thing to remember is that after sex, sperm stays in the body for up to 7 days (yes, you read that right) and can fertilize an egg for those 7 days (in some cases, up to 10 days). So even if it's past 72 hours, dose the Plan B. Give it up to 1 week after unprotected intercourse say the studies. It has decreased effectiveness, but can work. And hey, if it works for someone, isn't that better than an unintended pregnancy or an abortion?
OK, going off the drug topic and on to the pharmacy issue--I don't care if your shop is in a rural or an urban area. For some people, going to a different pharmacy 10 miles away is a hardship (no car? bus line doesn't run there? other pharmacy is closed?) therefore if you're calling yourself a pharmacy, stock the damn drugs you're supposed to stock. A Washington State law was enacted all the way back in 1960 mandating that pharmacists have to make a good faith effort to keep all drugs in stock that are reasonable to expect that their local population will use. I think that's a great idea, and whether you're rural or local, when you get your license you should be reminded you are here to serve patients and their health care, not your personal agenda.
To Alissa's question way back when about being able to refer elsewhere because of possible conflict, as PsyDs can do--I think that is more reasonable for someone in an iterative setting such as behavioral therapy. Being a doctor, a nurse, or a pharmacist, you get a diagnosis, you make referrals, you make sure the drug is proper, and you then support the patient. While there are gray areas at times, I think you need to serve the patient. For a PsyD, when you are going back and forth with the patient, I can see how it may be hard to separate out a conscious or unconscious issue. But when the algorithms are laid out for you, clear as crystal, as they often are in medicine, then it's more of a management issue in clearly delineated terms.
OK, I'm off to the opera now. Hope y'all have a good week!
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