August 01, 2017
Ken Baker, BS, PharmD, JD, is a pharmacist and a lawyer with years of experience dispensing medications and legal advice. He’s currently a consultant who teaches pharmacists across the country about ways to reduce medication errors, risk management and pharmacy law. Mr. Baker took a few minutes to talk about some of the workplace challenges pharmacists face, especially now that in many ways their job is more challenging than ever. They’re better educated and expected to apply that breadth of knowledge in many ways, even as their days are packed with an increasing amount of clinical duties.
What ethical issues do today’s pharmacists face?
The primary one is recognizing their professional duties and figuring out how to organize their job responsibilities into order to perform those duties. Pharmacists have an obligation to counsel patients when necessary about their medication use and to protect them from harm. Problems arise when pharmacists are filling 300 to 400 prescriptions a day. Where do they find time to perform those duties? Pharmacists must also conduct perspective drug reviews on each prescription. Although pharmacists ideally would like to have time to perform those checks on every prescription, when faced with the reality of the real-world care setting, they might have to prioritize which prescriptions they’ll give a more thorough review.
How can pharmacists use their time more wisely in order to optimize patient care?
Pharmacists often have to figure out which patients need their help the most and spend time with those individuals. They can do that by reviewing each individual case to see which diseases patients have and which drugs they’re on, and take into consideration their physical characteristics and their level of healthcare literacy. Pharmacy technicians can help by gathering that information and handing a checklist to the pharmacists, who will then have some idea about each patient’s clinical situation and determine who might need pharmacy services more than others.
Interview continues on page 2
What responsibilities do pharmacists have when it comes to monitoring medication compliance?
Half of patients with high blood pressure no longer take medications prescribed to treat the condition after they’ve been on the therapy for a year. That’s just one example of the type of compliance issues pharmacists must help manage. Pharmacists, along with physicians, are in a position to know how patients are complying with their medication regimens by noticing how long medications last between refills. If pharmacists notice trends that indicate patients are not taking medications as directed, they can and must talk to them about the importance of compliance.
What’s the best way for pharmacists to have difficult discussions with physicians?
First and foremost, they can’t worry about stepping on toes. Pharmacists have a job to do and must fulfill the duties of their profession. The pharmacist-physician relationship is often synergistic—both professionals want patients to be compliant with their medications. But once in a while, conflicts arise when pharmacists notice that physicians have prescribed medications that are contraindicated in patients or contraindicated because of other drugs patients are taking. They call the physician, who may or may not be aware of the drugs that should not be used.
I once called a physician to alert him to a contraindication involving a medication he prescribed to one of his patients. He became angry, but I told him the patient could take the prescription elsewhere, that I wasn’t going to fill it. In the end, pharmacists must sometimes fill prescriptions that they don’t think patients should receive. They don’t have the right to veto what physicians prescribe unless the medications are definitely contraindicated or pose a substantial risk to patients.
How should pharmacists manage the use of opioids?
That’s one of the most challenging dilemmas pharmacists face today. They must deal with patients who overuse the medications by taking substantially more than they’re prescribed. They must also recognize illegal prescriptions, and might have to deal with prescriptions written by pill mill physicians who are not prescribing drugs for legitimate medical use within the parameters of their duties.
If pharmacists question the legitimacy of a prescription, they can refuse to fill it. If they’re completely sure the prescription is illegal, they must alert the authorities to report the crime. There is a real ethical problem involving pharmacists who are being too cautious by reading too much into red flags that raise their suspicions. When pharmacists see a red flag—a patient paying with cash, for example—that doesn’t mean they should automatically refuse to fill the prescription. It means they should ask more questions to find out if the prescription is real.