Physician groups have begun quietly lobbying Congress, the FDA and anyone else who will listen to give them the right to dispense prescription medications. At first, I thought it was a joke, but they seem pretty insistent about it, so I will take it seriously. They realize it’s a long shot, but it is lucrative enough that they’re going to try.
After all, if pharmacists can administer shots and open point-of-care clinics, why not allow doctors to cut pharmacists out of the loop and dispense directly?
As readers of this blog know, I’m generally pro-consumer. If it expands options for patients, I’m in favor. But if physicians begin insisting that patients have to get their meds from the doc, that’s a problem.
In some countries, physicians have the ability to dispense medications in addition to prescribe. It is problematic because it opens physicians up to a considerable conflict of interest.
This won’t go anywhere anytime soon, but will be interesting to watch.
3 comments:
Yes. Often physicians and others see an inherent conflict of interest in the dispensing of medications for a fee. Those folks are correct. It is, in fact, a conflict. And so, we might add, are the following: scheduling additional office visits; ordering X-rays, blood tests, urine tests, hospital stays or surgery; or any other act in the medical profession for which a physician gets compensated. Conflicts are a basic part of everyday life. Conflicts only become problems when the resolution of the conflict is done improperly. That is the ethical part.
To be sure, that professional judgment must be devoid of consideration for any personal economic or emotional benefit to the professional. This requires a deliberate act on the part of the professional and often runs contrary to human nature. In the case of our health care, we have entrusted that ethical responsibility to our physician. We expect our physician to charge for the professional judgment and all services provided. The provision of medication is simply another service for which our physician is entitled to a fee. The act of dispensing medications is in no way an adverse reflection on our physicians’s ethics. Considering the lower cost, greater convenience, greater compliance and better health care resulting for the patient, it is one of the more positive statements that could be made about that professional’s ethics.
I don't think consideration must be devoid of any economic benefit to the physician, but preserving patient interests should certainly be a top priority. The Washington Post today published a feature story all about physician dispensing, suggesting this is a trend that will continue to grow across America.
See http://www.washingtonpost.com/wp-dyn/content/article/2007/10/26/AR2007102602484.html?sub=AR
I am a huge proponent of patient convenience. Anyone who reads this blog knows that.
I will also admit to healthy skepticism when it comes to physician motivations.
If docs are doing this to help patients great. If docs are doing it to make money, big problem. I suspect it is the latter.
One only need look to Japan to see the slippery slope that physician dispensing can lead too. Radical over-medication of some patients (namely seniors), point-of-sale abuse of narcotics (although I'd argue we've essentially got that here) and a system where physicians control access to medical knowledge and patients can't get independent information.
Physicians are being criticized right now for being on the take with drug companies. The logic is that doctor's can't be trusted to make their own decisions and we need some paternalistic force to keep doctors safe from pharma.
What happens when docs get the right to dispense in all 50 states and completely remove the pharmacist? Who is going to look over the docs shoulder and keep the patient safe?
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