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Just today I was at the pharmacy picking up a prescription. There was a gentleman there picking up a new prescription for amoxicillin who asked for the pharmacist to come to the desk to explain how to take the medication.

There was one of those harried pharmacists who finally came over to help him and said just that you take it every xx hours as needed. He had to force her to give him a little more information, like could he take it with food or what other instructions there were. She just said take it with plenty of water. There was not even a mention of finishing the entire prescription, and the pharmacist acted like she was being asked something unreasonable, like any idiot should know how to take this stuff.

I was irritated with her even though I wasn't the one being treated poorly. It would have taken even less time for her to do her job and explain thoroughly than the "pulling teeth" grudging response she finally gave.

Yes, there is lots of room for improvement when it comes to the antibiotics.

Best regards,

Ma'am, have I told you lately I'd love to give you a big kiss or at last, buy you a cup of coffee?

There is no excuse, on ethical if not even legal bounds, for providing patient counseling in the pharmacy setting. Many states have laws on the books in this regard but there is no Federal mandate as yet.

And if a patient ASKS?? Then it turns into potentially ugly legal recourse if any adverse reaction should occur, which can end up even backfiring on everyone involved in the chain of care, back to the pharmaceutical company.

For example, Amox prescribed to a Pt with an active mononucleosis infection often gives them a frightening purple rash and skin discoloration. I've seen it, it is not pretty.

All the new modern pharmacy systems such as the major chains use use rudimentary database methods to find dangerous drug interactions. It's a step. I guess. But I think it also provides a false sense of security.

Unless HIPPA / HCFA and other patient privacy rules are violated as Bush seems to want to do, Pharmacy and Pharmacist A won't know what their B counterpart are up to. Polypharmacy remains a risk, a terrible one, for the infirm and elderly, and in fact the general public.

On the other hand, I don't want Big Brother consolidating all my medical and drug records, no matter how good the intentions might be, because information systems security, particularly in medical and forensic systems, can be broken, for the right price, to the wrong people.

What to do?

Let's take your Amox Pt. as an example:

Prescriber should have briefed him on the purpose of the medicine, ensured he had no contraindicating conditions, maybe even done a culture? That's old fashioned these days it seems, but my stepfather routinely did in-office susceptibility cultures from nasal and throat swabs, sputum, and, er well other things. And of course either administered stat in the office, or prescribed; if he had the least suspicion of anything unusual, a susceptibility plate was run, and blood drawn and sent out. They used to be easy and cheap to do, a monkey could do them.

And certainly the prescriber should have instructed the Pt on how to take the medicine and side effects and what to do.

RN's out of this one.

Pharmacist, first, should have ensured proper labelling including the "FINISH THIS WHOLE BOTTLE OR WE SEND THE ANTIBIOTIC NAZI's OUT TO GET YOU" label. Labelling should also have included proper administration, take with food, on an empty stomach, yadda yadda.

More importantly, the Pharmacist should first have asked "Do you have any allergies? Especially to molds or to penicillin or to other antibiotics? Have you ever taken this medicine before, that you can recall, Mr. Jones?"

That could have caught a mistake that would have cost that patient his life; acute anaphylaxis is not a nice way to go.

And, lots of people cannot or will not read; if they cannot read or speak English, they are in even more trouble.

Labelling and printouts and computer systems will never replace family practitioners, nurses, and pharmacists who actually know patients as people, instead of by file or prescription number.

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