"Behind the Counter Drugs"
Learn more about them here.You learn something new everyday. Today, I learned about "behind the counter" drugs (BTC). It seems that the FDA is contemplating a new class of drugs to be added to the traditional dichotomy of prescription vs. over the counter (OTC).
BTC drugs will be halfway in between. They won't require a doctor's prescription but a patient can't simply purchase them on his own. A pharmacist can dispense them though, after questioning the patient and making a clinical judgment (presumably without performing a physical exam). I suppose that if this gives patients added access to health care, this may be a good thing.
But in all honesty, I have mixed feelings about it. Unfortunately it'll be difficult to voice them without giving the appearance of "protecting my turf". But here goes.
First of all, I can't believe that pharmacists will be willing to assume the role of clinician with its added liability without charging significantly for their services. Clearly, this marks them as direct competitors of physicians (particularly primary care physicians).
Will they then be objective about when a patient's problems are out of his range of expertise and be as willing to refer as previously?
Also, the pharmacist is in the same position that people often chide physicians about, namely having a vested interest in the treatment. When a pharmacist prescribes a BTC treatment, is he doing it out of purely clinical consideration or because in addition to collecting his counseling fee, he's also selling the drug as well?
Another obvious problem that would have to be worked out is the issue of malpractice. Will a pharmacist be held to the same standard as a physician? More to the point, will he be held to the same standard as a physician who diagnoses and treats without performing a physical exam?
Ultimately, I can't really think of a medication that I could imagine putting into this category. The dearth of potential candidates may in fact be the ultimate coup de grâce for such a policy. The article I linked failed to list a single example of such a drug.
On the other hand, perhaps there might be one exception.
Late one night, I was at a pharmacy picking up a prescription for my wife. I overheard the pharmacist talking to the customer next to me. The customer, a young woman, wanted to know which OTC could help her with the two days of terrible burning on urination she was suffering. The pharmacist told her that she'd have to see a doctor about that problem and that there wasn't anything she could recommend.
I came very close to ordering three days of Bactrim for her right then and there. Maybe a question about fevers and drug allergies...it would have been so easy.
I passed. Maybe the pharmacist had she been allowed to, wouldn't have.