Trend: Physicians dispensing drugs in offices

Pharmacists will never like a service that could potentially take business away from them. This is such a nice patient convenience. For a few extra bucks, I for one will skip a trip to the pharmacy, and also support my local physician.

It is really sad how rapidly the quality of medical care is declining in this country. Don't be surprised if the trends so common in India become commonplace here.
In India one could walk to a pharmacist and get anything from chemotheraputic agents to antibiotics! The pharmacist is the local nice guy (same image portrayed in this country). People walk to the counter, wait a while or shop around for sundry items and then casually ask the pharmacist what to take for a particular ailment. Not only does the pharmacist dispense the drugs with elan but also makes sure the prescriptions are in line with the local specialist's prescribing trend! Occasionally the pharmacists refer patients to the doctors of their choice. Drug reps details the pharmacists and pay them top dollar to stock the prescriptions and push a particular drug over their competition. Money changes hands at many levels and dynamic market place economics are in full play. This is ultimate capitalism applied to medial care. IS this what we want in this country? Perhaps the first step in this direction is the physicians playing pharmacists. Personally I feel it is a transgression into a field of study in which doctors have no expertise. Money spoils eveything...

How does the practice of physician dispensing transgress into doctors with no expertise?! In office medication dispensing involves stocking a very limited formulary of prepackaged medications and offering to dispense them to patients for a very modest profit margin. In many cases, dispensing physicians are dispensing 3-5 prescriptions each day at the point of care, which is nowhere close to the volume you'd find in a retail pharmacy.

I happen to like the idea of physician dispensing, so long as it's done in a safe and patient-centered fashion. Dispensing physicians should use information technology to avoid rare dispensing errors, and should always give patients a choice of whether they receive their medicine in the office or via a written script.

Perhaps I misunderstood your comment, Narayanachar?

Whether government or medicine or pharmacy a system of checks and balances ensures patient (citizen) safety.

I want my pharmacist to dispense my medicine and to counsel me about that medicine if I choose to ask for that service.

Recently, a physician/physiatrist prescribed a high blood pressure for my sister which was not first-line therapy for high blood pressure...

That same physiatrist/physician "poo-poo'ed" my sister's request to have an MRI to explain long-standing agonizing physical pains. While reviewing an X-ray the physician stated "we know that you have arthritis and look - here's the "Scotty bone"! My sister subsequently visited the local, expert neurologist who agreed to authorize an MRI, which showed herniated disks from C3 to C7!

That same physiatrist/MD who prescribed a blood pressure pill that was not pharmacologically "first-line" in 2007 verbally chastized my sister when my sister insisted that "my pharmacist thought
such and such a blood pressure drug might be a better alternative". The physician sniped, "you're pharmacist is NOT a DOCTOR!"

That same physiatrist/MD recommended gabapentin for it's reputed pain-killing attributes but wrote for a remarkably sub-therapeutic dosage - a most likely unhelpful dosage level...

We've witnessed the dumbing down of so many institutions over the past thirty years. We've seen too much greed, manipulation, and misreprentation of the truth. Physician dispensing in a unwise allocation of medical resources.
My pharmacist once told me that he could not understand how anyone could become a physician without first studying pharmacy.

I trust my pharmacist and I'm not willing to reliquish my health and safety to a dispensing doctor, nor a governmental bureaucrat, nor a bossy pharmacy technician who feels that she could do the pharmacist job...

Let the "dear doctor" do her doctoring and the pharmacist do her pharmacy. Actually, the Holy Bible is a starting point in seeking to clarify the division of labor required in the modern medical marketplace. The Bible speaks of "honoring the physician for the need thou hast of him" and eloquently mentions the medicines of the earth"...but the Bible does not proscribe that you visit your doctor in order to obtain a fistful gabapentin!

I respectfully submit that the pharmacist IS NOT the physician nor is the physician the pharmacist!

You either have an outstanding pharmacist or a poorly trained physician ... perhaps a combination of both. I'm in a different situation. I have an excellent physician who knows me very well. I do not have the same relationship with the college student at the local drugstore chain (the pharmacy technician) who fills my prescriptions under the "supervision" of a licensed pharmacist.

Moreover, even if I had a great relationship with my pharmacist, he cannot write a prescription. He simply fills the bottle, and double checks to make sure the pills in the bottle matches the pills on the prescription. If he disagrees with a prescription, he can tell the physician, but he cannot change the script without the physician's authorization. Said another way, the pharmacist double checks the drugs in the bottle. That's about it, in my case.

Today's physician dispensing systems automate the dispensing process, much like what happens in a retail pharmacy, and in many cases, at a level of detail that rivals pharmacies. Moreover, the drugs that are dispensed have been pre-packaged by an FDA authorized packager, who has also triple checked to make sure the pills in the bottle match what's written on the label.

I'm not suggesting that physicians become pharmacists, whereby all of your prescriptions are filled in the doctor's office, but we all know these fears about "checks and balances" are overdone. In certain cases - for example, when I'm sick and need a basic antibiotic, or when I just had a root canal and need a basic prescription pain medication - in office medication dispensing is a great choice.

For the record, I also think it's nice to find a retail clinic inside of a pharmacy, for those times when I have a simple sore throat and want an expert opinion about whether or not I have something serious that would require a trip to my primary care doctor. But that's not to suggest I want my pharmacy to replace my doctor's office, either.

This is the 21st century. Why can't we accept that physicians can dispense medications in certain cases, and that pharmacies can employ nurses to staff a retail clinic in certain cases?

The problem that is foresee is the fact that physician's, while experts at diagnosis and treating of diseases, they are not experts on dispensing drugs. Phsycian's only take 1 year of pharmacology. They also do not take any courses in pharmacokinetics, disease state management, or medicinal chemistry. A pharmacist is needed to make sure that a patient is not receiving drugs from different physician's that could interact with each other and produce adverse effects. As a pharmacist, the amount of revenue we would be losing is neglible, and doesn't really concern me. What does concer me is a patient receiving two of more medications from different prescribing physician's, and having serious medical problems due to drug interactions. I strongly suggest that physician's do not dispense medications to their patients, and leave that practice to the pharmacists, who know how to council, as well as provide information regarding drug interactions.

Anne, you are right about whether or not a doctor is already dispensing in handing out samples. We don't want to turn this into an indictment of the pharma industry, but I believe that if a doctor is prescribing a lot of the same types of medications, he should be able to offer the CHOICE to his patient. If the patient does not trust his primary care physician, then we have a much bigger problem than "division of labor" or who does what better.