Scope of practice of a GP/FP

A couple of days ago I posted this blog 

#Walgreens: pharmacist told me he can no longer fill it (opiate) because I do not have cancer

“Hello Steve do you know who I contact to complain about filling my prescription? For the last 2 years I have been filling my prescription at Walgreens and the pharmacist told me he can no longer fill it because I do not have cancer. I am 60 yrs old have had 2 back operations my prescription is oxycodone 30 mg two times a day it’s crazy what he told me. Thanks”

On comment by a person whose ID’d  suggested that they have a PharmD degree … got me thinking… of the “excuses” Pharmacists are using to support their “medical decisions”

“Wow. As a pharmacist, I can assure you there is A LOT MORE to that story. It’s far more likely that the MD who wrote the RX is under DEA investigation or the MD is practicing outside of the scope of his/her practice (family practice MD who’s trying to function as a pain specialist, etc). And you are correct – there’s nothing you can do to force the Pharmacist to fill a script. Just the same way that a MD cannot be forced to write you a prescription, a pharmacist cannot be forced (or coerced) into filling a script.”

‘the MD who wrote the RX is under DEA investigationlast thing that I knew about our legal system is that any us citizen is “innocent until proven guilty” I know one physician that has been “under investigation” for abt FOUR YEARS… this physician still has a license in good standing and still has a DEA license in good standing.  But this physician to is having trouble with some local pharmacists refusing to fill the controls this prescriber writes… to the best of my knowledge .. these same pharmacists do not have a problem with filling this prescriber’s prescriptions that are written for NON-CONTROLLED medications.

“MD is practicing outside of the scope of his/her practice (family practice MD who’s trying to function as a pain specialist, etc)….

I wonder if these same Pharmacist challenge a GP/FP’s prescribing within their scope of practice for treating any pt with any number of health issues where there is a specialist that deals with a specific disease state… some particular examples.

If a pt is diagnosed with diabetes, should the pt then be referred out to a endocrinologist ?

If a pt is diagnosed with asthma or emphysema should be referred to a Pulmonologist ?

This list can go on and on ad nauseam

Some years ago I got a call from a Dentist who specialized in treating TMZ, myofascial trigger point pain and the like, he was also an associate professor at a large west coast dental school, but his prescriptions for non-controlled medications for the appropriate treatment of the disease issues that he was treating was being challenged by some local pharmacist for him prescribing “outside his scope of practice”… when in reality these Pharmacists only saw the initials behind his name indicating that he had a DENTAL DEGREE and JUMPED TO THE CONCLUSION… based on that slim amount of information that he was “outside his scope of practice”

And I agree with this poster that THERE IS A LOT MORE TO THIS STORY…  if what this pt said in the email to me is true.. that the pt had filled the same prescription at the same Walgreens for TWO YEARS from the same doctor… and this Pharmacist ignored this fact that what he was dealing with was a opiate dependent pt…  The dose was within the CDC’s guidelines as upper limit of MME’s  Pharmacists will require pts to wait until there is only 2 to 0 days of medication left from the previous prescription… so this pt being denied his routine opiate (Oxycodone) prescription could end up in a full blown COLD TURKEY WITHDRAWAL within a few hours not to mention UNTREATED ELEVATED CHRONIC PAIN.

All healthcare professionals have a “scope of practice” … who is in charge of making sure that Pharmacists do not exceed their scope of practice?

 

 

One Response

  1. I have always felt that ONE doctor should be the one to provide my care, specialists are for specific care that the gp or internist can’t figure out. While that isn’t popular with specialists who charge mega bucks for their services which for me hasn’t been anything that the pc wasn’t doing already! I have found that for the most part keeping my care with one provider is best. Once a needed course of treatment is stabilized the specialist is redundant unless a further investigation is needed. In chronic pain care it’s ridiculous to be forced to pay for a specialist every month to get a prescription written! Insurance companies are always so worried about the bottom line would agree!

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