Why is my pharmacist asking so many questions?

I remember not too long ago, a friend of mine was complaining that the pharmacist asked her too many questions when she was getting her prescription filled. "What were you asked?" I wondered aloud. It turns out she was prompted to provide information about her weight, whether she was pregnant or breastfeeding, what other medications had she taken in the past, and what other medications is she on now. I explained to her that these questions are meant to help complete her profile so that the pharmacist can identify potential drug therapy problems with her medications before any adverse effects occur. She accepted that and later felt appreciation rather than the initial resentment.

In Connecticut, "a pharmacist shall make a reasonable effort to obtain, record, and maintain...:

(1) name, address, telephone number, date of birth or age, and gender;

(2) individual history where significant, including disease states, known allergies, and drug reactions;

(3) a comprehensive list of drugs and relevant devices dispensed by the pharmacy within the last 180 days; and

(4) the pharmacist's comments relevant to the individual's drug therapy."

This information will be helpful to the pharmacist when a patient presents a new prescription to identify any potential problems with the overall drug therapy. Basically, the pharmacist is looking for any:

• duplication of therapy (e.g. is the patient taking multiple medicines that work the same way or multiple products that contain the same active ingredient?);
• contraindication between the medicine and a disease (e.g. does the patient have a condition that precludes him/her from taking the medicine?);
• drug interactions (e.g. will this medicine increase or decrease the effects of the other medicines the patient is currently taking or vice verse?);
• issues with the dose and length of therapy prescribed (e.g. if the patient stated that he has kidney problems, is the dose going to be too high? or does the patient need to be on 3 weeks of high-dose steroids by mouth for an acute asthma attack? or if the patient is pregnant, she should not be taking certain medicines for blood pressure or cholesterol control);
• interaction of a medicine and allergy (e.g. if the patient stated that she is allergic to soy, she should not be given Atrovent as an inhaler); and
• clinical abuse or misuse and any other significant clinical issues relating to the appropriate use of drugs (e.g. is the patient really still in pain 4 weeks after a root canal treatment?). One's weight can be used to determine the appropriateness of the dose.

It is our duty as pharmacists to ask these questions. Unfortunately, as a patient, I've only been asked about my allergies and nothing else when I have had my prescriptions filled. In fact, I had to ask about the effect of the medications on the breastfeeding baby. I also wish I was asked my children's weight when I present their prescriptions. Well, it's not relevant when it is for a topical cream, but it could be for an oral antibiotic. It really doesn't matter what state you live in, because all pharmacists have been well-trained in all aspects of medications and common disease states. So, if you're visiting a pharmacy for the first time, and your child has a chronic illness or is currently on multiple medicines from a different pharmacy, ask if there is any other information the pharmacist might need for your child's profile. To make it easier, fill out a medication list (The Pediatric Pharmacy Advocacy Group has a sample you can download) and have a copy available for the pharmacist to review. It could save you some hassle later on.

Don't be shy

I was disappointed to learn that my own mother thinks that pharmacists do not have to make any decisions as part of their job. That pharmacists would not take the time to ask a patient why they are taking a particular medication. That doctors would never call a pharmacist to ask about a particular drug. In essence, they just read the prescription, fill it, and dispense it.

After a long and heated discussion, I realized that it's not her fault for having these misconceptions. I thought back to the times when I helped her bring and pick up prescriptions at the local pharmacy that she uses. When you walk in you see a row of chairs facing the counter. There are at least 3 people behind the wall of shelves (you can barely see the tops of their heads) and 3 people in the front behind the register. When you drop off the prescription, they give you a number. You can sit and wait 20+ minutes, or go back. Picking up the prescription involves handing them the number, the cashier reaching for the tray with your number, then handing you the goods. Sometimes you are advised about the medications, but by the clerk, not the pharmacist. When does the pharmacist step down from his workspace? If you have a question about why the drug isn't covered by your insurance or if you have a specific question that the clerk cannot answer.

True, this is not that different from other pharmacies, but patients have the right to ask questions. The pharmacy experience shouldn't feel like being in a factory. Do not feel that you are bothering the pharmacist. The role of a pharmacist has been much expanded to include more direct interaction with patients (face-to-face counseling) and more involvement in the design and execution of drug therapy plans for chronic disease states, like asthma, diabetes, high cholesterol, and high blood pressure. There are pharmacists who specialize in certain areas, like pediatrics. In fact, most states allow trained pharmacists to immunize adult patients. And yes, pharmacists can be interactive with patients in the hospital setting, too.

Your pharmacist is really a great source of information and is willing to talk to you. If you sense differently, seek better care elsewhere from another pharmacist. Don't be shy about your child's, or your own, health care.