http://thehappyhospitalist.blogspot.com/2009/02/its-time-to-get-rid-of-all-prescription.html

If those who are educated to prescribe aren’t keeping watch, then what do you expect will happen if all have access? Yes, people can get what they want if they search hard enough; but with the current system, most stick with one doctor and accept what they are given. Sure, they may google this & that, question their doctor’s motives or knowledge, and mess with their meds at home. But, what do you expect will happen if the floodgate is opened? If I don’t have to go to a doctor to get my meds, why go? Who then manages the disease process? Google? The only way this works is if you are taking the “natural selection” approach. Problem will be that innocent people get hurt due to antibiotic resistance or injury when Grandma has a syncopal episode and wrecks her car (there was a special on lopressor at the pharmacy…).

“Why not? As the patient I am ultimately responsible for my care. In any case, if I really want the care, I can probably find a doctor willin g to provide it.”

So lets say your brother Dave is a diabetic and hes dropping off your nieces and nephews for babysitting over the weekend. You say hey Dave, let me check my blood sugar, and sure enough its a bit high. Well Dave, just leave me a few of your diabetic medications that work so well for you so I can get my blood sugar under control too. So who is going to be watching your nieces and nephews when you are in a hypoglycemic coma? You need to think beyond yourself. Other people can be harmed when you don’t use medications properly. And yes, it should be fairly easy to find a doctor willing to provide you with drugs for your diabetes, hypertension, or high cholesterol etc, but that doctor will be giving you the 1) the correct medication and 2) at the correct dose, two fairly important concepts.

Yes a GP decades out of medical may not be as sharp as they once were when it comes to drug mechanisms, but make no mistake, they were taught the mechanisms in medical school. As graduates of medical school, I’m sure they have a healthy respect for the complexity of the the human body and are not going to be prescribing drugs that they shouldn’t be. Yes, a pharmacist knows some things about drugs that doctors aren’t taught and your doctor knows some things about the body that pharmacists aren’t taught. However, they are both looking out for your safety, why would you only want one? It would be like declining to wear a seatbelt because your car has airbags.

As for your #1, I sincerely doubt you know more about dosage changes, med changes, or labs than your doctor. You don’t become an expert in medicine by observing what your doctor orders for your chronic condition a few dozen times or so. I can drive a car and can even pump my own gas, but I wouldn’t pretend for a second that I knew more than a mechanic, let alone try to rebuild a transmission myself.

#2: Like I said the body is complex and even doctors can’t fix everything and anything alone. Maybe we should go back to the days when treatment for an acute MI was to put you into a dark room and avoid any exciting stimulus. No pesky cardiologist needed.

#3:You are taking for granted that your GP has many years of medical training and likely decades of experience and that vast knowledge base is ready to be tapped at your request in exchange for a nominal fee because it would be “extremely rare” that you will require it? Really?

Yes, your doctor didn’t refuse to prescribe you the medication you requested, but not before verifying the prescription was indeed indicated and wouldn’t interfere with any other medications you were taking and that you had the correct dose. Do you think these are not important somehow?

“It is illogical to require prescriptions for most medications but allow others to be purchased. 20 extra strength tylenol can be a lethal dose but you can get bottles of the stuff OTC. Alcohol, just be 21. Tobacco, age 18.”

You can buy a bottle of 200mg ibuprofen pills OTC, and maybe you take 3 pills to control your aches and pain. Wouldn’t it be nice if there was a 600mg pill and you could just take 1? Well turns out there is, but if you want the 600mg pills it is prescription only. Why? Because people are much more likely to harm themselves taking the 600mg pills. Why can’t you just accept that the FDA has determined more people would be harmed by 600mg ibuprofen being OTC than would be helped?

As for alcohol and tobacco, thats a whole other issue. They have become so ingrained in our culture that it would probably be impossible to make them illegal (see prohibition). As a compromise, we pass laws meant to protect other people from being harmed when you engage in using alcohol or tobacco (drunk driving laws, no smoking in restaurants etc).

The google med degree has given people the idea that they can doctor themselves. It’s great to learn more about your conditions, but there has to be some trust that your doctor knows more about the overall big picture. Unhappy with your doctor’s approach? Find a new doctor. But, don’t start messing with your own medications. As a nurse I wouldn’t even feel comfortable doing that (though, I’d ask plenty of questions!).

Why not? As the patient I am ultimately responsible for my care. In any case, if I really want the care, I can probably find a doctor willin g to provide it.

“Yes, you do need to know the mechanisms of action if you want to be the one deciding what prescription drugs you will be taking.”

I think you just excluded many GP’s. Oops. Pharmacists are the ones who know how the drugs work (if anyone does outside the labs…)

Here’s the issue, I go to my doctor for three reasons:

1. Management of chronic issues. Prescriptions (renewals, dosage changes, med changes), labs, etc. In these cases I know as much or more than the doctor. I have to see the doctor because I need a script for the med or test for the condition I’ve had for years.

2. Injuries. Standard routine = make an appointment for a problem doctor can’t diagnose, sent out for imaging that doctor can’t read, make another appointment for a condition doctor can’t treat, at which point doctor says make appointment with specialist X who requires referral to treat. Rinse, lather, repeat.

3. Something novel for which GP knowledge is useful (extremely rare).

I could save my insurance company a lot of money and myself a lot of time and aggravation if I didn’t need to see a doctor for numbers 1 and 2. Or I could get a catastrophic coverage plan and pay out of pocket for most of my expenses and come out ahead even with chronic medical conditions. However, there would be fewer doctors….

“else you are going to find out what “bad things” can happen.”

I have never had a doctor refuse to prescribe any medication that I requested. I am more aware of the bad things than the doctors are because in the end, I suffer the side effects.

It is illogical to require prescriptions for most medications but allow others to be purchased. 20 extra strength tylenol can be a lethal dose but you can get bottles of the stuff OTC. Alcohol, just be 21. Tobacco, age 18.

In regards to the home strep test, here is the problem. You are presumably a rational person who wouldn’t lie to their doctor about a strep test, but other people would. Lets say doctors would take your word for it and give you the antibiotic prescription without confirming the test. People want antibiotics for lots of things that they don’t help with such as colds and the flu. Once word got out that you could simply claim you had a positive home strep test and get antibiotics, people simply would lie to get the antibiotics they want. People would essentially have free access to antibiotics and all the problems this creates would follow.

So the choice is do we confirm the test or do we allow free access to antibiotics?