Q: A worried man in his forties comes to your pharmacy and shows you the pill in his hand. He wants to know how it is used. You are quite sure that it's a birth control pill. A week later, a woman picks up a prescription for her boyfriend and asks you what the drug is for. The prescription is for genital herpes. How should you approach these questions?
A: It is easiest to sort out these conflicts by starting with the extremes and working toward the finer points. In the 1970s, the Monty Python comedy troupe filmed a sketch about pharmacists (who are called chemists in England) that could be used to demonstrate how not to follow HIPAA rules. The pharmacists shouted out the patients' medical conditions from the pharmacy counter, bellowing: "OK, who's got the hemorrhoids?" The humiliated patients then crawled to the pharmacy counter to retrieve their medications.
In addition to observing HIPAA, pharmacists also have a clear duty to warn. The pharmacist (the expert) is required to warn the patient (the non-expert) about the hazards and appropriate use of medication. For example, pharmacists would agree that if the patient is not warned about potential drowsiness from pain medications, the pharmacist has failed in that duty. This responsibility also extends to information. When a pharmacist advises a patient about OTC or prescription drugs, a relationship is established. The patient trusts that the advice is both competent and confidential.
The real trouble begins when the questions are asked indirectly. Often, the patient waits in the car while the spouse runs in to pick up a prescription. Since the spouse has the prescription (and the insurance card), he or she represents the patient and has implied permission to assist and transmit information. If the patient usually sees another pharmacist, it may be necessary to coordinate care with that pharmacist; there may also be conflicts in drug therapy (often caught by insurance DUR systems) that must be resolved.
Be especially careful when:
*The issue is very personal (i.e., involving the patient's sex life, mental health, or HIV/AIDS).
*The patient has no relationship with you (no previous advice or care).
*The patient is under legal age (and still dependent upon a parent or guardian).
*The patient is unrelated to the person asking the …