Sunday, February 01, 2009

6wS: "Doctor's scrip? Sorry, we don't care."

In all fairness, this was a year or so ago... but I thought about it recently, at the play. One in 3 opens with Dena, the receptionist, coming in to work. She's carrying a CVS bag, with and EPT in it. My very first thought was about the stink a while back when a CVS pharmacist refused to fill a prescription for emergency contraception*, because of personal/religious beliefs. And the company fully supported the pharmacist's decision.

A woman entered the pharmacy with a prescription from a medical doctor -- someone who has gone through years and years and years of medical school and training to learn about medicine and health and patients and prescriptions -- and the pharmacist, a job that, to the best of my knowledge, does not require even a Bachelor's degree -- decides he knows better than the medical doctor what the patient needs. No, that's not entirely accurate: the pharmacist, a complete stranger to this woman, decides what this woman needs based on his own pig-headed personal preferences.

This hit the news, and the company changed its policy. Sorry, I still refuse to ever shop at a CVS.

*The story I'd heard involved EC, but when I Googled for a news link, I found one saying the pharmacist refused to give out PLAIN OLD BIRTH CONTROL. The pharmacist refused to give the woman THE PILL. Seriously??? Where do these people get off???

6 word Sunday challenge


  1. two problems in your premise:

    first, doctors prescribe way too many pills for too many problems that don't require them to give them the carte blanche of authority your post presumes.

    second, pharmacists go through loads of school, somewhere between a masters and doctorate plus strict licensing boards just to get to that first day of work. they have loads of liability and are indeed trusted by many many folks to dispense the right things in the right amounts so that they don't end up dead and stuff. you should have more respect for their profession.

    as far as you not shopping at CVS, that's on about the same moral elevation of the pharmacist's choice: kind of a childish move.

    he's stopping no one from getting the drug, just slightly inconveniencing them with no discernible. it's just about his own selfish ego.

    and you, because you are punishing (in a little way) all the other workers that procure, ship, stock, clean and cashier the store for thousands of other useful products. your choice takes money out of the pockets of the exact women that presumably work there that have difficulty obtaining excellent health care - you aren't punishing Exxon/Mobil execs, here.

    but, you probably don't feel bad about the overall negative impact you have on all of CVS' organization, if it impacts that pharmacist and the evil policy-setters at that company. fair enough. but he doesn't feel bad that he's given a woman one more chance to change her mind, no matter how much he's inconvenienced her.

    good day one. keep it up.

  2. Perhaps some doctors prescribe too many pills (that's a separate blog post); however, birth control is basic health care for women (it reduces cramping and other PMS symptoms, which for some women can be debilitating).

    Either way, a doctor is an authority. They go through all that school and take those oaths. When it comes to prescriptions, they should be the highest authority for that patient.

    I don't know the details of the story (my Google search revealed there were several occurrences), so I don't know if the person who refused to fill the prescription was a fully-credited pharmacist or just an hourly worker (a friend of mine worked as a pharmacist while she was going to college, she had not gone through those loads of school). I'm sure there are different levels of "pharmacist" (there must be one head person on duty at all times who has gone through years of schooling), but I know that some of the people behind the counter don't have anywhere near the credentials the doctor, who write the prescription and has seen the patient, does. And it could very well have been that guy who denied this woman the birth control she'd been taking for years.

    In my opinion, birth control should be over the counter anyway. The only reason it's not is because of the religious issues that sadly play a role in women's healthcare.

    (Looks like this will be an interesting month...)

  3. I'm not going to distract you in the comments from your already difficult goal, so don't reply to any of this.

    It's OK with me for sake of argument, not having the specifics. I recall the situation being real enough (though not specifically with CVS). I think you shouldn't mention a company without the specifics though.

    I agree on the concept of "highest authority" but dispensaries can veto doctors all the time - especially when drug seekers are running scams with multiple doctors. Not relevant in this scenario, but keep in mind that refusal is a normal, allowable, sometimes life-saving tool in their box.

    I was basing my pharmacist requirements on a cousin of mine that ran it all down for me once a long time ago. It was a steep climb. Perhaps she fibbed, but she's not the type. You are probably right on the multiple tiers of the profession neither of us is fully understanding.

    Assuming this non-specific pharmacist was very high up on the professional food chain, then I think he's in his professional realm to refuse something like this. Maybe get fired for it, but still his prerogative. Would you boycott a hospital if it had one doctor that refused to write emergency birth control prescriptions on religious grounds?

    Assuming a much lower professional food chain, or even blue-collar clerk, then this refusal is impossible to justify on even professional grounds.

    Finally, for the record I was commenting towards the topic of emergency birth control and not vanilla birth control which are really two different sorts of things. Still, I think for me the drug is not terribly relevant. We could be talking about blood thinners.

    You once astutely remarked that you frequently are reluctant to give an inch on these dear topics because you fear "them" taking a mile. I think this is where you differ from me (and probably many others) that entirely agree with your values on specific concrete matters like birth control and abortion. I see that giving this pharmacist an inch is just that, an inch.

    I'll try not to be contentious on future comments. I will keep it brief and constructive and not leading you to needing to reply.

    Finally, I think most any hormone pills are never going to be OTC. There are serious health pitfalls to know about (i.e., smoking), but you are right, the products are simply third rail politically.

  4. But I like replying! :P

    If a doctor denied me birth control or EC for "moral reasons" (which was the case with CVS -- it was not for medical reasons), then yes, I would go to another doctor. (Whether I'd go to another hospital depends on whether my crummy insurance would allow me to do so, but the state of health care is another post altogether).

    Either way, I never shopped at CVS before I heard this story (or stories, since it happened more than once, apparently). I've always gotten my scrips either at the grocery store or at Walgreens... so CVS isn't missing out on anything anyway. (But, if I'm driving around looking for a store to buy X, I'll keep driving if I see a CVS first.)

  5. And, PS: you're not being "contentious." You're starting a conversation, which is my goal in writing these posts!

  6. Crisatunity-

    I don't think we'd be as up-in-arms about this if we felt the pharmacists's refusal were truly about looking out for the best interests of the PATIENT. Yes, pharmacists reserve the right to refuse medicine in cases like drug scams, as you mentioned. That's b/c that's a scam, and people are abusing the drug, and it's ILLEGAL, etc.

    Telling a woman she doesn't deserve birth control b/c of your own personal beliefs is entirely different. If the pharmacists had refused to fill a prescription to, say, a black man b./c he didn't like black men, I'm guessing we'd all agree on that not being acceptable. And as Cristina pointed out, birth control is not only prescribed for pregnancy prevention, many women use it to treat other problems like extremely heavy cramping and PMS symptoms.

    And yes, it is technically correct that this pharmacist was simply "inconveniencing" the woman and she could just walk over to another pharmacy and get her prescription filled there. Unless that other pharmacy also refused. And then the third. And in the case of the Morning After pill, each hour you wait lessens the chance of preventing that pregnancy. So by refusing the woman and making her go on a wild goose chance trying to get her prescription filled, you are not only "inconveniencing" her but also making it more likely she will become pregnant to begin with. Isn't the whole point to prevent unintended pregnancies?

    As a side not to Cristina-- I've started looking into IUDs as a BC option lately, and stories like these make me wonder if we as a society should be pushing them more often since that's a one-time deal that a doctor does, and there's no pharmacists to get in the way. Just a random thought that popped into my head as I read the post and comments.

    Oh, and I LOVE the new template!! =)

  7. @marcy - we don't disagree on anything (equating a disagreement with a product and a race is kind of dubious though)

    one final tidbit, somewhat (ok, totally) off topic.

    religious grounds != moral grounds

    in my opinion, the former is concrete doctrine co-mingled with constitutional protections, and the latter is abstract and quite a fickle thing that the law distances from every chance it can.

    some people base their morality on religion, some base it on chemical feelings, and others on faith in things without an established doctrine. life without morality is that similar to that of lichen or a helium atom.

    most people base their religion on what they have been fed. life without religion is dangerous for most, but quite satisfying if done right.

    so I would feel different about the professional that refused me whatever service, were I told it was based on religious versus moral grounds that disagreed with me. with the former I could respectfully disagree and the latter would make me lose all respect for.

  8. Crisatunity-- I would feel deeply offended by any professional who denied me their services (especially ones that influence such a HUGE life-changing event like that of conceiving a child, the magnitude of which I understand much more now that I have one myself) due to their PERSONAL beliefs, be they religious or moral. If they refuse me due to LEGAL concerns (as in, running a drug scam with multiple doctors) that seems legitimate to me.

  9. Anonymous4:52 PM

    I just found this post because I was looking up doctor's scrip to see if it was "scrip" or "script".
    But this is a topic dear to my heart for a variety of reasons. First, clearly it's insane for someone with a PharmD (PhD in Parmacy) to deny birth control. I can't imagine how that person continues to have a license with such an absurd approach to medicine. Nor can I understand how that person was hired in the first place with such an over-the-top moral agenda. The ONLY reason to deny a perscription is if it has contraindication(s) with another medication. If there is a suspicion of perscription abuse, the pharmacist CONTACTS THE PERSCRIBING PHYSICIAN, before just saying "no" willy nilly. My presumption then, is that it was not a licensed pharmacist, but was a pharmacy tech who made that choice. Pharmacy tech is someone with a 2 year degree, and a license I believe, sort of the CNA of pharmacy. Important in our healthcare support system but without much clout.
    The idea that the company would stand behind such an arbitrary decision seems to be a political one. When this happened, it was fashionable to be anti-choice. Bush was in the whitehouse and everyone thought evangelical christians were the most powerful voting consumer block of all time. I'm sure CVS wanted to be the go-to pharmacy of the evangelical monolith.
    I think you're right to avoid this company. The only way we can truly affect change in the US is through our dollar. CVS employees are the absolute LAST on the company's list of people who profit from your purchase. CVS hourly employees are totally expendable from the company's point of view. If you are able to find a family owned pharmacy to take your perscriptions to, that is where you should go. That is a sustainable system. Things might be more expensive, but you're supporting your local community instead of gigantic corporate greed. Gigantic pharmacies such as CVS, Walgreens etc are the same as your walmarts - big box stores that destroy communities. The veil of "providing jobs" is a thin one, and as we've seen from wal-mart's and other big box stores' decimation of our nation's small businesses and union manufacturing jobs it's a completely unsustainable system. If it continues it will undoubtedly thrust America into massive poverty.
    SO, BRAVO to CONSCIOUS CONSUMERISM!!! It's our only true vote.