Going to the pharmacy

gardenia101

Former pharmacist here & have completed many of these MURS over the years. It is unusual NOT to find some issue with a patient's medication, whether it was something simple like taking a medicine with food when it should have been taken on an empty stomach (amazing how much better they work when taken correctly ), or the far more dangerous interactions/potential overdoses.

I also spent several months working in a GP surgery helping to improve their prescription issue system & that was an eye opener. For all of you on here that have commented that GPs monitor all prescriptions that are issued - it simply wasn't true where I worked (& I doubt I was in the worst surgery in the world).

Medicines would be added to a patient's record by clerical staff from hospital discharge letters, quite often with the instructions of "as directed" rather than "3 x daily" if the staff didn't understand the abbreviations used by the hospital doctor. This medication could then be issued on prescriptions for up to 6 months (& sometimes 12) before it needed to be re-authorised, ideally by a GP, but often by other admin staff.

The team of GPs would then sign the hundreds of repeat prescriptions issued each day during their tea breaks (poor things rarely got any true breaks during the working day unless they left the building & car park). So they couldn't check any patients records as there was no computer access in the tea room....

Depending on which GPs were on, the prescriptions would be laid out on the tables in the tea room in long lists so that often the only part visible to the GPs would be the box they had to sign. Two teams of 2 GPs were picked, one GP would press go on a stopwatch while their team mate would would sign every prescription as quickly as possible. The team that was the quickest got first pick at the biscuits.

Each patient prescribed medication would be allocated a medicines review by a GP - not necessarily their own GP, or even a GP that they'd ever seen for a consultation, just whichever GP logged in next was randomly allocated a patient. The patient wasn't present for this review & the time allocated per review was 2 minutes - not very long to check the history, blood results etc, check dosages & interactions.... Many of the GPs just set the default number of issues to 999 so that 999 months worth of medication could be issued before the "computer said no" to the admin staff doing the issuing.

So don't assume a GP will have even looked at a repeat prescription they've signed.

Actually, don't even assume a GP will have looked at a prescription they've issued during a consultation with you. Several times over the years I've had to query why a GP has prescribed penicillin to those who are allergic to it (its been on their computer records, but the GP hasn't noticed it or thought to ask the patient - its been picked up by me).

Twice I've had to ask a GP how they've managed to issue a prescription to completely the wrong person after a consultation (picked up when I've been yelling the wrong name out in the pharmacy & the right patient has queried why its taken so long :wall:). They'd managed to record the consultation under the wrong patient's details - when both patients had been male & both prescriptions issued for females you have to wonder.

This isn't meant as a GP bashing post at all - its a very hard job & not one I'd ever wanted to do. Certainly didn't feel like a failed medic when I started my pharmacy degree, as it was all I ever wanted to do. Its more to highlight, as others have done, how invaluable input from other healthcare professionals can be. GPs aren't right all the time, & I've been thanked many times for saving their bacon - sadly the patients often don't find out about this as many of the repeat prescription errors are sorted out long before the correct medicines are collected.

Its a shame the OP felt so pressurised - that isn't how the MUR system is supposed to be at all. Its supposed to help the patient (& the NHS by identifying waste etc.) & most patients have been glad they've had one.

gardenia101

Missus_Hyde wrote: »

I can totally understand OP's reluctance to discuss her medication with the pharmacist.

I have to take an assortment of different drugs and fortunately I'm able to collect my medication from the doctor's surgery, so don't need to visit the chemist to get my prescription. As far as I'm concerned it's none of the pharmacist's business and I'm afraid I would have no hesitation in telling them that, should the need arise. I also make sure I know exactly what I take and when, so certainly don't need anyone to advise me.

A simple, "no, thanks" would be my answer in those circumstances; should the pharmacist persist , then he/she would be told in no uncertain terms to mind their own business.

You're right, a simple "No, thanks" is all that is required if someone doesn't wish to take up the offer of a MUR. Some people who are taking multiple medicines are very aware of why/how/when to take their medicines, but (IMHO) most are not 100% sure & are glad to be offered & then receive advice.

If you were to have your prescription dispensed at any pharmacy, rather than by a dispensing doctor (if I understand your post correctly) then it is the pharmacist's business - since they could be held jointly liable with the GP should that prescription not be correct for you.

I assume if an incorrect drug had been prescribed by your GP & you had suffered some harm, you would want to know how the mistake had happened? Depending on the level of harm you may require compensation. If the pharmacist who had dispensed it hadn't noticed the error, wouldn't you hold them responsible too?

That's why your medication & prescription is their business.

I've had a few patients refuse to discuss things with me over the years & that's their choice of course. The result is they didn't get their medication from my pharmacy as I wasn't prepared to dispense a prescription that I wasn't 100% sure was appropriate.

If there are no issues with the prescription then of course it would be dispensed, however uncooperative the patient was.

fierystormcloud

gardenia101 wrote: »

You're right, a simple "No, thanks" is all that is required if someone doesn't wish to take up the offer of a MUR. Some people who are taking multiple medicines are very aware of why/how/when to take their medicines, but (IMHO) most are not 100% sure & are glad to be offered & then receive advice.

If you were to have your prescription dispensed at any pharmacy, rather than by a dispensing doctor (if I understand your post correctly) then it is the pharmacist's business - since they could be held jointly liable with the GP should that prescription not be correct for you.

I assume if an incorrect drug had been prescribed by your GP & you had suffered some harm, you would want to know how the mistake had happened? Depending on the level of harm you may require compensation. If the pharmacist who had dispensed it hadn't noticed the error, wouldn't you hold them responsible too?

That's why your medication & prescription is their business.

I've had a few patients refuse to discuss things with me over the years & that's their choice of course. The result is they didn't get their medication from my pharmacy as I wasn't prepared to dispense a prescription that I wasn't 100% sure was appropriate.

If there are no issues with the prescription then of course it would be dispensed, however uncooperative the patient was.

Why would you think their medication was 'not appropriate?' The doctor would have dispensed it to them. Are you implying that the doctor doesn't know what he is doing? :huh:

And also that the patient has no clue what they are taking?

Makes me wonder if some of the negative things some people have been saying about pharmacists may have a grain of truth in them. The DOCTOR is the one who has seen the patient, and spent time with them, and diagnosed what is wrong with them. Why would you assume you know better?

And it's great that you can afford to lose custom. You would lose mine if you refused my prescription; the prescription that I had just got from the doctor!

Person_one

fierystormcloud wrote: »

Why would you think their medication was 'not appropriate?' The doctor would have dispensed it to them. Are you implying that the doctor doesn't know what he is doing? :huh:

And also that the patient has no clue what they are taking?

Makes me wonder if some of the negative things some people have been saying about pharmacists may have a grain of truth in them. The DOCTOR is the one who has seen the patient, and spent time with them, and diagnosed what is wrong with them. Why would you assume you know better?

And it's great that you can afford to lose custom. You would lose mine if you refused my prescription; the prescription that I had just got from the doctor!

By dispensing a drug, the pharmacist becomes accountable for it. If they are concerned that there might be an interaction that's been missed, or an inappropriate drug/dose then they are completely right to decline to dispense it if they can't satisfy themselves that its not going to cause harm.

As a nurse, I become accountable when I give a patient a drug, even though the doctor has prescribed it I am expected to be aware of what I'm doling out and to catch any errors made by the doctors. If I think something is inappropriate I'm not going to recklessly endanger my patient, not to mention put my own job on the line! You'd be surprised how often even good, conscientious doctors get it wrong. They're busy and they're human beings!

catoutthebag

fierystormcloud wrote: »

Why would you think their medication was 'not appropriate?' The doctor would have dispensed it to them. Are you implying that the doctor doesn't know what he is doing? :huh:

And also that the patient has no clue what they are taking?

Makes me wonder if some of the negative things some people have been saying about pharmacists may have a grain of truth in them. The DOCTOR is the one who has seen the patient, and spent time with them, and diagnosed what is wrong with them. Why would you assume you know better?

And it's great that you can afford to lose custom. You would lose mine if you refused my prescription; the prescription that I had just got from the doctor!

I still don't think you understand.

Inappropriate dose, interaction, strength, form, contra indication ...missing prescription details etc etx

You'd be suprised the mistake a dr would make

No one is saying one is better. The doctor is the diagnostician and a pharmacist is the expert in drugs.

tomtontom

fierystormcloud wrote: »

Why would you think their medication was 'not appropriate?' The doctor would have dispensed it to them. Are you implying that the doctor doesn't know what he is doing? :huh:

And also that the patient has no clue what they are taking?

Makes me wonder if some of the negative things some people have been saying about pharmacists may have a grain of truth in them. The DOCTOR is the one who has seen the patient, and spent time with them, and diagnosed what is wrong with them. Why would you assume you know better?

And it's great that you can afford to lose custom. You would lose mine if you refused my prescription; the prescription that I had just got from the doctor!

Where someone has a complex condition they can have medications prescribed from several different sources - their GP, different consultants. The GP will not always be aware of what has been prescribed at the hospital, even where they are aware they may not have a detailed knowledge of the meds or the condition. This is the situation I am in, my GP had not even heard of the (multiple) drugs I am given at the hospital, and pays no regard to them when prescribing other items.

My pharmacist is a star, he knows about my condition and he keeps an eye on the various meds I am given. I'm pretty well informed so can tell the GP when he's prescribing something unsuitable, but I only have that knowledge because I talk to my pharmacist. Not only do they have far more knowledge on medication and their interactions, they tend to have more time to research the more unusual ones.

I'm really not convinced that some people understand what a pharmacist is - they don't just sell drugs!

Anatidaephobia

I understand how you feel, OP, I would just change pharmacy if I were you, assuming that isn't too big an inconvenience.

I've never had one of these MURs so this thread has been quite interesting. Overall, I think they sound like a good idea. Although some have said the GP should have reviewed your medication, many people get repeat prescriptions and may not have seen their GP to review it for months or even years. Nobody should be made to feel harassed or uncomfortable though.

Izadora

fierystormcloud wrote: »

The DOCTOR is the one who has seen the patient, and spent time with them, and diagnosed what is wrong with them. Why would you assume you know better?

If my mum had used that reasoning she'd quite possibly be dead. Fortunately the pharmacist was aware of the fact that she has a severe penicillin allergy so refused to hand over the drugs her DOCTOR had just prescribed for her.

onomatopoeia99

gardenia101 wrote: »

You're right, a simple "No, thanks" is all that is required if someone doesn't wish to take up the offer of a MUR.

Going all the way back to the opening post, it seems it was not made clear that this was optional (or even that it was a "MUR") and they kept asking on multiple occasions. The problem the OP faced would never arisen if the staff at the pharmacy had been clearer about the purpose of asking them "do you have a minute?"

If they had said "I would like to conduct a medicine user review to ensure your medication is appropriate, do you have 15 minutes? You are free to refuse, this is not required by law." then the entire debate wouldn't have arisen.

Petra_70

As I said, I am grateful for all the responses, and have decided I am going to politely decline next time, now that I know it's not compulsory. And yes, I agree with what many of the posters have said, that it should be made more clear that it is going to take 10 to 15 minutes, not just 'a minute,' and that it is optional...

However, I do wish all the doctor-bashing and pharmacist-bashing would stop. They are all highly qualified, they are all trained in their field, they all know stuff the others don't, they all don't know stuff the others do, and they all make mistakes. Overall, they are all worthwhile.

Me personally, well........I like doctors, but then again, I also like pharmacists.

But who is better......?

THERE'S ONLY ONE WAY TO DECIDE!!!!!!!!!!!!