Pharmacists, who have spent years dispensing free advice and money-saving tips (and who often are more accessible than doctors), are expanding their role to include patient counseling and case management: Across the country, private consultation areas are springing up next to drug counters. At some pharmacies, you can schedule appointments with the pharmacist. Some stores have even distanced themselves from retail trade, selling only medicine instead of hair spray and greeting cards. All this is a far cry from two decades ago when pharmacists were bound by a code of ethics not to voice a medical opinion.
Pharmacist Orsula Voltis Thomas, Pharm.D., of Hospice Pharmacia in Wyncote, Pennsylvania, considers herself an active player on her patients' health care team.
"Sometimes they come in to talk to us about a medical problem that they plan to treat with an over-the-counter drug before seeing their doctor," she says. "We're really primary care. Often we're the first people to interact with the patient and the ones that refer them to the appropriate health care professional."
Consumers, however, may soon be asked to pay for this added service. Some stores, including Amherst Pharmacy and Health Education Center in Lumberton, New Jersey, charge consultation fees in certain instances. Patients meet privately with a pharmacist each time a prescription is filled. During this complimentary session, they are briefed on side effects and told what symptoms to watch for. If patients have a chronic condition, such as diabetes, and additional time is desired, they can schedule a 45-minute appointment and pay a fee for the time.
Look for someone you feel comfortable with. "It's important for people to select their pharmacist as carefully as they select their family doctor," says Dorothy L. Smith, Pharm.D., president of the Consumer Health Information Corporation in McLean, Virginia. Her company produces educational materials for consumers and drug companies.
Pharmacists are trained to spot potentially dangerous drug combinations, which number in the thousands. The likelihood of suffering a mishap increases when you take multiple medications or see more than one doctor. Over-the-counter products, such as aspirin, also can react with many prescriptions.
If your pharmacist foresees a problem with a drug or its prescribed dose, he or she can phone your doctor. "Your pharmacist is your double-check," says Smith. "You have to trust your doctor and your pharmacist."
Choose a pharmacist who will give you time. Developing a rapport with your pharmacist is a good way to safeguard your health. He or she is probably your best source of information on prescription and over-the-counter drugs. And by getting to know your health problems, your pharmacist can steer you away from medicines you shouldn't take.
One way to facilitate communication is to ask questions. In one study, pharmacists spent more time with patients who initiated conversation. Patients who spoke up also received more in-depth information about their medications.
If your pharmacist is too busy to talk, ask if you can stop by at a better time or if you can call from home with additional questions. You should feel free to call the pharmacy if you think you're having a reaction to a particular drug. Some pharmacists make routine calls to check on patients taking new prescriptions or those on complicated regimens.
When speaking with your pharmacist about medication, don't forget to mention any health problems you're experiencing. Part of a pharmacist's training is knowing when to refer you to a doctor.
"If you can't get the attention you need at one pharmacy, switch to another," says Joseph Wiederholt, Ph.D., associate professor of pharmacy administration at the University of Wisconsin School of Pharmacy. "You should feel your pharmacist is really concerned about your health and your situation."
Check credentials. Pharmacists must pass a national exam that ensures certain standards of knowledge, and all pharmacists must be licensed, though requirements vary from state to state. In some states, you can find out if any serious complaints have been lodged against a pharmacist by calling the state licensing board.
Beyond that, you'll probably want to find a pharmacist who takes continuing education courses and attends academic seminars. This is a good sign that he or she is on top of current information.
Don't be afraid to question your pharmacist about training and ongoing education, as well as how long he or she has been with that particular practice. Also, find out what safeguards are in place to ensure patients get the right prescriptions.
Being interviewed is probably a new experience for most pharmacists, Weiderholt notes, so they may not be prepared to share a lot of information about themselves. But talking even briefly with prospective pharmacists before you need their services gives you an idea how helpful they'll be when you are sick.
Your doctor or nurse also can guide you to a good pharmacist. Ask where they have their own prescriptions filled and what they like about that particular drugstore.
You might be tempted, just this once, to patronize the drugstore closest to your office or your child's day care or to have a regular prescription filled at a different pharmacy that's running a special on diapers or laundry detergent. But this can be dangerous.
Your pharmacist maintains records on each prescription dispensed. This information is most likely computerized, with programs designed to flag dangerous interactions. And don't assume using different pharmacies within the same chain offers this protection. The computer systems may be separate to protect patient confidentiality, says Smith.
No one needs to convince Michael Lopez of Fresno, California, to fill all his prescriptions at the same pharmacy. A medical error resulted in the same drug being prescribed by two doctors. Lopez, 42, didn't catch the mistake because each brand name was different.
His pharmacist, however, spotted the problem and pointed out that taking both medications would have resulted in an overdose, possibly causing a heart attack or kidney failure.
"More than anything else, use the same pharmacy," warns Lopez. "If I didn't, I'd probably be dead or in a coma."
Today, he doesn't take any chances. He makes sure every doctor he sees is fully aware of each drug he is taking. Even then, he won't take a new prescription until his pharmacist says it's safe. If a doctor hands him a sample, he calls his pharmacist to make sure it won't cause a harmful interaction. "There are so many drugs on the market no physician could possible keep up with them," Lopez says.
Ask about over-the-counter drugs. It's more important than ever to involve your pharmacist when you buy an over-the-counter medication. Since 1981, more than 200 drugs have switched from prescription-only to over-the-counter status.
Over-the-counter medications are capable of causing adverse side effects, especially if you have certain underlying health problems. They also can react with many common prescription drugs.
Pharmacists are well-versed in the properties of both prescription and nonprescription drugs. It's part of their job to counsel customers on over-the-counter products bought within their store. Your pharmacist also can explain how to use and interpret the growing number of home-test kits.
Look for extras. In many parts of the country, pharmacies compete for customers. So, chances are, you'll soon see an increased number of extra services at drugstores in your area. One new feature is the private consultation room. Some rooms even include small medical libraries, so customers can browse through health reference books.
Many pharmacies also provide basic health screenings, conduct flu shot clinics, and sponsor educational seminars. Also becoming more common: Wellness programs, such as those teaching people to read food labels and "brown bag" days during which customers bring in medications for review.