Something else to get pissed off about

[wendyzski]

Apparently there is growing phenomenon of some pharmacists and even doctors who are refusing to fill prescriptions for birth control on the grounds that a possible effect of them (preventing implantation of a possibly fertilized egg) is morally objectionable to them.

The article from Prevention Magazine is here.

With the trend towards more use of managed health plans, it seems to me that this is very likely to limit many women's access to birth control of any kind, if their primary care physician decided that they won't deal with this, and it takes the woman time to arrange to switch PCPs. Also, there is the huge issue of women taking oral contraceptives for a variety of other medical reasons. I sure don;t think it's the pharmacist's business why I am taking any particular medication.

Thank the gods that Illinois has a law that insurance companies MUST cover birth control at the same rates as other medications.

Yet another reason to count the days until November....

Comments

[eacole72.livejournal.com]

I am incredibly lucky in that respect. My doctors (both my Primary Care/Internist and my GYN) both believe that I am fully capable of deciding for myself when or if I want children and that their responsibilities as physicians override any personal issues they might have with a particular procedure or medication. Yes, I've had this discussion with them.

My brother is, I believe, one of the pharmacists who would refuse to fill a scrip. He got out of retail pharmacy a long time ago, because he knows that there are things he would have to do in retail work that he might find morally objectionable, and he also believed that it would be better for his conscience and his license if he just never found himself in that position. I wish more folks had his professional ethics.

I know someone for whom her pills are truly lifesaving medication. She is manic bipolar. She has run across pharmacists who do not agree with or believe in psychoative medication and who believe that all mental illness can be treated with talk & behavioral therapy. She has a chemical imbalance in her brain, and she will have a psychotic episode if she goes without her medication for more than about 24 hours. No amount of talk therapy will change that. She's had to fight to get her scrips filled at times when she has had to deal with those folks. She is also on BCP, because a pregnancy would be devastating to her emotional condition and the drugs she takes would be almost certain to cause severe fetal abnormalities. On top of that, she is not a good candidate for sterilization, because the drugs she takes to regular her illness are completely contraindicated with general anesthesia.

[wendyzski.livejournal.com]

She has run across pharmacists who do not agree with or believe in psychoative medication and who believe that all mental illness can be treated with talk & behavioral therapy. She has a chemical imbalance in her brain, and she will have a psychotic episode if she goes without her medication for more than about 24 hours. No amount of talk therapy will change that

That's me too! Though I can go a week or so before my symptoms start. I have depression which manifests as anxiety and sleep disturbances, scaling into panic attacks if not treated. 6 months of therapy helped, but a keping symptom log proved that I have a chemical imbalance that causes these symptoms. I didn't like the idea of medication, and I am on the smallest dose possible, but I have a physicial condition that requires medication to treat. (And BC pills cut back on the hormonal triggers for these symptoms too). No one else's ill-informed opinions should be allowed to prevent me from getting the care I need.

[that-david.livejournal.com]

Wow. Has to make you wonder why some folks just don't do their jobs (filling 'scripts in this case) and let the people who are taking them make the decision. This is the equivalent of stating "You're to stupid to know what you need (and possibly your Dr. as well), but fortunately for you I know what I'm doing."

Unfortunately, this way of thinking about psychotropic meds is not uncommon. There are psychiatrists (Dr. Thomas Szacz (sp?)) who firmly believe that "mental illnesses" have no organic basis and are the result of the cultural ideals. This despite an overwhelming amount of information that some forms of mental illness are either exclusively organic, or have a very high degree of organicity.

I was always taught that no amount of therapy is going to touch the core of an organically driven problem (other than to help the individual recognize when its occurring so they can take their meds), nor are meds going to help with a problem behavior (other than blunting the behavior to give them time to learn to adapt).

[wendyzski.livejournal.com]

I was always taught that no amount of therapy is going to touch the core of an organically driven problem (other than to help the individual recognize when its occurring so they can take their meds

Ding ding ding! You win a prize! Therapy taught me coping strategies and the importance of monitoring, but I do still need the meds.

Wow - Is "organicity" a word? It certainly sounds impressive!

And when are your gonna get your own journal, PHD-man?

[jfc013.livejournal.com]

Pssst! He DOES. (check the username line) Maybe he doesn't have anything to say yet! :)

[that-david.livejournal.com]

Yep, that's actually a word used by psychologists/psychiatrists, although it is one of the larger denominations.

And Janet's right, I do have one now. Got it on the 20th. All of two posts to date. Whee...

[moizissimo.livejournal.com]

That is insane. See me, crossing my fingers and knocking on wood, hoping that this doesn't happen in Canada, or to me! I get shingles (not fun!) and it's the same medication as that for herpes. The pain I'd be in if the pharmacist wouldn't give me my drugs, due to a misconception!

What is the function of insurance?

[foolscap001.livejournal.com]

I guess it depends on what you think the purpose of health insurance is.

If it's what I'd always thought the purpose of insurance was, namely to join a group of people to pool risk and trade the chance of being ruined by a rare but expensive catastrophe for the certainty of paying what in probability theory is called the "expected value" of the catastrophe (its cost times its probability), then it makes no sense to cover birth control, vaccinations, or any foreseeable expense. Birth control is very much a foreseeable expense, since one's reproductive system is very close to certain to be functional. Its probability is thus very close to one, and its expected value is for all practical purposes its cost.

Re: What is the function of insurance?

[eacole72.livejournal.com]

I think the point of the comment about insurance is that in many HMO's, a patient does not get to choose their doctor. The doctor is assigned by the insurer. And, the choice of pharmacies is often regulated by the insurance company.

If the patient is assigned to a physician who will not prescribe BCP, it may be next to impossible for her to be transferred to a physician who will write the prescription. And, if she DOES get that scrip, she might well run across a pharmacist who will not fill it for her.

It comes down to insurance rules allowing medical professionals to force their personal version of morality on patients. And, as someone who works in the healthcare industry, I find it to be a violation of professional ethics for the practioners to do so.

Re: What is the function of insurance?

[foolscap001.livejournal.com]

Agreed, that is the point, but I couldn't let the other issue, i.e. whether people have the right to turn insurance into what is effectively welfare, pass.

The fundamental problem is the tying of insurance to employment, which dates back to WWII when it was a way to work around government-imposed wage controls. If that hadn't become entrenched, this (and other issues) wouldn't be an issue (or issues). If one insurance company requires you to go to a pharmacist who refuses to sell a given medication, you could take your business elsewhere, and if enough people did so, they'd have to reconsider their position.

Of course, the converse issue is: from the "pro-life" pharmacist's point of view, we're talking about people wanting to force their personal version of morality on the pharmacist. Again, if people had a choice, there wouldn't be a problem.

[anotheranon.livejournal.com]

I quite agree - in our health system where many folks can't choose their doctors, this is a DISASTER!!

Luckily my local Safeway pharmacy has no crazy idealogues, but I did have to change doctors last year because my previous doc joined a Catholic health group and by the rules couldn't prescribe birth control anymore. He was actually quite good, and referred me to a colleague for my BC needs, but I DID give him a piece of my mind about how he was going to lose business!

[jmaynard.livejournal.com]

Pharmacists do more than simply stick pills in bottles. They, even more than physicians, are experts in the effects and interactions of drugs. It's their job to raise a red flag if your doctor prescribes something that may cause problems with other drugs, both prescription and over-the-counter, or with your particular medical history. They work with the physician to make sure that your regimen of medication is appropriate, effective, and without nasty unforeseen problems.

That said, the final arbiter of whether or not a prescription is filled is not the pharmacist, but the patient and the physician. This one came up while I was a paramedic. Anyone refusing to give a patient his medications as prescribed by his physician is practicing medicine without a license (unless, of course, he's a physician himself), at least in Texas. I wouldn't hesitate to file a complaint against any pharmacist who refused to fill a prescription on any grounds other than those justified by medical necessity.

[gothicshidre.livejournal.com]

ok, that just sucks. Thing is, it's OUR bodies. Dr.'s are stupid, they don't realize that there are many of us out there that do not want children. they won't even consider a "tubal" till you're over 30. now if managed care get's rid of BC what the hell are we supposed to do? it's not like the whole world will abstain. there will just be more unwanted children.