Should Counseling Be Mandatory?

Mr. Eckel is a professor and director of the Office of Practice Development and Education at the School of Pharmacy, University of North Carolina at Chapel Hill.

A group of pharmacists made a recommendation to their Board of Pharmacy that pharmacists be required to make a personal offer to counsel patients receiving a prescription. They said that 14 states already had such a rule in place. It is true that for certain medications, pharmacists have a responsibility—even an obligation—to interact with the patient to make sure that an adequate understanding of how to use the product has been achieved.

No rules or laws prevent a pharmacist from talking to patients about how to use their medications. If a pharmacist is not counseling the patient, what, then, is the reason? I can think of at least 4: the current dispensing practice model does not allow it to happen easily; some patients may not want it; some pharmacists avoid doing it because they are uncomfortable talking to patients; and the reimbursement model does not pay for it.

In the end, most people do what they get paid to do and what the system they work in supports. If we want pharmacists to counsel patients, we better change the practice model and/or the reimbursement model. The creative use of technology and technicians could help to free pharmacists for counseling activities. Changing what we pay pharmacists to do would also help.

When we try to change behavior by rules rather than by changing the system, we might not achieve the goal of those well-intentioned pharmacists mentioned. Instead of a better educated consumer, we might drive counseling to the lowest common denominator and end up with no real improvement in patient understanding of how to use medications correctly, but with pharmacists thinking they had met the law’s requirement.

As we try to position ourselves to “be the health care professionals responsible for providing patient care that assures optimal medication therapy outcomes,” pharmacists will have to be more engaged in patient counseling. Mandating counseling is not the best way for the profession to get there. If you disagree, let me know your opinion at fred@ncpharmacists.org. â–