It seems that as pharmacies become more corporate in nature and larger in total business transacted, the concepts of pharmacy are tested, with the view of providing more financial benefit to the owners, either in the format of paying lowest possible wages to employed pharmacists, illegal removal or manipulation of award requirements (such as meal breaks) and the levying of charges for pharmacy patient records.
These activities are more pronounced in the US because of different legislation governing pharmacies. But similarities are creeping into the Australian landscape.
Pharmacy has always used the terms “customer” and “patient” interchangeably.
i2P research has indicated that the higher the mix of professional goods and services employed within a pharmacy the more the consumers of those services were thought of as patients.
And this thinking also extended to pharmacist uniforms.
The higher the level of commercial retailing the less inclination to wear a “white coat”.
The third largest pharmacy business in the US (Rite Aid) had cause to consider the concept of whether they were dealing with patients or customers, because it became part of a legal challenge, when one of their consumers complained about Rite Aid’s flat $50 charge to provide a personal prescription record.
At the heart of the case was a dispute over how much could be charged for access to a person’s prescription records.
Pennsylvania law set a limit on how much a patient could be charged, which Rite Aid said did not apply to them, as the people it serves should be defined as customers.
The company won the first round, when a judge compared what pharmacists do for people, to the services of a yoga instructor.
That decision was reversed on appeal, however; the second judge stated what most of us would say is obvious:
“The practice of pharmacy is not limited to filling prescriptions.”
Rite Aid, the third largest operator of pharmacies in the US, was actually contending:
(1) that pharmacists are not healthcare providers,
(2) that individuals who use the services of pharmacists are not patients, and that
(3) pharmacy records are not medical records.
The first round in court was won by Rite Aid with the court holding that the state’s Medical Records Act did not apply to pharmacies because customers of pharmacies did not count as patients.
The Medical Records Act (MRA) did not apply to pharmacies, said a trial court judge who dismissed the case, concluding that customers of pharmacies did not count as patients.
On appeal, the decision was reversed.
It was argued that the trial court erred in determining that pharmacy customers were not patients.
The Superior Court panel then agreed, noting that both the state’s Pharmacy Act and the state code specified an expansive definition of duties and functions.
“The language utilized in the code, as well as the Pharmacy Act, reflects that the pharmacist is a health care provider and that the recipient of the prescription medication is a patient.”
“A pharmacist is not merely an intermediary between a vendor and consumer.”
Rite Aid also argued that even if it was covered by the MRA, it still had the right to charge $50 for the records, contending that these charges were voluntary agreements accepted by the consumers when they paid their invoices.
The company emphasized that if it engaged in the voluntary agreements, it could deviate from the terms of the MRA
But the Superior Court concluded that there were no indications that consumers were entering into these arrangements with full knowledge of the facts, and ruled that the voluntary payment doctrine did not apply to the case.
One surprising aspect of this case was that when the APhA (the US equivalent of the PSA) was approached for a comment, it refused to make one.
That APhA would have nothing to say about an issue that goes to the core of how the profession is defined is astonishing.
Obviously, US pharmacy has a leadership problem.
So there you have it – a legal precedent that pharmacists are true health professionals, they are not mere intermediaries between a vendor and a consumer, and that the recipient of prescription medicine is actually a patient.
But what about items prescribed orally or in writing by pharmacists that have no connection to a medical practitioner in that specific transaction?
Are these consumers also patients?
My belief is that these items have been supplied on the prescription of a pharmacist and therefore qualify as being described as patients.
So who are the customers?
They can only be those consumers purchasing goods and services that do not require information or input from a pharmacist e.g. toilet rolls, toothpaste or soap.
Confusion arises in the dichotomy of the pharmacy business model where a consumer can walk in as a patient, then convert to a customer and back again in seconds.
The customer is always right but the patient isn’t necessarily right.
The treatment of a customer will always be different to that of a patient and pharmacy policies should highlight these differences.
Inter-professional and government communications, even pharmacy leadership bodies are often seen using the word “customer” when the correct term should have been “patient”.
Doctors politically have always contended that pharmacists did not have patients, only customers. And that has probably extended any confusion around this issue.
So is there a need for leadership bodies to tighten up the framework for defining pharmacy consumers?
Is there a need to review all pharmacy information sources to ensure clear and consistent definitions?
Certainly pharmacists at the coalface in community pharmacies need to position their own information and communication to be consistent and seamless in their professional information and marketing messages.