BODY WATCH : Pharmacists Dispense Advice as Well as Drugs

For years, researchers have studied how long a physician spends with a patient during an average office visit. (Female doctors, 17 minutes; male doctors, 13, according to one recent study.)

Now it’s the pharmacists’ turn.

The Study: Pharmacists spend just over a minute--67 seconds--counseling each patient about new prescriptions, according to a recent study by Ohio State University pharmacist Jon Schommer.

For refills, the average counseling time dips to 39 seconds, says Schommer, who timed the transactions of 265 patients at 12 Wisconsin pharmacies and presented his findings at the annual American Pharmaceutical Assn. meeting.

But if patients asked questions, the average conversation time’s increased, says Schommer, who conducted the study with Joseph Wiederholt, an associate professor of pharmacy administration at the University of Wisconsin.

Patients who asked questions about new prescriptions talked with their pharmacists an average of 95 seconds. When they didn’t ask questions, the average conversation took only 27 seconds.

But these are just averages, says Schommer. The longest conversation among the transactions was 11 minutes.

The Law: Under federal law, pharmacists must offer counseling on new prescriptions to Medicaid patients. In California, pharmacists are required to offer such counseling for all patients for all new or changed prescriptions, says Robert Marshall, chief executive officer of the California Pharmacists Assn.

Perspective: In counseling patients, pharmacists don’t want to overwhelm or frighten them, Schommer suspects. “Many pharmacists may be hesitant to talk about side effects because they don’t want to unnecessarily alarm patients--particularly when the chance of a particular side effect is small,” he says.

But once a patient shows an interest in side effects, the pharmacist will talk about them, Schommer says. Some consumers hesitate to ask questions, studies suggest, because they think the pharmacist is too busy or they fear looking stupid.

The Reaction: Some pharmacists say the time averages found by Schommer are misleading and that the time spent with each patient can differ greatly, depending on the medicine, the patient’s medical history and a host of other factors.

“If patients are predominantly elderly, for example, that time can increase drastically,” says Lee Souder, a pharmacist at Cal-Med Pharmacy West in La Canada.

The length of the counseling depends largely on the medicine and condition, says Stephen Schondelmeyer, professor and director of pharmaceutical economics at the PRIME Institute at the University of Minnesota, Minneapolis. “If a patient were just diagnosed with diabetes, the pharmacist might spend 20 or 30 minutes with that patient,” he says.

Patients picking up refills may already be well-versed and have no additional questions.

Not all the pharamacist’s counseling takes place in person at the pharmacy, Souder adds. “Often people don’t ask questions until after they have read the printed literature,” he says. “Then they come back or call back and ask questions.” (Schommer acknowledges that his study didn’t take this into account.)

The Rebuttal: Even though some consulting times might seem brief, Schommer points out that an experienced pharmacist can dispense a lot of information in a very brief time. In as little as six seconds, he says, many pharmacists can tell a patient the name of the drug, its purpose and how best to take it.

The Consensus: On one point everyone agrees: Patients should ask questions about medicine. “But a lot of times patients don’t know what questions to ask,” says Marshall of the California Pharmacists Assn. “So questions should always be preceded by the pharmacist providing consumers with as much information as he or she can.”

Among questions that might not occur to patients, says Jeff Jellin, pharmacist and editor of the Pharmacist’s Letter, a Stockton-based newsletter:

* What foods or other medicines does this drug interact with?

* Are there less expensive brands that are just as effective?

* Is there a longer-acting formula of this drug?

* Is there a once-a-day dose formula?

Asking will be easier, adds Schondelmeyer, if you find a pharmacist you like.

“Patients need to seek out pharmacies where the pharmacist is accessible and willing to answer questions and raise issues about which patients should be aware.”