In 1999 a New York Times article raised the prospect that pressure on pharmacists to increase prescription volume would erode their ability to counsel patients regarding dosage, side effects, and other safety concerns. Responding to the notion of "death by prescription," Daniel A. Hussar wrote an editorial in Pharmacy Today in which he acknowledged factors that could compromise the standing of pharmacology as one of the most trusted American professions.

Not unlike colleagues in medicine and nursing, during their more than 150 years of service American pharmacists have revised their ethical code to reflect transition from paternalism to a more collaborative relationship with patients and peers. The most recent revision of the Code of Ethics for Pharmacists, enacted by the American Pharmaceutical Association in 1994, describes the patient-pharmacist relationship as a covenant in which the pharmacist receives and maintains the trust of society by helping "individuals achieve optimum benefit from their medications . . . " This covenant relationship appears straightforward, even self-evident. But what should pharmacists do when patients do not want their assistance?

Consider for example the situation of a patient who says, "I am already late for work, and I need this medicine now. My internist prescribed it. That's good enough for me. Just print the instructions on the label so I can get going." The pharmacist has told the patient that the drug prescribed by his internist may have toxic effects if taken with a medication already prescribed by his orthopedist. (The harried patient forgot to mention this prescription when questioned by the internist.) Is it enough that the pharmacist has informed the patient of the possible risk, or should she insist on phoning the internist?

Years ago pharmacists' primary responsibility was fulfilled by accurately dispensing agents as prescribed by physicians. Today they have a greater duty to counsel and inform. Not only do pharmacists have special training and expertise in pharmacology, as this case shows they may have information about the patient's history unknown to prescribing physicians.

In this case ethics precedes etiquette. The inconvenience to this patient and others is outweighed by the responsibility to prevent potentially serious side effects.