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Thoughts on the Power to Prescribe

September 22, 1993

Re "Tug of War Over Prescription Powers" (Sept. 7): As a premed student, I had to pass courses in inorganic chemistry, quantitative chemistry, qualitative chemistry and organic chemistry. In medical school, I was required to take courses in biochemistry, pharmacology and prescription writing. During my two years of residency, I took two courses in pharmacology and psycho-pharmacology.

During active practice, I read endlessly to stay abreast of the advances in drug treatment and to be aware of the myriad harmful side effects of all the medicines, as well as the correct treatment for those side effects and for cases of overdose on the part of forgetful, careless or suicidal patients.

I think only the dental profession comes close to following an equally stringent course of instruction.

Nurses, depending on training, may have a greater or lesser knowledge of chemical and pharmacological matters. Pharmacists too have broad training and hence knowledge in these fields. But psychologists, optometrists and others seeking this privilege are unlikely to have the same extensive biochemical and pharmacological training. And I question whether 16 hours, or even 95 hours, will provide adequate training in what are frequently matters of life and death.

I am retired now, so I have no personal ax to grind. But I am no less concerned that patients must be our first priority, and potential dollar savings, while important, must not be placed above human life.

JOHN R. PHELAN, MD

Westlake Village

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I know your article was not intended to discuss the differences in qualifications to write prescriptions, but I nevertheless feel slighted. I do not think it is correct to lump psychologists, optometrists, physician assistants and nurse practitioners in the same category.

Optometrists, psychologists and nurse practitioners can hang up a shingle and work on their own. PAs cannot work without the supervision of an MD. Under legislation that is going to be proposed, PAs would be allowed to write prescriptions.

I work at Kaiser Permanente in Panorama City side by side with physicians. I am expected to see as many patients as the physicians do and give the best care possible. When I have to go to my supervising MD and ask for a prescription, it takes time away from that physician and me, time that could be better spent keeping health-care costs down.

JACK L. TREESE

Tarzana

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The privilege to prescribe carries with it the obligation to make the right diagnosis. The privilege should be earned through education, not handed out by politicians as a pay-back.

JOHN T. CHIU, MD

Coronado del Mar

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