Last Saturday I posted a diary entitled Refusal Pharmacists - a National Registry? (See Diary:
http://www.dailykos.com/...). There was a good deal of positive feedback, and I wanted to follow-up with my current thoughts surrounding this matter. First of all, I agree with those posters who said that the issue runs much deeper than just logging which pharmacists are refusing service for certain meds (specifically, birth control).
The intent with such a registry isn't to resolve the underlying issues that have allowed us to reach this impasse. Frankly, the primary intent isn't even to assist the market in redressing the issue, though that may (hopefully) happen. "Market redress" is a wonderful concept when contemplating the ease of use or ugly color of an MP3 player, but on social issues such as women's rights to contraception....change needs to occur through legislative means.
Follow me below the fold.
With that being said, I can envision the registry serving several functions.
1. Allow consumers to make educated decisions based on information gleaned at a neutral clearinghouse (yes, this means BOTH sides to the debate. I'm sure some conservative consumers may opt to shop at places with likeminded policies, while more progressive folks will seek out stores/pharmacists that meet their particular needs).
2. Avoid the "confrontation" of being refused services. Not only can it be a tremendous inconvenience, but it also can be an emotionally charged and stressful event.
3. Catalog incidents (by pharmacist, chain, hospital, doctor, pharmacist, etc) in which service was unduly denied, or denied in contradiction to a governing policy or law.
4. Allow pharmacist, chain, hospital, doctor, pharmacist, etc. to redress the issue, or explain themselves, or explain their policies.
By the way - there were some great names proposed, including: Pharmacist Refusal Information Clearinghouse, Pharmacist Information Registry, National Online Pharmacist Refusal Registry, The Prescription Report, Pharmacist's Choice, FillMyPill.com, and Ratemypharmacist.com.
To pursue this, however, a number of issues remain, and I'd love to see feedback on these.
LEGAL
How liable would we be, allowing people to rate their pharmacist by name? Should some sort of formal structure be set up (i.e., 501[c]3)? Any lawyers out there looking for pro bono work? Come on...you can't ALL be busy filing Freedom of Information Act petitions.
MEAT AND POTATOES DATABASE
How intense do you tech-lovers think the database would need to be? How much upkeep would be involved? What sort of infrastructure would be needed? Feel free to respond with all of your really big techie words and acronyms. (i.e., You'd need to run MySQL with a 5TB pipeline, or some such other unintelligible blather).
FINANCING
Such a registry would require some level of funding to maintain, and I wonder whether it would appeal to a Planned Parenthood type of organization, or even an organization from "the dark side." Ideally, it would be funded, equally, by both sides to the debate, in order to maintain neutrality. I don't think going the corporate route (chain pharmacies) would work.
(BTW, as the CEO of an early-stage biotech copmpany always on the lookout for investors, I tend to constantly think about business models, staffing and raising capital, so forgive me if this last point runs astray).
Please - some feedback, my lovelies...it makes the world turn 'round. (Unless it's flat today. I haven't read my daily dose of MSM yet this morning, though I can guess that the WaPo editorial page says it's flat, while the WaPo front page is running an article proving the earth's "general roundness").
UPDATE: I was thinking a bit about actual functionality, and wanted to propose how consumers/pharmacists/stores might actually interaqct with the site:
1. Consumers can enter data on pharmacists, doctors, hospitals, stores, etc. Data includes: medications refused or provided (at least one entry required), Pharmacist name (if known), Store/hospital name (required), store/hospital address (minimum State and City required), time/date of visit, comments. Comments which do not meet site guidelines (abusive, threatening, proselytizing, vulgar) would be stricken from the record made available publicly (or turned over to the appropriate authorities, in the case of threats).
2. Pharmacists can enter data regarding what medications they will/won't provide, their store(s) and addresses, and shift times, comments
3. Stores, chains, hospitals can enter data regarding what their policies are, hours, location(s), whether a pharmacist has left/joined their store, etc.
4. All data enterers can request that a given record be revoked, amended, challenged, etc. Challenged entries (I.e, "I Do prescribe contraception. Perhaps the customer didn't have a current prescription plan card" or "hospital staff have subsequently been instructed to offer XYZ to patients) will be notated to the record, and will be available for viewing.