Buying Drugs in Mexico

We doctors seem to have a double standard when it comes to paternalism. On the one hand, it rankles us that the government expects us to document the quality of our KOH exams and wants a system to pay us for performance.

On the other hand, many of us want the government to regulate other people’s behavior, from that of tanning bed operators to optometrists. We feel we should be trusted to do what is best for our patients, while at the same time believing the government should protect people from their own risky behavior and that of others.
 

Restrictions on Patients’ Access to Drug

This kind of paternalism by doctors toward patients comes into play as we stand between patients and their access to prescription drugs as though they don’t have enough sense to choose the right products for themselves.

Yet, this paternalistic tendency is beginning to change. More and more, there seems to be a trend toward giving patients a greater role in decisions about their treatment. After all, it would stand to reason that living as we do in a “free country,” one might have some sympathy for the idea of letting patients choose what’s best for themselves.
 

A Free Country?

When it comes to medications though, the United States is definitely not a free country.
On a recent trip to Mexico, I needed an antibiotic. Here in the United States, getting the antibiotic would have required phone calls to the doctor’s office and another between the doctor’s office and the pharmacy before the prescription would be available.

In Mexico, I just walked into a small pharmacy, asked for the antibiotic, and paid for it without involving a doctor for a prescription or insurance for coverage (and the price was quite reasonable).
What a great system, if you’re a patient who wants to just get the medication and get started on it. This gets doctors out of the middle of the relationship between patients and their drugs. Now, that’s what I call a “free country!”
 

Consequences of Easier Patient Access to Drugs

When doctors don’t control patients’ access to medicine, interesting things happen. A physician might be a bit more reluctant to recommend starting a risky medication that requires monitoring if patients could easily continue their medication without returning for office visits. We doctors might be a bit more circumspect about recommending methotrexate, or even clobetasol, if we knew the patient could continue the medication without ever returning to the office to be rechecked.

Those aren’t major problems for us now — although one wonders how often pharmacies here refill medications without a prescription.
Still, paternalistically assuming responsibility for making the right decision for others isn’t always easy. In psoriasis care, I find it hard to choose between methotrexate and the many biologic options, so I’m grateful when, after hearing their options, patients tell me what they think is best for them.

However, most still ask, “What do you think, Doc? I trust you.” This suggests to me that most patients would still seek my advice, even if they didn’t need my prescription to get access to their medications at the pharmacy.