Back in the 1990s, the Massachusetts Board of Pharmacy conducted a sting
operation on patient counseling. It sent people out, each with two new,
valid prescriptions: one for Nardil (an MAO inhibitor) and another for a
product containing pseudoephedrine. Of the pharmacies visited, only 35%
intervened in any way.

Counseling patients on MAO inhibitor cautions is a classic call for
pharmacist action. We didn't need OBRA90, patient counseling laws, or the
concept of pharmaceutical care to move  us do this in the days prior to that
philsophy. We just did it because, as pharmacists, we knew it needed to be
done. This was also true of a number of other matters, such as warning
patients of the staining properties of Pyridium (phenazopyridine) or the
interaction between alcohol and Flagyl (Flagyl can act like Antabuse and
make one sick if alcohol is taken along with it).  In my days as a community
pharmacist, I would never let a patient (or the patient's relative or
friend) leave without getting this information personally from me. Yes,
there's time to do it. It takes seconds.

In my experience as a prescription patient myself, I have, since the
inception of counseling requirements in January 1993, been counseled only
two or three times on new prescriptions.  In fact, for the past ten years, I
have almost never spoken to the pharmacist. He or she is super-glued to the
cathode ray tube. I just don't think counseling is being done, so I wonder
how effective the rules are. But, as I predicted, they are not being
enforced by boards of pharmacy as effectively as they are being enforced by
judges and juries.