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A SURVEY conducted through MJA InSight suggests many doctors regard pharmacists as retailers who accurately dispense medicines.
About two-thirds of doctors who responded to the survey did not see pharmacists having any other role in primary health care.
The survey, conducted by Mr Rollo Manning, a former pharmacist who is now a pharmacy and public relations consultant, asked MJA InSight readers six questions about their perceptions of pharmacists.
Mr Manning invited readers to complete the survey as part of a Comment article he wrote on the role of pharmacists in primary health care. (1)
He said he wanted to do the survey because little had been done to gauge how other health professionals viewed pharmacists.
Most surveys measured the standing of pharmacists with the general public, Mr Manning said.
There were 104 responses to Mr Manning’s survey, including 55 doctors, 24 allied health professionals, eight nurses and one allied health worker.
The survey found about two-thirds of doctors (36/55) did not believe pharmacists had a body of knowledge to contribute to primary health care.
Of these, 24 saw pharmacists as owners of a retail outlet, seven saw them as providing medicines properly labelled and recorded and five said they rarely had contact with a pharmacist.
Only 15 of the 55 doctors regarded pharmacists as health professionals contributing to primary health care.
Of all respondents, most thought a career in pharmacy was in the middle of the health professional spectrum. However, 19 doctors put pharmacy near the bottom of health professions.
On the question of how respondents rated the value of pharmacists’ contribution to positive patient outcomes, 42 of the 55 doctors ticked “not much”, “low” or “could be more”. No doctors rated the pharmacists’ contribution as “high”.
Many doctors (34/55) believed pharmacists should continue what they were doing — supplying medicines that were accurately dispensed, recorded and labelled.
However, nurses were unanimous in supporting pharmacists having a wider role in primary health care.
Only one doctor supported the idea of pharmacists having a legal right to prescribe Schedule 4 drugs.
Mr Manning said it was evident from the survey that if pharmacists wanted a wider role in primary health care, they must demonstrate to doctors what that contribution would be.
Posted 17 January 2011
Yes, we are trained in diagnosis, especially of trivial complaints like skin rashes, although not to the level of a doctor. We are also taught when to refer.
Doctors generally don’t have a clue about much else in the world, and do tend to undervalue the contribution other can make. I remember the director of orthopaedics chastising me for not prescribing his drug of choice – Vioxx – and thinking “if you knew what I know about drugs, you wouldn’t be so quick to prescribe new ones!” but in his eyes, I was a junior doctor, and so knew nothing.
I am always grateful for a phone call from a pharmacist or a nurse. These people are our eyes and ears out there, and see the patient way, way more than we do. So have some respect for your colleagues. They know more about their area of practice than you do, and they just want to help you help the patient.
Dr Julian Fidge
GP and Pharmacist
My experience as a Clinical Pharmacist is that it is hard for doctors to accept someone correcting them or intervening to change a dose, ask for lab tests or suggest another regimen. If this is the case, and they do not accept that, I think we may need grocers who have some knowledge of medicines.
Since my recent retirement I’ve had time to stand quietly in pharmacies while shopping, in two states, and overhear the advice given to patients. It has usually been fairly basic and non-specific, and has tended to include the introduction of a “natural” alternative from the shelves as an option. My impression is that nurses generally give better advice based on some practical experience.
Chatting to Pharmacists I have known personally, and gotten on well with as individuals, I find they do not seem to be aware that clinical differences do occur between products generically the same, or to be aware that factors like particle size, and different excipients, can influence the absorption of a product.
As far as I am aware, pharmacists are not trained in diagnosis, or in long term management. I value greatly the role of pharmacists in providing drug information to patients, for which I understand the Commonwealth pays them a special fee. Unfortunately, instances have been reported where no adeqauate Consumer Medical Information has actually been given.
What upsets me more re pharmacists is the fact that they claim a $1.50 ( I believe) subsidy from the Commonwealth each time they dispense a generic drug. The words by the pharmacist “Would you like a generic?” don’t have the patient wholly in mind, I fear. This is in spite of the fact that generic drugs are often purchased in bulk, or through buying cartels, at cheap prices anyway. I don’t object to bulk purchase of generics, and I am glad the patient gets the drug a dollar or two cheaper. But, I object to the special subsidy for generic dispensing, which I believe would be better spent by the Commonwealth in other needed areas of health care. When it comes to lobbying the government, pharmacists have it all over the doctors. Oh yes, by the way, they should stick to their area of training and expertise — the professional preparing and dispensing of medications, and providing drug information to the public. Leave the diagnosis to health professionals trained to do so.
One of my concerns about pharmacists and primary health care is that substandard care would be the result. I have too often been waiting in a pharmacy when someone has come to ask about a health problem that would have been much better dealt with by their GP, eg, rashes, respiratory problems, allergies, childhood diseases, weight loss or a blood pressure check. Too often an over-the-counter product is recommended by a staff member (with minimal if any training) or maybe the pharmacist, and sold without adequate history taking or examination, resulting in possible misdiagnosis, unnecessary cost to the public and profit to the pharmacy. Doctors are not allowed to suggest products in which they have a pecuniary interest and this conflict is all too obvious.
It would be interesting to see the entire results of the survey to see where 2/3rds of those surveyed placed other health professionals on the health care hierarchy. It seems to me that many doctors have no concept of the training or the specialised body of knowledge held by other health professionals, seeing themselves as at the apex of the healthcare pyramid. Pharmacists and professionals in other branches of health care make a valid contribution to primary healthcare. Doctors should be willing to recognise the expertise of pharmacists and other professionals and acknowledge the valid and valuable contribution they make to primary health care. Accepting that other professionals may be able to deal with some client issues would free up their time to consult with patients who genuinely need their particular expertise.