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NOTIONS of privacy vary widely among societies, influencing what people will accept as adequate privacy protection in the clinical setting.
Our society’s strong emphasis on medical privacy contrasts to my experience of the tribal culture in Papua New Guinea in 1968. The operating theatre in the small hospital at Baiyer in the western highlands was at ground level and relatives and friends would clamber on top of each other outside the windows to watch the progress of surgery.
In Australia in 2013 the notion of a crowd of people watching and listening to medical conversations is an anathema. Yet, for women seeking the morning-after pill at a pharmacy, a lack of privacy when discussing their requests with the dispensing pharmacist can be all too real.
An Australian study conducted a few years ago showed just over 60% of pharmacists “usually counselled where confidentiality could be assured” — the implication being they didn’t always offer privacy while the other 40% made no attempt at all.
Asking for the morning-after pill is not a simple encounter and often important personal information needs to be exchanged. Little wonder that some women may prefer to attend their GP instead for the security of the closed door of the consulting room.
Pharmacists comprise an energetic and entrepreneurial industry with much political clout. They undergo extensive training and possess knowledge that is critical to ensure the safe dispensing of medications including evidence of side effects and potential interactions of drugs, both prescribed and over-the-counter. With the impressive armamentarium of medications currently available, polypharmacy is also an area where pharmacist know-how is essential.
The skills and information offered by pharmacists can be a great supplement to the skills of GPs.
I recall my experience with patients with severe respiratory disease. Many were confused about their medications, sometimes depositing a supermarket bag of jumbled meds on the consulting desk. Others kept a medication list written in their own hand, while some offered a neat computer printout from their GP indicating name, dose and date of prescription.
When I asked about sorting out what meds to take and when, most patients said that they found their pharmacist to be the most helpful adviser.
However, the skills, information and help that pharmacists can offer is muted if they are reluctant or unwilling to deal with the issue of privacy.
When I discussed this issue with a senior GP, she made the point that privacy concerns could grow exponentially as pharmacists push to increase their interaction with patients by offering repeat scripts, and monitoring blood pressure, blood sugars and warfarin.
Added to these concerns is that help from outside GPs’ rooms does not always lead to the best outcomes for the patient. Diagnosis, for instance, is a skill essential to the practice of medicine that remains concentrated among doctors.
Another example where the pharmacist’s expanded role is unclear is screening for hypertension. Except in the context of ongoing primary care, this has been shown to be not only useless but harmful. A randomised controlled trial conducted in England in 2007 showed that pharmacist home visits to patients achieve no real benefit and are expensive.
We have a distance to travel before the relations between pharmacists, GPs and patients reach optimality. There is much that pharmacists can do and a rightful place for their contribution can surely be found, especially in the care of people with persistent, multiple chronic illnesses.
It would certainly help patients if pharmacies could offer more privacy, such as the opportunity to use a booth where patients could discuss personal and potentially embarrassing issues with the pharmacist. It would avoid that awkward moment of being overheard by anyone who happens to walk into the shop.
Professor Stephen Leeder is professor of public health and community medicine at the University of Sydney. He chairs the board of the Western Sydney Local Health District and works at the Menzies Centre for Health Policy (formerly Australian Health Policy Institute), where he was director from 1999 to early 2013.
Posted 8 April 2013
There is a fundamental difference between the aims/demands of discount retail pharmacy and providing important medical advice in an appropriate setting. As Professor Leeder suggests, this conflict will need to be addressed before pharmacists can effectively partner their medical colleagues in ensuring comprehensive medical/ pharmaceutical care.
Given my recent attempt to secure some vaginal Clonea at the pharmacy – dealing with 2 inexperienced and awkward pharmacy assistants before a mature person took over the interaction – I can well imagine that many young women would baulk at the idea of asking for the morning-after pill in similar, awkward public circumstances.