Printed From: i2P - Information To Pharmacists (http://archive.i2p.com.au/)

The Lessons From History

Issue: Issue 82: May 2009
Author: Neil Johnston
URL: http://archive.i2p.com.au/?page=site/article&id=1298

It has always been said that there are “lessons to be learnt from history” or that “history repeats itself”.
The recent influenza potential pandemic has highlighted an anomaly.
After other health professionals had been detailed on the Mexican “Swine” Influenza pandemic and supplied with patient information, masks etc,  it was found that the  process deliberately excluded pharmacists.
This triggered a damning pharmacy bulletin board response by pharmacist Peter Crothers, who said in an open letter to the Minister for Health and Ageing (Nicola Roxon):

”It would have been useful therefore to include pharmacists in the recent emergency 'swine flu' communications to GPs and other 'front-line' health workers
Perhaps all those epidemiologists who have never been into a pharmacy might disagree, but I reckon that it is obvious that pharmacists' role in a pandemic won't just be in dispensing; educating the public about infection risks and control ; advising on products; redirecting people from our doors to other care without trying to assess them (how do we, by the way, simultaneously 'advise' and 'educate' people while not allowing them through the door?) and the other no doubt important but basically 'second line' and/or 'after the event' roles mentioned on the Australian Government pandemic website for pharmacies.” 1

Have we already forgotten that modern pharmacy was borne in the pandemic of 1665 during the black plague?
That’s the one where the physicians of London left town with their wealthy patients while the apothecaries remained to care for the sick and the poor who were unable to escape.

“The nobility left the city for their estates in the country. They were followed by the merchants, and the lawyers. The Inns of Court were deserted. Most of the clergy suddenly decided they could best minister to their flocks from far, far away. The College of Surgeons fled to the country, which did not stop several of its members from writing learned papers about the disease they had been at such pains to avoid. The court moved to Hampton Court Palace.”

“Throughout the summer the death rate escalated, reaching a high of over 6,000 per week in August. From there the disease slowly, oh so painfully slowly, receded until winter, though it was not until February of 1666 that King Charles thought it safe to return to the city. How many died? It is hard to say, for the official records of that time were patchy at best. The best guess is that over 100,000 people perished in and around London, though the figure may have been much higher.” 2

That was the baptism of fire for pharmacists and the tradition was followed during the influenza pandemic of 1918 and 1919 (the Spanish Flu’) that entered Australia through soldiers returning from World War 1
In 1919 nearly 6000 people died in NSW and one person in three in Sydney, suffered from a virulent form of the disease.
”People had to wear masks in shops, hotels, churches, theatres and on public transport”. 3
Pharmacists were working a minimum of 15 hours per day (some days up to 24 hours), seven days per week simply to service the demand. Price controls on medicines were introduced and rigidly enforced.

Fast forward to 2009 and we have a debate as to whether pharmacy is actually a part of primary health with a history of two major pandemics under its belt and a few minor ones as well.
In the intervening time pharmacists have become so highly trained that they are ready to take on prescribing roles.

One really has to wonder about the sanity of the health bureaucracy and why there is a deliberate exclusion of pharmacy from being developed as part of the primary health team, multi-skilling along the way.

It’s been a deliberate policy by health officials, backed up by the AMA to downgrade pharmacy to “allied health”. It has also been a deliberate policy to drain service income from pharmacy through the utilisation of practice nurses to perform tasks that would normally be performed by pharmacists.

And it has not helped that the PGA has developed policies antagonistic to the development of professional practice. Monies are being spent purely on efforts that support the supply function, all else is cosmetic, with minimal substance.
It also appears that an unwritten policy to replace pharmacists with as many pharmacy assistants as possible is under way, and has gathered legs with the impetus of the global credit crisis.
The PGA promotes itself as representing all pharmacists.
It’s time they recognised that they are failures in that regard and tender their resignation, so that some other pharmacy group can take their place.

I would also suggest that all readers have a look at the article prepared by New Zealand pharmacist John Dunlop in this edition of i2P. He tells us that when he organises focus groups of doctors, nurses, bureaucrats, pharmacists and the public and asks them to describe the health care role of a pharmacist, he is met with silence.
Not even the pharmacists can answer the question!

Opportunities have abounded since 1978 when the PGA first identified a pharmacy model that would be “clinical”. Nothing has been done since then, except to encourage supermarket pharmacies to position themselves for an easy takeover in the event of deregulation in 2010+.

The shame of all the above is that many pharmacists have a clear vision on how they can impact primary health in a positive and economical fashion.
But they lack the tools to work with – a supportive pharmacy environment, a flow of grants to research their own systems and processes, and a lobbying process that communicates the clinical message to politicians and other health professionals.

It has always been my experience that when I work in a clinical setting or an educational setting involving other health professionals, I am accepted and incorporated as part of the team effort.
It is only when I work in a community pharmacy that I encounter disrespect when other professionals talk about what we sell not being evidence-based, or from the usual run of patients that say “You only have to stick a label on it” or “I know all about my medicines. I don’t want printed information. Just give me my tablets and stop wasting my time”.
Or indeed from the owner-supported dispensary technician who tells you that an asthma card is not required for Ventolin or attempts to sell an S3 product without reference.
It happens often enough and you just know that if you buck the system, you will not be invited back.
This is not a new experience for most employee pharmacists, but it still grates each time I experience it.
It is obvious that despite all the time and money invested in community pharmacy it has an image problem in respect of the general public, other health professionals and non-owner pharmacists.

I have yet to work in a pharmacy that consistently observes all of the following elements:

1. Properly promotes clinical services with a view to generating an income to cover pharmacist time, and trains support staff in the form of clinical assistants.
2. Has formed their business structure into a corporate format and invited investment from employee pharmacists as shareholders.
3. Has evidence on file to support the sale of the products it sells.
4. Has a staff-friendly policy to ensure tea breaks and lunch breaks are taken, and provide adequate facilities to sit down and eat in a civilised fashion.
5. Has a consistent mentoring program to ensure that all staff is continuously trained in a friendly and supportive manner.

The fact that pharmacy has a chorus of organisations such as the Skeptics, Choice and various government agencies voicing concerns, and that the lead pharmacy organisation (PGA) has not taken steps to address the various concerns raised, means that the profession is losing respect.
Being a powerful lobbyist does not mean that pharmacy is respected for the right reasons.
And if the profession is unable to communicate a message to all concerned as to what healthcare function it performs, it positions all pharmacists between a “rock and a hard place” as to their future.

References:

1. Crothers P. Auspharmlist Bulletin Board, Wednesday 29th April 2009. Accessed here

2. Britain Express The London Plague of 1665, http://www.britainexpress.com/History/plague.htm 
Accessed 1st May 2009.

3. Haines G. The Grains and Threepenn’orths of Pharmacy.


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