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- Issue 81: April 2009
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- Issue 78: December 2008
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Maybe Doctors and Pharmacists Should Swap?

Stephen Carbonara
From an Independent Professional Pharmacist Perspective

Issue 78: December 2008
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Well… the title says it all! This might be the one way that we can sort out community primary care without the inter-professional bickering. Doctors want us ‘off their turf’, we want doctors ‘off our turf’; but something still needs to be done about primary health care. So let’s swap ‘turfs’ (or is it ‘turves’? Maybe I’ll ask a doctor, they’re more trained than me).

Imagine if, in one fell swoop all pharmacists became the primary consultants and prescribers; and all GPs became the scrutinisers and dispensers. I would believe that the public would enjoy at least an equivalent standard of health care in this model. After all, the process still enjoys the engagement of the same two professionals. Who is to say, which is the cart and which is the horse?

Pharmacists, using appropriate clinical knowledge (particularly regarding prescribing of medicines) could order a course of treatment for an individual and then have a ‘more highly trained’ doctor making sure the treatment is appropriate and providing final advice and instruction at the point of dispensing. This therefore ensures that the ‘more highly trained’ professionals only spend time dealing with the people that are ‘really sick’.

Other advantages would be:

  • Pharmacists could practice QUM during the inward phase, not the outward phase.
  • Doctors would get rid of snake oil remedies from their shelves (or would they?).
  • Pharmacists would be able to regularly medication-review their patients – and enact all of their recommendations!
  • Doctors would be able to enjoy being the last-point-of-contact during the dispensing phase, so that customers will remember what they said instead of what the pesky pharmacist said.
  • Pharmacists would be able to appropriately explain and prescribe within the rules regarding Reg24, the 20-Day-Rule and authority prescriptions.
  • Doctors could make sure that customers are actually using their inhalers and nebulisers correctly.
  • Pharmacists would issue an appropriate number of prescriptions for the supply they have directed regarding Webster pack and nursing home dispensing, thus reducing the need for owing prescriptions.
  • Doctors will be able to derive immense satisfaction from providing extensive and thorough health advice to the public for free!
  • And above all, both professions will finally appreciate each others role in the health care system!!!

Obviously, this change would require an enormous amount of legislative surgery and is therefore unlikely to happen (and not in the least part due to my ever-so-subtle flippant commentary). However, it must be acknowledged that the differing professions have a unique job to do; and this (micturition) competition about who is ‘more highly trained’ must stop.

I respect GPs who are able to evolve toward the health care needs of the future by involving allied health professionals. I have scant regard for the GPs who drag their knuckles on the ground and yell, “Get off my turf you snake oil peddler!” Don’t they see that by opposing change, they may win the battle but they’ll ultimately lose the (allied health involvement) war? Whereas, if they negotiate on civil ground, away from the mouth of the cave; then they will protect their role and there may be a chance at arriving at a better system for all!

Stephen Carbonara.

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