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Do "They" Know What We Do

John Dunlop
From a New Zealand Clinical Pharmacy Perspective

Issue 82: May 2009
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Pharmacy is probably the only health profession to move into the third millennium that has not developed a clearly defined role to clarify to funders, the public and the profession where it fits within the health care environment.
This is beginning to cause many problems for pharmacy.
Community pharmacy was once the repository of a unique skill set upon which the public depended in order to receive the extemporaneous preparations that the doctor prescribed.
These days there is very little prescribed by way of extemporaneous product and this has left a big gap in the minds of the public as to what it is that pharmacists actually do.

In New Zealand we rely on the Medicines Act for the legal descriptions of Pharmacist; Pharmacy; and Pharmacy Practice.
It may surprise some people to realise how non-definitive these descriptions are.
A pharmacist is a person registered as a pharmacist by the Pharmacy Council (the New Zealand registration body).
A pharmacy is described as the place where the practice of pharmacy is carried out and not surprisingly, pharmacy practice is not defined at all.

Clinical pharmacists have created a role for themselves that addresses and attempts to resolve issues surrounding drug related morbidity and mortality, which to my mind at least, is a sensible way of describing what we do.
Unfortunately there is no acceptable definition for clinical pharmacy, which almost takes us back to square one.

Over the last few years our small company has been involved in a little contractual work for government agencies.
Some of this work has required us to organise focus groups of doctors, nurses, bureaucrats, pharmacists and the public.
When each of these groups are asked what they perceive to be the health care role provided by pharmacists we have been confronted by silence.
Giving advice about medicines, and making sure the tablets are correct, and checking up on the doctor, are about as far as we get.
These roles are certainly undertaken, but how valuable are they? We have no measure of how important the public think they are what their expectations are, or how they would cope if we didn’t do these things.
It’s not that long ago when pharmacies in New Zealand tried to charge the public a fee of up to $2.00 for the professional advice and service they provided to make up the difference the government wouldn’t pay.
It was a salutary lesson for many of us to be - often very angrily - informed that their doctor had told them everything they needed to know and they certainly weren’t going to pay us!

We get even bigger surprises when we ask the focus groups “what services would you like your pharmacist to provide?”
A frequent response is “that if they had more training they might be able to….”, which demonstrates an amazing amount of ignorance about the profession.
Surrounded by all this ignorance there is still an inordinate amount of government goodwill to try and bring community pharmacy into the primary health care arena.

I can’t help but conclude that pharmacy leaders are neglecting their duty by not working to research and develop working definitions that adequately describe the role of the pharmacist in society. Definitions that reflect the training and education pharmacists have worked so hard to achieve. Pharmacist have a right to expect that their organisations will work at a higher level for the profession and create an environment that establishes pharmacists’ self esteem and provides a base from which to develop innovative professional practice. It might also just make it a little easier to attract a reasonable amount of funding for the profession to move forward.

In the absence of a universally accepted professional role definition we are all likely to be relegated to the role of a ‘pill counter’, a label which once upon a time had a tinge of humour about it as in those days everyone knew we had amazing skills creating suppositories, emulsions, pills, and ointments.

These days they just don’t know what else we do and worse – we can’t tell them!

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