On the ward, we are debating the addition of a third drug to control an elderly patient’s labile blood pressure when the pharmacist asks if I am sure. The years have taught me that this represents a testing of the waters to see how receptive a doctor might be to advice.
“What do you suggest?” I ask.
“I could check with his pharmacy whether he has been filling his existing scripts.”
The suggestion is soft, almost apologetic, but she is right. The local pharmacist who has known him for decades says that since his son died, the man’s self-care has faltered. This nugget of information helps us avoid another drug and instead shift our attention to the whole patient.
When the team commends the pharmacist’s foresight, I am reminded of the days of paper charts when careless handwriting of dangerous drugs like insulin and warfarin could make the difference between life and death. The hospital pharmacists’ tireless pursuit of legible orders saved more than a few nascent careers from being cut short by a fatal error.
In the hospital, no day goes by without pharmacists improving patient outcomes. We have different skills but the same goal, to serve the patient, so it has never crossed my mind to think that pharmacists are “less” than doctors.
When I visit the local pharmacist, I see evidence of a community spirit that has left the hospitals. Good pharmacists know their patients. They know who is cognitively impaired, who has a disabled child, and who needs a nudge to get vaccinated. For regular patients, there is a reassuring familiarity but even for infrequent customers like me, there is demonstrable professionalism and care that instils confidence.
Most doctors I know count pharmacists among their trusted colleagues and friends, which is why the latest war of words between the two profession’s lobby groups seems so unedifying.
Community pharmacists want a right to limited prescribing, such as antibiotics for uncomplicated urinary tract infections and the contraceptive pill, claiming this will relieve pressure on doctors and allow low-risk patients access to timely treatment when it’s impossible to find a doctor.
The scarcity of general practitioners is real. A retired specialist told me that after repeated rejection, he had to write an “application” to his local practice reminding them that he had devoted his career to caring for their patients. If this is the kind of influence required to get a general practitioner, “regular” people have a problem.
But doctors strongly reject expanding the scope of pharmacists. They say that the success of pilot programs for limited prescribing has been misrepresented and warn about pharmacy overreach as well as a conflict of interest if pharmacists both prescribe and sell medicines.
In another argument, doctors want commonly prescribed drugs dispensed as an extended supply of 60 rather than 30 days to promote patient convenience and reduce administrative burden. Patients with stable chronic diseases would benefit while those with fluctuating conditions would receive a limited supply and earlier review. I personally see the value in this because an increasing number of patients attending my specialist clinic request repeat prescriptions for their blood pressure and diabetes “while I am here”; they either have trouble getting to a GP, can’t afford the gap or consider a monthly visit to the GP to renew a script unnecessary. The time I spend generating these scripts detracts from the specific things I need to do for these patients.
However, the doctors’ sensible recommendation has been strongly opposed by pharmacists who perceive it as a tit-for-tat move to reduce their income from a dispensing fee, renewing the Pharmacy Guild’s reputation as “the most powerful lobby group you have never heard of”.
Meanwhile, the government is striving to get the balance right in an environment where there are no magic solutions. The healthcare crisis is global. The population is ageing, expectations keep rising and funding is finite.
Clinicians and policymakers agree that good healthcare means delivering the right care by the right provider in the right setting. Primary care needs urgent resuscitation but it can’t hurt for professionals to give and take in the best interest of the patient.
In this febrile atmosphere, the Australian Medical Association recently released a video warning the public that funding pharmacists to go beyond their current remit “will threaten your safety, fragment your care, and undermine Australia’s world-class health system”.
This sounds too bad to be true.
When rating honesty and integrity, the community consistently puts nurses higher than doctors, who closely mirror pharmacists. There are probably “bad” pharmacists just as there are rogue doctors and unethical nurses, but to tarnish an entire profession is a recipe for inviting ridicule upon oneself.
No one doubts the value of doctors. But to underline this, doctors can sometimes get carried away by the refrain that it takes years to train one of us and no other profession comes close. Ask any healthcare worker and they describe an undercurrent of disdain that a nurse is not a doctor, a physiotherapist is not a doctor, a pharmacist is not a doctor. But the public is unmoved by such protestations because it isn’t looking for substitute doctors; people appreciate nurses, paramedics, allied health workers and pharmacists for who they are.
Doctors will never shift public opinion by turning their badge of honour into a chip on the shoulder.
But the real reason we should all care about the spat between two powerful lobby groups is that it undermines patient confidence. Patients are right to suspect that the arguments seem largely self-serving and ignore their best interest. Professionals on both sides are discomfited by the disparagement of their colleagues and want the spotlight back on public good. No one wins when healthcare workers turn on each other.
Winston Churchill observed that healthy citizens are the greatest asset any country can have. Doctors can’t defend the asset alone.
Imagine a world where doctors and pharmacists respected each other and put the patient first. For most of us, that is the real world. Don’t let the lobbyists tell you otherwise.
Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is called A Better Death