[e-drug] Recognition of pharmacists as health care providers (3)

e-drug
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E-DRUG: Recognition of pharmacists as health care providers (3)
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[E-druggers might be interested to look in the archives at a similar discussion in May 2005.
Thread - pharmacists v/s physicians]

Dear Atieno Ojoo,

I know that this is an old hobby-horse of the American College of
Pharmacy, but:
To me as a European physician this seems a disastrous and even foolish
initiative. Why, if pharmacists want to put their hands - physically -
on patients, issue prescriptions, order and interpret laboratory tests,
make a diagnosis and follow-up patients, why don't they study medicine
in the first place?

It reminds me of a famous story about the "Most Worshipful Society of Apothecaries"
in London in the middle of the 19th century, whose members requested the same
privileges, and then were told by the College of Physicians, that that
wish was OK, but that they should then acquire a degree in medicine -
which they did and then were incorporated in the College as full
colleagues. This strange club still exists.

In no way the study of pharmacy of 3-4 years can be compared with the medical curriculum.
This development may be appropriate in remote regions in the USA, where
primary health care is notoriously deficient, and where the pharmacist
fulfills the role of the "bare-foot doctor", the "Feldscher" of the
Russian steppe. But otherwise? One has only to look at the showcases in
the average European pharmacy which tend to be mainly filled with
homeopathic and beauty products.

It has been suggested that it is useless to discuss clinical
pharmacology (i.e. medical science about drugs) with a pharmacist as
long as there is a cash register on the counter (now replaced by a
computer which tries to print as many letters on the label as possible).

The result is that we are raising a generation of medical students and
doctors who are largely ignorant of the choice and the action of drugs
because this facet of medicine is taken out of their hands by not
medically trained assistants.

As readers will understand I am very upset by this Xth repetition of a
dated idea.

Regards,

Dr.Leo Offerhaus, retired internist and clinical pharmacologist, the
Netherlands.

Dr.L.Offerhaus
Koedijklaan 1a
1406KW Bussum
Leo Offerhaus <offerhausl@euronet.nl>

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E-DRUG: Recognition of pharmacists as health care providers (5)
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Dear Leo,

Did you check the curriculum of Spanish "Licenciado en Farmacia" (before
lasts reforms, when it was a 5 years University degree) and posterior
specialization as residents in our Health System?

There are disciplines related to biological medical science, as Organic
and Inorganic Chemistry, Biochemistry, Toxicology, Microbiology or
Parasitology, where a Licenciado in Farmacia, has broader and deeper
knowledge than a "Licenciado en Medicina". A Spanish clinical
pharmacologist has same knowledge and capacities after residence studies
and training, independently if they are Licenciado en Medicina or en
Farmacia.

That being said, I am not saying a pharmacist has capacities to make
clinical diagnosis, but yes to input on related treatments if
pharmaceuticals are involved or laboratory diagnosis, depending on
training.

I believe the potential of pharmacists knowledge is under-valued by the
medical profession in many cases. Also, that it is too much extended the
idea that Pharmacists are only business people who are not interested
on health issues, that pharmacist are cosmetics sellers. This image of
the private pharmacist is Global. There are other health professionals,
which are pharmacists and do not respond at all to that image.

Kind regards

Pablo Alcocer Vera
Licenciado en Farmacia
PD in Tropical Medicine and Public Health.
PABLO <palcocer@gmail.com>

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E-DRUG: Recognition of pharmacists as health care providers (4)
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Dear colleagues,
I recall a lecture I had as a pharmacy student in Aberdeen back then in the 80s, when we referred to the story referred to by Leo Offerhaus ("Most Worshipful Society of Apothecaries"). It still surprises me that the support services that are provided by pharmacy to clinical care often compels or tempts some (and indeed within pharmacy) to propose extending the pharmacists' role into actual, physical clinical care practice. Frankly speaking, and unless we as pharmacists have too much time on our hands, there is more than enough on the hands of pharmacists to be addressing, than to start digressing into other professional areas.

As a service provider to clinical and other public health services (eg,human and animal health; public health policy; services at the health delivery point, etc), there is of course no harm in our understanding of these areas; I suppose that may explain why 'clinical pharmacy' came about us a training programme: I do not believe it is the intention of that programme to turn pharmacists into clinicians. If pharmacists want to practice medicine, then go for that training and get properly sorted to provide full clinical services to the public. However, to suggest that one can practice medicine without the full medical training is rather too simplistic, and poses a danger to public health.

There is a clear division of labour in medical practice and services. Where public health authorities make strategic decisions of training non-professionals to provide certain services, based on addressing immediate public health challenges, it is simply making best of a difficult situation. That is not to suggest that any one can practice medicine, let alone pharmacy (I have of course come across some physicians who claim that they 'can do pharmacy, just...like that!').

We also see this development these days where everyone is a specialist in access to essential medicines, resulting in many pharmaceutical professional matters being looked at simplistically (eg, from the science of medicines manufacturing, logistics and supply management for medicines, to handling of medicines by patients). I think this has to do with the fact that there is indeed immediate access challenges to be addressed; but that is not to say pharmacists have had their role diluted.

The fact of the matter, I believe is that the pharmacist is indeed an important part of the health care team, just like other support services to clinical services. These are specialist areas, of course, and have to be given the same type of recognition within the healthcare sector. How they develop in future is really a matter for discussion relative to developments in all areas of life.

Regards,
Bonnie

Bonface Fundafunda PhD., MBA., B.Pharm
Manager, Drug Supply Budget Line
Ministry of Health,
P.O. Box 30205,
Ndeke House,
Lusaka,
Zambia
Tel: +260 211 25 41 83
Fax: +260 211 25 33 44
Mobile: + 260 979 25 29 00
Email: bcfunda@hotmail.com
[Amplifying Bonnie's case, pharmacists are among other things: community and hospital pharmacists, specialty clinical pharmacists, Primary Health Care team members, specialists in scientific activities, researchers and educators, managers and administrators, logisticians, policy directors, and in many places have the skills to manage all of these at once. Moderator]

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E-DRUG: Recognition of pharmacists as health care providers (5)
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I wonder whether the closer we are as pharmacists to frontline "clinical practice" and, vice versa, the closer we are as clinicians to frontline "pharmacy", the more vulnerable we become to the avoidable pitfall of asking for more work and, probably, the related renuneration and recognition? But this can of course mean that we are also more likely to lose control over our core competencies and responsibilities.

In my area of pharmacy practice i.e. public procurement, I really cannot ask for more because, in a twinkle, things directly traceable to my irresponsibility and incompetence can go wrong, and sometimes at high cost - health as well as economic. Recently, I was just about to sign-off on an international procurement tender for medicines when, as a last stroke of a pharmacist's responsibility for routine due dilligence on specifications, I realised that two of the important and high volume items were described as follows:

(1) Dried Ferrous Sulphate equivalent to Ferrous Iron 30mg & Folic Acid IP 0.1 mg/250 µg enteric coated tablets.

(2) Trimethoprim & Sulphamethoxazole Tablets IP (Paediatric),Trimethoprim IP 40 mg+ Sulphamethoxazole IP 200 mg, dispersible and scored tablets.

I leave any flaws in the above specifications to e-druggers' own probing, but suffice it to say that when, in addition to the time it often takes to winch the devil out of the detail, and to ensure adherence to all the intricate national and international best practice requirements for quality assurance of pharmaceutical procurement, a public health procurement pharmacist also has to deal with, or at least understand the implications of, contractual issues such as 'title to goods", "performance security", "liquidated damages", "proprietary rights", "changes to contract", "termination for default or convenience", "consequences of termination", "remedies for default", "force majeure", "corruption and fraud", "non-waiver of rights", "non-exclusivity", "taxes", "advance notice of arrival and advance shipping documentation", "amicable settlement of disputes", "arbitration", and so on and so forth, then such a pharmacist should really have no space to need more and, frankly, this has even made me recently reflect on just what the profile of a pharmacist who wishes to move into public procurement should be.

It seems to me, therefore, that our primary responsibility as pharmacists is to cover our professional and competency bases first, and I think this is much better appreciated these days than the 1980s that Bonnie recalls. At the same time, we should keep in mind that the more we adventure beyond this base, the more fragile and vulnerable our professional game becomes.

Murtada Sesay, B Pharm.Hons(Ghana), MSc(UK), MMI(USA), MCIPS(UK),
Pharmacist and Procurement Specialist,
New Delhi,
India.
e-mail - kindiatown@hotmail.com

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E-DRUG: Recognition of pharmacists as health care providers (9)
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Dear E-druggers,

It is quite logical and acceptable that a number of intelligent members
of the professions have a keen interest in what others in allied
professions are doing, and that they let their professional behaviour
guide by how others behave. But it does not mean that they should
uncritically copy or incorporate such behaviour. But there are logical
reasons why some professions should maintain a strict separation.

In Europe we have struggled for years to ban the phenomenon of the GP
selling his own drugs, and we no longer accept such disreputable
behaviour. Now the same conflict has started around veterinarians
selling drugs, particularly antibiotics, and we all realize the awful
consequences of such lack of control: Q-fever in goats, salmonella in
chickens etc.

A more extreme example is the separation between the
police on the one hand and the judicial apparatus on the other - they
try to achieve the same goal, but we would not like the picture of armed
judges or of police officers judging criminals in the lawcourts - two
world wars sufficed to demonstrate the usefulness of separating such
tasks. We have an old saying in Holland that a cobbler should keep to
his last. However, one thing seems certain, that extending the tasks of
the pharmacist will raise the cost of health care, and not the other way
round. But we probably will never agree on this sensitive subject.

Best wishes,

Leo Offerhaus

Dr.L.Offerhaus
Koedijklaan 1a
1406KW Bussum
"Leo Offerhaus" <offerhausl@euronet.nl>