By Peter Farley
Recently, I have had unexpected conversations with two pharmacists in different
branches of our profession which made me stop and think about the future of
pharmacy.
The first happened at a party. I was introduced to a young pharmacist who seemed
full of enthusiasm. He was a proprietor pharmacist who owned one pharmacy in
a small parade of shops on one of the larger housing estates in our city. Having
got past the opening pleasantries, we conversed quite animatedly about the pleasures
to be had from talking to and advising the public about their health problems
and the most appropriate treatments available. It was only towards the end of
our conversation when he was preparing to leave that I discovered his shop was,
not unusually, open from 9am to 7pm and his dispensing average was over 350
items every day.
The second conversation took place in the hospital pharmacy where I am currently
employed. There, we have recently been involved in new systems of working which
will increase the responsibilities of technicians involved in the dispensing
process. All the prescriptions which arrive in the dispensary are first vetted
by a pharmacist - the professional check. After that the aim is to have the
potential to leave the remainder of the process - both the dispensing and the
accuracy check - in the hands of technicians. After an hour and a half sitting
in the hot seat, one of the young pharmacists in the department said to me:
"That was good. I felt like a real pharmacist while I was sitting there."
These two exchanges portray two totally different views on the role of the pharmacist.
First, there is the freely available health care adviser who is able to talk
knowledgeably to the general public about all manner of health issues; in effect,
he is the patient’s advocate. Secondly there is the hospital’s expert on drugs,
whose role is to clarify and confirm, or otherwise, the prescribing intentions
of the medical staff. He performs the final intellectual check between the end
of the doctor’s pen and the inside of the patient’s body.
Both of these roles, if undertaken well, are equally appropriate for the future
of our profession.
To the pharmacist in a community pharmacy, part of the attraction is that when
someone says, "Can I have a word with the pharmacist?", there is that
sudden, minor adrenaline rush. What do they want? The question could be anything
and will have to be dealt with in a professional and knowledgeable way, generally,
within hearing of everyone else in the shop. But to undertake this role appropriately
requires that the pharmacist is up to date with all of those health issues which
concern the customers of his shop. There the trivial is interspersed with the
profound. There, amid the myriad consultations about colds and rashes and verrucae,
will come the bombshell: "I have had a letter asking me to take my child
for MMR vaccination but my mother says that it causes autism. Help!" "Which
brands of baby food have no salt, starch or genetically modified ingredients?"
"My friend says that disposable nappies are very bad for the environment
and that I should be using terry toweling nappies. Which is best?" Even
worse might be an overheard conversation between a counter assistant and a customer
during the sale of a medicine: "Do you take any other medicine?" "Yes
I am being treated for Parkinson’s disease."
To the hospital pharmacist, the job is similar. When a clerk comes out of the
office and asks the pharmacist to speak to a patient or doctor, there is a similar
thrill. What might they want to know? Is it a patient seeking confirmation that
the change in medication is appropriate? Or is it a relative or carer seeking
clarification about some high-tech medicine? Much more scary might be a senior
physician with a question like, "What is the likelihood of cross sensitivity
between carbimazole and propylthiouracil?". Or, the pharmacist sitting
in the checking seat may have to deal with such situations as, "This patient
has a peanut allergy and the doctor wants to prescribe Naseptin cream",
or "This patient has an allergy to citrus fruit and he has been prescribed
Calcichew", or "This patient has jaundice and prostatic hypertrophy
- should he really have chlorpheniramine for his itch?". In a similar way
to practice in a community pharmacy, these questions have to be dealt with knowledgeably,
tactfully and, above all, professionally.
But the real question is how does one fulfill this role throughout one’s entire
professional career. For someone who has spent, probably, too many years pushing
paper across a desk and who is now attempting to relearn the role of dispensary
supervisor and minor ward pharmacist, such a question has a real ring of relevance.
I hear you say "ongoing education". That is all well and fine, but
how does one make it happen. Again, I hear you say, "there are lots of
courses". Meetings of the College of Pharmacy Practice, the Centre for
Pharmacy Postgraduate Education, local Royal Pharmaceutical Society branches
and local branches of the Guild of Healthcare Pharmacists are all freely available.
But when one has worked a long day and one still has to eat, put the children
to bed, as carry out all the other tasks that are essential to maintain a sensible
life, summoning the necessary enthusiasm to turn out for an evening meeting
is often quite difficult. And, anyway, such education does not even attempt
to cover all of the other matters, such as a cost-benefit analysis of disposable
versus reusable nappies, MMR, autism or the antigenic properties of medicinal
excipients, that are relevant to the interaction between our profession and
those whom we seek to serve, and which are really only mentioned in newspapers
and magazines.
I once heard someone at a professional meeting say that, given the current educational
opportunities for our profession, the age at which a pharmacist is best able
to practise for that which he or she has trained (ie, getting the patient’s
drugs right) is 30, and that it is down hill all the way from there.
Given the large and growing expenditure on drugs and the potential for damage
if something does go wrong, is it time to consider compulsory reregistration?
I say it with no real enthusiasm. But if we are to avoid treading the path that
the doctors have trodden recently with regard to ageing, incompetent and malicious
practitioners, then the profession needs to be seen to be doing something. A
major high-profile error is inevitable and if appropriate measures for ongoing
education, training and regulation are not in place, then we will have all our
dirty linen out on show and the Government visibly telling us how to regulate
our profession. This is a scenario to be avoided at all costs.
Peter Farley was previously chief pharmacist at Birmingham
City hospital.
He currently works at Sandwell general hospital, Birmingham