The Pharmaceutical Journal
Vol 271 No 7260 p147-148
2 August 2003

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Letters to the Editor

CPD

What is the wisest course of action?

From Mr D. A. Canniford, MRPharmS

Three letters on continuing professional development grabbed my attention as I was reading my PJ recently (12 July, p48). "How foolish to disregard experience and knowledge", "Foambrain!" and "Where is the common sense?".

This leads me to relate the following conversation I had with an old friend of mine who is also retired. He suffers from diabetes and is stabilised on oral tablets. He had been to see his doctor the previous day because he had "heartburn" when he lay down at night. He was given a prescription for pain relievers, which he took to his regular pharmacy and had dispensed. He took one that night on retiring. The next morning he read the patient information leaflet and noticed that there could be an interaction between the pain relievers and his diabetes medicine, and he decided not to take his diabetes tablet while he was taking the pain reliever.

I arrived at his house at about midday and he asked my advice. Thinking about the above three letters, I wonder what would be the wisest course of action:

1. Take Dr Robert Dewdney's advice and keep my mouth shut

2. Suggest that he went along to his local fruit shop and ask the woman behind the counter for advice

3. Use some common sense

He said his blood glucose reading that morning had risen to 12 so I told him to take his diabetes tablet at once. To cover myself I also told him that the Royal Pharmaceutical Society forbade me to give him advice — he was not impressed by this. I am happy to say that his blood sugar levels are now back to normal.

Dennis Canniford
Co Carlow, Ireland

We need better definitions

From Ms E. Harrop, MRPharmS

Dr Robert Dewdney states (PJ, 19 July, p84) that to be eligible for the inactive register you must claim that you will not carry out "any activity or advice-giving to do with medicines or health care". Last week I bought some headache tablets, gave advice to a friend on how to treat a sprained ankle and read The Pharmaceutical Journal. I believe that not only pharmacists but most people would be unable to make such a declaration. Therefore, if there is not a better definition of what is "active" and "inactive", some pharmacists will have no choice but to leave the register. Is this really what the Royal Pharmaceutical Society wants?

Elaine Harrop
Leicester

A plea for common sense

From Dr G. Jefferson, FRPharmS

I have read with interest the letters from David Shenton (PJ, 5 July, p13), Stephen Axon (PJ, 26 July, p120) and others on the giving of pharmaceutical advice by retired pharmacists and, with great concern, the responses on behalf of the Royal Pharmaceutical Society.

At last in this debate, from Mr Axon we have clear reference to professionalism — the placing of the patient's or client's interest first — which requires the exercise of judgement and responsibility by the pharmacist, qualities that do not, or certainly should not, cease because of a change in registration status.

Many retired pharmacists, especially those with first-hand experience or knowledge of professional and scientific developments during their careers, may well in certain select areas still be more "expert" than younger colleagues.

Is it fanciful to interpret the position of the Society as one leading to denial of the professional, cultural and scientific heritage embodied in its retired members? It is of interest to note, for example, that a priest entrusted with a pastoral role remains a priest unless removed for grave misdemeanour. Thus, I echo the concerns of Mr Axon regarding the trust of the Society in its own members.

As one who has been immensely privileged and proud to have served our Society, I would be extremely saddened and disillusioned if I was no longer allowed to exercise appropriate professional judgement in my dealings with others. I might then have to speak merely as a retired pharmacologist or as a sufferer from a chronic disease. Indeed the expertise of the latter in respect of their diseases and based on experience, not certification, is officially recognised and is being used.

This is not an attack by me on appropriate CPD, to the planning and delivery of which I have made a contribution during my career; rather it is a plea for common sense and the exercise of trust by the Society.

Gordon Jefferson
Edinburgh

How to recycle old pharmacists

From Mr T. H. Spence, MRPharmS

I suggest that David Shenton (PJ, 5 July, p13) uncorks the bottle and becomes an expert patient (PJ, 31 May, p743) as soon as this is possible. Wearing the cloak of a patient suffering from a chronic condition and remembering that charity begins at home, he should be able to retain his membership of the Royal Pharmaceutical Society. A statement that he is "non-practising" must be sustainable. It seems that it is a matter of how Mr Shenton opens the bottle and with whom he shares the contents.

Mr Shenton is already developing skills in the interest of his own health care in relation to his heart condition. He has also shown a willingness to share his experiences with other professional people. Alas, without compliance with mandatory continuing professional development, he cannot continue to exploit his skills in any situation — voluntary, charitable or otherwise. He probably cannot publish health care articles in the popular press.

However, casting one's eyes to the future in the company of a specially trained pharmacist well-up in mandatory CPD, a recycling process for old pharmacists can begin.

It is proposed that a community or hospital pharmacist, well-versed in promoting the benefits of user-led programmes, forms a partnership with each patient having a key chronic condition. The patient for the purposes of this proposal is a retired pharmacist who is not willing or able to cope with mandatory CPD, yet seeks involvement.

I am such a pharmacist with the unenviable combination of glaucoma and Parkinson's disease. Nobody knows more about me than me. Every six months I have a brief encounter with the specialist and little changes superficially. Behind the scenes things are happening all the time as one adapts to the effects of chronic conditions. I am a passive recipient of health care and a potential candidate for recycling.

Thomas H. Spence
Glan Conwy, Gwynedd

Resign, and regain free speech

From Mr P. H. Nutton, MRPharmS

I could not agree more with Stephen Axon (PJ, 26 July, p120), who suggests that the only course left open to the retired pharmacist is to resign from the register of the Royal Pharmaceutical Society.

When common sense fails to prevail in a situation, then the only option is to remove oneself from that situation. Every Tom, Dick or Harry, or Mrs Jones over the garden fence, can give freely of their knowledge in all matters, including those of general health and how and when to take or not to take a medicine.

I say to all retired pharmacists who do not want to do continuing professional development, resign now. Get rid of the yoke of the Society from around your neck and regain the freedom of free speech that all the years of study and experience gave you.

Philip Nutton
Ryde, Isle of Wight

An annual declaration should suffice

From Mr D. R. Kent, MRPharmS

Kieron Donlon (PJ, 26 July, p119) appears to thinks that the '1984' of George Orwell is a valid concept for this profession. He argues that continuing professional development that is not recorded never happened. As an honourable profession the exercise of our work is, quite rightly, based to a large degree on trust in our professional knowledge. To record everything that may or may not be CPD is an administrative nonsense. If I pick up information from my Sunday Times or at an informal meeting with colleagues from other health care disciplines, is that knowledge invalid unless recorded? Does Mr Donlon carry a notebook to record all such informal CPD events? I think not.

What we need is a sensible approach to CPD, which, inevitably, must rely on a large degree of trust that the professionalism of pharmacists, such that a totally over-the-top approach to the recording of CPD is avoided. You cannot exercise this profession without, on a day-to-day basis, acquiring knowledge and I would be surprised if the amount of time during which informal knowledge was received did not exceed any simple time formula that may be put in place. A simple annual declaration should suffice.

I have just had a cup of coffee at my desk. I did not record this anywhere thus, according to Mr Donlon, I am still thirsty.

David Kent
London N21

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