|
Hemant Patel is secretary of the North East London
Local Pharmaceutical Committee and member of the Royal Pharmaceutical
Society's Council
|
It is clear that most pharmacists, including the profession’s
spokespersons, have missed the fundamental issue raised by the Which? report (see PJ,
7 February, p143). The issue is not just about supply of potent over-the-counter
medicines and absence of good advice; it is about an apparent lack of
social conscience and civil responsibility within the profession. As
a result pharmacy, which has been given a role in statute to protect
the public from harm, is damaged. Not surprisingly, a blame-shifting
game is being played.
The blame game began when Adam and Eve ate the forbidden fruit. Their
story says a lot about immaturity and it describes an archetypal drama
re-enacted time and again in various societies
(including pharmacy). The professions are given responsibility and are
expected to be responsible. Responsibility, in order to be reasonable,
must be limited to objects within the power of the responsible party.
These objects are clearly defined and, in order to be effectual, must
relate to operations of that power. Pharmacists’ training and continued
education programmes are designed to meet the objects, but there are
apparent problems in the exercise of that power. The reasons are complex
and society’s leaders do not fully understand the operations, or
the pressures, or the decision-making frameworks that govern pharmacy
practice. I believe most pharmacists are decent and self-disciplined.
So, when and why does self-discipline, a mark of a noble profession,
break down?
In his essay “Civil disobedience”, Thoreau argues that the
government which governs best is the one that “governs not at all”.
People who misinterpret his work stop there, failing to recognise that
what he advocated was “better government”.
In a country made up of “superior” citizens as advocated
by Thoreau, there would be no need for much government at all. And, in
such a society, there would be no need for inspectors and police. Pharmacists,
and other professionals, would keep their knowledge base up to date and
employ well-trained assistants. Every patient, customer or client would
get high-class service because of an ingrained sense of responsibility.
Systems and all individuals would work consistently and in harmony. Value
statements, setting out the key values or themes considered important
by society, would provide a useful reference point for appraisal and
reward systems.
In the past, calls for development of a social conscience by each and
every member of the Royal Pharmaceutical Society have, to a large degree,
failed. I ask, must the pharmacist even for a moment resign his conscience
to the legislator? Why has every pharmacist a conscience, then? We must
not only have laws and a professional code of conduct (which rarely includes
contributions from ethicists) but also widely accepted professional values.
These principles and standards of behaviour should be inculcated from
the first day at a school of pharmacy and thereafter throughout life.
Our profession’s basic philosophy was, and should still be, about
accepting responsibility without being patronising. In the future, there
would be greater scrutiny and, paradoxically, even greater responsibility
placed in our hands.
Many pharmacists have contempt for people when substandard workers enjoy
the advantage of the trust-based distribution system. Yet, they do not
want to bear any responsibility for setting it right. The Council’s
and the Government’s role is to create the right climate, not simply
to allocate responsibility and make rules.
Simply put, we must hold each of us responsible for the society we live
in today. It matters not that you and I were not a party to establishing
the institutions and systems which continue to fail in some respects.
That we benefit from them today, in ignorance of our own continued complicity,
is not an excuse.
People who deny their culpability for an alleged failure because they
were not there when it happened, find it hard to comprehend that they,
as pharmacists, are collectively responsible for pharmacy’s situation
today. If there are still people who are irresponsible, then each of
us has the duty to discover the cause, the effect and the remedy.
In autumn of 2000, the Society’s Council, when considering a recommendation
on the supply of emergency hormonal contraception, made an error, in
my view, because, instead of making a decision based on concerns of public
health and an appropriate access to medicines, it based its policy on
appeasing “our partners”, and we allowed relations management
to dictate policy. The recommendation was based on an informal understanding
with the supplier and the NHS. The Government wanted to reduce teenage
pregnancy and pass the costs on to the private sector for the drug. The
company wanted an early entry to the OTC market and maximise its return
from a patented product. In my view, clearly stated at the time, the
Society colluded and opted to support POM-to-P reclassification rather
than, at least for a time, promote supply through the patient group directions
(PGDs).
In POM-to-P reclassification there is:
· No communication with GPs
· Leakage of usage data making public health policy-making difficult
· No confidence-building in pharmacists, GPs and policymakers
· Little local supervision of service provision
With a PGD or pharmacist prescribing there would be:
· Communication with GPs
· Accurate capture of usage data to help public health policy-making
· Building of confidence in pharmacists, GPs and policymakers
· High quality training plus more effective local supervision of the
standard of service
We failed to apply an exemption to a POM-to-P general rule.
We become what we are as pharmacists by the decisions that the Council
makes on our behalf. Having now been part of that system for a decade,
I am as much to blame as anyone else.
The bogus excuses and criticism of the methods used to gather evidence
distract us from the work to understand the cause of the problem without
which there can be no effective remedy. Responsible people are mature
people who have taken charge of themselves and their conduct. Responsible
pharmacists own their actions and own up to them. We need to be brave
and take intelligent and timely action to set new standards of practice
and self-discipline. |
The
Pharmaceutical Journal