[e-drug] Pharmacist v/s physician? Summary of discussion

[e-drug@healthnet.org]

E-DRUG: Pharmacist v/s physician? Summary of discussion
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Thank you very much e-druggers,  for the flood of responses in this 
thread.  The discussion began on April 29 with a contribution that 
concluded:

     'Should the base line of our responsibility be based on: physician 
responsible for making diagnosis & line of treatment where pharmacist 
for delivery of pharmaceutical treatment?'

Responses in another thread: Motivating Pharmacists for Enhanced 
Contribution in Healthcare, have covered much the same ground.

There have been more than enough responses for the time being, many 
very similar and some quite emotional.  We think it is time to 
summarise the responses and end the discussion for now. 

It is clear that the details are situation specific but in all cases 
the pharmacists and doctors are members of a health care team. 

The roles of pharmacists are determined by a range of factors. Here 
are some examples:

1. National Standard Treatment Guidelines
Where National Standard Treatment Guidelines are operational, they 
specify the levels at which different medicines can be prescribed. 
The responsibilities for prescribing will be clearly defined. 

The levels specified might include pharmacists' responsibilities 
among the responsibilities of other health providers, eg
_ Community health workers
_ Trained Birth Attendants
_ Rural Drug Vendors
_ Nurse practitioners
_ Pharmacists
_ Doctors at District Health facilities
_ Doctors at Central Referral Hospitals.

2. Regulation
In countries with strong regulatory systems, the limits of 
prescribing will be clearly defined and complied with.  Medicines are 
divided into (usually) four categories:

For example:
a. General sales medicines like paracetamol, antacids, some topical 
applications.
b. Medicines available OTC from trained pharmacists or prescribed by 
trained pharmacists
c. Medicines available on a registered physician's prescription only 
and dispensed by a pharmacist
d. Heavily controlled medicines like narcotics and some other 
categories that are available on a registered physician's 
prescription only and dispensed by a pharmacist, and in addition must 
be stored in a locked safe with records of all transactions 
maintained in detail.

3. Clinical setting
Hospital example:  Hospital pharmacists have a crucial role in the 
management of patient care as mentioned by a number of e-druggers. 
In major Australian hospitals, all interaction with patients concerning medicines
 (including of course, very sick patients) is undertaken by a pharmacist.   
The doctor prescribes medication on the medication sheet and the pharmacist 
prepares the medication, visits the patient, discusses all aspects of the medication
 in detail and addresses any concerns of the patient. 
On discharge, it is the pharmacist who provides the discharge 
medication and detailed counseling. Australian hospital pharmacists can also 
undertake further training in specialties such as oncology, renal pharmacy, etc. 
making them an extremely important resource. 

Several contributors mentioned the important role of pharmacists during ward rounds.

4. Community role
Pharmacists are very often the first point of contact for people who 
have concerns about their health. Because of their professional 
training, pharmacists will know the extent to which they can help 
people and when people should see their physician.   Many examples of 
special roles of pharmacists in counseling and advising have been 
provided by e-druggers.  These include roles in diabetes management, 
smoking cessation, control of asthma and many many more.


Where the regulatory systems or the use of treatment guidelines are 
not so strong, the professional behaviour of pharmacists is extremely 
important and the importance of training has been emphasized:

     'Maybe to help pharmacists have better motivation there should be a 
new minimum standard of education following modern trends that suits 
a pharmaceutical public health approach bringing to them a better 
economic status and a clear operational field.'

It was also suggested that
     'Pharmacists should demonstrate that they are of benefit to society 
by what they do or are seen doing and not by going round telling 
everyone that they are of benefit and expect to be appreciated.'

Beverley Snell
Moderator