Disclaimer; my claim of ‘world’s best’ relies heavily on the supposition that this is also the ‘world’s only’ such video animation.
It introduces the novel concept of embedding a pharmacist within a general practice (in addition to the pharmacy business owner down the road). This in-house pharmacist would consult from the GP’s rooms, and would not sell or dispense medications.
Besides the obvious benefits to patients in terms of fewer medication errors and misadventures, the appeal to me is that the in-house pharmacist has no conflict of interest.
Because they are non-dispensing, there is no gain or loss to them whether a patient takes one more pill or one less. If a vitamin is of no use to you, they’ll say so. These pharmacists don’t have anything to sell – their role is to advise, educate and oversee.
My video was commissioned by academic pharmacists Debbie Rigby and Chris Freeman, and launched at their AACP Consultant Pharmacy annual conference last weekend.
They tell me that around 25 Australian general practices currently have in-house pharmacists.
Let’s get more.
Laudable in principle but I can see some practical problems.
The first one is where you expect to source such pharmacists. I’ve gotta assume that few people complete a pharmacy degree without encountering the business model of modern pharmacies. At that point those who are concerned that patients receive effective medications and only effective medications are going to reconsider their vocation. Perhaps the job is more suited to aspiring GPs just out of med school whose research skills are still well-oiled and up to date. The experience would probably stand them in good stead if/when they become GPs themselves.
Secondly, your model seems to incorporate the assumption there is an objective, evidence-based correct way to prescribe, rather than a huge scope for differing interpretations of the available evidence. I for one tend to agree with the head of the Nordic Cochrane Collaboration, Peter Gotzsche, that psychiatric drugs shouldn’t be prescribed at all. Would you want me in your practice vetting your ‘scripts?
Then there’s the question of remuneration. While having someone in the front room bulk billing to write ‘scripts and someone in the back room paid to rip them up might be good Keynesian economics I’m not sure the bean counters who work in the Health Ministry would be enthused.
And what’s Ollie supposed to do if she disagrees with your prescriptions? Overrule them? Interrupt your next five minute consult to discuss them? Escape your practice down a 2cm drainpipe and find a rewarding career advising fish about the medication residues around sewage outlets?
I can’t help thinking an eight armed pharmacist would simply revert to type. One arm would sign off on the antibiotics you prescribed a cold sufferer while the other arms load the patient down with vitamin C, zinc supplements, garlic capsules, echinacea, breath fresheners, an aromatherapy kit and a new pair of fashion sunglasses.
Justin, that P hatted, happy looking octopus is soo trustworthy, one can just tell!
Great drawings; and your writing has improved a treat!
But please enlighten at least me about the role you envisage for the in-house pharmacist. Is he/she supposed to caution the doc, or rediagnose or suggest treatment other than what the GP has advised? If the doctor prescribes an anti-biotic or a pain-killer, would the pharma merely suggest instead Vicks Vaporub or a bit of physio? Or the opposite scenario wherein the GP says to “give it a few days and it should right itself” and have the pharma argue for a medicine or prescription?
Confusing! And the hapless patient? Is he/she sitting there looking from one to the other and becoming somewhat anxious as they discuss all these alternatives? Surely one would prefer the GP decide the immediate treatment – and hope it works!
oh wow, this article and comments are really illustrating the esteem in which pharmacists are held, isn’t it!?!
I might point out that “conflict of interest” is inherent to all professional roles – while your income relies on your reputation, you have a conflict to ensure that your reputation is one that will being in more paying clients (or those who bring a medicare swipe with them). To suggest it exists in pharmacy without acknowledging it exists in medicine or elsewhere would be disingenuous.
Hey, I was trying to be diplomatic.
This is what I really think.
Jarrod, I wouldn’t have made the video if I didn’t hold pharmacists in esteem. What’s more, my public writing, and indeed this blog, are filled with me discussing potential conflicts of interest throughout medicine: I talk about it more than 99.9% of doctors. Given that this is accompanying a pro-pharmacist video, I don’t think I’ve overstepped the mark.
I think I may have found the sort of (anti-)pharmacist you’re looking for.