Should Pharmacists be Allowed to Prescribe Medications?

Raghu Venugopal and Sameer Masood – Toronto emergency room doctors

In medicine we learn that “hoofbeats” are not always horses and sometimes they are “zebras.” Physicians consider not just the most common cause of a patient concern, but also the most serious illness possible. We develop a list of probable diagnoses based on the patient’s history, physical examination, our clinical experience and supporting tests. This is challenging over a pharmacy counter.

To diagnose and treat seemingly “minor” ailments, like a sore throat or rash, emergency physicians undergo several years of training, including undergraduate studies to understand human physiology, medical school to learn essential core skills, followed by specialized residency training in a discipline. This training can take anywhere from 10 to 15 years on average. Thousands of patients are examined under supervision before independent medical practise is allowed.

Physicians continuously keep up on the evolving evidence, are mandated to attend continuing education courses and regularly attend meetings to learn about challenging cases with bad patient outcomes or a missed diagnosis. Remaining an updated, evidence-based and competent physician is a lot of work. Canadian taxpayers deserve this standard.

Pharmacists undergo undergraduate training and a four-year degree to enter practise, the focus of which is not diagnosing medical conditions. Pharmacists are experts on medications and this is an essential part of the health-care team.

But, asking a pharmacist to assess and diagnose a patient with a sore throat is a dangerous suggestion. Not all sore throats are simple viruses or strep throat. There can be an underlying serious infection. Is your pharmacist trained to diagnose a peritonsillar abscess that can mimic strep throat, requiring surgical drainage, and not just antibiotics? Can they diagnose a case of epiglottis that looks like a “sore throat” but can sometimes need an artificial breathing tube inserted in the operating room?

These are emergencies a physician who has seen thousands of previous “sore throats” is able to diagnose by examining you.

If you have a possible urinary tract infection, will your pharmacist examine you and diagnose that it is in fact a kidney infection or infected kidney stone?

If you have pink eye, will your pharmacist use a microscope to rule out a foreign body or a herpetic rash of the cornea, which if misdiagnosed could permanently damage your cornea?

If you have a persistent cough, will your pharmacist consider heart failure or lung cancer? If you have heartburn will they dispense antacids and potentially miss a heart attack, which can sometimes present with symptoms identical to heartburn?

If emergency rooms (ER) are busy, offloading patient care to pharmacists is not the answer. Rather, investments should be made to ensure the public has access to timely medical care. The Ontario government should focus on helping patients who do not need an acute hospital bed to be transferred to nursing homes or respite facilities. Minor ailments are not why patients spend hours waiting in hallway stretchers.

In fact, having patients assessed by those without the right training may increase unnecessary ER visits. A recent study done at the Institute for Clinical Evaluative Sciences demonstrated that patients who had their blood pressure measured at a pharmacy were more likely to present to the ER unnecessarily. Patient safety and quality of care should be the goal.

Undoubtedly, pharmacists play an important role. There are circumstances in which they can help patients who are ill. Administering inhalers to a known asthmatic while calling 911 or sending the patient to the ER makes sense. Helping minimize medication interactions or extending a prescription for a patient waiting to see their physician is value added.

Those who diagnose medical conditions and those who dispense medications should be decoupled to ensure no physician’s or pharmacist’s business interests get ahead of providing medical care.

We are not pharmacists and pharmacists are not physicians. Our patients and the government need to know that.

Head on over to The Star for the full article!