Pharmacists

“Pharmacists pitch cure for ailing health care budgets,” read the front page headline of our local daily newspaper. The article that followed summarized the BC Pharmacy Association’s (BCPA’s) proposal to government on “staking out a bigger role in health care.” They plan to build on their experience administering 200 000 flu shots in the last year and dispensing emergency contraception without a prescription. 

Pharmacists claim they would save the health care system tens of millions of dollars if they could deal with some simple problems such as headaches, heartburn, insect bites, back pain, diaper rash, and nasal congestion. They also offer to play a bigger role in smoking cessation and in the management of chronic diseases like diabetes and asthma. The BCPA states its members would require extra training to properly diagnose and treat people. They also feel that there would be no financial incentive for pharmacists to prescribe during these minor ailment visits. Lastly, they state they would be helping us overburdened family phy­sicians by lightening our caseloads.

Interestingly, the article makes no mention of whether the pharmacists’ current programs are cost effective or beneficial. I am curious to know if a larger proportion of the provincial population has received flu shots since the pharmacists have been administering them or if less money overall was spent on these immunizations. Also, are more patients currently likely to receive emergency contraception at a reduced cost to the system?

I am also curious as to what extra training the pharmacists are going to receive so that they can properly take a history, perform an adequate clinical exam, and come up with a differential diagnosis. Are they going to start performing fundoscopy for headaches or cardiac auscultation to assess a possible cardiac problem masking as heartburn? Are they going to start ordering basic tests such as urine analysis to look for kidney problems posing as back pain, blood work to rule out multiple myeloma, or an ECG to look for myocardial ischemia? Last time I check­ed, the extra training required is already available and it is called medical school.

Does the BCPA really think there isn’t a financial incentive for pharmacists to prescribe medication when dealing with these minor ailments when many pharmacists have a financial stake in the pharmacies in which they work? 

I am very appreciative of my pharmacy colleagues’ desire to lighten my load and make my life easier by dealing with these minor ailments and chronic diseases. I feel I should return the favor and show my gratitude by starting a small dispensary in my office. I will fill prescriptions for my exiting patients thereby reducing the workload for my busy pharmacy colleagues. I will only do this for the majority of patients with straightforward needs as this will leave the more complicated and time-consuming pa­tients better suited to the pharmacist’s expertise—it is the least I can do.