A war of words

A community pharmacist has responded to a column that referred to the profession as ‘usurpers’ who only have ‘dispensing degrees’

An outraged community pharmacist has responded to a recently penned column by AMA vice president Dr Chris Zappala.

In his article, published by the AMA’s Australian Medicine, the thoracic specialist from Queensland slammed community pharmacist professional services.

He wrote: “Retail pharmacy owners i.e. the Guild (who need to be differentiated from the more numerous pharmacists working collaboratively in hospitals, general practice and elsewhere) want two main things:

  1. To dispense/prescribe more of anything they can possibly get their hands on.
  2. To offer medical advice as a ‘professional service’ to patients as a substitute for general practitioners (or anyone else really) with MBS funding to do so.

“I suspect the sole reason retail pharmacy owners desire this is to increase foot traffic in their pharmacies, so more supplements, foot massagers, perfume and over-the-counter drugs can be sold,” said Dr Zappala.

“Usurpers often abandon activities truly in scope that they have been appropriately trained for, as they make a blatant grab for extended scope.”

He referred to asthma management in pharmacy, saying pharmacists were not qualified to practise in this area.

“Treating asthma is clearly not in the scope of practice for a pharmacist with a dispensing degree,” he said.

“Any attempted assessment regarding disease severity in this context is fraught and leads patients into further harm. How could anyone safely treat an asthmatic without listening to their chest?”

Caroline Diamantis, who works full-time in community pharmacy but also holds a position as vice president of the Pharmacy Guild NSW branch, told AJP that Dr Zappala’s comments are “disappointing on so many levels”.

“We hold a five-year Bachelor of Pharmacy minimum—a four-year degree plus one year of internship.

“We do not hold a ‘dispensing degree’ – what is that anyway?” asked Ms Diamantis, who received her pharmacy degree from the University of Sydney.

“Community pharmacists call themselves clinical pharmacists, and do not appreciate the nickname ‘retail pharmacy owners’,” she continued.

“No one uses it except the AMA. This is once again an attempt to discredit our clinical capacity.”

“Pharmacists have comprehensive clinical training on diagnosis and treatment across a broad spectrum of diseases, as well as the thorough knowledge of how medications when correctly used will improve disease states,” she said.

“It is poor form to continually belittle our capacity.”

In response to Dr Zappala’s comment about community pharmacist products, Ms Diamantis said that “while some models of community pharmacy have chosen to expand their offer to include various retail items (some of the larger banners come to mind), it is important to note that not all community pharmacies stock the ranges of perfumes, foot massagers or other paraphernalia constantly being referred to.

“Nevertheless this in no way compromises the extremely strict and comprehensive legislation and practice guidelines that pharmacist clinicians are bound by.”

Dr Zappala said pharmacists embedded within a general practice team would be an “invaluable resource”, however he suggested community pharmacists could be done away with altogether.

“Let’s promote online options for patients (e.g. UberPharmacy) or dispensing in GP practices,” he said.

“If patients and the government want convenience, there are many ways to achieve this that streamlines and shortens the medication supply chain from wholesaler to patients, and saves patients from having to trudge to their pharmacy every month for medications, all without compromising the quality of community care that remains the sole purview of the general practitioner and his/her integrated team.”

Ms Diamantis said she is shocked by Dr Zappala’s suggestion of leaving out community pharmacists altogether.

“The arrogance of diminishing our role to ‘irrelevant’ simply demonstrates the total misunderstanding of the vital role pharmacists play and the sheer lack of vision this doctor has,” she told AJP.

“How sad that he may never enjoy the professional satisfaction and rewards of genuinely putting his patients first and collaborating with any allied health professional who wishes to contribute to patients’ best medical health outcomes.”

Read the full Australian Medicine article here

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  1. Kevin Hayward

    “Treating asthma is clearly NOT in the scope of practice for a pharmacist with a dispensing degree”
    I have worked for over 20yrs as a GP practice support pharmacist, over 10yrs as an accredited pharmacist in Australia. Yes I do hold a Bachelors in “dispensing” , but I also hold a higher degree from my local medical school, and, as an accredited pharmacist I am assessed 3yrly on my clinical competence.
    I hold multiple qualifications in training and education, and take my patient education commitment seriously, I take professional pride in educating the patients I see.
    I work within my professional competencies, I don’t prescribe, diagnose, bandage vaccinate or purvey alternative remedies.
    I would therefore take issue with the broad statement that as a pharmacist I cannot be involved in the treatment of a patient diagnosed with asthma

    • Jarrod McMaugh

      Kevin, you don’t need any of the other achievements, qualifications, or experience you have to take issue with that broad statement. It’s blatantly offensive…. but of course, the opinion piece by Dr Zappala was specifically crafted to be so…. and not worth responding to.

      • Kevin Hayward

        I tried responding directly, they have not displayed my post!

  2. Anthony Tassone

    Whilst there has been a substantial amount of public commentary that has been in part adversarial in nature between medical groups; AMA and RACGP and pharmacy representative groups including the Guild – the major difference is that you would be hard pressed to see a pharmacy representative criticize doctors as individuals and as health professionals.

    The depths that elected representatives at the national level of AMA and RACGP have recently stooped to questioning the; integrity, competency and professionalism of pharmacists as health professionals during the public conversation about scope of practice is absolutely shameful and unacceptable.

    Obviously the organisations will simply agree to disagree on various things, but there is absolutely no need to degenerate the discussion to attacks of pharmacists as health professionals themselves

    Dr. Zappala’s latest “contribution” to this public debate does absolutely nothing to help advance patient access and improving primary health care.

    Clearly Dr. Zappala (and his National President, Dr. Tony Bartone regarding recent comments made on national radio around allegations of pharmacists using ‘old vaccine stock’ at the start of the 2019 flu season) need a reminder of the Medical Board of Australia Code of Conduct, Clause 4.2 which reads:

    “4.2 Respect for medical colleagues and other healthcare professionals

    Good patient care is enhanced when there is mutual respect and clear communication between all healthcare professionals involved in the care of the patient.
    Good medical practice involves:

    – Communicating clearly, effectively, respectfully and promptly with other doctors and healthcare professionals caring for the patient.
    – Acknowledging and respecting the contribution of all healthcare professionals involved in the care of the patient.
    – Behaving professionally and courteously to colleagues and other practitioners including when using social media.”

    As spokespeople and elected representatives of our respective organisations, we are health professionals first and foremost and must be bound by our code of conduct that underpins our registration to practice and provide care to patients.
    There are also responsibilities in ensuring our conduct is appropriate.
    I can only wonder what members of the AMA must think about these types of remarks and representations.

    With each derogatory and offensive comment that peak medical body representatives direct towards pharmacists as individuals, it further weakens whatever argument they may actually have.

    Thankfully, the sheer arrogance exuded by some national representatives of the AMA in such public statements is not reflective of the strong relationships that pharmacists have with their GPs and their local level, and also the constructive engagement I can say occurs between the Victorian branch of the Guild and with AMA (Vic).

    Anthony Tassone
    President, Pharmacy Guild of Australia (Victoria Branch)

  3. PharmOwner

    “If patients and the government want convenience, there are many ways to achieve this that streamlines and shortens the medication supply chain from wholesaler to patients, and saves patients from having to trudge to their pharmacy every month for medications, all without compromising the quality of community care that remains the sole purview of the general practitioner and his/her integrated team.”
    While we’re at it, Dr Zappala, let’s do away with GP’s, after all we now have Dr Google, patients can self-diagnose. With all the GP’s now practising hypnotherapy, acupuncture and naturopathy, they’re not really that relevant anymore. All we really need are specialists. No need to wait 1-2 hours to see a GP. How’s that for convenience?

  4. Nicholas Logan

    It is sad that the “leading” doctors associated with their professional bodies are sounding more out of touch every day. They need to reconnect with their members who have fabulous relationships with their local pharmacies. Their current war on pharmacy is misguided and spiteful.

  5. Kevin Hayward

    I wish that I could share with my esteemed peers in this column, the many postive experiences I have enjoyed in a long career as a Pharmacist working closely with GPs.
    I will try to give a flavour
    Many years ago, in another place, I was contracted to provide Pharmacist support to a rural GP practice that was achieving quality indicators. I was warned that the practice head had most strenuously objected, a Pharmacist was not felt to be a value added addition. I worked collaboratively with that practice team, to improve patient care, within the confines of my professional remit, skills and competencies. When it was decided the goals had been met, that same GP formally objected to the loss of a Pharmacist from the team.
    Regarding the subject of asthma, raised in this column, I was due to see a patient at home, the GP told me he doubted my visit would be of value. A charming older lady revealed a tall boy stuffed with unused preventer inhalers. Subsequent discussion with the GP was restricted to the comment “that was my mother”, we worked together well for the duration of posting.
    I have found time and time again, in many and varied primary care settings Pharmacists and GPs and the rest of the primary care team can work together for the betterment of patients, observing the highest standards of clinical governance, respecting each other’s professional boundaries and expertise.

  6. Adele Tahan

    Dear Dr Zappala and Dr Ackermann,
    It’s the same degree and education that the majority of registered pharmacists hold in Australia.its the competency, training and exams!!

    So the “ dispensing degree” that you are referring to is the same degree that every other registered pharmacists hold in this country. The pharmacists that you are promoting to be embedded in GP practices are the same pharmacists that also contributes to the clinical medication management in community pharmacy.
    The Pharmacy Guild Of Australia is a member organization that represent over 5000 community pharmacy nationally. These pharmacies are small business. The Guild is not and will not be a big business.

    I work with doctors every day and I see how much time and effort those doctors spend with their patients. Doctors aren’t remunerated for the time they spend administering all the daily tasks required from providing a full clinical advice. In addition to this, the doctors I know and I have in my family are absolutely amazing and would
    love to see me contribute to ALL our patients.

    • Kevin Hayward

      Whilst all Pharmacists currently registered are likely to hold the same broad undergraduate degree, they do not hold the same post graduate qualifications or experience.
      Many contracts I have held as a registered health professional have been because of formal qualifications skills and competencies in other disciplines.
      As examples, I would not have been engaged in my first post as a practice support pharmacist without a higher degree, you cant do HMRs without additional AACP exams, you cant teach NVQ pharm techs with out vocational trainers quals, I would not have been engaged to work in health education without my formal qualifications in healthcare and education.
      I would therefore suggest that although all pharmacists with general AHPRA registration are equal, the pharmacists that are embedded in GP practices (and also teaching, manufacturing etc ) are NOT the same pharmacists in community pharmacy, because they are very likely to have a different skills matrix and formal qualifications to facilitate their post graduate roles.

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