Top researcher calls for independent prescribing and pharmacist recognition as medical professionals, telling doctors to ‘get over it’
Pharmacists are medical professionals, just as doctors are, Professor Ross Tsuyuki told delegates at the Pharmacy Connect conference held by the Pharmacy Guild last week.
Professor Tsuyuki, who chairs the Department of Pharmacology within the Faculty of Medicine at the University of Alberta, Canada, and works within a heart failure clinic as an independent practitioner, told delegates that he is unhappy with the way pharmacists are described by those outside the profession.
“The problem is there is a lack of understanding and a lack of respect for what we [pharmacists] do,” he said.
“We’re treated like a retailer or a shopkeeper or a small business owner. I’m not against business, but I don’t like being treated like I own a corner store either.
“As a result, whenever there is a discussion around primary healthcare, we’re not a part of it. It’s all about GPs.
“Instead what we should be calling ourselves is healthcare professionals, healthcare providers,” he said, adding later that “we’re all medical people”.
The use of language is crucial to defining the pharmacist profession, said Professor Tsuyuki.
“One of things I hate is being called an allied health professional. What the hell is that anyway? What I also hate is being called a paramedical or an ancillary thing – which is like an appendage.
“Or in the hospital, we’re a support service or just non-medical. I hate that. All these terms imply second tier or accessory or less important. They also imply subservient roles. I hate that and I don’t think that we should be talking in that way.
“Another thing that I really don’t like—why do physicians have patients and pharmacists have customers?”
However he also called out the use of discounting terminology within the community pharmacy sector, as well as the promotion of products “of dubious value”.
“If you look at the conference program, there are some things in there that may have little to no evidence for and I think that denigrates us as well,” he said.
Professor Tsuyuki explained that as a pharmacist in a heart failure clinic he is able to independently prescribe and even conduct physical examinations, and his colleague doctors have had to accept this.
“I see the patients myself and I do all their cardiac exam and I make the decisions. Sometimes I let the cardiologist touch the patient a little bit if I’m in a good mood, because it’s my patient. We’re 100% comfortable with that overlap, so get over it guys.
“What do the doctors think? I don’t care. Why are we subservient like that?”
“If you’re making the case for prescribing, what you should be asking for is independent prescribing,” he told conference delegates.
“In all my previous studies, there was a ceiling effect. You could not get the blood pressure any lower because the physicians wouldn’t follow your recommendations, or the patients just couldn’t even get in to see their GP.
“We need to be able to do this autonomously and that means taking responsibility for it too, which some pharmacists are not ready to do. But a lot of pharmacists are and so I think that’s the direction that we need to go in, that independence.
“When I prescribe independently, I don’t ask for permission, but I do tell the other physicians involved in the care of that patient what I’ve done and why I did it.”
Doctors’ groups in Australia have responded with outrage to pharmacists wanting to expand their scope of practice to include further prescribing rights beyond Schedule 3 supply such as prescribing antibiotics for UTIs, and expanded vaccination.
AMA President, Dr Tony Bartone, said last month that if the Pharmacy Guild wants pharmacists to be doctors, then pharmacists should spend 10 to 15 years studying for a medical degree.
“GPs study and train for more than a decade to provide quality holistic care for individuals and families through all stages of life,” said Dr Bartone.
“The Guild claims that a pharmacist’s ‘half a decade training prior to being registered’ is sufficient to practise as a doctor, with all the complexity and specialised skills and knowledge that entails. This is simply not true or possible.
“GPs know the medical histories of their patients and their families. The enduring long-term and trusted doctor-patient relationship is at the core of safe, high-quality health and medical care in Australia,” he said.
“Undermining or diluting this relationship, as the Pharmacy Guild is proposing, is irresponsible and dangerous.”
Dr Tsuyuki says pharmacists shouldn’t pay attention to what GP groups are saying.
“Why do other professions think it’s their right to define our scope of practice? All health professions should function at the full capacity of their training.
“What do the doctors think? I don’t care. Why are we subservient like that?” he asked.
“It’s one thing to be nice, but that’s a little too nice. How do you think that they would feel if we ventured to say, well you know I think physicians should be limited to doing this and this. Obviously we should define our own scope of practice.”