How to: combat undue criticism of pharmacist vaccinations

A senior psychology researcher and a pharmacist explain why other professions may feel threatened and how to react

Attempts by some professions to augment their services can evoke criticism from other disciplines who feel threatened by the move, argue senior psychology lecturer Dr Simon Moss and pharmacy lecturer Dr Mary Bushell, both from Charles Darwin University in the Northern Territory.

Their recent paper suggests that various psychological biases are behind doctors groups’ attempts to stifle pharmacist-administered vaccination.

The Australian Medical Association and Royal Australian College of General Practitioners, and some outspoken individual doctors within these groups, have maintained the line that vaccinations are the role of GPs and that changes to this system could lead to fragmented care.

Despite more research coming out in support of pharmacist-administered vaccination, its safety and efficacy at improving immunisation rates in the community, this criticism has not abated.

The authors highlight four forms of professional prejudice that are triggered by uncertainty:

1. Status quo bias: “People tend to overestimate the value of existing practices but underestimate the value of alternatives, called the status quo bias. Because of this aversion to change, members of professional bodies could oppose the attempts of other professional to extend their services.”

2. Certainty bias: “People feel vulnerable to unexpected complications in unpredictable and uncertain settings… [and they] exhibit a range of biases to promote certainty.

When deciding on whether a problem is important, people tend to consider the gravity, but dismiss the probability, of some event.”

Dr Moss and Dr Bushell point to a comment made by AMA NSW President Dr Saxon Smith as an example of the neglect of probabilities: “[In a] two-day training course [there] is not enough exposure or experience to be gained to manage the whole gamut of potential possibilities that can occur when it comes to vaccination … and that can include the sort of delayed side effects that people suffer from,” he told the ABC in 2015.

3. Self-enhancement bias: “People sometimes overestimate their capabilities when their sense of coherence is threatened… Because of this illusion of control, medical practitioners may inflate the degree to which they, but not members of other professions, can prevent the complications of vaccinations.”

4. Just world bias: To reinforce the belief that society is just, people are “inclined to presume that benefits to one community will disadvantage other communities”, or look at the situation as “zero sum”. “They reject the possibility that many communities can benefit from some change simultaneously,” they write.

How to overcome these biases

The authors offer some points to combat professional bias – although they warn that challenges to some people’s assumptions can make them strengthen their beliefs even more – known as the ‘backfire effect’.

With this caveat, Dr Moss and Dr Bushell offer the following ideas:

1. Stabilise values: “Professional bodies that want to extend their services need to underscore the durability of their values… They should underscore some impediments that must be circumvented – and clarify how their proposal to broaden their services resolves these impediments.”

2. Foster certainty: “Professional bodies should attempt to empower other professions … for example, before they attempt to extend their services, pharmacists should consult representatives of relevant medical associations.”

(However they are quick to point out that while the Pharmacy Guild had commenced such stakeholder conversations by approaching GPs for input on pharmacist vacinations, only one of the 15 GPs approached accepted the invitation to be interviewed.)

3. Facilitate self-enhancement: Basically, reassure the threatened party that they are secure in their own goals. The authors suggest holding an informative conference, preferably in “lush green surroundings”, in which to discuss the plan to extend services. “When surrounded by nature, people tend to experience a sense of meaning and coherence, diminishing their biases,” they write.

Dr Moss has been widely published in both books and journals, with experience ranging from management and workplace psychology to helping people with autism spectrum disorder.

Meanwhile, Dr Bushell is a consultant pharmacist and researcher with a special interest in pharmacist-administered vaccination.

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  1. Jarrod McMaugh

    I love this article

    There is another factor I would add

    There seems to be a view amongst doctors that pharmacists aren’t really qualified health professionals who make clinical decisions…. it would seem that the perception is that a pharmacist is akin to a technician or even robot…. a role whererin a defined function is performed with no capacity to change or influence that function based on the input or desired output.

    I don’t know whether this is an intentional attitude that makes it easier to form the types of arguments they generate in the media, or if they truly believe it, but when you look at comments made by many doctors in the media, it seems that they are (either intentionally or not) ignorant of the training and expertise pharmacists have

    • vixeyv

      Completely echo you Jarrod – its surprising and saddening that doctors have this condescending, distrusting attitude towards pharmacists when we’re working alongside doctors and even saving their butts when they prescribe the wrong thing….

  2. David Haworth

    Meh! The % of doctors with this attitude may be way smaller than you think. The loud ones in the press are likely a small minority. I say ignore them and get on with being the best professionals we can be. In a few years it will be the status quo

  3. Paige

    Halfway through our second? Vaccination season the receptionist of the neighbouring medical surgery comes in the door breathless urgently requesting an epipen. I gave it to them straight away. I later found out that someone had had an anaphylactic reaction and they needed adrenaline. They had been vaccinating on site for 6 months without adrenaline handy. Case closed.

    • Valerie Vaughan

      Perhaps it is more a loss of income for a consultation that requires small contact time

  4. Nicholas Logan

    A state AMA president admitted to me that flu vaccines in pharmacy was a brilliant idea that we could never admit publicly.

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