Professional disagreement


doctor wearing boxing glove

New pharmacy pain program a “slap in the face” for GPs: AMA

The AMA has reacted angrily to the announcement of the $20 million pharmacy Pain MedsCheck trial, claiming it is a “slap in the face”. 

The trial, announced on Friday by Health Minister Greg Hunt, will see pharmacists evaluate a patient’s medicines, analgesic use and pain management program in a face-to-face consultation, to ensure it supports their clinical need.

Taking to Twitter in the wake of the announcement, an irate AMA President Dr Michael Gannon said that: 

“Sorry . It’s wrong. Another slap in the face for GPs, the real community health experts. Time to face , shift focus to non-drug solutions. What underlying cause of pain? Is pt depressed? Physio? Relax’n techniqs? Massage? Answer not always in a pill”

His comments sparked a heated response from pharmacists, with many castigating his comments as being unaware of the program detail and focus.

Anthony Tassone, president of the Pharmacy Guild of Australia (Victoria) responded: 

“Before coming out publicly criticising a program,would be worth to learn more.Pain MedsChecks through community pharmacies are aimed towards identifying patients with chronic pain concerns and could lead to referrals to other health professionals including GPs. Hows that wrong?”

Jarrod McMaugh, PSA Victorian Vice-President agreed:

“This response suggests you aren’t familiar with the program Perhaps you’d like to familiarise yourself before casting judgement?”

The social media war continued with other doctors joining the fray.

Surprisingly, regular pharmacy critic Dr Evan Ackermann was positive about the plan, saying “I think this is a good move. I remember suggesting it to a Vic PSA rep. (Govt gives pharmacy a chance to recoup credibility) MedsCheck for pain to be trialed”.

 

 

 

 

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16 Comments

  1. JimT
    29/01/2018

    Another turf war in the making….why can’t the AMA and Phy bodies and the Health Minister nut this sort of stuff out before announcements are made. Is there a hidden agenda here. a bit of divide and conquer by Govt. ?

    • Debbie Rigby
      29/01/2018

      Do you think the AMA was included in the initial discussions? Perhaps this would mitigate these twitter discussions.

      • Jarrod McMaugh
        29/01/2018

        No it wouldn’t at all.

        The AMA has been opposed to just about every new innovation in health for the last 50 years; including (initially) the change in schedule of codeine, and the formation of Medicare!

        The AMA is a political body, and remains relevant to its financial members by being seen to call everything in to question.

        AMA is not a body from whom any pharmacist or pharmacy organisation needs to seek permission or approval.

        • Debbie Rigby
          29/01/2018

          Collaboration, not “permission or approval”

          • Jarrod McMaugh
            29/01/2018

            I get your differentiation there Debbie, but how do you think the AMA sees it.

            You will have been in at least as many meetings with AMA and RACGP as I have; probably far more.

            Tell me the last time that you were at one of these meetings that was collaborative instead of paternalistic.

            Look at how the regular commentators have responded so far. The only response out of this whole week that has been a surprise is that Evan Ackermann said it was a good idea (with a backhand at pharmacists & trying to take credit… But you can’t have it all).

            It helps no one to call for something that will never be reciprocated. As Willy says below, do you think the AMA would consult with us on their professional development?

            Not SHOULD the, but WOULD they. The answer is no. No one would answer yes to “would they”.

          • Debbie Rigby
            08/02/2018

            I have been on numerous committees, advisory groups and meetings where there has been collaboration and respect between individuals and organizations. It’s about relationship building, consistent policies and positions that are focused on the patient and improving health services.

      • Willy the chemist
        29/01/2018

        Aside from being inappropriate or non-relevant, my question to you would be, do you think that AMA would discuss their professional development matters with pharmacy to mitigate any concerns as well?

        • Debbie Rigby
          29/01/2018

          Yes, I do. I agree that comments back and forth between pharmacy and medical organisations is a bit of a game; but think we should always act professionally and in the best interests of the patient. So collaboration and respect works both ways. In my experience, the working relationship between GPs and community pharmacists is just fine in practice. Programs such as MedsChecks, Diabetes MedsChecks and the proposed Pain MedsChecks need this collaboration if we are to support patients with better medication management. Chronic pain management is complex, and should not be conducted in isolation from other health professionals involved in the care of the patient.

          • Willy the chemist
            30/01/2018

            Professional and collegial collaborations between professionals; yes, and the bulk of pharmacists and GPs do so.

            But the AMA has never been professional, collaborative, creative or positive in the manner they treated pharmacy. Please bear in mind, the AMA does not represent the majority of doctors. Estimate approx. 30% of doctors are members with failing numbers. They are a grandstanding self serving group mostly.

            The position they always take seem to be “me” and then everyone else.

            Collaboration requires respect from both parties. Without which it’s a pipe dream.

          • Andy Harris
            31/01/2018

            So the AMA represents a higher proportion of doctors than the guild does pharmacists?

  2. Ron Batagol
    29/01/2018

    Despite what AMA or anyone else says, this is precisely what is needed at this time.

    Pharmacists, with their special expertise and training, are ideally placed to
    counsel and advise patients who were previously buying and using OTC
    Codeine-containing products, on their pan relief needs, including medication
    and non-medication options, as appropriate.

    To me, given the changes in prescribing patterns of cardiovascular and antihypertensive medications, and our updated knowledge to evaluate the risks versus benefits of using Paracetamol with or without NSAIDs.

    Also, importantly, as outlined in the AJP Opinion article of 11/1/18 A side effect to the upschedule 11/1/2018 https://ajp.com.au/columns/side-effect-upschedule/),
    this move also lends weight for pharmacists be in the best position to comprehensively advise and assist those in the category of patients, who may have previously “self-selected” , or may be motivated to self-select, NSAID products( i.e. Ibuprofen) in general stores, for their pain relief needs, without risking exposure to predictable potential adverse outcomes. (That is, of course, if TGA takes up the suggestion of again restricting ALL NSAID PRODUCTS IN ALL PACK
    SIZES, to pharmacies!!

  3. Bruce ANNABEL
    29/01/2018

    The reality is so many people visit pharmacies, not GPs because of easy access and convenience, with primary health and medication issues. The new chronic pain management programme announced by minister Hunt last week provides pharmacists with an excellent platform to help patients improve chronic pain management holistically that will possibly result in more referrals to GPs by pharmacists. After all pharmacists are the medication experts and with GP interaction plus other health professionals can only benefit chronic pain sufferers and isn’t that the objective everyone seeks ?

    • Debbie Rigby
      29/01/2018

      I agree Bruce. But the evidence has shifted away from medicines, especially opioids, in the management of chronic persistent pain. “The Brain that Changes Itself’ is a great book to read and would recommend it to anyone interested in chronic pain management.

  4. Philip Smith
    29/01/2018

    It smells a little bit like compensation for perceived loss of codeine sales.

    Will pharmacist have to do any extra training before offering?

    Or will it be subject to abuse like medschecks “just sign here” that go unpunished?

    Will outcomes be measured?
    Feedback from participant’s sort?

    • Amandarose
      29/01/2018

      MedsChecks make my blood boil- they in theory could be good but I have yet to witness any quality work. I have seen them used for HMR compensation ( the pharmacist claims it before passing on HMR to be done) as a regular thing and several pharmacies. Two others use them to claim “ naturopathy” consults. One other person witnessed regular dodgy Medschecks involving nothing more then a printed history ( not a chart or anything) and asking the date of birth when the patient comes in. A “ you know what these are for don’t you? Any questions? And that was it.
      I am sure there are others that do them as intended and well with extra staff etc- I just have not witnessed it. The abusers always ruin it for everyone else.
      This program defies logic and I daddy don’t think will add value.

  5. Amandarose
    29/01/2018

    I can kind of see the point. To be honest I have witnessed terrible abuse of Medschecks- many pharmacies claiming them as a fee for the HMR that has been ordered. Others giving some very basic advise and a computer history. 5 minutes and it’s over. I know they could be useful in some cases but like most things many will abuse it.
    I just had a local pharmacist ask me to tell them when I had a HMR referral do they can do a “MedsCheck” to classic m a cut. I told them politely what I thought of that dumb idea- the short sighted greed that harms the profession- the same short sighted greed that sees care plans abused by GP’s.
    If they want help with pain maybe A HMR would be better or more subsidies for non medical help like massage etc. Maybe funding for better education for GP’s would be better use. I agree with the doctor. It’s another silly political payment for pharmacy that most don’t take seriously and is just “compensation” for lower profits. This attitude leads to sloppy services that degrade the profession.

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