Who do you think you are?


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Community pharmacists may lack confidence and a fully developed professional identity, impacting their ability to achieve a full scope of practice: study

A study by researchers from the University of Toronto has found community pharmacists may have incomplete professional identities, reducing their self confidence in clinical decision-making.

While the study was done in Canada, the country’s community pharmacy system shares similarities to Australia including professionals services, however with added scope of practice including pharmacist prescribing.

Seventeen community pharmacists (age range 37–63) who practised at least 24 hours/week were recruited and interviewed by phone or in person.

They also had to be either caregivers or patients themselves, as the researchers wanted to explore how pharmacists utilised their professional identity to advocate for themselves or their loved ones.

Most participants in the study neither actively participated in care planning nor fully disclosed their educational and professional backgrounds to their healthcare teams unless explicitly asked.

One pharmacist-caregiver stated: “No, I didn’t think it was actually necessary to say, ‘Hey, I’m a pharmacist.’ When I’m with my mother in an ICU, I’m actually not a pharmacist, right? I’m a daughter first and foremost.” 

They continued: “I don’t want them to think that I’m second guessing their work, their decisions. I’m just a community pharmacist after all so what do I know about [intensive care medicine]?”

On the same topic of self-disclosure, a pharmacist-patient stated: “What difference would it make anyway? I mean, there’s nothing I know or can do that is better than these people, is there? I’m just a community pharmacist, so what’s the point of anything I could do here?”

Without our own clear understanding of who we are as a profession … is it any wonder that patients, physicians and other health professionals don’t really know what to make of us and our claims to be medication experts?—Professor Zubin Austin & Paul Gregory

Another pharmacist-patient said: “You just have to believe—you have to trust that the people [in the health care facility] know what they’re doing, you can’t always be asking too many questions otherwise you are labelled a troublemaker or a know-it-all. And then they don’t want to come see you or take care of you and that’s when you get into trouble.”

The results reflected findings from previous research conducted in 2006, which saw community pharmacists rarely if ever volunteered their occupation, nor did they overtly question care plans or treatments—including prescriptions.

Conversely, studies have found doctor-patients often request access to laboratory information and medical charts, and are also more likely to negotiate diverse care options, insist upon fuller discussion and disclosure of details and options.

“As scientifically trained health care professionals, it would be reasonable to assume physicians and pharmacists would have similar responses and behaviours to becoming patients/caregivers, yet this study has highlighted (and replicated) findings that these patterns are strikingly dissimilar,” write author Professor Zubin Austin and Paul Gregory in their paper published in the Canadian Pharmacists Journal.

“Physicians do not simply perform medical work; they are physicians in a fuller psychological and existential sense,” say Professor Zubin and Mr Gregory, adding that this could explain the self-advocacy, self-confidence demonstrated by physician-patients.

Meanwhile “the somewhat more trusting, acquiescent and cooperative behaviours demonstrated by pharmacists may suggest a professional identity that is separated, incomplete or functional, rather than existential,” they say.

“Pharmacists perform pharmacy work but may not have a fully developed internalised psychological sense of profession-hood … it may explain some of the difficulties in achieving a full scope of practice—lack of confidence and reluctance to take responsibility.

“Without our own clear understanding of who we are as a profession … is it any wonder that patients, physicians and other health professionals don’t really know what to make of us and our claims to be medication experts?”

The study had limitations including: its innovative yet indirect qualitative assessment of professional identity; the participants were all from the same geographical area; and interpretive and implicit bias inevitable in this kind of research.

Caution must be exercised in generalising from this study to all pharmacists, the authors add.

A 2014 study published in Currents in Pharmacy Teaching and Learning on Australian pharmacy students found many of them struggled with their professional identity formation.

Students experienced dissonance between the idealistic notion of pharmacy practice and the realities of placements, which “left them concluding that the role of the pharmacist was constrained and limited”.

The researchers argued that more focus needs to be put on professional identity formation from the very beginning of pharmacy degrees and throughout the curriculum.

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