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What use is the high moral ground when you are being eaten alive?

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BY AMA VICE PRESIDENT DR CHRIS ZAPPALA

 

GPs’ livelihood and ability to practise are being attacked on many fronts. Dubious role substitution creep from usurper health care practitioners must stop. Does the fight need to come to their doorstep instead of doctors always being in defence?

The Acting President of the Pharmacy Guild recently likened the AMA to a “salivating and barking dog,” following a perceived “onslaught of abuse and derision,” in a response to broader scope of practice for pharmacists.  The hyperbole was rousing!

It was suggested that prescribing medications, being able to capably understand and diagnose a patient’s medical problems without appropriate training or ability to garner a full history and examine, and to provide health prevention advice is within the scope of pharmacy training?  Clearly not true. The aircraft engineer doesn’t pilot the plane, serve the drinks, or unload the luggage. Being able to work a sphygmomanometer and having a basic understanding of physiology does not make you a doctor or capable of giving medical advice while standing in the middle of a retail pharmacy. The benefits of an enduring, familiar family doctor who knows you well and can provide wide-ranging advice and treatment is well evidenced and the appropriate cornerstone of our health care system. Pharmacists are not required to do any part of this job.

It was also asserted that self-defined broader scope of practice for pharmacists will also save money and time for patients. Not really if outcomes are inferior. Where is the evidence that pharmacists behaving as quasi-doctors achieves anything? Regular interactions with general practitioners is crucially important in developing an enduring bond, discussing risk factor modification, and so on. Government cannot ‘de-fund’ general practice, then attempt to remove the more simple work, and expect the system will still work given growing patient complexity and potential risk.

If you want to be a doctor – go to medical school. Australia is graduating just under 4000 doctors this year – there’s no lack of space! Please, do not abandon doing the job you are actually trained to do. Patients need direction in how to use their inhalers every few months (or their technique degrades), explain the purpose of medications (both prescribed and over the counter), clarify dosing regimens for patients, make sure warfarin interactions with diet are understood by patients, sort out pill boxes or Webster packs to reduce medication errors, and so on. This unequivocal in-scope pharmacy activity is performed far less than it should. If it was done frequently and properly, it would be far more useful to patients and contribute more robustly to the safety and quality of the system, compared to the constant attempts to do a doctor’s job in a rudimentary and inferior way.

The AMA has always decided it is morally and ethically more appropriate for doctors to not dispense medications as a system- wide policy (bearing in mind it has usefully occurred in rural areas for a long time). It would actually be very convenient to patients if doctors did dispense medications (to use one of the Guild’s main arguments for role substitution), and we could make it cheaper to the system as a whole if the costs reflected the dispensing fees only, without profit being generated, and/or any profit being retained within the practice for other patients’ services. If doctor dispensing of medications became a reality, individuals would not have to do it, if they didn’t want to. If patient convenience and cost are paramount in the system, whereas training, evidence, and professionalism do not matter as much to decision-makers, then we perhaps need to recognise this.

Offence might serve us better than defence. Is the AMA position due for a re-think?

 

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