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Gold, incentives and meh

Pharmacist, know thy place

Pharmacists' star is most definitely in the ascendant, but Phil has several reasons why they shouldn't get too uppity

Pharmacists' star is most definitely in the ascendant, but Phil has several reasons why they shouldn't get too uppity

My next patient is up in arms. She has issues and needs to get them off her chest. And she's going to unload them all on me.

You'd think if a patient wants to moan about the actions of a pharmacist, they'd moan to the pharmacist. But they don't. They moan at us because we're accessible and we listen - or at least we look as if we do. But on this occasion my patient had an interesting story to tell. This lady gets recurrent vulvovaginal thrush. On the last occasion she was afflicted, she went to the chemist, rather than take up a GP appointment.

She was a bit shocked to be charged £12.99 for a single capsule of treatment plus a small tube of cream (NHS list price for fluconazole is forty-seven new pee) but she was also a little taken aback to be told that her husband had to have the same treatment or she would get the infection straight back again. So she was charged another thirteen quid for another capsule.

I doubt I would prescribe oral fluconazole for the husband in this situation, partly because I think that scrupulous personal hygiene and maybe a dab of Canesten cream would do the job at less risk and at a fraction of the price, but mainly because I happen to know that my patient and her husband have not had a physical relationship for several years now.

The chemist did not ask, and therefore did not find this out. I get the impression that even if he had thought to ask, an open shopfloor is not the place to announce the failure of a physical relationship to all and sundry, so maybe my patient would have been reluctant to tell him anyway. In any case, the pharmacist still sold her some treatment her husband didn't need.

Mad dash

The Department of Health, in its mad dash to enable all sorts of alternative providers of primary health care, would like to enable pharmacists to prescribe from the entire pharmacopoeia.

It is proposed that chemists are ideally placed to deal with 'minor' illnesses such as this one, and should be doing more consulting and issuing (selling) more treatments - or be given the power to prescribe from any and all sections of the BNF. This case illustrates just a couple of reasons why I have my doubts about this.

Dr David Roberts has long experience in negotiating on behalf of dispensing doctors, and he has detected a hint of hypocrisy from the pharmacy profession. One axiom he has often been assailed with says: 'The prescriber and dispenser should never be the same lest he benefits financially from his prescribing.'

Another is: 'Doctors should prescribe and pharmacists should dispense, each according to their own field of expertise.'

Now that the pharmacist's star is in the ascendant, maybe we should be flinging these points of principle back at them.

At the very least, we should be stressing, forcefully, and with good evidence, that it takes five years at medical school and a similar number of years of intensive postgraduate training to make a GP, and even then we are far from infallible.

A degree in pharmacy and a conversion course is not enough. You won't recognise lichen planus or a phaeochromocytoma if you've never heard of them.

Dr Phil Peverley is a GP in Sunderland

Phil Peverley

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