The philosophical divide between GPs and pharmacists


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Compare and contrast.

Patient phones GP with diarrhoea. Diagnosis: obvious mild gastroenteritis. Given advice re fluids, natural course of illness, how to manage in future. No appointment and no prescription.

Customer consults pharmacist with diarrhoea. Diagnosis: obvious mild gastroenteritis. Sold paracetamol, fluid replacement sachets, loperamide and two-for-one offer on multivitamins to ‘boost his immune system’.

Anyone see a problem? A major one, in fact, even though it’s about minor illness. It’s this: the relative philosophies that GPs and pharmacists have to managing minor ailments are diametrically opposed.

The GP approach is to offer explanation in preference to prescription, establish cause rather than treat individual symptoms, and promote self-help in favour of seeking assistance.

Yes, it’s self-serving to a degree in that one of our agendas involves reducing our own workload. But it’s also rational, sensible and avoids over-medicalisation.

Whereas for the pharmacist, minor illness represents a retail opportunity, which is not unreasonable given that the interaction takes place in a shop.

Attendance, intervention and medication – and therefore future dependence – are all encouraged.

Now transplant pharmacists into practices as patient-facing practitioners working at the front-line of minor illness – as per the current direction of travel – and you have, let’s say, a certain tension.

In the sense that you will be pulling in exactly the opposite direction to the GP. So for this brave new world to work, pharmacists are either going to need some pretty intense training/value realignment. Or a lobotomy.

And for any sceptical readers, I’d like to point out that I haven’t made up the gastroenteritis/pharmacist scenario above. I know it happened because I was next in the queue, with a similar complaint, clutching one of the few evidence-based items I could find – a toilet roll.

Dr Livingstone is The Pharmacist’s new GP blogger.

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