New role for pharmacists raises questions, concerns

There has been much reporting on pharmacists prescribing for minor ailments, but much of that was around increased access. However, there are also very serious concerns and unaddressed questions around this topic.

I will summarize them here, and but the list is not exhaustive.

The main concern is that pharmacists are not trained to obtain medical histories or perform physical exams to diagnose and treat medical conditions, which can lead to misdiagnoses and worse outcomes.

As doctors, we are trained to do a differential diagnosis, which means we have to figure out what the problem is among many possible problems.

An example is that people can have lower belly pain for many reasons, some of those reasons are serious, and you must be able to ask the right questions and do a proper physical exam to know how to treat it or if it needs follow up. Pharmacists are not trained to do this.

Furthermore, to diagnose a urinary tract infection, one of the minor ailments on the list, you should do a urine test. Do pharmacists know how to do that, and are they set up to do it?

What if they miss a kidney infection because they are not doing a physical exam? What if it is a sexually transmitted infection and mistreated?

Secondly, pharmacists will not be taking a full medical history so they will not know how other conditions affect the proper treatment for one problem.

Third, if the pharmacist misses a serious issue, it can lead to bad outcomes, so will the pharmacist be held responsible for their treatment decisions? If so, how?

Fourth, will pharmacists be required to complete continuing education, the same way doctors must, to keep up with the latest evidence on these health issues?

Lastly, there are no unified medical record systems in Ontario, so if a pharmacist treats someone, how will that information be relayed to the person’s family doctor?

While there are theoretical benefits of increasing access to care in Ontario through having pharmacists prescribe for minor ailments, there needs to be proper training, supervision and supports to shift tasks of medical care to other health workers. I am not assured these are in place for pharmacists.

Health-care workers who are trained to diagnose and treat, such as registered nurses (RNs) and physician assistants (PAs) often work under a physician’s supervision, but that is not the case for pharmacists. Also, what monitoring and evaluation systems are in place to determine if this is a good policy, whether we are achieving our intended goals or whether there is harm caused?

Anecdotally, I received two vaccinations from pharmacists, and they placed them incorrectly. Giving a vaccine is a relatively simple process. How will more difficult processes of care be supervised appropriately?

There are significant concerns and many unanswered questions about how pharmacists will be able to safely prescribe for minor ailments while not being trained to diagnose, take medical histories, or perform physical exams, and without a unified record system.

Hopefully there are plans in place to monitor and evaluate so we can ensure the safety of the public.