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Why are pharmacists not trained better at diagnosing?

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  • Why are pharmacists not trained better at diagnosing?

    We have all been told from our very first year at pharmacy school that pharmacists are the experts in medicines, something which is not up for debate. However, as a newly qualified pharmacist I have been upset at this rather abysmal lack of training we receive to be able to assess and diagnose patients. As pharmacists in the community, we have more patient exposure than any other HCPs, yet, I would say, we probably receive the least amount of training in diagnosing even the most simple ailments.
    I keep hearing that pharmacists only deal with "minor ailments" so we don't need more in depth training, but this is rather silly. Nothing is minor until it has been determined to be minor by someone trained to make that decision. Are we as pharmacists trained adequately to make such judgements? I am reminded of a case involving a GP diagnosing a 50 something year old lady with IBS after she complained of having constant bloating and she ended up dying as she actually had ovarian cancer. Even GPs i.e trained diagnosticians can make such errors and yet we pharmacists are expected to see more patient by the day. On some days I almost feel like a dermatologist given the number of skin ailments patient's present with, on other days I feel like a paediatrician and so and and so forth.

    Now I love this patient exposure, but I just wish we would actually be trained much better at dealing with such things. At a time where patients are being encouraged to come see their pharmacists by the NHS, GPs etc I feel there needs to be a change to the pharmacist training program to make us better diagnosticians compared to now. I went to a decent university and we barely even got OTC training. I am always reading the NICE CKS etc to increase my skills, especially regarding diagnosis but many pharmacists's do not appear to be doing that and thus there is very little standardisation across the board when it comes pharmacists and their clinical assessment skills. Some are decent whereas others lack the confident and refer for even the most basic things (which I can understand due to reasons highlighted earlier).

    We need to train pharmacy students much more in university for clinical assessment skills and once we qualified, at least provide us with a more structured training pathway rather than having some sporadic training courses here and there. We need for the creation of proper Primary Care Pharmacists (not this nonsensical clinical vs non clinical pharmacists notion) which are given robust clinical assessment skills and prepared from their time in universities to become advance practitioners with independent prescribing qualification. This is what we need, but instead all we're seeing is attempts to create apprenticeship pharmacy programs and other nonsense.

    I am attempted to write a letter or something to whoever are in change of pharmacy trainings program about this matter. I think we pharmacists need to start being more proactive to increase the value of our profession. I feel we are currently too passive.

  • #2
    Historically, barbers did some surgery which is why their sign posts show blood and bandages. Apothecaries made up nostrums and really followed on from the alchemists. Pharmacists were responsible for some significant chemical products. So, gradually it became that Drs diagnosed and chemists made up OTC meds and prescriptions. I remember pharmacy being termed the hand maid of medicine. Now pharmacists no longer compound and the DOH have assumed they have time on their hands. Thus the stress on pts going to the pharmacy to relieve pressure on GPs. Naturally, pharmacists receive nothing for this. The DOH say that it just increases footfall and this is sufficient reward.
    Not sure what happens now in the schools, but in my day certainly no diagnostic training at all, but I was taught how to prepare extracts, tinctures, ointments etc and the synthetic processes behind popular meds at the time such as stilboestrol, aspirin, phenacetin, magnesium trisilicate etc.
    Ie Are the current courses fit for purpose. Perhaps pharmacy schools should be attached to a hospital. You do not find medical schools in isolation.
    johnep

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    • #3
      Skin is something that primary care is absolutely shocking about dealing with in all kinds of ways. It's often low level and time intensive to chat about. Feeds very much into what Johnep says. Also some fairly mid-high level skin queries can be dealt very well by pharmacy staff. The laugh is that on prescription you don't make much on emollients, on OTC you can make a killing on some of the stuff.

      Surely it's the fault of the pharmacy profession itself for being too proactive and roadblockers? Unlike many other professions apart from the clinical diploma/MSc and more recent independent prescribing there aren't any mainstream add ons to the degree after you've qualified. The IP is at the whim of GPs. The clinical diploma is for hospital pharmacists. That basically means unless you want to add on the random list of 'services' there's nothing. Any proposed changes to the pharmacy profession and there are loud shouts of MPHARM MPHARM MPHARM DON'T YOU KNOW I HAVE AN MPHARM! This is a bit weird because of the endless number of newly qualifieds who complain about the pointless fourth year and how things need restructuring and what is learnt at university isn't really preparation for community pharmacy life. If only they'd done a 4th year that had more clinical...

      You could integrate some of the training with Physician associates, have IP on the degree etc. That would make a small difference. Really you need modular add ons at postgraduate level after undergrad. Pharmacy hasn't kept up with the rest of the world, it's still stuck in the 1980s/1990s when degrees were rarer. An alternative might be to standardise the 4 CPD things a year to train pharmacists up on clinical areas. Again this is going to get the old spiel off pharmacists. I'm not optimistic, it's like the piss up in the brewery of summary care records.

      The value of the profession is a completely separate matter. Learn even more and do it for free and you're worth even less.

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      • #4
        It is disgraceful that there are few add on modules in diagnosis for pharmacists who should have such modules available and examined in all medical specialities. Many pharmacists read huge numbers of medical books during their careers but some do not and there are no diagnostic examinations and relevant diploma awards for such study. It's time there were.

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        • #5
          I agree with the posts above. One of the problems we have is that in pharmacy schools and even beyond, we simply don't have the necessary trained people to train us in diagnostics. For example, who is going to teach us to recognise skin ailments in practise?

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          • #6
            What about the very necessary support services for diagnosis, e.g. Pathology and X-Ray for a start?

            Diagnosis is extremely complicated and significant errors are made, even by very well qualified and experienced Doctors.

            And if Pharmacists train as Diagnosticians then the Doctors might demand to be trained in dispensing and open their own Pharmacies.

            OOOOOOOOOOOWWWWWW!!!!

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            • #7
              If diagnosis is to be taught, then Pharm schools need to be attached to a teaching hospital. This should reduce the inflated number of Pharm schools.
              It will also raise the profile of pharmacists. I await both Oxford and Cambridge opening schools.
              johnep

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              • #8
                It is amazing that the Royal Pharmaceutical Society doesn't encourage universities to set up diagnostic pharmacy courses attached to teaching hospitals. And I agree johnep they should start with Oxford and Cambridge.

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                • #9
                  I was told that pharmacy was the handmaid of medicine. It will always be a subservient "trade". However, with diagnostic skills and recognition by Oxbridge it will at last be seen as a Profession. Such a course would have suited you Gordon as a frustrated would be Dr and I am sure there are many others like you. It would certainly have suited me.
                  johnep

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                  • #10
                    Pharmacists skills were, up to 70 or so years ago, in diagnosing minor ailments and differentiating them from serious ones, and teaching them was part of the duties of the 'apprentice-master' under the then qualification system. The massive upsurge in prescriptions the profession faced consequent upon the introduction of the NHS made it impossible for for such teaching to take place.

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                    • #11
                      Originally posted by Merlyn View Post
                      Pharmacists skills were, up to 70 or so years ago, in diagnosing minor ailments and differentiating them from serious ones, and teaching them was part of the duties of the 'apprentice-master' under the then qualification system. The massive upsurge in prescriptions the profession faced consequent upon the introduction of the NHS made it impossible for for such teaching to take place.
                      +++1 The NHS has been the making of Pharmacy as a cash-cow and its demise as a profession.

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                      • #12
                        Correct, the cash has gone to the few not the many.
                        johnep

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