As a young pharmacist to a young doctor, I admit I still sometimes don’t know where I stand. Do you wish you saw more or less of us? Should I hang around for a chat rather than scrawl green or purple pen and leave again, or do you prefer it that way? Equally, I often consider the workload of JMOs, and I am impressed by their effectiveness in managing this. I do not envy the decisions JMOs have to make; instead I often wonder if there can be improvements to the ways pharmacists help. I hope you feel your ward pharmacist is a supportive part of your allied health team, assisting you as you learn to prescribe safely and efficiently. I hope you’re able to run medication-related decisions past them on a daily basis.
Possibly, however, your pharmacist may seem to ghost around the ward, leaving green or purple pen scrawl over medication charts as evidence they have been and gone. Ideally their scribbles are helpful, however, maybe they just highlight how rushed you were an hour earlier and leave you more confused about what you should do next.
I often wonder if many of you feel that your interaction is more like a deer caught in headlights of a car. At times you probably feel reprimanded for a crime you didn’t mean to commit. You may have been acting on a recommendation from another source, or had promised yourself to review it again later when you had more time and available resources.
I want us to avoid these feelings. I want you to greet me with a smile. I never like to see a new JMO’s face start to droop as I approach, or receive a “what have I done wrong now?” response to my phone call. It gives me great satisfaction when someone asks for my opinion instead. I am secretly chuffed when someone asks my opinion on an antibiotic they want to prescribe, or needs a medication history from an elderly man with a confusing bag of medications.
There are probably many other reactions junior doctors have to pharmacists, including feeling frustrated or even angry at our constant enquiries. To be honest, pharmacists aren’t always the best at communicating in these situations either. I’d like to think about how we could avoid a Friday afternoon tiff over a rushed Endone prescription.
It is well-known that communication between healthcare providers is the key to preventing medication errors. However, cultural and inter-professional differences have meant that doctors and pharmacists haven’t always had the best relationships.
Both professions essentially descended from the same ancestor – the apothecary. At one point in time, there was no differentiating between prescriber, compounder, and dispenser. Diagnosis, prescription and dispensing came in one patient interaction and payment for medication was the primary means of moneymaking (1,2).
In the year 1231 the Edict of Palermo was signed in medieval Europe, which separated the two professions in order for the government to have better influence over the manufacture and sale of drugs. Physicians and pharmacists could no longer have business relationships and pharmacy was recognised as its own profession with an individual set of skills. Subsequently the professions started to evolve distinctly and are today primarily represented by the general practitioner and the community pharmacist (1).
With this history in mind, it makes sense that there have been many repeated instances of both professions crossing boundaries and rubbing the other the wrong way. While we like to think that these attitudes don’t flow onto the consumer, I’m sure we could dig up a multitude of incidences of patients caught in the middle of a communication breakdown.
The safe and effective diagnosis and treatment of patients is the common goal and cornerstone of our work in both professions. We should both try to remember this when I page from the dispensary about that Endone script you hoped to rush through late on Friday afternoon. This is the reason we are both here.
The model of pharmacy services in hospitals is evolving to include more and more non-dispensary roles. There is evidence to indicate considerable benefit to safe medication use, cost reductions and better patient outcomes (3). At a minimum, hospital pharmacists perform activities such as regular medication chart review, supply, and medication reconciliation. In these activities they may approach you to make recommendations and flag anything that may have potential for medication-related harm. This is generally retrospective in nature.
Many hospitals across the globe, including Australia are now encouraging the integration of pharmacists into doctor-led teams (3). This permits prospective recommendations by pharmacists and potentially prevents harm before it can occur. It is suggested that when involved in doctor-led teams pharmacists are able to make significantly more medication-related contributions, or “interventions”, than on a basic ward service alone (4). This model could not only result in a safer hospital journey for the patient, but could also help avoid the feelings of confusion or guilt that understandably could follow when a medication charting issue is pointed out.
However, the benefits of these non-dispensary roles of pharmacists can only be achieved when working together with the support of medical officers.
I think it is important for both doctors and pharmacists to equally consider how they can improve their relationships.
You could engage your ward pharmacist in medication-related decisions. Often we fall out of the loop and miss crucial information, as we aren’t always present on the ward. By asking for our thoughts we could bring to light an adverse drug reaction or interaction, or give you greater confidence with that gentamicin dose.
Use your ward pharmacist’s knowledge and skills to your advantage. We may be able to help ease your workload. Pharmacist skills include medication reconciliation, rationalisation and medication counselling. Outsource to us to help you with this. Together we may be able to divulge crucial information from that particularly confused little lady. We could also save you time by helping her understand changes to her medications, potentially avoiding readmission due to medication misadventure.
Keep calm, and remember your pharmacist is a part of your team. Remember it is natural to make mistakes. It can be easy for doctors and pharmacists to let constant critique of us affect our confidence, especially at the beginning of our careers. Remember that we are never passing judgement on your skill as a prescriber.
Pharmacists are trained to consider prescribing in a different light. When you next see a pharmacist approaching, remember we are your allies and are here to support you and your journey as a doctor.