Speeches and Transcripts

AMA Transcript - Pharmacy Agreement

Transcript: AMA Vice President, Dr Stephen Parnis, with Neil Mitchell, 3AW, 19 May 2015

Subject: Pharmacy Agreement


NEIL MITCHELL: There's going to be changes at your local pharmacy. This new deal, which is almost done between the Pharmacy Guild and the Federal Government. It does mean things like slightly cheaper prescriptions but also there'll be changes in what pharmacists are able to do in terms of medical advice, even treatment of some injuries and that type of thing. Now, you know I've got a pharmacist, I like them and trust them and they've certainly helped me after there've been mistakes with medication, but that is in the area where they are expert which is the chemicals, the drugs, the medication. On the line the, Vice President of the Australian Medical Association, Dr Steven Parnis. Good morning.

STEPHEN PARNIS: Good morning Neil.

NEIL MITCHELL: Well, what will pharmacists be able to do?

STEPHEN PARNIS: Well this is still all up in the air. The press release was fairly non-specific from the Minister but they're talking about moving into areas that have been the domain of doctors and nurses for many many years.

NEIL MITCHELL: What sort of thing now are we talking about?

STEPHEN PARNIS: Well, last year, the pharmacists put a proposal up that they'd take photos of skin lesions or moles on people's skin and send those off to doctors. Potentially things like checking of blood pressure, whatever that means. Advice about weight and one that really made my jaw drop was mental health assessments. So it really beggars belief for the reason that you outlined. Where's the training, where's the expertise, what happens when, not if, something goes wrong, and where is the evidence of the cost effectiveness?

NEIL MITCHELL: I did read about even having wounds dressed by the pharmacists, does that concern you?

STEPHEN PARNIS: Well I don't know that they've got any training about the principles of pathology or wound healing or circulation or dressing. My concern is that the first action will be to look at what they've got on the shelf that they can use for this and that is exactly the wrong way to go about providing care to a patient. So I don't think there's any sense in what's being proposed here.

NEIL MITCHELL: It isn't unusual for people to go to their pharmacists though, is it, and ask for advice. Oh, look, I've got this cut on my hand, what should I put on it?

STEPHEN PARNIS: Yeah, over the counter, immediate, but that doesn't necessarily mean good quality. As you say, pharmacists have real expertise. I consult and work with pharmacists every day I'm in my hospital, and that works extremely well. I'm just not sure that - the proposals being put forward in this agreement make sense, particularly when they talk about allocating $1.2 billion for this and then we'll work out the details later.

NEIL MITCHELL: Yeah, the blood pressure area interests me, I think most pharmacies now have a blood pressure machine sitting there where you can take your own blood pressure. What's wrong with that?

STEPHEN PARNIS: Well, the number’s fine, but the question is what do you do with it, how do you interpret the result?

NEIL MITCHELL: Well, if the result's bad you say, mate your blood pressure's a problem, better go to your doctor.

STEPHEN PARNIS: Yeah, but if someone's standing up just walked in or...

NEIL MITCHELL: Yeah sure.

STEPHEN PARNIS: Blood pressure varies from minute to minute...

NEIL MITCHELL: You're telling me…

STEPHEN PARNIS: Yes, exactly. You're talking to someone who's on medication themself. It's about I think understanding what the problem is in the first place and if you've only got a tiny piece of the puzzle it's really hard to know how you do this. And again why can't you simply arrange a plan when you meet your GP for your six monthly or 12 monthly check up to have your blood pressure checked so that then the person who actually knows what to do with the information is sitting in front of you.

NEIL MITCHELL: Aren't some pharmacies already doing flu shots, that sort of thing?

STEPHEN PARNIS: Yes, they are. The vaccination issue is one that's been happening in a few places around the country. Again, we've said that that's something that should be reserved for doctors and nurses because we're the ones with the training and again haven't seen one thankfully thus far, but what happens when something goes wrong. Allergic reactions are not uncommon. Patient selection is an important part of this, and even basic anatomy. Now, you can't learn those things by doing a weekend course, which is what some of the pharmacy organisations have been trying to do.

NEIL MITCHELL: What? A weekend course on where to stick the needle?

STEPHEN PARNIS: Yeah. It beggars belief sometimes, and again everything's fine if nothing is seen to go wrong, but when something does - and I've been witness to an anaphylactic reaction to a vaccination and I can tell you I'm an emergency specialist and even that gets your anxiety levels up, but I've got the training to deal with this. Pharmacists don't.

NEIL MITCHELL: So, what do you want to happen here? No, come back a step, why is it happening, what's the Government up to?

STEPHEN PARNIS: Yeah, well, with the best of intentions I suspect, the Government's trying to look for innovative models of care, try and save money in the provision of care and make services accessible to people. So, if that's the intention, that's great, but the details matter here. Now there is room, always has been for development of scope of practice. In other words, what are the procedures, what are the responsibilities you can have as a health professional but that does need to be collaborative. This isn't. It does need to be based on whatever evidence and trials you can devise. And you also need to make sure that it actually saves you money. I mean, if you're injecting an unnecessary step in the process - an example is, as you say, vaccination, are you saving money or is it just costing a lot more.

NEIL MITCHELL: Na, it's a good point. I'll tell you - a bit of secret though, I know a few doctors who'd tell me that pharmacists have saved their neck occasionally with dosage errors and even medication errors.

STEPHEN PARNIS: Absolutely. And that's the way it happens in, say, general practice. In my hospital practice, I have a pharmacist accompany us on the short stay ward round and their advice, their assistance, is invaluable. I can't imagine going back to the way it use to be beforehand, so there are very positive models of multi-disciplinary care. And that's the best way to do it and, ultimately, the most important thing is the patient’s benefit, but when people move into areas that they don't have expertise in - you know, for example, I'm an emergency specialist, I'm not going to go and do a bowel resection in theatre, I haven't got the training for that. The principle is still the same. If you get out of the areas that you are safe, competent, accredited to perform, then you put the patient at risk, and no one is going to thank you for it.

NEIL MITCHELL: Could I just ask you one more thing. We're talking a bit about trust today, for various reasons which I won't go into now, but do you think people still trust doctors, or has trust been lost a little?

STEPHEN PARNIS: Well, I always say to people that the first decision that a patient must make is do they have trust and confidence in the person looking after them. I think at an individual level that happens, and generally speaking I think in the community there is trust of the public in my profession, the nursing profession, in pharmacists. And that's a good thing, and we always work to try and maintain and build that.

NEIL MITCHELL: Thank you very much for your time.

STEPHEN PARNIS: Thanks Neil.

NEIL MITCHELL: Dr Stephen Parnis, Vice-President of the Australian Medical Association, as he said, an emergency physician.

 


19 May 2015

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