Re: Pharmacist prescribing

You are to be congratulated upon the recent editorial [“Pharmacist prescribing: Good medicine?” BCMJ 2007;49(2):52-54] concerning the right demanded by pharmacists to prescribe directly to the public, with all its likely ramifications. To prescribe without examination, complete medical history, and relevant investigations would be considered unacceptably poor medical care. There has long been some tension between physicians and apothecaries. In the 17th century druggists trading upon general ignorance extorted exorbitant prices for their services undermining all efforts to cheapen medicine. In 1689 the College of Physicians in London persuaded its members to give free advice to the sick poor but the whole object was nullified by the high cost of drugs. Because ethical concerns of conflict of interest, physicians do not sell prescribed medicines directly to their patients. The practice is however the norm in many types of unorthodox forms of treatment. Most pharmacists are employed by large corporations and the likelihood that the cheapest generic brand would be suggested over the more expensive product is remote. Even more remote would be the suggestion that no treatment is necessary.

— Hugh H. Macartney, MB, FRCP
Victoria

Enjoyed your editorial for March. I think most would agree that some caution is indicated when opening the privilege of prescribing to practitioners other than physicians.

One thing to remember, however: In British Columbia we already share the record of prescribed medications. Since November 2005 physicians have been able to use the PharmaNet network to check current and past medication profiles. Anything issued by a community pharmacy in the province is available, going back 14 months. Not a lifetime record for a chronic patient, but pretty useful, nevertheless, and not in some pharmacy database.

Our company, Medinet, is one of several suppliers of PharmaNet access to physician offices, emergency rooms, and hospital departments across BC. The service is underused by physicians at present, perhaps because of the necessary paperwork, but mostly, we suspect, because physicians aren’t used to the idea of web-based lookups for patient care.

Anything you can do to encourage the doctors in British Columbia to take advantage of this simple and convenient service will be a great help. Whether pharmacists or physicians are doing the prescribing, the record will be held in one place, and all will have access to it.

—John R. Culter
President, Medinet Vancouver

Medinet is only one of several providers, and they all have monthly charges. Medinet currently charges $8/month/user.—ED

I agree with you that pharmacists should not work as doctors. But I had trouble getting to the heart of your editorial because of the mention of compulsions. Any reference to compulsions stops me in my tracks, and incites an overwhelming need to check, clean, and count. Maybe you could clean up the introduction to your editorials so that we can check out the content, and count our blessings at having a good editor!

—Robert Shepherd, MD
Victoria