What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Saturday, September 01, 2007

Controlling The Prescription Pad

The above was the heading on the Calgary Herald’s editorial page on Mon., Aug. 27/07. It was followed with the statement “Doctors should recognize that pharmacists can share the load.
From my perspective, editorialists of Calgary’s major newspaper should recognize that pharmacists already share the load. Furthermore, editorialists should recognize that they might inform themselves better when writing on a complex subject.
Giving them the benefit of any doubt, perhaps they were simply trying to generate discussion by presenting an absurd and negative perspective on a subject that demands good clear thinking. On the other hand perhaps they really don’t have a clue.
First, the editorial rants on and on about such things as the ever increasing cost of drugs, the fact that many patients are consuming far too many drugs, that medications are the fastest growing cost in our health care system, that many deaths and hospitalizations occur from drug interactions, etc. THEN, they suggest that prescribing be opened up to pharmacists, midwives and nurse practitioners. Will someone please tell me how opening the door to MORE prescribers will decrease the cost of drugs, the number of drugs a patient takes, or the number of drug reactions that occur? In fact, the more people prescribing to one patient the more likely patients will become large volume consumers. At present pharmacists do a great job of monitoring the drugs a patient takes along with the family doctor (if a Canadian patient is fortunate enough to have one). They are very involved with patient education regarding the medications they are taking and they work closely with the family doctors in the communities. It is quite appropriate for them to renew an ongoing medication for hypertension and other chronic illnesses in the family doctor’s absence, but they are not trained to diagnose, and should not be writing new prescriptions.
Many years ago many specialists felt so strongly about the principle of “One patient, One prescriber” that they refused to prescribe for a referred patient and sent the suggestions to the prescribing doctor to initiate. Today the family physician must review with the patient the possibility of specialist prescriptions, dental prescriptions, naturopathic medications, over the counter medications, walk in-clinic medications, and herbal medication intake before writing a prescription (the editorial suggests the addition of midwives, pharmacists, and nurse practitioners to this already inflated list).
They then suggest this has something to do with TURF protection and don’t even mention the fact that it may have something to do with good medicine. Like we need to protect our turf when every area of Canada could use 20% more physician manpower.
From my perspective, perhaps we should open the doors to pharmacies so patients can freely access what they wish (welcome to Mexico) and physicians simply act as consultants who make suggestions. Unfortunately the courts in our country deem the physician who last saw the patient as the one most responsible and mete out punishment accordingly.
So, to the editor of the Calgary Herald I would like to suggest the following “Go to Mexico and get and take whatever medications you wish on the advice of whom-ever you wish. You will find the medications considerably cheaper than in Canada and there are several drugstores on every city block. But don’t suggest we move in that direction in Canada to save a failing healthcare system, and don’t berate a profession for doing what they can to prevent harm coming to their patients. We all must work as a team, but we must bring to the team, the talents and abilities derived through appropriate training.

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