Tuesday, February 05, 2008

Dr Crippen and Quackitioners

We all know that Dr Crippen of NHS Blog Doctor doesn't like nurse practitioners, who he so kindly refers to as 'quacktitioners', but now he has taken a pot shot at pharmacist with a special interest(PHwSI). Now just in case Dr Crippen doesn't realise this, pharmacists do four years at uni, followed by a years on the job training (a pre-registration year). To become a PHwSI you would no doubt have to do a clinical diploma which takes another two years, and most pharmacists don't start these just after registration. So a minimum of six years training until a pharmacist could be a PHwSI. Lets not also forget that pharmacists get taught far more about drugs than doctors do - we don't really have to worry to much about diagnosis.

Dr Crippen comes across as a GP who has been qualified for quite a while and seems to take the view that no one can do any job better than a medically trained person. But how good are GPs at dermatology? My experience is that they are not that good - I've spoken to a GP with a special interest in dermatology who complained that GPs were prescribing oral antibitotics for acne without a topical treatment, and I've also had a patient who I found out was using Fucibet (fusidic acid, which is an antibiotic, and betamethasone which is quite a strong steroid) on her face! Dermatology is also an area that is conducive to management by people other than doctors - I'm no dermatology expert but I generally see at least one skin rash per day and normally have a decent idea of what it is and how to treat it, and those patients I send to their GP normally come back with a prescription for what I was expecting.

The question is why is Dr Crippen so defensive and so against pharmacists or nurses looking after certain conditions. What would he think if he knew that I was responsible for the care of some patients on warfarin?

At the end of the day there are lots of patients out there with chronic diseases. Doctors, pharmacists and nurses should be working together to look after these patients, after all there are more than enough of them to go round, and GPs can get money from work done by other people (I've got 80 COPD patients to check inhaler technique for, so that the GP practice can get their QOF points). Pharmacists are not generally diagnosticians, (PHwSI may be an exception) but we are eminently qualified to look after patients with established diseases.


Anonymous Anonymous said...

Hear hear! Got to say one thing in GP's defence. I am currently training to be an independent pharmacist prescriber, and my GP supervisor said pharmacists are eminently suited to this. She also said no way should most nurses be allowed to prescribe.....! If Dr crippen wants to work all the hours God sends, let him remain isolated from other health professionals who can do some of his role as well if not better than he can.

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Blogger william said...

We have frequently met the ludicrous GPwSI, a clumsy acronym which at least has a pronounceable homonym. I could not think of a homonym for PHwSI. And what does PHwSI mean? My GP colleague says it stands for “PHuckwit with a special interest” which, given current government policy, sounds plausible.
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Anonymous Anonymous said...

I cant wait to be able to prescribe, I have a GP sponsor, i just need the finances now :). I think it is right we prescribe, obviously we should know our limits in diagnosis etc, but there is so many times when i know exactly what is wrong, exactly what is required, but have to send the patient on their way because of the little POM on the box.

With regards nurses prescribing, most of them are great, but some really shouldnt be prescribing, and if you need to phone me (a non-prescriber, which happens at least once a week) and ask what to prescribe, maybe you have overstepped your area of expertise

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(Too bad so much spam gets stuck on the blog.) Interesting idea here in the US. I believed there is limited pharmacist prescribing in Florida., but specialized pharmacists in the Veterans Administration have been working in different types of refill clinics for years i.e. they assess current medical condition and may authorize refills. And, of course we administer vaccinations, and run lipid and warfarin clinics, under our physician's guidance. Bringing up this issue raises the spectre of conflict of interest, when physicians were essentially barred from dispensing from their office. (I live in a once rural quite state, Indiana, and various small town docs do have a pre-bottled supply of antibiotics and OTC anti-inflammatories to send out after diagnosis.) To me, dermatologics might be a no-brainer as to conflict of interest, as there are so many expensive brands of creams, lotions, that don't differ significantly from each other, yet can be sold for quite a hefty fee even without a prescription. And, I see FRAUD with $$ if public insurance would be asked to pick up the cost (much the way if faith-healers were covered under Medicare.)
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