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.

I'm back

Sorry for the long absence, but lots of things have been going on since the summer. I've left the branch I was managing (for a number of reasons), did some relief work across the south east for a few months and am now at one branch full time because I've replaced one of my friends who has gone back to Australia to study medicine as a postgrad. The bonus is that my trip to work is about 30 seconds as I'm living in the flat above the pharmacy.

I've also been busy with my clinical diploma and all is going well. The exam was a few weeks ago and seemed to go ok, apart from a question on baby milks. I also have a new girlfriend, so am very happy and content at the moment.

I'll try and post more regularly in the future as I get back into the habit. The branch I'm at now does 20,000 items a month, so we have quite a few interesting patients to discuss.