When you do the kind of work I do, you are constantly being bombarded with some version of this: “I have a great story idea for you.”
Reader, I must confess. Most of them are not all that great.
Sometimes, though, someone really does bring you something interesting, which is why it never hurts to listen. A few weeks ago, at a social event, a family doctor I personally know and admire told me about a major concern she had with a relatively new facet of health care in Ontario. She was concerned about pharmacists being able to prescribe for various relatively minor ailments in Ontario, and her concerns had merit. But I confess I wasn’t totally convinced, so I decided to go do some digging.
Let’s pause for a moment to give the necessary context. Starting earlier this year, pharmacists in Ontario gained the ability to issue prescriptions on their own authority for a series of relatively minor medical conditions — this had previously been mostly limited to doctors (some nurses who have undergone additional training can also prescribe some medications). Pharmacists are limited to relatively minor conditions that can be managed by the patient themselves. (A list can be found here.)
My doctor friend had two major problems. The first is that some pharmacists run their own pharmacies, so there’s a financial conflict of interest in issuing a prescription that you’ll then bill the patient to have filled. That’s… a real concern. I don’t think it’s an insurmountable one or worth scrapping the approach over (for reasons we’ll get into in a minute), but it’s real and should be given consideration.
The other concern is the more basic one: that the prescribing should be left to those with the training and the proper facilities. My doctor friend sketched out a scenario. One of the minor ailments pharmacists are allowed to prescribe for is a urinary-tract infection. Unfortunately, the primary symptom of such an infection — pain or irritation during urination — is also a primary presenting symptom for some sexually transmitted infections.
“When someone comes to me with those symptoms,” my doctor friend said, “it’s probably a UTI, but I have to at least ask about any new sexual partners or higher-risk sexual activity. I get to do that privately, in the exam room in my office. Imagine being a young man or woman who may actually have a sexually transmitted infection and being asked in front of a bunch of people in a pharmacy about your sexual habits.”
I laughed, but she had a point. You’d lie. You’d lie through your teeth. Because of course you would. And my doctor friend is right about the facilities. A few years ago, I was waiting at a pharmacy counter to pick up a medication, and the woman in line in front of me and the pharmacist were speaking in hushed tones and looking awkwardly around. Actually, they were looking at me. “You have something sensitive to discuss, and I’m standing too close,” I announced, verbalizing my realization in real time (I do that sometimes). “I’m going to go stand somewhere else.” The woman and the pharmacist both laughed, but they were also both palpably relieved. I went and waited for my turn somewhere else.
Some pharmacies have the space to permit private consultations, of course, but not all. So, yeah. I think my doctor friend had valid concerns. And I am glad to use my platform to put them on the record.
I feel obliged to also point out, though, that I told her that we have to be careful not to let the perfect be the enemy of the good. Her concerns about patient privacy and conflict of interest are valid. They deserve consideration. But the decision to let pharmacists prescribe for relatively minor ailments didn’t occur in a vacuum. The decision was made against the backdrop of updated numbers, from the Ontario College of Family Physicians, no less, showing that the number of Ontarians who don’t have a family doctor has increased in recent years — by a lot. It’s now over 2 million. Literally millions of us — millions, plural — don’t have a family doctor.
What are those people to do? Emergency rooms are clogged. In some areas, they’re closed entirely on a rotating basis. Walk-in clinics are spectacularly unreliable and often limited in their service hours. This has created a real gap in our health-care system, one that will result in people needing care not receiving it. That’s it, full stop. People will not access needed care due to the failure of the system to provide adequate staffing.
Let’s not sugarcoat this: those failures will result in death and suffering. In a perfect world, we’d have enough doctors and nurses to provide timely care to all in need. This is, to state the obvious, not the world we live in. In the here and now, with critical (and crippling) shortages of both, pharmacists are an imperfect but real solution for Ontarians who do have genuine health-care needs that cannot be realistically addressed any other way.
Again, I agree with my doctor friend. There are real problems using pharmacists in this role. There are privacy concerns. There are potential conflicts of interest. And there is also the real danger — the certainty, really — that a pharmacist will prescribe a treatment for a minor ailment that isn’t really a minor ailment at all, but something much more serious. And that patient will go home, take the medication they were prescribed by a health-care professional they trust, and get sicker. Potentially seriously sicker.
Granted. But what the hell are we going to do? We won’t have more doctors soon. We won’t have more nurses soon. Any success we have at recruitment and training will serve mainly to hold the line against the tide of health-care professionals either leaving their careers or moving to another jurisdiction. Again, we can’t let the perfect be the enemy of the good. The pharmacists will provide care to people who may not reasonably have any other way to access it and who aren’t likely to have any other way to access it anytime in the near future.
Personally, I’d rather take my health complaints to a doctor. I’m lucky enough to have one — and I like the one I have! But I’d rather get a prescription from a pharmacist than not get one at all because I didn’t have a doctor and the local ER was jammed or closed and the local walk-in clinic was overwhelmed.
This is the reality in Ontario for millions of people today, and we need to say that plainly. The choice for millions of us isn’t between health care from a doctor or a pharmacist; it’s a choice between health care from a pharmacist or no health care.
But there is another really interesting angle to all this — a question my doctor friend had that I couldn’t, and still can’t, answer. We’ll get into that next time. Until then, stay healthy.
Donate Now