Pharmacists Defend Quality of Advice

The village or neighborhood pharmacist in Britain sometimes plays family doctor, answering questions and recommending remedies for minor ailments.

Pharmacists are eager to do more, but doctors are resisting. A recent survey by the Consumer’s Assn. suggests that pharmacists are in over their heads already.

“It’s pretty traditional for people to go their local pharmacist for health advice rather than wait or pay a doctor,” said Ruth Hilditch, a pharmacist at the C. E. Harrod in London’s Chelsea neighborhood.

Many of her well-off customers go to private doctors instead of the National Health Service, so seeing a pharmacist saves money as well as time, she said.

British pharmacists are allowed to sell more drugs without prescriptions than are their counterparts in the United States. There is a special class of drugs, labeled “over-the-counter-pharmacy,” sold without prescriptions but only in pharmacies.

In the last year, pharmaceutical organizations have been pressing for legislation expanding the range of non-prescription drugs. They also want to be allowed to do basic health checks, such as measuring blood pressure.

The British Medical Assn. opposes these changes, contending that pharmacists are not adequately trained to distinguish between trivial and serious complaints.

“Many trivial complaints mask serious problems,” said Nigel Duncan, a spokesman for the medical association. “Although we value the role of the pharmacist, we believe diagnosis and advice about treatment is a matter for doctors.”

The Consumer’s Assn. sent eight researchers to 240 pharmacies in Britain to ask for help about five common problems: indigestion, cough, diarrhea, nutrition, and hemorrhoids. A panel of six pharmacists and two doctors assessed the advice and medicine suggested.

“Any proposals to extend the pharmacist’s advisory role should take into account the quality of advice they give now. Our survey suggests it isn’t good enough,” said the Consumer’s Assn.

Among the findings published by the association:

* Nine out of 10 pharmacists failed to ask appropriate questions.

* Only a third of 66 pharmacists questioned about a dry cough asked how long the patient has been coughing. A long-lasting cough may mask a serious lung infection, like bronchitis or cancer.

* Of 67 pharmacists asked about indigestion, 66 correctly recommended an antacid, but only one in 10 suggested seeing a doctor if symptoms persisted.

Both the National Pharmaceutical Assn., which represents most pharmacy owners in Britain, and the Royal Pharmaceutical Society, the professional organization, argued that having healthy volunteers pose as patients is not a fair assessment of a real-life situation.

The recent survey has rekindled an age-old turf war between doctors and pharmacists, said Beverly Parkin, spokeswoman for the Royal Pharmaceutical Society.

The society was founded 150 years ago in response to a campaign led by doctors who wanted to bar pharmacists from giving health advice. Legislation was never passed, she said.

Colette McCreedy, a spokeswoman for the National Pharmaceutical Assn., said pharmacists are asked a million questions every day, heading off thousands of unnecessary visits to doctors.

A survey of 2,894 consumers, commissioned by the association, found last year that 73% believed pharmacists were expert in medicine.

If pharmacists were doling out bad advice, “we certainly would have heard a lot of complaints,” McCreedy said.

Hilditch said the pharmaceutical societies have been encouraging pharmacists to take on more responsibility.

“Obviously we need a bit more training,” said Hilditch, who added that sometimes it is difficult to distinguish between trivial and serious complaints. On the other hand, “My customers know when they come to see me, I trot right out. I’m here 9 to 6 if someone needs to see me.”