Tuesday, 30 October 2007

Fisher Price NHS

The dumbing down continues apace, with pharmacists being given the chance to diagnose and manage 'minor illness' in another hair brained and arguably cost ineffective government scheme. One wonders quite how the pharmacist will be able to tell if an illness is 'minor', given that their training includes nothing on the diagnosis of disease? Apparently the following are minor:

"acne (a dermatologist may well be needed if nasty), athlete's foot, back ache (cauda equina can present with minimal pain if atypical), cold sores, constipation (hopefully not bowel cancer), cough (hopefully not asthma or lung cancer), diarrhoea (again hopefully not inflammatory bowel disease or cancer), ear ache (possibly something an ENT bod may be needed for), eczema and allergies, haemorrhoids (piles) (something that a colorectal bod can treat easily in clinic) , hay fever, headache (hopefully not hydrocephalus, meningitis, raised intracranial pressure), head lice, indigestion (hopefully not cancer or barret's oesophagus), mouth ulcers , nasal congestion (nasopharyngeal cancer), pain (quite a few things could be missed here), period pain (ectopic for one), thrush, sore throat , threadworms, warts and verrucae (don't miss a melanoma)"

I have just added in brackets a few of the ways in which these pharmacists could very easily miss a diagnosis and harm, or even kill a patient. GPs get things wrong enough, and this is with a proper medical degree and years of supervised training in the art of history, examination and diagnosis. The potential for pharmacists to go wrong is enormous.

Also how on earth can a pharmacist make a diagnosis? Are they trained to use a stethoscope, an otoscope, a proctoscope or an opthalmoscope? I very much doubt it. It is a bit like Dr Crippen's analogy of letting the air hostess take over from the pilot in the cockpit!

More evidence is coming to light showing that various dumbing down reforms are not really cost effective or safe. GPs with a special interest (GPwSIs) are really a very poor alternative to proper specialists, and this is evidenced by their cost effectiveness. While the dangers of nurse prescribing have already been written about in many quarters, here is yet more ammunition in the locker demonstrating how an inadequate level of training may well impact on standards of care:

"We may expect a marked escalation of preventable prescription-related disease from independent nurse prescribing on the basis of these figures."

Whether it be in the form of pharmacists acting as family doctors, nurses acting as doctors or GPSIs acting as specialists; the trend is a dangerous one away from proper training and high standards of care, towards dumbed down training and lower standards of care. That's progress for you.


Claire said...

Professor David Colquhoun reports the following in his post 'Can you trust Boots' (http://dcscience.net/?p=191). The overall theme is Boots's promotion of homeopathy but this particular vignette is relevant to your dumbing down concern:

"Dangerous advice from Boots: a small sting.

I have been into several Boots stores, sought out the most senior pharmacist that I can find, and asked them the following question. “I have a 5 year old son who has had diarrhoea for three days now. Please can you recommend a natural remedy”. The response was interesting. In every case but one, the pharmacist reached for a copy of the Boots pamphlet on homeopathy, and thumbed through it, while desperately, but unsuccessfuly, trying to retain an air of professional authority. Then one or another homeopathic treatment from the booklet was recommended. In only one case out of six did the pharmacist even mention the right answer (GP and rehydration). One pharmacist, who turned out to have qualified in Germany, was very insistent that homeopathic treatment was inappropriate and that I should should start rehydration and take the child to the GP. The other five, including one who had an impressive-looking badge saying “consultant pharmacist”, did not even mention rehydration.
Conclusion The education of the pharmacists was clearly insufficient for them to give reliable advice. On the contrary, their advice was downright dangerous."

The Welsh Pharmacist said...

That really, really, really boils my fucking piss. And is about what I'd expect off the typical brainwashed Boots "pharmacist", and the whole culture of that company.

Try complaining about their promotion of homeopathy to the RPSGB.

I'd do it myself, but I don't really want to come to the attention of my governing body's Big Cheeses anymore...

Garth Marenghi said...

thanks for highlighting these issues, will try to investigate further

jayann said...

did you notice this 'opportunity', as New Labour might call it, is only for people exempt from prescription charges? A poor service for the poor, chronically ill, and old.

When the ******* Welsh Assembly brings it here -- and I bet they will -- they'll have to find another way of excluding people who might complain about it.

(My nearest Boots has already 'refurbished', adding a 'consulting room'. And, BTW, it does seem to have added a lot of homeopathic remedies. I'm not all that well at the moment but nor am I ill enough to need to see a doctor so I might try asking for 'natural' remedies to get you some more ammunition.)