UNDER plans revealed this week, patients with long-term conditions such as diabetes will be able to consult “expert pharmacists” for advice. Meanwhile, the NHS is to
curb outdated treatments, with pressure being put on doctors to stop prescribing ineffective drugs.
It sounds great, conjuring up visions of eager young pharmacists providing up-to- the-minute advice on the best medicines, and doctors making more effective use of their time. But will it work? When my mother took a new statin, a medicine to lower her cholesterol, she developed dizziness (one of the side-effects). She sought advice from a pharmacist, who recommended switching to another urgently. When she later told her GP about this, he boomed: “You don’t want to believe everything shop girls say” and insisted that no changes were necessary. My mother was caught between two professionals both of whom thought they knew best.
Many doctors are not good at treating disease with drugs. Between 4 and 10 per cent of prescriptions made by family doctors involve some sort of error, for example, neglecting to notice that two medicines interact badly with each other. How to prescribe (as in the dose, form and frequency of a medicine) is not taught at medical school, highlighted in the news in July, when Professor Sir Mike Rawlins said that a great deal of mis-prescribing is due to a lack of knowledge by doctors. Instead the skill is assumed to be acquired by some osmotic process at a later stage.
Many doctors aren’t very interested in prescribing.
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Their view of pharmacists is often patronising, while simultaneously recognising that pharmacists are the last line of defence between GPs and serious trouble if their prescribing puts the patient
at risk.
This week’s stories are significant because we are moving into a new era. More and more people are taking many medications at the same time, and not just older people. As the NHS heart czar Roger Boyle said this week on my Radio 4 programme Am I Normal?, because statins are prescribed to more people, it will be normal, rather than unusual, for people over 50 to be taking these drugs. So knowledge of medicines and their interactions has never been more necessary.
If doctors and pharmacists do not agree to lower some of the barriers between them, work out who’s good at what, look to their own deficiencies and work as equal partners in a team, the poor old patient is likely to be left as wobbly as my mother. Not sure who to go to, not knowing whose advice should be trusted and no better off as a result.