HOW DO WE DEFINE THE PUBLIC INTEREST?

 

There is no one perfect definition for what is in the public interest.  It is therefore largely left to the discretion of provincial regulatory authorities (PRAs) like the Ontario College of Pharmacists (OCP) to set their own frames of reference.  The definition could be narrow, or it could be broad, or it could be in between

The recent “Code of Ethics” booklet put out by the OCP states on page 4:

“In exchange for our promise (to act in the best interest of our patients and place their well-being first and foremost) society agrees to provide our profession with the autonomy to govern ourselves as a self-regulating profession with all the privileges and statuses afforded regulated healthcare professionals.”

The question that surfaces is this.  If the definition of what is in the public interest is interpreted at a very narrow level, to what degree does a regulatory body continue to deserve the privilege of self-regulation?

A look at how the profession of pharmacy has evolved over the last 50 years does not present a pretty picture.

The main issue is not education.  Today’s pharmacy graduates are several times more knowledgeable than graduates of even 25 years ago.  Schools like the University of Waterloo are doing an outstanding job of producing stellar grads with a re energized outlook as to how pharmacy should be practiced.

The main issue stems from the loss of control of the pharmacy profession to big business interests or Big Pharmacy Retail (BPR).  Until this is reversed, the profession will continue to spiral downwards until it ceases to be a profession and is relegated to a commercial activity within a retail mega-complex.

The one source for hope towards gaining back at least some of this control rests, not in the hands of pharmacy associations as is well known, it rests with the regulatory authorities…….if they only choose to exercise their mandate to protect the public interest utilizing a broader definition of what the public interest is.

The regulatory body governing jet pilots is extremely strict as to how many hours a pilot can fly…for good reason.

How is it then that pharmacists can be allowed/forced to work 12 or even 16 hours straight?…in many cases without a break.   This is not only dangerous, it is inhumane.  But more importantly, how is this in the public interest?

A recent CHN poll clearly indicates that this is routine for many pharmacists.  The OCP chooses to respond by stating that “business issues” are not their concern, but when these business issues cross over to safety issues it is definitely OCP’s concern.  If the predilection is always to define the public interest in the narrowest of terms, then a lot of important public interest issues could be overlooked.

In an even more overt and obvious example, what about the scourge of professional services quotas?  How can it be remotely in the public’s interests to force professionals to meet ever increasing quotas for services designed solely for the purpose of creating more dollar retail revenues and increased store traffic?  No one wants to touch this one.  Certainly not the pharmacy associations who rely so heavily on the continued support of BPR.  But why not the regulatory bodies?  This one is obvious.  It can only be assumed that they just don’t want to put up the fight.  It would be a hard fight and these guys are simply not fighters.

Let’s not even approach the embarrassment of flu injections.  Why are pharmacists being forced to personally inject people?  This is a technical act and borrows nothing from the knowledge skills of today’s pharmacists.  How many more road side signs do we need imploring people to “come in and get your shot”.

Unfortunately, as long as the OCP and other regulatory bodies continue to sit in their ivory towers and feign public protection while allowing significant transgressions and compromises to the public interests, this only encourages business interests to further push the pharmacy profession towards a product category, like the meat and produce departments.

How long can pharmacy remain a self-regulating profession when it so loosely and narrowly defines its raison d’etre?

 

3 thoughts on “HOW DO WE DEFINE THE PUBLIC INTEREST?

  1. Excellent article on questioning how to define public interest. I agree with all your points and am very troubled as to where pharmacy is heading. Pharmacists are losing control of their profession and in many situations, their working conditions are terrible. How the Colleges of Pharmacy can ignore these problems when they can impact on the safety of patients is hard to understand.

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  2. Unfortunately it boils down to:

    “Are pharmacists really that important in the medical care of a patient?”

    Hint: We are not important at all.

    And it hurts to say that. It does. Why did we spend the better part of a decade earning a license that is spat upon and stepped upon?

    Pilots risk peoples’ lives if not regulated, but pharmacists aren’t important enough to spend resources on.

    Yes, pharmacist mistakes cost lives. The child who overdosed on Risperidone. The mix up between Accutane and Accupril, the drug interaction between mercaptopurine and allopurinol.

    However the sheer statistics of actual mistakes… are hidden. It looks like DESPITE the fact that pharmacists are working 12 – 14 hour shifts the rate of error is …. unknown. Therefore it is interpreted as minimal.

    For the sake of argument let’s say there was a 50% rate of error, absolutely unacceptable, and changes will be made.

    Essentially you’re paying someone to be an overpriced proofreader. Plain and simple.

    If a zombie/ robot with a pharmacist degree and license just followed the physician orders to the letter they will never be wrong. Many, many pharmacists have practiced like this for their entire careers, and had no clue that aspirin takes away the protective properties of a coxib, or that long term PPIs are bad.

    They just follow the orders mindlessly.

    If pharmacists were, today, to be replaced by ScriptPro filling machines, e-prescribing, and online electronic mail order companies… would there be a difference?

    No. There wouldn’t be.

    Lick, stick, and pour.

    “What if the physician makes an error/ omits something/ messes up?”

    [The machine will respond – error cannot fill. Please verfiy…. just like a pharmacist generally would]

    “What if the physician makes a therapeutic mistake?”

    {Again, the machine will respond – error cannot fill. Please verfiy…. just like a pharmacist generally would]

    “But a machine cannot recommend alternatives like a real pharmacist can!”

    [Many physicians will ignore a pharmacist, or the pharmacist doesn’t bother sending a recommendation, or the physician isn’t smart enough to understand what the pharmacist recommends, or doesn’t trust the pharmacist, or the pharmacist doesn’t know enough about the drug/ condition/ patient to recommend anything at all]

    Let’s ask the real questions, pharmacist to pharmacist. What can we do that is absolutely necessary that no other profession can do?

    [Medication management – no] – “Pharmacists are at the mercy of the prescribing doctor. Send the most talented, smartest, PharmD up to the middle of nowhere with a doctor that graduated in 1930 and see how far you would get in providing evidence based medicine”

    [Dispensing – maybe]: Legally only pharmacists can dispense. But if for some reason that legal right is taken away from us…. then we are in a world of hurt. It is the only privilege we have left and other industries would love to rip it from us. Doctors LOVE dispensing. I’ve had patients who see their physician every month because their doctor will give them a month supply of physician samples of expensive drug. They will never get it from the pharmacy anymore.

    Inhalers? Come every month
    Expensive Blood Thinner? Every month
    Pain meds? Every month

    It’s frustrating to see physicians UNDERMINING pharmacists by essentially doing backdoor dispensing and actually talk trash about pharmacists like, “don’t go to the pharmacy because they will overcharge you. Come every month and you can get this free while the government pays for the clinic visit”

    [Being nice to people, because machines can’t be nice]

    Machines can theoretically replace us. And no amount of ethics will help.

    We have to provide a singular service that is totally irreplaceable. The problem is that with technology and Google, our information is essentially obsolete. The smartest 10% of pharmacists in this country can’t hold a candle to Google and anti vaxxers who get their info from the world wide web.

    The world doesn’t need us anymore.

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  3. Same issue with the new Error database divulging… Can we see the same thing in Hospital and MD errors. We know there is a closed door morbidity and mortality committee but of course it is closed door.
    The new public revelation of errors could and maybe should exist in all professions but then we only have a thirst for gossip just like the tabloid because of the internet and social media where everything gets questioned in a left leaning governmental model. IBEW union style might help pharmacists develop standards of practice and work standards, benefit standards, pension standards etc.

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