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Proposal to turn philosophy of pharmacy on its head

Liane Topham-KindleyWednesday 05 July 2017, 3:16PM
Proposal to turn philosophy of pharmacy on its headResearchers (from left) Megan Anakin, Daniel Wright, Carlo Marra and
Stephen Duffull propose a philosophical framework for pharmacy

Otago School of Pharmacy re­searchers propose a philosophical framework for the profession in a paper recently published in the journal Research in Social and Administrative Pharmacy (doi: 10.1016/j.sapharm.2017.04.049). 

Pharmacy practice needs a change in philosophy to link the changing activities executed by pharmacists in the 21st century and the decision-making processes that are required to undertake these roles.

It's the view of the school's former dean, Stephen Duffull, who developed the paper together with senior lecturer Daniel Wright, current dean Carlo Marra and professional practice fellow, Megan Anakin. 

The researchers observe that pharmacists' main roles have expanded from providers of medicinal products, dispensers and clinical checkers to also include an active involvement in shaping patients' treatment plans. 

Consequently, there is a need to re-evaluate the skills and knowledge pharmacists require in order to be able to fill their current and growing future roles. 

There is apparently a line in the sand in the profession that separates "reducing harm" (non-maleficence) from "helping others do good" (secondary beneficence) or "doing good de-novo" (primary beneficence), Professor Duffull explains. 

"This line is hard to cross as the practice and educational philosophy that underpins avoiding harm is quite different to doing good." 

The clinical checker and dispenser roles of the pharmacist have, historically, been a primary focus and both carry a philosophy of reducing harm.   

But there is a need for pharmacists to embrace more professional service roles such as medicines optimisation and prescribing, requiring pharmacists to adopt a philosophy of "doing good", Professor Duffull says. 

"For a profession that has been reared on a risk-averse diet, these new roles signal a change in the operating conditions of the profession," the paper states. 

The new roles require a fundamental change in how the pharmacist contributes to a patients' healthcare. 

"For many practising pharmacists, an approach to patient care that involves the notion that to do good will risk harm will be in conflict with their current risk-adverse approach," the paper states. 

It is time for the introduction of new "do good" models of clinical decision-making skills that provide pharmacists with the tools to integrate reasoning processes with their knowledge base and experience, to best meet the needs of an individual patient. 

Clinical decision-making is, therefore, the essential skill for modern pharmacy practice, but is relatively underdeveloped in pharmacy education compared with medicine and other professions, the paper states.  

The paper's conception came about in 2010 when Professor Duffull attended a meeting in Sweden where a speaker presented a case about a pharmacist who had increased harm to a patient by making a recommendation that was aimed to improve patient care. 

There was a lot of discussion; this mostly focused on how pharmacy had to "improve its game" and how harm is not acceptable, Professor Duffull explains. 

"I was a little surprised at the time as, from my perspective, every intervention carries risk," he says. 

"But if your natural state is risk adverse then I can see how any risk could be perceived as bad. 

"It is very difficult to teach under both non-maleficent and beneficent frameworks simultaneously - and there is the need for one to predominate to allow education and practice to be ­optimised."


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