The South Australian Government's expansion of the range of conditions pharmacists can prescribe for – without a diagnosis – is a risky move and driven by political lobbying and the state's stretched health system rather than patient needs, the Royal Australian College of GPs has warned.
Conditions for which pharmacists will be allowed to dispense medication without a diagnosis include ear infections, nausea and vomiting, and a range of skin conditions including shingles, psoriasis, dermatitis, school sores, and acne.
RACGP South Australia Chair Dr Siân Goodson said this expansion of pharmacists' scope beyond their training will lead to patients with serious conditions delaying care.
"This is just reckless – it's hard to see how this won't lead to patients with serious conditions delaying medical treatment because they've been given a medication by a pharmacist that may treat the symptoms, not the disease," she said.
"There's a reason why doctors diagnose patients before we treat them. Eczema, meningitis, and shingles look similar to an untrained eye. What looks like an 'uncomplicated' ear infection could lead to a hearing loss, or could even be cancer. You need someone who's trained in differential diagnosis to know if the right step is antibiotics, or an entirely different approach.
"Even someone who has finished medical school, but not trained as a GP or other specialist doctor, does not claim to be ready to make such big calls without supervision, yet the SA Government wants pharmacists to make these kinds of decisions off the back of a short online course. Calling that postgraduate training is stretching the definition as far as it can go.
"There are areas where pharmacists can and should do more, as we're seeing with pharmacy movement into vaping and smoking cessation counselling. This is the kind of thing pharmacists can do with additional non-medical training, as we're seeing, and it makes sense given pharmacies are the place for patients to go to buy nicotine cessation medicines. But when a patient has been told a treatment will address a symptom and it just masks an underlying condition, that can easily add weeks or months before they actually get treatment. In the meantime, the untreated underlying condition just keeps getting worse, and can send them to hospital when a GP could treat them in the community.
"This is a political move by a South Australian government under pressure to address issues in its hospital system, and no one should be surprised if it backfires. There is a reason why GPs and other medical specialists spend at least 11 years in training. A large body of evidence shows that GPs reduce emergency department presentations and hospital readmissions.
"Every medical student and doctor has had an experience of realising they're fundamentally wrong about a medical scenario, even after years of study. It's easy to underestimate how complicated an 'uncomplicated' symptom is when you don't have the context of years of training and experience. This decision was based on politics and lobbying, not evidence. There is no substitute for the care you get from a GP who knows you and your medical history."
~
