Explaining the role of pharmacists in multidisciplinary care

I would like to address the author’s concern about multidisciplinary care.¹ As stated, his article is not meant to be disparaging towards pharmacists. However, the message delivered is potentially misleading, as it suggests delegating jobs to other professionals could cause patients harm. I would like to clarify the role of pharmacists because it is often misunderstood.

Community pharmacists are here to make an initial assessment and care plan rather than an official diagnosis. If patients return with unresolved symptoms, pharmacists would suggest that the patients see their doctors. Once doctors establish the diagnosis and management plan, pharmacists monitor patients’ therapies in the community, and report drug therapy problems to doctors. It appears that the author is not satisfied with pharmacists’ diagnosis of dark stool. However, making a diagnosis of gastric ulcer probably requires full abdominal examination, digital rectal examination, and endoscopy, which are beyond the scope of practice of many pharmacists.

Anybody is prone to make the wrong initial assessment, because making the right diagnosis requires a lot of clinical experience that aids pattern recognition.² Making the right diagnosis also depends on the amount of time spent with patients and choice of investigations ordered. One of pharmacists’ roles is to identify symptoms possibly caused by drugs, and aid doctors’ differential diagnoses. Pharmacists tend to be excited whenever they identify possible drug therapy problems, because this is their opportunity to shine. However, their enthusiasm can result in criticism and denial by others, as evidenced in a recent study.³

If doctors are concerned about pharmacists’ assessments, doctors can offer interprofessional teaching. Alternatively, doctors can request to see every patient with dark stools who concurrently take iron tablets, but I doubt whether our busy general practice and A&E colleagues would appreciate this approach. Similarly, I myself am grateful to other professionals helping with venipuncture and intravenous cannulation on the wards, and escalating when needed.

To conclude, I acknowledge the author’s concern about potential patient harm, but only if pharmacists are expected to fulfil the entire role of doctors. It would be equally unsafe to expect doctors to perform all of pharmacists’ duties.

Competing interests

Eugene YH Yeung has received salaries from working as a medical doctor and a pharmacist, but neither has paid him to write this letter.