Statement on the professional role limits of doctors and pharmacists

Foundation: Comisión Central de Deontología de la Organización Médica Colegial Española.
sourceSpanish: Comisión Central de Deontología de la Organización Médica Colegial Española.
language original: Spanish.
Approval: General Assembly of 25-III-2000.
Publication: Revista OMC, April 2000.
Copyright: No.
Checked on 16 May 2002.

Declaration of the WTO Central Commission of Deontology on the limits of the professional functions of doctors and pharmacists.

Introduction

1. For some time now, there has been a growing concern in the field of medicine about the expansion of the functions pharmacists perform in their offices, which do not appear to be far from intrusive behaviour. Changes of varying nature and intensity have contributed to this.

a. issue Firstly, social changes: the high consumption of medicines paid for by the National Health System, the decrease in tolerance to the little aches and pains of life, the ease of obtaining advice and medicines from the pharmacist, has increased the number of people who go to pharmacies and has favoured the contact of pharmacists and their assistants with customers.

b. Secondly, changes in the demographics of the pharmacy profession: the excess of pharmacy graduates forces not only individuals, but also professional bodies, to try new outlets and functions, which may, of course, conflict with those peacefully held by other health professions.

c. Thirdly, changes brought about by certain movements within the pharmaceutical profession. As experts in medicines, pharmacists have demanded a new and autonomous role in the monitoring, control and modification of treatments prescribed by doctors. They wish to assume, through what has come to be known as pharmaceutical care, new functions and responsibilities in the programming of therapeutic objectives, in the control of interactions and adverse effects of medicines, or in the reordering of complex treatments. Some even feel that they feel empowered to fine-tune drug therapy in order to improve its economic effectiveness and patients' quality of life.

d. Finally, some legislative changes referred to below.

2. The status that is being created is worrying because, judging by appearances, some pharmacists want to enter a field reserved for doctors and break the current paradigm of strict professional separation of the functions of prescribing and dispensing, a separation that must be maintained with the necessary adaptations. For, just as it would be imprudent to waste the pharmacist's skill knowledge of the effects and interactions of medicines, it would be extremely imprudent for them to be given the power to modify the therapeutic plans established by the doctor without the doctor's knowledge and acceptance. Undoubtedly, such unauthorised modifications could constitute a case of intrusiveness.

3. In order to avoid conflicts in the relationship between pharmacists and physicians, and to maintain the traditional cooperation between the two professions, this Declaration is offered. reference letter In it, after referring to the lack of clarity of certain legal rules on subject, the ethical foundations favouring the open and constructive maintenance of the Salerno Principle, on the necessary professional separation of the acts of prescribing and dispensing, are pointed out.

Legal uncertainty, a source of concern

4. The clarity of the legal regulations governing pharmacists' activities, contained in the Law of 29 July 1943, which in Chapter I defined the mission statement and functions of the School Pharmacy and the professional value of their academic qualifications, contrasts sharply with the silence, vagueness or blurriness of some subsequent legal regulations, such as the Health Law of 25 April 1986, the Medicines Law of 20 December 1990, and the Law of 26 April 1997, on the Regulation of Pharmacy Office Services.

5. Specifically, article 1 of the latter provides a generic list of the functions assigned to pharmacies, which includes some basic services to be provided to the population and which constitute a blank cheque for pharmacists to interfere in functions that belong to the genuine content of the medical profession. The expansionist policy that the pharmaceutical profession has been pursuing in recent times can find support here. Thus, pharmacists' offices are attributed functions such as monitoring patients' pharmacological treatments, or partnership - it is not stated with whom - in the control of the individualised use of medicines, in order to detect and report any adverse reactions that may occur, and so on.

6. It is understood that the attribution by law of such vague functions to pharmacists is an invitation to create conflict with doctors.

On the one hand, they tend to place the pharmacy office as the first link in the health care attendance , when they invite to use the pharmacy office as the initial written request of health care, which presupposes that the person in charge of the office, or one of his assistants, is competent in the diagnosis of the nature and importance of the condition that the client describes to him. In this way, the essential doctor-patient relationship is replaced by a new, not risk-free, pharmacy-patient relationship.

On the other hand, they authorise the pharmacist to modify the therapeutic plan prescribed by the doctor, without the law defining the scope and circumstances of this prerogative, or indicating who is the final manager before the patient. In this way, the peaceful doctor-pharmacist-patient relationship, hitherto in force, is evolving into a problem-generating trimurti.

7. The Law of 26 April 1997 on the Regulation of Pharmacy Office Services seems to facilitate the intrusion of the pharmaceutical profession in the field of medical care, unless measures are taken to ensure that the attributions of both professions and the field of their mutual cooperation are perfectly defined.

Professional relationships between doctors and pharmacists

8. In the opinion of this Commission, the two principles which have governed the relationship between doctors and pharmacists over the past decades remain fully valid: the separation of the two basic functions of prescribing by the doctor and dispensing by the pharmacist, and the cooperation of pharmacists and doctors in optimising the therapeutic and economic aspects of the use of medicines.

9. The principle of separation of the two basic functions of prescribing and dispensing is supported by two basic and immutable reasons.

One is of a professional nature: the necessary and irreplaceable professionalism, the skill due in professional fields that are clearly differentiated. A doctor is not an amateur pharmacist, nor is a pharmacist a dilettante in medicine.

The other is ethical: the elimination of any risk of conflict of interest. The decision to recommend a treatment cannot be tainted by the financial benefit that may accrue to the person making the recommendation. Practising physicians cannot own pharmacies, nor can they prescribe influenced by financial considerations, nor can they sell medicines or medical devices to their patients. Nor may pharmacists, except in the case of over-the-counter products, sell on their own initiative to their customers medicines that require a medical prescription presentation . The prescription requirement is the ethical and legal test, that the pharmacist is a professional whose primary interest is to serve the interests of the patient, not to maximise profit from work .

10. The principle of cooperation of pharmacists and physicians in optimising the proper use of medicines derives its strength from the professional obligation to serve the best interests of the patient and to do no harm to the patient.

Several obligations arise from this principle. Firstly, the obligation to inform each other of any errors in prescribing or dispensing that may have occurred. This speech must always be correct and respectful of professional reputation. Secondly, to offer and accept the necessary information to prevent the appearance of incompatibilities or undesirable drug effects and to educate the patient in the best way to conduct the treatment. Mutually agreement, pharmacists and physicians should develop ways of co-operation that improve patient care, with the consent of the patient. This cooperation subject should always be based on rationality and consensus. The physician must recognise the pharmacist as an expert in medicines. The pharmacist must not forget that medication is applied not to abstract pathological processes or statistical entities, but to specific individuals with their particular characteristics.

11. Recently, the Declaration on Freedom of Prescription and the Declaration on Prescribing and Substitution of Generic Drugs, both of which were authored by the Central Ethics Commission and which contain criteria complementing the present Declaration, have been issued. In preparing and discussing them, the Central Ethics Commission has been guided by the ethical criteria of protecting the rights and interests of patients and creating an atmosphere of cooperation among health professionals.

Madrid, 27-28 November 1998.