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    Another day, another outraged rent-seeking parasite.

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    “Doctors spend years of dedicated study, under expert medical tutelage in both the art and science of differential diagnosis”

    Can someone please double-check that med students aren’t skipping these classes? My experience with GP’s is that their knowledge of differential diagnosis AND pharmacology is appalling. I have personally witnessed GP’s prescribing dangerous medicines, not checking for contra-indications, not checking that it is OK for the patient to take that drug, not even understanding the very basics of pharmacokinetics….

    I would always hope that a Pharmacologist would have this knowledge – but then in all the cases I just mentioned above, the dispensing pharmacist has never been the check-and-balance and have dished out the incorrect medication anyway!

    So what’s the big deal if someone with some training jump into this racket? Maybe these kinds of mistakes will be avoided with another fresh set of eyes….

    Just like with Midwives/Obstetricians – this is nothing but a turf-war!

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    I don’t see a problem with a nurse traiging the calls and referring as necessary. As long as their “strict remit” is indeed strict. A registered nurse really doesn’t have much training in pharmacology at all (that’s not a core nursing duty).
    It would be inappropriate for a nurse to advise in detail on medicines.
    Although the message was a bit strong in tone, I thing he was just making that point.

    The idea that some have that nurses can do everything in the health system – be a nurse as well as a doctor and pharmacist is folly.

    And ‘Pete’ – your “GP’s are rubbish” diatribe was as just as ridiculous as most of the turf war issues you refer to. Mistakes are made with medicines at many points, from prescribing to despensing to adminstering and can involve doctors (pre-vocational, specialist and gp), nurses or pharmacists…..

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    ron batagol

    ron batagol Says:
    July 12th, 2010 at 10:19 am
    Firstly, I must emphasise that my concerns in my article on this issue should not be seen as being either about turf wars or demeaning the important roles that nurses play in the health system. It is neither of those things! . Nurses have special expertise in patient observation, and monitoring of vital signs and changing levels of health status, plus a host of other specialised and varied functions such as wound care, stomal therapy, bowel management, special nutrition, fluid balance etc. They also monitor and titrate the giving of parenteral nutrition , blood replacement, and a whole range of other bedside procedures. They also set up and manage various health care plans for patients. And, again, they do these things better than anyone else!

    However, the best way I can summarise my concerns over the issue of NPS replacing pharmacists with nurses on their Medicines Line , is to repeat the caution expressed by an international expert on health systems and the various roles of health professionals, Prof.Des Gorman, of Auckland School of Medicine, when speaking on ABCs Life Matters in June 2009. Prof.Gorman said :“Role substitution makes sense only if the skills are transferable”. In this case, clearly they are not!

    This has direct relevance to NPS stating that “many questions can be answered by “reading the consumer medicine information(CMI). leaflet”, which is why I stated that “it is precisely the attempted decoding and deciphering of the convoluted “gobbledygook” in the CMI, which brings many a consumer to seek out the expertise of a pharmacist for clarification, and, often indeed, reassurance, about their medicines.” This is in fact even more important with a dedicated National medicines advice line, where, by its very nature, there are, potentially, queries which will require expert drug information advice, or at least pharmacist expertise, , to obtain relevant information from the caller and then accessing and interpreting appropriate databases and specialised texts, which is obviously well outside the scope of information contained in a standard CMI. As I indicated, in these cases, this will occur at the initial contact point with the caller.

    This process will be relevant and applicable to patient queries on medication use outside approved indications, mismatches between CMIs and also expert clinical consensus recommendations that doctors, in this day and age, preferentially rely upon. Also, underlying medical conditions affecting drug absorption, metabolism and excretion, which, again, may be a major area of concern in the clinical context. These are areas which the specific training and expertise of a pharmacist is geared up to advise upon. Should these calls now be handled initially by a nurse instead? I don’t think so!

    However, I guess the criticisms that I have expressed about this issue are symptomatic of a wider concern that I and others have over the moves in the past year for Governments to find a “quick fix”for the shortage of doctors by attempting to upskill nurses to take on the roles of doctors in diagnosis and prescribing. Again, I refer to that Prof.Gorman Life Matters interview, which, in fact, addressed the issue of more effective utilisation of health professionals and allowing them to enhance better health outcome, by contributing their special skills and expertise to the system in a collaborative way , rather than competitively substituting or replacing each other’s roles.

    But, it’s not all gloom and doom. The new move to give nurses a greater role in GPs surgeries with Practice Incentives Progammes is obviously a good thing. Similarly we now have well-researched templates for pharmacists to become more involved in selecting and advising doctors on drugs and their utilisation, which in major teaching hospitals at least, are starting to bear fruit as part of the plan where pharmacists and other health professional collaborate with doctors to develop comprehensive discharge, including medication management, plans. One can only hope that.over time, when the overall primary health care plans are fully developed and bedded down, there will be a more seamless transition and interaction between high-level institutional care and community care to the benefit of better overall patient care.

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    As a cancer patient, herbal remedies were recommended to me. As a scientist I phones the AME hotline (several times), I talked to phamacologists – they were amazing.
    Nurses are wonderful people and are fantastic at patient care etc – but I would not like to take advice on interactions with pharmaceutic drugs and herbal remedies with them – as a consumer I think we have lost one of the most valuable resources in the expertise of those pharmacologists.

    It’s false economy and I won’t be using or recommending that help line again.
    What were the NPS thinking???
    What next? – an Indian call centre?


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