or many decades, economic necessity forced pharmacists into a constant search for "sidelines" to supplement their income. These ancillary activities often were not performed to benefit the "patient's health." And why should they be, since pharmacists were at best marginal members of the health care team? What was true then is still true. Even today, pharmacists who want to improve their lot often veer from the direction of their forte: pharmaBy EUGENE V. WHITE cotherapy. Some seek additional degrees in business administration, hospital administration, or phar-
Prescription
F
for
Family
Practice
Eugene V. White recently celebrated the 18th anniversary of his office practice at One West Main Street, Berryville, VA 2 3 611. This article is adapted with permission from The Office-Based Family Pharmacist, © 1978, Eugene V. White.
12
macy law. Others enter the surgical garment/appliance and sickroom supply business, often to such an extent that their pharmacy practice becomes the sideline. Some completely abandon their field in fav or of undertakings such as insurance sales, real estate, investments, or fast food franchises. But pharmacists need not sacrifice the integrity of their profession. Community pharmacists can practice private, patient-oriented pharmacy full time and earn an adequate income without becoming involved -in these unrelated activities. The development of the patient medication profile record, the establishment of drug information centers, the pharmacist's involvement in detecting hospital medication errors, and pharmacist participation in hype~. tension screening, monitoring, and American Pharmacy Voi.NS19. No .3 . Mar.1979/ 124
,
I
patient adherence programs are only the first signs that pharmacists can help the patient by using the knowledge they have in their own field. Drug Therapy Specialists
To assume their new role as drug therapy specialists, pharmacists must move beyond the point of dispensing medications. They can no longer be involved only in managerial roles, responsible for the procurement, distribution, and control of drugs and health-related items. They cannot be "chained" to the office by law or regulation whenever the office door is unlocked. They must have the privilege of maintaining office hours as other professionals do. The patient, of course, must have access to pharmacy service even when the pharmacist cannot be present. Thus the procurement, disThe notable absence of product shelves and the pensing, and managerial roles can be characterize White's unique family practice. delegated to supportive personnellicensed aides with at least two years of formal training. As the pharmacist becomes a full-time mechanism of action and any hazspecialist in pharmacotherapy, it ards associated with its use? The old will be these technicians who will "diagnosis and treatment are insepdispense the prescriptions that orig- arable" cliche will no longer suffice. inate in the office consultation However, before pharmacists can room. become pharmacotherapists, they For along with drug monitoring must demonstrate both to the and patient consultation, prescrib- health professions and to their paing will be one of the functions to be tients that they are qualified health filled by the family pharmacist. Phy- care specialists. This step cannot be sicians simply cannot be competent taken without the cooperation of all in both their field of medicine and groups. A major change of attitude our field of pharmacy. Medical in both the medical team and the schools are teaching less and less patient must take place before full pharmacology. As a result, physi- use of the pharmacist's expertise cians in practice cannot fully evalu- can be realized. Pharmacy faces the ate the mass of information derived task of developing a comprehensive from the drug knowledge explosion, public and professional relations nor can they keep up with all the education program. latest findings on drug interactions, 'Dinosaurs' biopharmaceutics, bioavailability, and pharmacokinetics . Pharmacists at the grassroots Rational decisions about drug level are totally unprepared for the therapy are thus becoming more emerging role of the pharmacist as and more difficult for physicians. prescriber. Although many of this Studies have shown the extent of generation will never qualify, their drug-induced illnesses or therapeulack of specialized education should tic misadventures attributable to not prevent them from redirecting faulty prescribing.I their efforts toward patient-orienIf physican's assistants can preted services. Unless the stereotyped, scribe drug therapy (see December apathetic, conforming, business1978 American Pharmacy), why not and profit-oriented pharmacists pharmacists, who know not only the change their ways, they will become optimum drug of choice, but also its the dinosaurs of the medical team. American Pharmacy Voi.NS19, No.3, Mar.1979/125 ..........._
comfortable consultation setting
Dissociation from a product will accelerate the pharmacist's exodus from the mercantile scene; once this step is accomplished, the abandoned "corner drug store" is destined to join other museums across the nation . Our professional survival depends on the elimination of product orientation. Unfortunately, some of the major problems facing the profession have been perpetuated by its own members. Pharmacists' willingness to practice as salaried employees of large corporations has caused price to become a disproportionate factor in providing pharmacy services. By using various gimmicks and · discount plans, these corporations have deceived the public into believ-
'Although many of this generation will never qualify, their lack of specialized education should not prevent them from redirecting their efforts toward patient-oriented services.'
13
Assistant Susan Whitacre checks the records with Pharmacist White ... "a valuable asset," White says.
ing that only price matters and that the pharmacist's professional services are worthless. These tactics can only be harmful-both to the public and to the profession. Everyone knows that innovation in research cannot be achieved by counting pennies. When an inadequate value is placed on the pharmacist's services and medications, efforts to improve pharmacy services for the patient must cease, and progress in our profession is stymied. How can the word be spread to price-oriented pharmacists that they are jeopardizing their chances to be full members of the health care team? One way is to reach the pharmacy students-before they receive tempting offers from discount chains-to show them the risk they run if they snatch at the
Eugene WhiteS V1ews on Future Pharmacists
As specialists in drug therapy, the new pharmacists will assume a comprehensive and continuing responsibility for all of the drug requirements of their patients. When the need arises for any drug therapy, the family physician, family dentist, or other specialist will refer the patient to the drug specialistthe pharmacist-who will follow through to the termination of drug therapy. The pharmacist's responsibilities will include: • Prescribing the drug of choice for the particular physician diagnosis; • Maintaining ongoing surveillance over the drug action and application to insure the desired effect; • Being directly answerable for toxic or adverse drug reactions; • Acting as the primary source of information in the drug experience reporting system. Family pharmacists, by the very nature of their new position on the health care team, will know the patient's complete drug history as well as any hypersensitivities or idiosyncrasies. This vital knowledge must not be restricted by the threshold of the office. If the family physician
14
recommends hospitalization, the patient's family pharmacist will continue the team role at the hospital or extended care facility, working cooperatively with the family physician, the intern, the medical specialist, and perhaps a specialist in a pharmacy field. The pharmacotherapist will ob~ tain detailed drug histories from patient interviews, perform physical examinations to follow drug therapy progress, order laboratory tests, formulate simple diagnoses and screen for referral the more complex cases, and develop therapeutic treatment plans . Other areas of major professional involvement will be the prevention and early detection of illness in the ambulatory patient and community involvement in health education. The pharmacist of the future will play an active role in managing and monitoring drug therapy in disease states such as diabetes, asthma or chronic obstructive pulmonary disease, and cardiovascular disease and in the fields of pediatrics, obstetrics, surgery, ' radiopharmacy, mental health, and oncology. The pharmacist's services will be vital to the hos-
_ __
pital emergency room staff, espe- , cially in cases of toxicity. The pharmacotherapy knowledge explosion in most of these fields will result in the creation of pharmacy specialties . Pharmacists' new status as highly qualified health professionals calls for the establishment of a specialty board, certification examinations, and diplomate status for family pharmacists. Board certification is the only appropriate recognition for pharmacists who have invested the time and effort required to complete prescribed training programs and who have demonstrated their competence in this important field of phar- I macy. Certification is necessary to provide status to the field and toreward those who have prepared themselves in a suitable manner. Both status for the field and reward for the individual are essential to attract young pharmacists to careers in family pharmacy practice. The pharmacist in the primary care role is destined to become a major point of entry into the health care sys tern.
_ A_ m_ er_ ic_ an~ Pharmacy Voi.NS19, No.3, M~r. 1979/126
___About ...... the Book
bait. If pharmacists refused to work for the commercial enterprises, these emporiums could not offer pharmacy service. Then all community pharmacists could practice privately or in group practice, like medical and dental practitioners. The pharmacists could enjoy a higher income, practice on a higher plane, and insure that the ownership of pharmacy practices would be restricted to pharmacists .
-
'Unless the stereotyped ... pharmacists change their ways, they will become the dinosaurs of the medical team.'
Universal Effort
The success of our quest for recognition as health care professionals depends solely on our actions. The advantages gained by our new status will accrue to all of us. If society's expectations of the typical community pharmacist do not change appreciably during the next few years, it will be the profession's fault, not society's. The meager patient-oriented activities of contemporary pharmacists- for example, selecting frorn among therapeutically equivalent generic drug products-are a mere beginning in the expansion of the practitioner's role. Although the strictly professional pharmacy office setting has not been adopted by the profession as readily as the patient medication profile record, it will eventually evolve from a "radical innovation" to an accepted standard of pharmacy practice. We need only convince a minority of the profession of the merits of the office-based family pharmacist concept; once convinced, they will motivate the whole profession. Dissatisfaction, disillusionment, and frustration with what they see in contemporary community pharmacy practice will instill in them the enthusiasm, determination, and challenge to fight for a better way. · When pharmacists become pharmacotherapists, focusing all of their drug expertise on patient care alone, the future of pharmacy will take on a new perspective. 2 • 3 o References 1. Task Force on Prescription Drugs, Second Interim Repo~ t
,~,...
-
-~~-====!1
By EMIL W. BAKER The Office-Based Family Pharmacist, Eugene V. White, One West Main Street, Berryville, VA 22611, 1978, 159 pages, $10.70. In the author's own words, "This is a common sense essay on the philosophy and fundamentals of and the steps involved in establishing an office practice of pharmacy." Pharmacist White, who is credited with originating the patient-oriented office practice of pharmacy in 1960, relates his experiences and beliefs concerning his practice. He emphasizes that the office practice of pharmacy is the proper base from which the new breed of competent patientoriented community pharmacists can function and perform professional duties. Although there is no in-depth treatment of the use of medication profiles, how the pharmacist can become involved in the patient's pharmacotherapy regimen, or the pharmacist's role as a member of the primary health team, these concepts are all part of White's philosophy. Nine brief chapters, two pages of references, and 94 pages of appendices make up this paperback book. White covers everything from his-
and Recommendations, U.S . Department of Health, Edu cation, and Welfare, Washington, DC Aug. 30, 1968 . 2. E.V. White, in "Proceedings of the Pharmacy/Medicine / Nursing Conference on Health Educa tio n," Ann Arbor, Ml, Feb. 16-18, 1967, pp . 6 7 -77. 3. E.V. White, Drug Intel/. Cl in. Plwrm ., 11 , 94 (1977).
American Pharmacy Vol. NS 19, No.3, Mar.1979/127
-
L---------~~~ ~~--------~
Emil W. Baker owns his own office-based pharmacy practice in Mt. Sterling, KY 40353.
torical perspectives to the future of the family pharmacist. Especially important to the development of a more professional image is the section in Chapter V entitled "New Vocabulary A Must!" This chapter also contains the author's opinions concerning de-emphasis of the dispensing pharmacist and discusses the future use of pharmacy technicians and assistants to free more of the pharmacist's time for patient-oriented duties. The appendices contain personal letters, papers published in pharmaceutical journals, and communications by White and others concerning the patient-oriented pharmacy practice concept. I feel that every pharmacist should read White's philosophy. His prediction that pharmacists of the future not only will oversee dispensing of medications, but also will be the prescribers, may not be so far-fetched, considering recent developments in the pharmacy world. This book is long overdue and is perhaps the only publication of its kind describing the office practice and promoting the concept for the future . It should be incorporated into the curriculum of all pharmacy colleges so that pharmacy students, the future pharmacists, can see the advantages of the office-based community practice.
15
Prescription
F
for
Family
Practice
Eugene V. White recently celebrated the 18th anniversary of his office practice at One West Main Street, Berryville, VA 2 3 611. This article is adapted with permission from The Office-Based Family Pharmacist, © 1978, Eugene V. White.
12
macy law. Others enter the surgical garment/appliance and sickroom supply business, often to such an extent that their pharmacy practice becomes the sideline. Some completely abandon their field in fav or of undertakings such as insurance sales, real estate, investments, or fast food franchises. But pharmacists need not sacrifice the integrity of their profession. Community pharmacists can practice private, patient-oriented pharmacy full time and earn an adequate income without becoming involved -in these unrelated activities. The development of the patient medication profile record, the establishment of drug information centers, the pharmacist's involvement in detecting hospital medication errors, and pharmacist participation in hype~. tension screening, monitoring, and American Pharmacy Voi.NS19. No .3 . Mar.1979/ 124
,
I
patient adherence programs are only the first signs that pharmacists can help the patient by using the knowledge they have in their own field. Drug Therapy Specialists
To assume their new role as drug therapy specialists, pharmacists must move beyond the point of dispensing medications. They can no longer be involved only in managerial roles, responsible for the procurement, distribution, and control of drugs and health-related items. They cannot be "chained" to the office by law or regulation whenever the office door is unlocked. They must have the privilege of maintaining office hours as other professionals do. The patient, of course, must have access to pharmacy service even when the pharmacist cannot be present. Thus the procurement, disThe notable absence of product shelves and the pensing, and managerial roles can be characterize White's unique family practice. delegated to supportive personnellicensed aides with at least two years of formal training. As the pharmacist becomes a full-time mechanism of action and any hazspecialist in pharmacotherapy, it ards associated with its use? The old will be these technicians who will "diagnosis and treatment are insepdispense the prescriptions that orig- arable" cliche will no longer suffice. inate in the office consultation However, before pharmacists can room. become pharmacotherapists, they For along with drug monitoring must demonstrate both to the and patient consultation, prescrib- health professions and to their paing will be one of the functions to be tients that they are qualified health filled by the family pharmacist. Phy- care specialists. This step cannot be sicians simply cannot be competent taken without the cooperation of all in both their field of medicine and groups. A major change of attitude our field of pharmacy. Medical in both the medical team and the schools are teaching less and less patient must take place before full pharmacology. As a result, physi- use of the pharmacist's expertise cians in practice cannot fully evalu- can be realized. Pharmacy faces the ate the mass of information derived task of developing a comprehensive from the drug knowledge explosion, public and professional relations nor can they keep up with all the education program. latest findings on drug interactions, 'Dinosaurs' biopharmaceutics, bioavailability, and pharmacokinetics . Pharmacists at the grassroots Rational decisions about drug level are totally unprepared for the therapy are thus becoming more emerging role of the pharmacist as and more difficult for physicians. prescriber. Although many of this Studies have shown the extent of generation will never qualify, their drug-induced illnesses or therapeulack of specialized education should tic misadventures attributable to not prevent them from redirecting faulty prescribing.I their efforts toward patient-orienIf physican's assistants can preted services. Unless the stereotyped, scribe drug therapy (see December apathetic, conforming, business1978 American Pharmacy), why not and profit-oriented pharmacists pharmacists, who know not only the change their ways, they will become optimum drug of choice, but also its the dinosaurs of the medical team. American Pharmacy Voi.NS19, No.3, Mar.1979/125 ..........._
comfortable consultation setting
Dissociation from a product will accelerate the pharmacist's exodus from the mercantile scene; once this step is accomplished, the abandoned "corner drug store" is destined to join other museums across the nation . Our professional survival depends on the elimination of product orientation. Unfortunately, some of the major problems facing the profession have been perpetuated by its own members. Pharmacists' willingness to practice as salaried employees of large corporations has caused price to become a disproportionate factor in providing pharmacy services. By using various gimmicks and · discount plans, these corporations have deceived the public into believ-
'Although many of this generation will never qualify, their lack of specialized education should not prevent them from redirecting their efforts toward patient-oriented services.'
13
Assistant Susan Whitacre checks the records with Pharmacist White ... "a valuable asset," White says.
ing that only price matters and that the pharmacist's professional services are worthless. These tactics can only be harmful-both to the public and to the profession. Everyone knows that innovation in research cannot be achieved by counting pennies. When an inadequate value is placed on the pharmacist's services and medications, efforts to improve pharmacy services for the patient must cease, and progress in our profession is stymied. How can the word be spread to price-oriented pharmacists that they are jeopardizing their chances to be full members of the health care team? One way is to reach the pharmacy students-before they receive tempting offers from discount chains-to show them the risk they run if they snatch at the
Eugene WhiteS V1ews on Future Pharmacists
As specialists in drug therapy, the new pharmacists will assume a comprehensive and continuing responsibility for all of the drug requirements of their patients. When the need arises for any drug therapy, the family physician, family dentist, or other specialist will refer the patient to the drug specialistthe pharmacist-who will follow through to the termination of drug therapy. The pharmacist's responsibilities will include: • Prescribing the drug of choice for the particular physician diagnosis; • Maintaining ongoing surveillance over the drug action and application to insure the desired effect; • Being directly answerable for toxic or adverse drug reactions; • Acting as the primary source of information in the drug experience reporting system. Family pharmacists, by the very nature of their new position on the health care team, will know the patient's complete drug history as well as any hypersensitivities or idiosyncrasies. This vital knowledge must not be restricted by the threshold of the office. If the family physician
14
recommends hospitalization, the patient's family pharmacist will continue the team role at the hospital or extended care facility, working cooperatively with the family physician, the intern, the medical specialist, and perhaps a specialist in a pharmacy field. The pharmacotherapist will ob~ tain detailed drug histories from patient interviews, perform physical examinations to follow drug therapy progress, order laboratory tests, formulate simple diagnoses and screen for referral the more complex cases, and develop therapeutic treatment plans . Other areas of major professional involvement will be the prevention and early detection of illness in the ambulatory patient and community involvement in health education. The pharmacist of the future will play an active role in managing and monitoring drug therapy in disease states such as diabetes, asthma or chronic obstructive pulmonary disease, and cardiovascular disease and in the fields of pediatrics, obstetrics, surgery, ' radiopharmacy, mental health, and oncology. The pharmacist's services will be vital to the hos-
_ __
pital emergency room staff, espe- , cially in cases of toxicity. The pharmacotherapy knowledge explosion in most of these fields will result in the creation of pharmacy specialties . Pharmacists' new status as highly qualified health professionals calls for the establishment of a specialty board, certification examinations, and diplomate status for family pharmacists. Board certification is the only appropriate recognition for pharmacists who have invested the time and effort required to complete prescribed training programs and who have demonstrated their competence in this important field of phar- I macy. Certification is necessary to provide status to the field and toreward those who have prepared themselves in a suitable manner. Both status for the field and reward for the individual are essential to attract young pharmacists to careers in family pharmacy practice. The pharmacist in the primary care role is destined to become a major point of entry into the health care sys tern.
_ A_ m_ er_ ic_ an~ Pharmacy Voi.NS19, No.3, M~r. 1979/126
___About ...... the Book
bait. If pharmacists refused to work for the commercial enterprises, these emporiums could not offer pharmacy service. Then all community pharmacists could practice privately or in group practice, like medical and dental practitioners. The pharmacists could enjoy a higher income, practice on a higher plane, and insure that the ownership of pharmacy practices would be restricted to pharmacists .
-
'Unless the stereotyped ... pharmacists change their ways, they will become the dinosaurs of the medical team.'
Universal Effort
The success of our quest for recognition as health care professionals depends solely on our actions. The advantages gained by our new status will accrue to all of us. If society's expectations of the typical community pharmacist do not change appreciably during the next few years, it will be the profession's fault, not society's. The meager patient-oriented activities of contemporary pharmacists- for example, selecting frorn among therapeutically equivalent generic drug products-are a mere beginning in the expansion of the practitioner's role. Although the strictly professional pharmacy office setting has not been adopted by the profession as readily as the patient medication profile record, it will eventually evolve from a "radical innovation" to an accepted standard of pharmacy practice. We need only convince a minority of the profession of the merits of the office-based family pharmacist concept; once convinced, they will motivate the whole profession. Dissatisfaction, disillusionment, and frustration with what they see in contemporary community pharmacy practice will instill in them the enthusiasm, determination, and challenge to fight for a better way. · When pharmacists become pharmacotherapists, focusing all of their drug expertise on patient care alone, the future of pharmacy will take on a new perspective. 2 • 3 o References 1. Task Force on Prescription Drugs, Second Interim Repo~ t
,~,...
-
-~~-====!1
By EMIL W. BAKER The Office-Based Family Pharmacist, Eugene V. White, One West Main Street, Berryville, VA 22611, 1978, 159 pages, $10.70. In the author's own words, "This is a common sense essay on the philosophy and fundamentals of and the steps involved in establishing an office practice of pharmacy." Pharmacist White, who is credited with originating the patient-oriented office practice of pharmacy in 1960, relates his experiences and beliefs concerning his practice. He emphasizes that the office practice of pharmacy is the proper base from which the new breed of competent patientoriented community pharmacists can function and perform professional duties. Although there is no in-depth treatment of the use of medication profiles, how the pharmacist can become involved in the patient's pharmacotherapy regimen, or the pharmacist's role as a member of the primary health team, these concepts are all part of White's philosophy. Nine brief chapters, two pages of references, and 94 pages of appendices make up this paperback book. White covers everything from his-
and Recommendations, U.S . Department of Health, Edu cation, and Welfare, Washington, DC Aug. 30, 1968 . 2. E.V. White, in "Proceedings of the Pharmacy/Medicine / Nursing Conference on Health Educa tio n," Ann Arbor, Ml, Feb. 16-18, 1967, pp . 6 7 -77. 3. E.V. White, Drug Intel/. Cl in. Plwrm ., 11 , 94 (1977).
American Pharmacy Vol. NS 19, No.3, Mar.1979/127
-
L---------~~~ ~~--------~
Emil W. Baker owns his own office-based pharmacy practice in Mt. Sterling, KY 40353.
torical perspectives to the future of the family pharmacist. Especially important to the development of a more professional image is the section in Chapter V entitled "New Vocabulary A Must!" This chapter also contains the author's opinions concerning de-emphasis of the dispensing pharmacist and discusses the future use of pharmacy technicians and assistants to free more of the pharmacist's time for patient-oriented duties. The appendices contain personal letters, papers published in pharmaceutical journals, and communications by White and others concerning the patient-oriented pharmacy practice concept. I feel that every pharmacist should read White's philosophy. His prediction that pharmacists of the future not only will oversee dispensing of medications, but also will be the prescribers, may not be so far-fetched, considering recent developments in the pharmacy world. This book is long overdue and is perhaps the only publication of its kind describing the office practice and promoting the concept for the future . It should be incorporated into the curriculum of all pharmacy colleges so that pharmacy students, the future pharmacists, can see the advantages of the office-based community practice.
15
