I STUDIED pharmacy in a different century, in a different healthcare world. A world before pharmacy was considered a full part of the NHS. Pharmacy was at a crossroads, on the verge of a New Age. As a result, when I hear people question whether all pharmacists are clinical pharmacists, I have some understanding of how there was once a gap and still could be.
I have always been a clinical pharmacist. Spending the majority of my career in hospital pharmacy, practicing clinical pharmacy, it seems natural to consider myself a clinical pharmacist. But what does that mean?
One of the problems is that “clinical” can mean many different things. I see this in hospital pharmacy, when the majority of mandatory training I attend is the “non-clinical” variety. Off the top of my head, the following are potential definitions:
- Clinical can mean direct hands on care to patients. Some pharmacist and pharmacy technicians are hands on, particularly with the recent successes in community pharmacy around influenza vaccination. However, many of us never touch a patient. We support patients over a counter or beside their hospital bed instead.
- Clinical can mean a role impacting on patient care. A broad definition which includes anyone who works in healthcare, and so unsatisfactory.
- Clinical can refer to a pharmacist who runs clinics. Taking direct responsibility for the optimisation of medicines (prescribing or otherwise), which is the spirit of Hepler and Strand’s Pharmaceutical Care. Over 25 years, their approach has failed to gain sufficient traction in an increasingly joined up NHS.
- Clinical can relate to the observation and treatment of actual patients rather than theory. Pharmacy is about getting the most benefit from medicines, and we often appreciate the gap between theory and the messy world of individual patients’ lives.
- Clinical could mean efficient, exacting, precise, diligent action. Another definition which is so tied up with pharmacy that it is a useless way of separating out the clinical from the non-clinical.
- Clinical could mean anything relating to illness. All pharmacy is a way of treating, ameliorating or preventing disease.
However, I’d promote a definition of clinical pharmacist as a healthcare professional, trained to degree level in pharmacy, who makes decisions about medicines that benefit individual patients. That professional empowerment in the interests of patients is the special sauce that elevates us as a clinical profession.
So what would a non-clinical pharmacist look like? I’d suggest a non-clinical pharmacist is one whose practise of pharmacy never directly involves individual patients. Non-practicing superintendent pharmacists and academic pharmacists may fall into this domain. They should never be denigrated for using their pharmacy expertise in roles away from patient care, for we all benefit greatly if those roles are carried out expertly.
For the majority of us, the power to make decisions to improve patient care is the inheritance from decades of our forward-thinking patient-centred predecessors. For those of us who face patients, we have an obligation to make the most of their medicines; an obligation to be a clinical pharmacist.
Kevin Frost is senior clinical pharmacist/lead antibiotic pharmacist at Airedale NHS Foundation Trust
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