Letters to the Editor
The President of the Pharmaceutical Society of Singapore is suggesting that patients see pharmacists instead of doctors for “minor ailments” and that this will save costs. He asserts that lessons in anatomy, physiology and pharmacology put together equip pharmacists to be minor ailment doctors.
What exactly is a “minor ailment”? When does that this ailment become a major ailment? Doctors are humbly aware that many vague insignificant symptoms that the patient dismisses initially often turn out to be something serious.
The truth is that the patient brings along not symptoms but perceptions of the problem he is having. The symptoms that he presents to the doctor are symbols to describe his discomfort. The patient’s interpretation of his symptoms is again based on his life experiences. These add meaning to his symptoms.
Thus, a patient who experiences vague epigastric discomfort may sense that something serious is wrong with him because he has seen his friend eventually die of cancer of the stomach. He will behave differently from one who does not have a similar life experience.
Hence, the same dyspepsia can be associated with danger or it may be dismissed as indigestion. This latter perception explains the mean period of several months between onset of epigastric pain and seeking medical attention in many patients with stomach cancers. Thus, there is no minor ailment until the doctor is satisfied that a history, clinical examination and when in doubt, investigations have conclusively ruled out something ominous. Only then is the ailment a minor one.
Then there are symptoms that are somatic manifestations of problems of living: chronic backache, headache or insomnia. Analgesics or hypnotics may be requested. Treating symptoms alone would not solve the problem. Counselling and engaging the patient through brief psychotherapy may be needed and not medications.
What about those symptoms that have obvious reasons?. The bodyache that accompanies a hike or a hectic soccer match is an example. Here, some liniment or analgesic will resolve the matter if the patient decides to self-medicate. The role of the pharmacist here is clear.
The pharmacist cannot professionally decide for the patient whether to self-medicate or to seek medical consultation. A pharmacist using algorithms based on patient symptoms may want to help the patient decide whether to self-medicate or to seek professional opinion and treatment from a doctor. The patient could have referred to such algorithms in books written to help patients evaluate their own symptoms and would have come to the same conclusion anyway.
However, once the patient makes the decision to self-medicate, a pharmacist has the important role of advising on the medications and sometimes, on the wisdom of not self-medicating. He is professionally responsible therefore, for the advice on medications given to patients, not on the diagnosis, and not on the patient’s decision to self-medicate (see flow chart below).
The pharmacist’s main job in retail pharmacy and dispensary work is to advise patients and doctors alike, on the proper use of medications that have been prescribed or purchased for self-medication, rather than prescribing medications. They should set their sights to be first class pharmacists doing this and not to be second class minor ailment doctors.
A/PROF GOH LEE GAN