We Are All Clinical Pharmacists

I know that this puts me in the minority of pharmacists, but I feel that it needs to be said. The phrases "clinical pharmacy" and "clinical pharmacist" set back our profession and should stop being used. There is certainly nothing wrong with expanding roles as appropriate and within our training, but we should simply use "pharmacy" and "pharmacist." The word "clinical" is causing a rift in the profession.

Clinical pharmacists “work directly with physicians, other health professionals, and patients to ensure that medications prescribed for patients contribute to the best possible health outcomes,” according to the American College of Clinical Pharmacy.

Clinical pharmacy is, according to the abridged definition, “the area of pharmacy concerned with rational medication use.”¹

So far, that describes every job I have had in my career. Whether pharmacists work at community pharmacies, hospitals, or in nontraditional roles, they are all in the position and have the tools necessary to work directly with others to ensure that patients are on the right medications. In the community pharmacy setting where I have spent most of my career, that means calling physicians about dangerous drug interactions (which most of us do on at least a weekly basis), medications that are not covered by insurance (because if patients skip their medications because they cannot afford them, it will not contribute to the best possible health outcomes), or those who are not at optimal dosing. In addition, most pharmacists provide immunizations and oftentimes blood pressure and cholesterol screenings. Some have started providing oral contraceptives after evaluation. As a group, we also provide medication synchronization, smoking cessation services, and over-the-counter consultations, among other things. In short, community pharmacists make a big impact on public health, and I am proud to be part one of them. I am sure that those who have a different specialty can also name the myriad ways in which they provide that type of care to patients.

The problem is that when we use the term "clinical pharmacist," it implies that some pharmacists are not clinical and sets the profession up for classes of pharmacists. Soon enough, pharmacists who are not in 1 of these supposed clinical roles start believing that they are not clinical. If we need more pharmacists in rural areas to provide expanded services due to physician shortages, for example, then the pharmacists best positioned to fulfill that role are rural, community pharmacists already there who are often being labeled as not clinical. What they need is the opportunity to maintain and advance their training.

There is a famous experiment in which an elementary school teacher named Jane Elliott divided her students into 2 groups based on eye color and then started treating them differently to illustrate discrimination. It wasn’t long before the groups were perpetuating the division among themselves.² Think this is an extreme example? Just walk into any pharmacy school and listen to the students saying, "I don’t want to just do retail; I want to do something clinical," and "I want to actually use my training." Actually, whether pharmacists use their training to the fullest extent is more dependent on their approach to practice than it is to their job titles.

The first pharmacist for whom I worked when I was still an undergraduate had so many patients loyal to him that if he had switched pharmacies, he would have taken hundreds of prescriptions with him. In short, people depended on him. He didn’t just fill their prescriptions, he took care of them. I had the same experience with my first community rotation at Walgreens (Louis and Austin, if you a reading this, thank you!). My preceptor really knew his stuff. People knew and loved him, and I am sure still do). In the same way that patients go to a clinic to see a specific doctor, people visit pharmacies to see specific pharmacists.

All this, of course, means huge responsibility for pharmacists. I am a huge fan of the continuous professional development model. Those who only read the bare minimum continuing education to maintain their licenses and nothing more will fall behind. Based on 15 hours per year, that means only studying an average of 1.25 hours per month, and those who are just searching for the answers will put themselves in an even worse situation. Also, not everything worth reading has CE credit attached to it. Pharmacists who see their careers as just a job or who think they are not clinical are part of the problem. A pharmacist's knowledge base should improve over time, not decline.

So, just as there is no distinction between a clinical physician and a physician, if we want the pharmacy profession to move forward, it is time we describe all our professionals as simply pharmacists.

References

1. American College of Clinical Pharmacy. accp.com. Accessed November 26, 2017.

2. Bloom SG. Lesson of a lifetime. Smithsonian Magazine. smithsonianmag.com/science-nature/lesson-of-a-lifetime-72754306/. Published September 2005. Accessed November 26, 2017.