Abstract
It's certainly inspiring to read about the various pharmacy initiatives that are detailed in this month's coverage of the CPhA award winners. From fees for cognitive service to providing innovative diabetes care, pharmacists are clearly pushing the envelope for practice change, helping patients at the same time. As a person who has spent lengthy periods of time without a family physician, as is the case with so many Canadians, I can certainly attest to the value of pharmacists stepping into the health care breach.
But at the same time, I'd be interested to see what kinds of spaces are hosting these expanded services. As we've seen recently, privacy issues are hot topics and the general public is becoming more aware of their rights in this respect.
I may be a bit oversensitized to concerns about privacy, as I spent seven years working in Saudi Arabia, arguably one of the most private societies on earth. This need for privacy was clearly seen in the pharmacy of the hospital where I worked, with its separate male and female areas for dispensing prescriptions.
When I needed a prescription filled, I would go to the pharmacy, enter on the women's side, take a number, and then wait my turn. When my number came up on the screen above the pharmacist's window, I would take a seat there, and hand over my prescription to the female pharmacist. Without making any eye contact, she would efficiently pluck the medication from the carousel behind her, and stick the computer-generated label on. Then the box or bottle would be stapled into a bag and handed to me, sometimes with a reiteration of the instruction on the label, but without any extensive counselling.
When my family and I returned to Canada, and couldn't find a doctor, I was happy to discover how helpful pharmacists could be. I was quite comfortable chatting to a knowledgeable professional about my son's allergies or how a generic cold medicine stood up to another brand, but was disconcerted when I was counselled about a fertility drug I had been prescribed, while standing at the counter in full earshot of a long line of people. This is the experience that usually comes to mind when I read of complaints about the lack of privacy at pharmacies, especially within the context of being counselled about the emergency contraceptive pill.
In the last few years many pharmacies, in particular the chains, have been undergoing redesigns, with clearly labelled private counselling rooms and semi-private counters. Yet many of the smaller independent and clinic pharmacies lag behind, as do the pharmacies within the big box stores, allowing newspaper and medical journal editorials to cite concerns about lack of privacy as valid reasons against pharmacists controlling the distribution of such medications as ECP.
The small pharmacy adjoining my family physician's office illustrates the current conundrum. While it is not formally linked to a medical practice, my doctor certainly makes use of the pharmacists' expertise. At my latest visit, he left the examining room at one point to consult with the pharmacist about a medication, and at the end, asked me to double-check something with her, as she was “the medication expert.” He clearly believes in pharmacists as part of the primary health care team. And yet, as I waited for an antibiotic in that pharmacy, I was dismayed to see one tiny counter, split by a cash register, acting as both drop-off and counselling area. I overheard several conversations that really should have been private.
What could the owner of this pharmacy do? The place would have to be gutted and redesigned, but how? I'm sure that many of you have undergone redesigns and might have some bright ideas for carving private niches out of small spaces. One redesign, focusing on improving work flow, is featured in this issue on p. 31, and we'd love to include others. E-mail your suggestions to us at
Before overcoming the next major hurdle, be it administering vaccines or limited prescribing privileges, all pharmacies need to have dedicated private counselling spaces available. Or will two classes of pharmacies evolve — those that just dispense drugs and those that include pharmaceutical care with the medications?