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GPs have intensified their opposition to the Victorian government’s expansion of pharmacist prescribing powers, releasing a dossier of 64 alleged medical blunders involving pharmacists misdiagnosing patients.
The Royal Australian College of General Practitioners (RACGP) presented the examples – which include patients being prescribed antibiotics to treat suspected urinary tract infections that turned out to be herpes and cancer – to the state’s healthcare watchdog Safer Care Victoria on Thursday.
It included cases of one patient receiving antifungal ointment to treat skin cancer, and another patient being repeatedly given ventolin to treat suspected asthma when he had cancer that had metastasised.
RACGP Victoria chair Dr Anita Munoz expressed concerns that pharmacists, despite their expertise in medication, lacked the clinical experience to differentiate between similar-looking conditions in the pressure of a retail environment.
“In order to prescribe medicine safely, the starting point is having a correct diagnosis ... these protocols appear to be giving assurances that you will be starting with the right diagnosis, and that is inherently untrue.”
Munoz has repeatedly lashed out at the state government’s recent move to allow adults to access oral contraceptives from pharmacists without having a script from a GP, calling the decision “bad medicine”.
“This is turning the most, the most significant asset that we have, which is our health, into a retail commodity.”
But a Pharmacy Guild of Australia spokeswoman said doctors groups had made similar claims in the past without evidence, arguing pharmacists followed rigorous clinical protocols and were required to undertake additional training before safely prescribing medications.
“The RACGP’s pathetic attempt to create some type of bygone era turf war is not in the best interests of patients,” she said. “Allegations are not facts.”
She said when patients ask for symptomatic relief for health issues, pharmacists listen and provide initial treatment. She said they were advised to speak to their GP if symptoms persisted.
Data from the Australian Health Practitioner and Regulation Authority (AHPRA) also showed that just 1 per cent of pharmacists were the subject of a notification last financial year, compared with 3.5 per cent of doctors, with clinical care concerns making up 39 per cent of complaints about doctors, compared with only 4 per cent of complaints about pharmacists, the spokeswoman said.
“Any concerns with the care received by patients – whether that’s from a specialist, GP or pharmacist – should be raised directly with the clinic or AHPRA for investigation,” she said.
The examples of misdiagnosis provided to the RACGP were submitted from GPs around Australia, with around one-quarter based in Victoria.
Other alleged cases include:
- patients treated for a suspected migraine when they had pre-eclampsia and/or a brain tumour;
- patient given topical steroids for perioral dermatitis, which worsened the condition;
- shingles managed with steroid cream.
Last week, Victorian Health Minister Mary-Anne Thomas liked a scathing social media post by Munoz that criticised Premier Jacinta Allan for making “captain’s calls” to allow pharmacists to initiate oral contraceptives in patients. Thomas unliked the post when contacted by this masthead and said the policy had her full support.
A rift has also emerged between state and federal Labor over Victoria’s plan to allow pharmacists to initiate oral contraceptives, with federal Victorian senator Michelle Ananda-Rajah warning the move could fuel a rise in unplanned pregnancies.
She said the pill was only 92 per cent effective at preventing pregnancies, compared with intrauterine devices (IUDs), which reduce the risk of pregnancy by more than 99 per cent.
The former infectious disease and general medicine doctor said Australia had one of the world’s highest rates of unplanned pregnancies, with 40 per cent of pregnancies unintended. It also has a low uptake of IUDs and contraceptive implants.
Ananda-Rajah said that by bypassing a GP, women missed a critical “opportunistic consultation” where they could be educated on superior forms of contraception.
“I’m not sure what problem they’re trying to fix here,” she said. “I’m concerned it’s going to create a whole bunch of other problems. Having an unplanned pregnancy is not a trivial thing.”
Last week, in an email to a Victorian GP, federal Bruce MP Julian Hill said he was surprised the state government had made the announcement against the advice of the relevant medical colleges.
“Going to a pharmacy for a first prescription for a contraceptive pill seems a terribly risky thing to do,” said Hill, whose daughter developed deep vein thrombosis linked to an off-label prescription of a contraceptive pill.
A Victorian government spokeswoman said oral contraceptives had been safely supplied by pharmacists around Australia and the world for some time, and the changes would improve access to the medication.
“Care at the chemist works and it’s women who are reaping the benefits, with more than 51,000 women’s health-related consultations to date,” she said.
She welcomed the federal government’s announcement last week that it would commence a trial outside the Pharmaceutical Benefits Scheme to allow concession card folders to access pharmacy-prescribed contraceptives and antibiotics for urinary tract infections at the concession rate of $7.70.
The Victorian opposition’s health spokeswoman Georgie Crozier said while she saw merit in pharmacists safely prescribing medications, the community needed to be aware of the true number of misdiagnoses.
“Victorians deserve to understand the validity of what the government is doing and the risks to patients,” she said.
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