December 10, 2023

Dayo Oyewo

There seems to be no end in sight to the age-long rivalry between Nigerian medical doctors and their pharmacist counterparts in what has been a clash in their professional duties.

It is generally believed that the primary duty of doctors was to diagnose ailments and prescribe drugs to patients, while pharmacists were expected to administer the drugs.

While the physicians alleged that pharmacists go beyond the line in discharging their basic responsibilities, the latter rather argue otherwise.

One such contentious view that has remained protracted over time has to do with who heads teaching hospitals in Nigeria.

The medical doctors have maintained that such a position is their exclusive preserve arguing that the emergence of any health official who is not a member of the Nigerian Medical Association stands at variance with what obtains in the medical world.

Similarly, the furore over the Doctor of Pharmacy Degree in Nigerian universities had gained traction in the healthcare circle, as some medical doctors expressed their reservations over what is considered an upgrade of the B.Pharm.

The argument, however, took a new twist recently, as the Association of Community Pharmacists disagreed with the position of the President of the Nigerian Medical Association, Dr. Uche Ojinmah, over the latter’s remarks about the Association.

Ojinmah, in an interview with Saturday Reportr Door, said community pharmacists had always insisted that they must prescribe even as the policy of prescription is with the doctor.

He said, “We want to talk to ourselves and acquire the capability to lead better because if you want to be a leader, you should prepare to be a leader. It doesn’t fall from heaven. Now, the person who is a pharmacist must know that his business is to dispense drugs and to check the quality of the drugs. Classically, dispensing is not even the job of a pharmacist; it is the technicians that dispense in classical places. A pharmacist’s major business should be producing, compounding, getting molecules, and making them useful for us.

“However, in a hospital setting, they understand the quality controls and storage; not to prescribe drugs, but that is what is going on everywhere. In this country today, go to an average pharmacy shop in the evening and you will see people coming to take injections, and people coming to be given drugs and you wonder why things are going wrong. Some people even say they are community pharmacists and so they must prescribe but the policy of prescription is with the doctor. If you are a nurse, please restrict yourself to nursing. I’m sure you’ve never seen a doctor practising as a nurse. I don’t encourage doctors to practise as pharmacists.

“The difference between medicine and other professions is that everything they do, we did in training. I did pharmacology, which is an aspect of pharmacy that deals with drugs, the prescription, and their impact on the body and possible side effects. I’m not saying I don’t need a pharmacist but he should be astute in his field and be ready to help when I need him, not to try to be me. Everybody in the hospital wants to be a doctor but there can only be one doctor.

“Today, in classical places, the rave is that every course related to medicine is trying to produce a degree that would make them a doctor. You now talk about PharmD. They say they are doctors of pharmacy. Very soon, nurses will also have NurseD and everybody keeps allowing it. The National University Council does not regulate it. This will confuse the people. In places like America and Britain where things are well drawn-out, even if you have a PhD in Pharmacy or Nursing, and you put Dr. in your name in a hospital, you must write PhD behind it, so that patients will know that you are not a medical doctor. While those of us who are doctors can write just “Dr.” If it’s in America, they write MD.”

President of the Association of Community Pharmacists of Nigeria, Adewale Oladigbolu, however, frowned at the remarks, describing it as an attempt to disparage the body and its members.

In a statement titled, ‘NMA Goofs Again’, Oladigbolu said the association is the unsung hero in the Nigerian health space who saves Nigeria from more significant morbidity and mortality rates through their services and interventions.

He said, “The attempts to disparage Community Pharmacists by Ojinmah confirm our age-long predilection to brand a preponderance of Nigerian physicians as perpetually celebrating their arrogance of ignorance. It is most unfortunate that the supposed leader of the medical profession in Nigeria is not familiar with the nomenclature and concept of community pharmacy practice which is a globally recognised reality. The community pharmacist is the unsung hero in the Nigerian health space who apparently saves Nigeria from more significant morbidity and mortality rates through their services and interventions. 

“Over 65% of clinical visitations traceable to malaria in Nigeria are effectively treated to the extent of almost 90% in community pharmacies in Nigeria. 

“During the peak levels of the COVID-19 pandemic, it was community pharmacies that provided affordable management costs through wellness protocols of dispensing routine vitamins and other remedies including appropriate diet at costs well below N2,000 to Nigerians when private hospitals charged between N5M to N50M to manage patients in their hospitals.

“These community pharmacists were not provided with PPEs and had to pay for it themselves to save their lives and that of their families It is a sad commentary that no government official in Nigeria at State or Federal levels has found it worthwhile to convey an appreciation of the patriotic gestures of these community pharmacists till now.”

He also reacted to Ojinmah’s claims that community pharmacists prescribe and dispense medicines in Nigeria.

He said, “In as much as we have a phenomenon of prescribing pharmacists and dispensing doctors which is unlawful, we hasten to put on record that attempts to deal a decisive blow on it when a past president of the PSN championed the establishment of a National Committee on Prescription and Dispensing Policy in 2013 was truncated by the NMA which staged a walkout at the terminal stages of the committee work because it could not achieve its agenda to maintain the status quo of eating its cake and having it as it insisted on being allowed dispensing rights while pharmacists would cease to prescribe POMs.

“For the records, drugs are universally classified into OTCs, Pharmacist Initiated Medicines (PMIs), and Prescription Only Medicines (POMs). Pharmacists have a legal right to dispense OTCs and PMIs without prescriptions and a segment of the misguided constituency of physicians still raises hell in such circumstances. It is important to state for the umpteenth time that the biggest beneficiaries of the unlawful phenomenon of prescribing pharmacists and dispensing physicians are the private sector physicians as WHO studies confirm that the drugs cost more in private hospital pharmacies and public hospital pharmacies.”

Oladigbolu also reacted to Ojinmah’s declaration in the interview that physicians “study Pharmacology as an aspect of Pharmacy” and so know everything about pharmacy.

According to him, Pharmacology is only one of eight core areas in pharmacy training which includes: Pharmacognosy, Pharmacology, Pharmaceutical and Medicinal Chemistry, Pharmaceutical Microbiology, Pharmaceuticals and Pharm Tech, Forensic Pharmacy, Clinical Pharmacy and Bio Pharmacy.

He also wondered why physicians dread competitive selection processes to identify who the cap fits when leadership opportunities emerge in healthcare.

Oladigbolu further stated that the Pharm. D has come to stay, adding that other professions that desire the true change mantra will get what they clamour for.

He said, “The NMA mouths international best practices when it suits its perceived interests. It actually attempted to decree in its MDCN amendment bill that only physicians could use the title of Doctor because, in their ridiculous imagination, this must be the exclusive preserve of Doctors.

“Nigerian physicians have done everything possible including blackmailing the NUC for recognising the Pharm. D programme for Nigeria. The Pharm. D curriculum has been in existence for about 60 years in the USA, one of the places we import our health values and reforms from, yet the NMA does not want skills acquisition like consultant status or reform agenda that boosts the output of other principal stakeholders in health.

“We make bold to impress it on Ojinmah that Pharm. D has come to stay. Other professions that desire the true change mantra will get what they clamour for. It is those who don’t want progress for others who will continue to suffer what they must,” he said.

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