Which?


Guest Post

These are the personal opinions of an anonymous pharmacist and do not mean much – apart from them having a rant!

So maths then. Maths that great subject where you can add and subtract, multiply and divide. Where numbers can be manipulated into percentages and fractions. Manipulations that can bring forth great tools such as statistics…and tables and graphs.

Maths is a great tool which informs people as to whats going on within areas of interest.

And – maths can be abused.

In maths the very tools that can be used to express larger numbers as percentages can then also be used to show the effects of smaller numbers and the changes and differences that these smaller numbers can mean as percentages and can be confusing! And (far worse) damaging.

Within the world of pharmacy maths is a great tool. It is used extensively when checking to see if medicine X is better then medicine Y and/or placebo. It can help people check to see if people are prescribing effectively, in audits to find out if SOP’s are being used correctly.

And then maths can be used to make something look shocking.

Recently the Which? consumer people went round a “selection” of pharmacies around the UK and used 1 of 3 scenarios to check on the advice etc given and then compiled a report. I have now read articles in a few magazines which was saying how bad we were in response to the Which? consumer report, well that’s how it felt to me.

The results in the Which? article weren’t good!

In fact, the results showed that whilst multiples had improved, for independants there had either been no change or a worsening in advice given since the previous Which? report a few years earlier.

This doesn’t look good for any profession.

HOWEVER. Which? only visited 122 pharmacies. Out of (in the region of) 13,500.

There are approximately 92 counties in the UK.

So….

122 out of 13,500 = 0.9% of the toal number of pharmacies
122 in 92 counties = Which? visited just over 1 pharmacy per county on average. (1.33 to be exact – assuming 92 counties)

From their 122, they visited multiples, small chains and single independents. They must (surely) have visited some inner city pharmacies and some in the countryside within the 122.

It’s at this point that you have to stop and ask yourself..how relevant a sample size was this. To me the numbers don’t stack up. How can you visit 122 pharmacies and then compile a report that basically says “Pharmacy isn’t doing its job”

I have also heard that academics may have viewed this sample size as “good”..

Which propaganda machine do they work for? The “Ministry of Truth”

What size were the error bars again….

Or am I missing the point?

A less then 1% sample size is enough to tarnish a profession and seek much hand wringing from within the profession. If the sample size was 50% then fair enough. We would have to sit up and take notice. but 1%…

I also note that one of the situations has been challenged by a group of people regarding warfarin interacting with pantoprazole…

If a drugs manufacturer used data from 1% of the available “population” to get a new medicine to market – they would be laughed out of town. Application denied.

This report does highlight one big problem. We are being asked to provide more and more healthy living advice to members of the public, yet regardless of this we are still stuck to the dispensing bench.

More then anything, I am somewhat annoyed by the tone of the magazine’s columns which i believe should have chosen to look at the report more objectively and reported as such with much less bias and more balance – rather then decry against the profession! We are taught (as any good scientist is) to evalute data and then dissect and check to make sure the data and the conclusions are valid.

Any new scientific paper published is open for checking by peer review – quite honestly it feels like no one has done this and taken the Which? report at face value.

The Which? report is nothing more then a tiny snapshot of pharmacy life on a single visit. Pharmacy does a fantastic job at providing excellent healthcare to the general public and this should not be lost in the maelstrom.

Mystery shopping is a very useful tool to provide some information as to what happens. Maybe in future mystery shopping in Pharmacy needs to have a different approach. By all means have your “test the knowledge” questions, but maybe allow the shopper to rate the approach of the staff of how they deal with all their customers – before and after them. ie an all round approach rather then just “narrow focused”.

One off situations do not give the full picture of how all pharmacy works. But if this approach is the only way forward and the sample findings of future reports are deemed to be the same.. what then.. more outcry and more beating and berating.

It’s funny, we have a book in our pharmacy – in fact ALL pharmacies have one – it’s called the “complaints book”. This is indicative of how i feel things are stacked against us. We always focus on the negative – why cant we have a “congratulations book”… The more negative we have, the more feelings of doubt we instill, the more the profession feels apathy.

It’s hard to walk upstream wading through treacle when you feel that the people connected to your profession are diverting more treacle into the mix.

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