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More than a decade and a half has gone since the introduction of the Pharm. D course in India. About 10 batches of students have completed the 6 years course and are roaming in India in search of suitable jobs. Pharmacy Council of India which has introduced the course with much fanfare seems to have washed its hands! There is still resistance or reluctance from the doctors to appoint these Pharm. Ds as clinical pharmacists in our hospitals.
Doctor’s apprehension
When a principal approached a big hospital to provide training for Pharm. D students, its chief doctor put forth the first condition that Pharm. Ds should not criticize doctor’s prescription! We should understand that apprehension. Nobody likes to be criticized, especially in front of their customers. Hence Pharm. Ds should take a pledge first, not to hurt the feelings of doctors for that matter, all the colleagues in the hospital. Such lessons and training are given to Pharm. D students, even then there is disbelief among the doctors, that's why the conditions as above. It may take some time to vanish, after the introduction of clinical pharmacy services in our hospitals. Thus Pharm. Ds should be aware of what is preventing their entry as clinical pharmacists.
Other concerns
Few other issues with the doctors are the prestige, ego and superiority complex with them. They think if clinical pharmacists are appointed in words they may lose their importance and respect. To overcome such problems, a clinical pharmacist should play only second or third fiddle to a doctor as a subordinate assistant. Only by such behaviour can they lay their way. As of now there is no motorable, why, even walkable road ahead. First generation Indian clinical pharmacists have that great responsibility before them to make a way by tolerating the thorns and stones while laying the road.
How to do that?
Only by the dedicated service Pharm. Ds can win over the confidence of doctors. There are few examples. In Tamil Nadu, Ooty district headquarters hospital doctors, who were reluctant when Pharm. D students entered for the first time there for training, are now waiting for their arrival from their college before starting ward-rounds. Why? Those students have proved their usefulness, merit and services more than once, that too, in complicated cases by gathering and giving valuable, unknown information about successful treatment of such cases. There are many more examples. Pharm. D students are doing their final year project under the guidance of senior doctors and their College Professor. Their interaction goes up and they end up in selecting wonderful topics for their projects under doctor’s guidance and which can be used for their better medical practice. These projects acquire significance in that they are accepted and published in international peer reviewed, reputed, research journals where the doctor’s name is published as research scientist and he get Glory among his colleagues and management. Otherwise, they cannot imagine this given their tight schedule and practice. Thus, they started accepting and appreciating the services of Pharm. Ds and ever willing to welcome them. Pharm. D students should remember it is one of the ways to enter into the hospitals and good books of doctors.
A word of caution While highlighting the merits of Pharm. Ds we should look at the other side also. By ignoring the emerging darker side, we should not make ourselves fools. Because of heavy capitation fee, of late, we hear, students from crorepati families are joining Pharm. D course just for the prefix ‘Dr’ and it is evident from the fact that they join after knowing very well that there is not even single post for them in any government hospital, very few in corporate hospitals and thousands of their seniors are unemployed. Hence, they are not willing to work hard and learn tough Clinical subjects, especially under the circumstances where there is reluctance by doctors who has to teach them. In the initial years self-learning is must and doubled, no other go. But these students are not ready, and if given a pass, they will spoil the already fluid atmosphere and profession. Private Self Financing colleges may not bother about it, that's why we demand govt colleges to start Pharm. D courses.
Can't the doctors do it on their own? When we point out valuable drug information can be collected and supplied by Pharm. Ds, people naturally ask the question can't the doctors do it on their own. They cannot, why? because they have the following impediments, first of all a busy practicing doctor has no time to wade through the ocean of information in internet and find out the needed material, secondly, they can use that time for practicing and developing their career, thirdly research and finding out the correct information material for it and all time consuming full time job for any scientist. A practicing doctor cannot leave his job just for a piece of information, for that a drug information specialist will be of great help to them, finally drug information resources are not easy to get for a doctor because up to date information are not collected and readily available in internet. They are available in the form of DVD and/or annual subscription to the database for the price ranging from 3 lacs to 5 lacs rupees. Pharm. D colleges should purchase mandatorily those database DVDs or subscribe, hence it is available for the students at their fingertip. Doctors in need of that information must visit Medical College libraries to access those DVDs or databases. Is it possible for all doctors?
Why then do doctors oppose it?
It is because most of the doctors, about 90% do not know these useful services by Pharm D clinical pharmacists but bluntly oppose the appointment of them. Only about 10% of doctors who work in hospitals, where these students are undergoing training have a chance to know it. Thus, communication or information gap is the major road block in the entry of Pharm. D graduates into the hospitals. What to do?
Fill that gap This information gap we saw even among other elite educated sections of our society like High Court and Supreme Court judges and senior lawyers practicing there. We saw it in the Supreme Court judgement rejecting the demand by a patient to direct doctors to inform side effects of all drugs they prescribe to their patients. While rejecting this demand, Pharmacist, the maker, analyst, dispenser and specialist in drugs, never came to the mind of all the above dignitaries. No wonder! It is not their fault but of pharmacists in failing to spread their merits and services. Refer to my article, “Knock the door but the right one!” published in Pharmabiz on 22. 1. 2025, for full detail. The information gap is glaring and disappointing! Hence the void should be filled at the earliest. Who has to do it? By all the stakeholders like IPGA, IPA, IHPA, APTI and particularly Pharmacy Council of India.
How to do this duty of PCI? PCI should collect all the best published projects, research papers and Write- Ups about valuable life-saving inputs Pharm. Ds provided to doctors while treating complicated cases in the last 15 years. Then, it should publish them as a book both as a hard copy and on the internet along with their merits in a few lines just above the synopsis of those research papers. Needless to say, internet links should be printed along with those research papers, if it is not possible to print a full research paper in book format. PCI can also direct Pharm. D colleges to collect best episodes of their assistance to doctors and forward them to PCI. Many such cases are not reported to the outside world. This book should be sent to the National Medical Commission and Indian Medical Association and all its branches and even to individual doctors who matters. Follow up action should be taken by seeking their opinion. A few years back, the then PCI president said he was planning to have a joint meeting of PCI and MCI. What happened to that proposal, thereafter, there was no information. To put it in a nut shell, prove your merits to improve your prospects!
Other duties of clinical pharmacists
Some other duties of clinical pharmacists include conducting medication history interviews, patient counselling, monitoring adverse drug reactions etc. Only the prospects of providing drug information to doctors is highlighted here, all other benefits doctors can watch and know first hand when the Pharm. Ds are appointed as clinical pharmacists. Many examples for that are available but they are voluminous and out of scope here.
The path not treaded
In western countries Pharm. D Clinical Pharmacist’s approval is needed for each drug written on a prescription for insurance reimbursement. That's why our corporate hospitals started appointing them to approve the prescriptions of their foreign patients who demand it to get insurance money in their country. If only our Indian insurance companies adopt it, our Pharm. Ds can get appointments at least in big hospitals. This is the path not treaded by our Pharm. D graduates so far.
Light at the end of tunnel
Of late many state governments started realising it after watching Clinical Pharmacist’s services in our corporate hospitals and coming forward to appoint them. For example, the government of Andhra Pradesh has plans to appoint clinical pharmacists in their hospitals shortly. Tamil Nadu government, after the infamous incident of stabbing a doctor by a patient's relative and few other attacks on doctors, recently proposed to appoint Clinical Pharmacologists for counselling patients and other services. Thus, there is light at the end of the tunnel, dear Pharm. D graduates. Proceed without let up! You will win! If only PCI was proactive, we would have achieved it long back. Better late than never!
(The author is Ex-president, Indian Pharmacy Graduates Association, Madurai,Tamil Nadu)
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