Reluctance to examine patients limits pharmacists’ clinical reasoning skills, according to research by Manchester University. The researchers asked 11 nurse and 10 pharmacist independent prescribers to think aloud about the management of clinical vignettes.

Nurse and pharmacist independent prescribers (generally working in hospital-based services) approached the clinical vignettes “holistically”, the researchers found. Nurses, however, tended to describe interacting with patients and seven said that they would perform a physical examination.

Pharmacists were generally more focused on medical notes and laboratory results. Only two pharmacists, both nutrition specialists, said that they would perform a physical examination, either by looking at the patient or searching for certain signs related to their speciality.

Five pharmacists mentioned physical examination skills while thinking aloud, but they would not perform the examination. Pharmacists expected that other members of the multidisciplinary team would perform the examinations and document the results in the notes.

“Pharmacists’ reluctance to examine patients is a limiting factor for their clinical reasoning skills compared with other prescribers, such as nurses and doctors,” the study authors comment.

According to the GPhC, pharmacists should be taught relevant clinical examination skills during their independent prescribing programmes. Nurses, however, tend to be competent in clinical assessment, diagnosis and history-taking before starting such programmes.

The authors suggest that “this could explain why pharmacists report lacking confidence with such examinations” and say that “the professional culture of pharmacy” is one in which “pharmacists report being unused to physical contact with patients, viewing themselves as experts in medicines, not diagnoses”.

J Adv Nurs 10.1111/jan.13375

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