Advances in Health Sciences Education

, Volume 17, Issue 2, pp 247–257 | Cite as

Improving the working relationship between doctors and pharmacists: is inter-professional education the answer?

  • Ruth M. Gallagher
  • Helen C. Gallagher


Despite their common history, there are many cultural, attitudinal and practical differences between the professions of medicine and pharmacy that ultimately influence patient care and health outcomes. While poor communication between doctors and pharmacists is a major cause of medical errors, it is clear that effective, deliberate doctor-pharmacist collaboration within certain clinical settings significantly improves patient care. This may be particularly true for those patients with chronic illnesses and/or requiring regular medication reviews. Moreover, in hospitals, clinical and antibiotic pharmacists are successfully influencing prescribing and infection control policy. Under the new Irish Pharmacy Act (2007), pharmacists are legally obliged to provide pharmaceutical care to their patients, thus fulfilling a more patient-centred role than their traditional ‘dispensing’ one. However, meeting this obligation relies on the existence of good doctor-pharmacist working relationships, such that inter-disciplinary teamwork in monitoring patients becomes the norm in all healthcare settings. As discussed here, efforts to improve these relationships must focus on the strategic introduction of agreed changes in working practices between the two professions and on educational aspects of pharmaceutical care. For example, standardized education of doctors/medical students such that they learn to prescribe in an optimal manner and ongoing inter-professional education of doctors and pharmacists in therapeutics, are likely to be of paramount importance. Here, insights into the types of factors that help or hinder the improvement of these working relationships and the importance of education and agreed working practices in defining the separate but inter-dependent professions of pharmacy and medicine are reviewed and discussed.


Communication Inter-professional education Medicine Pharmacy Working relationships 


  1. Akici, A., Kalaca, S., Ugurlu, M. U., Karaalp, A., Call, S., & Oktay, S. (2004). Impact of a short postgraduate course in rational pharmacotherapy for general practitioners. British Journal of Clinical Pharmacology, 57, 310–321.CrossRefGoogle Scholar
  2. Areskog, N. H. (1988). The need for multi-professional health education in undergraduate studies. Medical Education, 22, 251–252.CrossRefGoogle Scholar
  3. Austin, Z., Gregory, P. A. M., & Martin, J. C. (2007). Negotiation of interprofessional culture shock: The experience of pharmacists who become physicians. Journal of Interprofessional Care, 21, 83–93.CrossRefGoogle Scholar
  4. Barnett, M. J., Frank, J., Wehring, H., Newland, B., Vonmuenster, S., Kumbera, P., et al. (2009). Analysis of pharmacist-provided medication therapy management (MTM) services in community pharmacies over 7 years. Journal of Managed Care Pharmacy, 15, 18–31.Google Scholar
  5. Benavides, S., Rodriguez, J. C., & Maniscalco-Feichti, M. (2008). Pharmacist involvement in improving asthma outcomes in various healthcare settings: 1997 to present. The Annals of Pharmacotherapy, 43, 85–97.Google Scholar
  6. Bernsten, C., Bjorkman, I., Caramona, M., Crealey, G., Frokjaer, B., Grundberger, E., et al. (2001). Improving the well-being of elderly patients via community pharmacy-based provision of pharmaceutical care: A multicentre study in seven European countries. Drugs and Aging, 18, 63–77.CrossRefGoogle Scholar
  7. Bond, C. A., Raehl, C. L., & Franke, T. (2001). Interrelationships among mortality rates, drug costs, total cost of care, and length of stay in United States hospitals: Summary and recommendations for clinical pharmacy services and staffing. Pharmacotherapy, 21, 129–141.CrossRefGoogle Scholar
  8. Brock, K. A., & Doucette, W. R. (2003). Collaborative working relationships between pharmacists and physicians: An exploratory study. Journal of the American Pharmaceutical Association, 44, 358–365.Google Scholar
  9. Carter, B. L., Bergus, G. R., Dawson, J. D., Farris, K. B., Doucette, W. R., Chrischilles, E. A., et al. (2008). A cluster randomized trial to evaluate physician/pharmacist collaboration to improve blood pressure control. Journal of Clinical Hypertension (Greenwich, Conn.), 10, 260–271.CrossRefGoogle Scholar
  10. Clark, T. R. (2008). Customer assessment of long-term care pharmacy provider services. The Consultant Pharmacist, 23, C19–C21.CrossRefGoogle Scholar
  11. Cooksey, J. A., Knapp, K. K., Walton, S. M., & Cultice, J. M. (2002). Challenges to the pharmacist profession from escalating pharmaceutical demand. Health Affairs, 21, 182–188.CrossRefGoogle Scholar
  12. Curran, V. R., Sharpe, D., & Forristall, J. (2007). Attitudes of health sciences faculty members towards interprofessional teamwork and education. Medical Education, 41, 892–896.CrossRefGoogle Scholar
  13. Daniels, C. E. (2008). Hospitalist-pharmacist collaboration: Only natural. American Journal of Health-System Pharmacy, 65, 207.CrossRefGoogle Scholar
  14. Davies, C. (2000). Getting health professionals to work together. BMJ, 320, 1021–1022.CrossRefGoogle Scholar
  15. Department of Health and Children, Ireland. (2004). The national primary care steering group–progress report. Retrieved August 6, 2010, at:
  16. Edmunds, J., & Calnan, M. W. (2001). The reprofessionalisation of community pharmacy? An exploration of attitudes to extended roles for community pharmacists amongst pharmacists and General Practioners in the United Kingdom. Social Science and Medicine, 53, 943–955.CrossRefGoogle Scholar
  17. Emmerton, L., Marriott, J., Bessell, T., Nissen, L., & Dean, L. (2005). Pharmacists and prescribing rights: Review of international developments. Journal of Pharmacy & Pharmaceutical Sciences, 8, 217–225.Google Scholar
  18. Ferner, R. E., & Aronson, J. K. (2000). Medication errors, worse than a crime. Lancet, 355, 947–948.CrossRefGoogle Scholar
  19. Florentinus, S. R., van Hulten, R., Kloth, M. E., Heerdink, E. R., Griens, A. F., Leufkens, H. G., et al. (2007). The effect of pharmacotherapy audit meetings on early new drug prescribing by general practitioners. The Annals of Pharmacotherapy, 41, 319–324.CrossRefGoogle Scholar
  20. Foekema, H., & Hendrix, C. (2006) Mistakes are expensive, An investigation into medical transcription errors (Part 2) (Amsterdam TNS NIPO) pp1-31.Google Scholar
  21. Franson, K. L., Dubois, E. A., de Kam, M. L., Burggraaf, J., & Cohen, A. F. (2009). Creating a culture of thoughtful prescribing. Medical Teacher, 31, 215–219.CrossRefGoogle Scholar
  22. Government of Ireland. (2007). Pharmacy Act 2007. Official government publications bill number 20 of 2007. Retrieved August 6, 2010, at
  23. Greene, R. J., Cavell, G. F., & Jackson, S. H. D. (1996). Interprofessional clinical education of medical and pharmacy students. Medical Education, 30, 129–133.CrossRefGoogle Scholar
  24. Hand, K. (2007). Antibiotic pharmacists in the ascendancy. Journal of Antimicrobial Chemotherapy, 60, i73–i76.CrossRefGoogle Scholar
  25. Henman, M. C. (2008). Pharmacy and the future of healthcare in Ireland–Part One. The Irish Pharmaceutical Journal, 86, 42–45.Google Scholar
  26. Hepler, C., & Strand, L. (1990). Opportunities and responsibilities in pharmaceutical care. American Journal of Hospital Pharmacy, 47, 533–543.Google Scholar
  27. Holland, R., Lenaghan, E., Harvey, I., Smith, R., Shepstone, L., Lipp, A., et al. (2005). Does home-based medication review keep older people out of hospital? The HOMER randomized controlled trial. BMJ, 330, 293–297.CrossRefGoogle Scholar
  28. Horsburgh, M., Lamdin, R., & Williamson, E. (2001). Multiprofessional learning: The attitudes of medical, nursing and pharmacy students to shared learning. Medical Education, 35, 876–883.CrossRefGoogle Scholar
  29. Howard, M., Trim, K., Woodward, C., Dolovich, L., Sellors, C., Kaczorowski, J., et al. (2003). Collaboration between community pharmacists and family physicians: Lessons learned from the Seniors Medication Assessment Research Trial. Journal of the American Pharmaceutical Association, 43, 566–572.CrossRefGoogle Scholar
  30. Hughes, C. M., & McCann, S. (2003). Perceived interprofessional barriers between community pharmacists and general practitioners: A qualitative assessment. The British Journal of General Practice, 53, 600–606.Google Scholar
  31. Hunt, J. S., Siemienczuk, J., Pape, G., Rozenfeld, Y., MacKay, J., LeBlanc, B. H., et al. (2008). A randomized controlled trial of team-based care: Impact of physician-pharmacist collaboration on uncontrolled hypertension. Journal of General Internal Medicine, 23, 1966–1972.CrossRefGoogle Scholar
  32. Johnson, S., Hughes, E., & White, R. (2002). Developing communication skills for pharmacist-led clinics. Medical Education, 36, 1110–1111.CrossRefGoogle Scholar
  33. Kaboli, P. J., Hoth, A. B., McClimon, B. J., & Schnipper, J. L. (2006). Clinical pharmacists and inpatient medical care. Archives of Internal Medicine, 166, 955–964.CrossRefGoogle Scholar
  34. Krska, J., Cromarty, J. A., Arris, F., Jamieson, D., Hansford, D., & Duffus, P. R. S. (2001). Pharmacist-led medication review in patients over 65: Randomized controlled trial in primary care. Age and Ageing, 30, 205–211.CrossRefGoogle Scholar
  35. Krska, J., Gill, D., & Hansford, D. (2006). Pharmacist-supported medication review training for general practitioners: Feasibility and acceptability. Medical Education, 40, 1217–1255.CrossRefGoogle Scholar
  36. Leversha, A., & Pedler, D. (2008). Pharmacists’ contribution to medical education: Australian case study. Medical Education, 42, 1111–1146.CrossRefGoogle Scholar
  37. Mackie, C. A., Lawson, D. H., Campbell, A., MacLaren, A., & Waigh, R. (1999). A randomized controlled trial of medication review in patients receiving polypharmacy in general practice. The Pharmaceutical Journal, 263(suppl), 7.Google Scholar
  38. Muijrers, P. E., Knottnerus, J. A., Sijbrandij, J., Janknegt, R., & Grol, R. P. (2003). Changing relationships: Attitudes and opinions of general practitioners and pharmacists regarding the role of the community pharmacist. Pharmacy World & Science, 25, 235–241.CrossRefGoogle Scholar
  39. National Heart Lung and Blood Institute. (2007). National asthma education and prevention program. expert panel report 3: Guidelines for the diagnosis and management of asthma. Retrieved August 6, 2010, at
  40. Neary, J. (2002). Clinical medication review by pharmacists. BMJ, 324, 548.CrossRefGoogle Scholar
  41. Nkansah, N. T., Brewer, J. M., Connors, R., & Shermock, K. M. (2008). Clinical outcomes of patients with diabetes mellitus receiving medication management by pharmacists in an urban private physician practice. American Journal of Health-System Pharmacy, 15, 145–149.CrossRefGoogle Scholar
  42. Parsell, G., & Bligh, J. (1998). Educational principles underpinning shared successful learning. Medical Teacher, 20, 522–528.CrossRefGoogle Scholar
  43. Parsell, G., & Bligh, J. (1999). Multiprofessional working: Learning from experience. Medical Education, 33, 632–633.CrossRefGoogle Scholar
  44. Pharmacy Ireland 2020 Working Group. (2008). Advancing clinical pharmacy practice to deliver better patient care and added value services. Interim report. Retreived August 6, 2010, at
  45. Rakel, R. E. (1974). The problem-oriented medical record (POMR). American Family Physician, 10, 100–111.Google Scholar
  46. Roberts, M. A., & Stokes, J. A. (1998). Prescriptions, practitioners and pharmacists. Medical Journal of Australia, 168, 317–318.Google Scholar
  47. Savage, D. A. (1994). Professional sovereignty revisited: The network transformation of American medicine. Journal of Health Politics, Policy and Law, 29, 661–677.CrossRefGoogle Scholar
  48. Schellens, J. H., Grouls, R., Guchelaar, H. J., Touw, D. J., Rougen, J. A., de Boer, A., et al. (2008). The Dutch model for clinical pharmacology: Collaboration between physician- and pharmacist-clinical pharmacologists. British Journal of Clinical Pharmacology, 66, 146–147.CrossRefGoogle Scholar
  49. Schumock, G. T., Butler, M. G., Meek, P. D., Vermeulen, L. C., Arondekar, B. V., & Bauman, J. L. (2003). Evidence of the economic benefit of clinical pharmacy services: 1996–2000. Pharmacotherapy, 23, 113–132.CrossRefGoogle Scholar
  50. Sellors, J., Kaczorowski, J., Sellors, C., Dolovich, L., Woodward, C., Willan, A., et al. (2003). A randomized controlled trial of a pharmacist consultation program for family physicians and their elderly patients. Canadian Medical Association Journal, 169, 17–22.Google Scholar
  51. Sonnedecker, G. (Ed.) (1963). Concepts and medicaments become modern. In Kremers and Urdang’s History of pharmacy (3rd ed.) (pp. 39–52). Philadelphia: J.B. Lippincott Co.Google Scholar
  52. Zermansky, A. G., Petty, D. R., Raynor, D. K., Freemantle, N., Vail, A., & Lowe, C. (2001). Clinical medication review by a pharmacist of elderly patients on repeat prescriptions in general practice: A randomized controlled trial. BMJ, 323, 1340–1343.CrossRefGoogle Scholar
  53. Zillich, A. J., Doucette, W. R., Carter, B. L., & Kreiter, C. D. (2005). Development and initial validation of an instrument to measure physician-pharmacists collaboration from the physician perspective. Value in Health, 8, 59–66.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  1. 1.Trinity College Dublin/Health Services Executive Specialist Training Programme, Department of Public Health & Primary Care, Trinity College Centre for Health SciencesAdelaide & Meath HospitalTallaght, DublinIreland
  2. 2.School of Medicine and Medical Science, Conway InstituteUniversity College Dublin, and School of Pharmacy and Pharmaceutical Sciences, Trinity College DublinDublinIreland

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