An interesting inquiry into the nature of pharmacy service has recently caused a certain degree of an uproar among the profession. It was ruled by an Australian Tribunal Member that a person served by a pharmacist is not a patient, but a customer.

Many pharmacists were not in favour of the conclusion—and felt that their professionalism was mocked by the insensitive remark. However, this does raise the noteworthy question about the increasingly blurred line between patient-service and customer-service in a pharmacy.

The ruling that started it all

The spark that started the wildfire was about an Australian tribunal ruling on the number of car parking spaces of a new medical centre and its ancillary pharmacy. In this particular case of Mahwendepi Pty Ltd vs Moorabool Shire Council, the number of medical professionals allowed to work in the medical centre must correlate to the number of available parking spaces.

Sibonis ruled that “On the question of whether the pharmacist is a person providing health services, within the particular facts and circumstances of this case, I am persuaded that they are not.”

“Unlike professionals such as GP, physiotherapist, and dentist, the pharmacist doesn’t diagnose and treat people’s health condition. A person served by a pharmacist is not a patient – but, a customer.”

It is not surprising to understand why pharmacists are angered over the statements. When interpreted on face value, the arguments did considerably alienate pharmacists from the bulk of healthcare professionals. At the same time, it also equates pharmacists to conventional shopkeepers.

The downside of labelling a patient “customer”

We should not attempt to brush aside the potential impact of calling a patient our “customer”. This is a subject that goes beyond a simple mix-up of terminology – as both words are not, and should not be, interchangeable. The meaning of both words, and the subconscious contexts that we affix on each of them, may alter our behaviour during our interactions. This subsequently decides the course of action we will take, and as part of the healthcare professional, such action should not be taken in the wrong frame of mind.

One thing we all can agree with is that healthcare is a service industry and the core function of various healthcare practitioners, including pharmacists, is to serve the community members who are in need of medical care. However, the age-old saying " the customer is always right" cannot be rightfully implemented in the healthcare industry.

Many argue that a patient should not be considered as a "customer", at least not in the conventional definition of the word. The action of seeking pharmacy service, such as requesting to fill a prescription or to seek consultation on side effects of chemotherapy, is not similar to shopping for a jar of candy at your neighbourhood grocery stores. The outcome of such activity could be a matter of life or death – and should not be taken ever so lightly.

Some also argued that, by considering a patient as a “customer”, the focus of pharmacy service may shift towards maintaining the highest level of satisfaction when the “customer” walks out the premise. It is common to encounter patients who demand multiple "strong" medicine to cure minor illness in the community pharmacy. Although it may be financially favourable for the pharmacist to comply with the demand, given the action is also compliant with legal requirements, the action may lead to unnecessary exposure to potent medication for the patients.

The rising tide of consumerism

Our debate will not be complete without looking at why the remark was made in the first place. The majority of pharmacies are privately operated, i.e. a for-profit business. In fact, in the face of increasing privatisation of the healthcare sector, many hospitals and clinics are becoming for-profit entities. A sensible business operation must ensure the patient who walks out of the premise is also a happy and satisfied customer.

There is increasing literature that supported the changing attitude among our patients. In fact, the New England Journal of Medicine (NEJM) Catalyst devotes an entire section called "Patients as Customers" which offers various resources in helping organisations to integrate customer service with routine health care activities.

Gone are the days where paternalistic doctors and pharmacists commanding patients on the course of actions that are considered optimum care for them. Today, our patients are demanding more rights and controls over how they want to manage their own condition. It may be prudent for pharmacists to acknowledge the changing mood in healthcare consumerism, and respect patient's desire to be recognised as a "customer" who can exert more rights. MIMS

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