Andy Gray
What has Cuculus solitarius got to do with practising pharmacy in organised healthcare settings? Well, whether we call her Piet-my-vrou, the Redchested cuckoo or uPhezukomkhono, what makes her interesting is that she is a brood parasite, laying her eggs in the nests of other species. Now if we forgive her for providing the etymological basis for the word ‘cuckold’, she can instead provide us with an analogy for the community approach to Pharmaceutical Care. In almost all organised healthcare settings in this country there are too few pharmacists to provide the highly individual level of pharmaceutical care envisaged by the likes of Hepler and Strand. Instead, pharmacists in such settings will have to ensure the desired clinical outcomes that result from drug use by their interventions with intermediaries. They will have to rely on the robin, the chat or the thrush to hatch the egg. To do so does not imply a lesser commitment to attaining the desired outcomes, or to the philosophical basis for the covenantal relationship between pharmacist or patient, or even to the rights of the individual. This is still, to quote the 1997 Vancouver WHO meeting, the "seven-star pharmacist" – the care-giver, decision-maker, communicator, leader, manager, life-long learner and teacher. In fact, to practise that way by influencing from afar, by the judicious use of support personnel, by interaction with nursing staff, by protocol development and monitoring is perhaps even more challenging when the opportunity for face-to-face contact with the patient is not practically possible. It requires a keen sense of systemic possibilities as well as limitations. To declare such practice "unethical" would thus seem mendacious in the extreme. And we thought the sole representative of the family Struthionidae, proud owner of Roberts number 1, was restricted to dryer western parts!
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