Healthcare is a complex tapestry woven from threads of ancient tradition and cutting-edge science. Within this tapestry, the role of the pharmacist has transformed dramatically, evolving from its shamanistic origins to today’s specialised, scientific practitioner.
Negotiation of professional identity and boundaries is fraught with challenges. Consider the echoes of the past. Some scholars suggest that early man believed that disease was caused by an evil spirit that had entered the person.
One member of the tribe was a shaman: priest, scientist, magician, doctor and pharmacist. Early foul-tasting remedies were probably intended to disgust the internal demon so it left. That may be the origin of our folk belief that nasty medicine does you good.
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Over time, these roles began to differentiate, with distinct practitioners specialising in either spiritual guidance (the Church) or physical healing. The apothecary was subordinate to the physician, even dismissed as only the physician’s cook.
Other antecedents of pharmacists include alchemists, amulet, charm, fetish, holy relic and talisman purveyors, chymists (chemists), druggists, drysalters, herbalists, grocers, monks, nuns, pepperers and spicers; also, mountebanks.
This historical context is crucial for understanding the present-day dynamics within healthcare. As the shaman’s role split again and again, healthcare became increasingly specialised.
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We see echoes of past disputes in recent debates. For example, initially, medical practitioners vigorously objected to optometrists examining eyes using ophthalmoscopes. Interestingly, I am unaware of objections to pharmacists examining ears using otoscopes.
Changes can trigger anxieties about professional encroachment. The stethoscope, that ubiquitous symbol of the physician, remains a potent signifier of medical authority, a “red button” topic.
Professional livery—the white coat, once a symbol of scientific authority, has become somewhat demystified by the widespread use of scrubs across healthcare professions. Today clothing is more casual.
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Badges, cards on lanyards and so on, continue to label professions. Pharmacists lack a ubiquitous icon. They must make do in the UK with green cross symbols and maybe the historical relic of a mortar and pestle.
The digital realm complicates. The battles over professional territory are no longer confined to the physical world; they play out in cyberspace, in online forums and social media. The Venn diagram of professional responsibilities continues to shift, with areas of overlap and contention.
Both medicine and pharmacy, for example, have legally defined scopes of practice that include certain shared activities. One is that in the UK doctors in rural areas can dispense.
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The question of titles further complicates the picture. In the UK, the traditional use of “Mr”, “Mrs”, or “Ms” for surgeons and pharmacists contrasts with the “Dr” title used by physicians. Many dentists (dental surgeons) today adopt the “Dr” title.
This disparity in titling can confuse patients and raise questions about professional hierarchy. Pharmacists with a PharmD degree are legally entitled to “Doctor,” adding another dimension to this discussion. This difference in practice highlights the varying cultural and professional contexts within which pharmacists operate internationally.
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Priests are also successors to those shamans, retaining some pastoral healing role. They may support a worshiper’s mental well-being long after NHS psychiatric support ceases.
Professional titles within, for example, the Christian Church of England, make prestige clear from “The Reverend,” for a parish priest to “The Most Reverend” for Archbishop. Livery includes dog collars. These distinctions, like those in the medical field, highlight the importance of clearly defined roles and responsibilities.
The traditional privileges afforded to GPs, such as the right to sign death certificates, act as expert witnesses, and legally section patients under mental health legislation, underscore their leading position within the healthcare system.
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Patients profoundly trust physicians and the breadth of their training. Centuries of political lobbying, connections in high places—and (perhaps) recent militant action—have also contributed.
The contributions of other healthcare professionals, including nurses and technicians, are essential for the healthcare ecosystem. So are lay carers; they often provide the day-to-day care and support that patients need. But specialised professional expertise remains invaluable.
Today’s community pharmacists and general practitioners are blessed (and cursed) with residues—that might be viewed as “fractional crystallisations”—of their mingled multitude of antecedents. Their journeys and jostling continue as roles change. They are still evolving.
Dr Malcolm E. Brown is a retired community, hospital and industrial pharmacist, and is a sociologist and honorary careers mentor at the University of East Anglia.