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From Seeking Permission to Permission Granted

By David Witmer posted 04-30-2015 12:50


The May 1 issue AJHP features Susan Winckler’s 2014 Zellmer lecture, titled “The Intersection of Public Policy and Professional Responsibility.” I highly recommend that all pharmacists read this paper and ponder its implications as we enter a new era of health care.

Winckler describes pharmacy’s historical approach to law and regulation and compares our profession’s approach with that of medicine’s. She notes that pharmacy has chosen a detailed road map seeking detailed and specific permissions, “In defining the pharmacist’s scope of practice, our profession has chosen a very detailed, step-by-step structure that can be quite restrictive… But if a certain activity isn’t explicitly authorized, I may not engage in it on my own, even if it’s in the best interest of my patient.” Whereas other professions, notably medicine, provide wide discretion, “Other professions have taken a different approach: state medical practice acts, for example, tend to be far shorter than ours and provide physicians wide discretion in how to best care for their patients. In a nutshell, they define the practice of medicine as ‘everything you do to care for a patient.” She closes her lecture noting that “In the evolving healthcare system, the road is opening up a bit for us—requiring more individual engagement to stay within the guardrails and increase our speed, but with the opportunity to better contribute to patient care.”

If we are to truly seize the opportunities that are being created by converging trends of spiraling health care costs, and evolving health care delivery models we will need to change our profession’s culture of seeking the safety of specific permission in laws and regulation and place a greater emphasis on our role as professionals. Our profession has repeatedly sought external validation and permission to do what we know is in the best interests of patients. Some would advocate that we define in law and regulation specific credentials to be a provider. This would greatly limit our future options to respond to a changing environment. As Winckler notes, “In an era when policymakers are attempting to step away from mandates and specifying new covered services, the need for exercising our professional responsibility—and creativity, and collaboration—increases.”  She argues for an increased emphasis on professional responsibility and a less proscriptive and more empowering legal framework.

Winckler’s lecture reminded me of Dan Ashby’s 2011 Whitney Award Lecture, “Permission Granted”. Ashby defined the concept of “Permission Granted” as a concept that the profession should embrace not because it implied permission from a higher authority but because of personal sense of responsibility. Specifically Ashby said, “The expression permission granted is not about asking for and receiving permission; it is not about a higher authority granting permission. It instead conveys a strong message about motivation, empowerment, responsibility, and accountability.” He encouraged that we grant ourselves permission to assume a leadership role and implement change.

Will we continue to seek external validation and demand laws and regulations defining which pharmacists can provide care or will we grant ourselves permission to serve our patients to the fullest extent that our training allows? 

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