Decision making by community pharmacists when making an over-the-counter diagnosis in response to a dermatological presentation

BACKGROUND
Healthcare policy in many developed countries now promotes the concept of patient self-care, which has resulted in the expansion of the community pharmacists’ role in the management of minor illness. Pharmacists are now custodians of potent medicines to treat a growing list of medical conditions. However little research has evaluated the way in which pharmacists arrive at a diagnosis.

OBJECTIVE
To explore the ways in which community pharmacists make a diagnosis.

METHODS
Ten community pharmacists were asked to ‘think-aloud’ their reasoning as they interacted with a researcher posing as a patient with a skin rash. Pharmacists were recruited from the West Midlands region of England. Each interview was transcribed verbatim and analyzed in iterative cycles allowing major themes to be developed.

RESULTS
Three pharmacists offered a diagnosis of ‘allergy’; one for eczema; one for allergy/cellulitis and the remaining five pharmacists were unsure or offered no diagnosis. All offered treatment that provided symptomatic relief of itch. Transcript analysis revealed two major components to patient consultations: establishing a diagnosis and therapeutic management planning. In establishing a diagnosis three distinct themes emerged: questioning strategy; question framing; and underpinning knowledge.

CONCLUSION
Pharmacists rarely exhibited medical decision making techniques when establishing a differential diagnosis, and diagnostic performance was poor.