As the Pharmacy Guild of Australia continues its quest for pharmacists to provide the medical care traditionally reserved for general practice, this issue about whether a retail environment is the right place for it to occur is growing increasingly important.

Recently, I was standing in a queue at a community pharmacy when I witnessed for myself what can happen.

A young man was asking for advice at the desk, with a helpful pharmacist firing questions at him about his groin rash.

In full earshot of the queue, we all got to hear about the rash in question, followed by John’ s diagnosis and management plan.*

The comings and goings of the dispensing desk continued during this open‘ consultation’. Scripts were dispensed; people moved in and out.

Behind me, a retail assistant was asking about another customer’ s insomnia before recommending a homeopathic product.

I walked away knowing far too much about John’ s groin and Glenda’ s sleepless nights.

Commenters on the Reddit post bemoaned having to publicly describe how their“ vagina is

burning” while attempting to access thrush treatment.

All of the incidents described on the forum seemed to involve awkward, inappropriate encounters,

with their neighbours and community

listening intently as personal information was exchanged.

Medical practices are built around the need for private spaces for consultations to occur: dedicated buildings designed around consultations as a service, with closed doors and quiet corridors.

These structures preserve a certain dignity, where both patient and doctor know that what is said in those rooms will be closely held by a trusted party.

Expressing concern about my rectal bleeding is unlikely to happen with Bill buying jelly beans a metre away.

Retail pharmacies are designed with a completely different business in mind, and it is not medical care.

Bright lights, open spaces. Perfume and tacky decorations up the front. Prescribed evidence-based pharmaceuticals all the way at the back.

Yes, many pharmacies have constructed‘ consult rooms’. But these are

often a flimsy cupboard with a couple of chairs off to the side, neglected because of the demands on the pharmacist’ s time.

Privacy is not optional in healthcare. Yet in retail pharmacy, it is often the first casualty, with patients thrust under a public spotlight without being asked.

Pharmacies are terrible environments for patients to feel safe while telling their story. I am hardly likely to tell you about my high-risk sexual encounter last night while Cathy is behind me.

Expressing my concern about my rectal bleeding is unlikely to happen with Bill buying jelly beans a metre away.

But if you want to start making informed and safe diagnoses,

that sort of information seems to be fundamental.

The pharmacy guild wants expanded scope, which is a separate debate we can discuss all day. But let’ s be serious, this expanded scope operating in the current setting is unethical.

After all, I am pretty sure John’ s rash was not— as was being suggested— ringworm … but what would I know? I am just a guy waiting to buy some toothpaste.

* All names have been changed to protect patient privacy( a courtesy these customers were not provided at their local pharmacy).

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