go to the doctor or the drugstore?

Should a nasty cold or poison ivy require a trip to the doctor to get a prescription? What about an earache, urinary tract infection or something as serious as a pre-existing heart problem?

Those are the questions many health professionals across Canada are grappling with as more provinces look to grant pharmacists greater power to prescribe drugs.

This week, an advisory council to Ontario's Health Ministry recommended that pharmacists in the province be allowed to write prescriptions for minor conditions, adjust dosages, extend prescriptions and order laboratory tests in some instances.

The move follows developments across the country to expand the role of pharmacists.

Last month, New Brunswick became the second province to allow pharmacists to write prescriptions and dispense drugs to patients. Alberta pharmacists have had that power since last year. Many other provinces are in the process of considering similar changes.

"The key assumption over all is that pharmacists are qualified to provide these services and have been underutilized," Paul Blanchard, executive director of the New Brunswick Pharmacists' Association wrote in an e-mail yesterday.

The expanded powers have several advantages, proponents say, including increased convenience and accessibility for those who need refills or have a minor condition, improved ability of the pharmacist to help manage a patient's long-term care, and the alleviation of pressure on hospital emergency rooms and doctor's offices.

"It's working very, very well," said Greg Eberhart, registrar of the Alberta College of Pharmacists.

Other benefits include the ability of pharmacists to prescribe drugs in times of emergency and assist patients who don't have a family doctor, Mr. Blanchard said.

Pharmacists who have been granted expanded powers can dispense drugs for a variety of minor conditions such as seasonal allergies, athlete's foot, infant thrush, some rashes, some types of pain, a serious sunburn or heartburn.

Of course, there are some restrictions. Pharmacists in Alberta and New Brunswick are not allowed to prescribe narcotics. They also don't have the authority to diagnose serious medical conditions such as diabetes and asthma.

And although some Canadian pharmacists now have the authority to dispense drugs, that doesn't mean all of them are eager to use this power to its fullest extent.

Many pharmacists in Alberta are exercising caution when it comes to prescribing antibiotics. Although they have the authority to dispense treatments for urinary tract infections, yeast infections and ear infections, many don't want to make waves by treading too far into the traditional territory of doctors.

"We want to move carefully," Mr. Eberhart said.

That means pharmacists may write a prescription if a child has a recurrent ear infection and the family's doctor is unavailable. Otherwise, many pharmacists may still refer patients to see a physician for those types of conditions.

However, with greater experience and training, the country's pharmacists do expect to exercise their expanded powers to a greater degree, Mr. Eberhart said.

"I think the time will come in Canada where that does become more accepted," he said.

Some medical associations have warned that letting pharmacists diagnose some minor conditions and prescribe drugs could lead to problems, such as missing a more serious underlying problem.

They may also face questions about potential conflicts of interest because they would be both prescribing and selling drugs.

But pharmacists' associations across Canada say any new powers will be subject to strict oversight and that pharmacists will have to pass rigorous tests to qualify for an expanded role.