Beyond the counter: discovering the clinical power of pharmacy

I was 16 when I had the privilege of working as a pharmacy assistant, although, at the time, I did not see it that way. My role did not feel enticing, it involved counting pills, labelling prescription vials and passing them to the pharmacist. I falsely assumed, “So… this is what a pharmacist does? They check labels on bottles and answer medication questions all day? Yeah, not for me.” Sixteen-year-old me definitely needed a wake-up call—and she got one.One day, I encountered a patient coming in for a refill and directed him to the pharmacist for counseling. During which he mentioned he had been getting frequent nosebleeds and very painful headaches. “Probably stress,” he said. The pharmacist noticed he hadn’t picked up his amlodipine— a medication used to manage high blood pressure—in over a month. Alarmed, the pharmacist offered to take his blood pressure: it was 210/120 (for reference, normal blood pressure is 120/80). Upon reading the measurement, the pharmacist immediately referred him to the ER and faxed his medication history ahead. Days later, the man returned to the pharmacy, grateful. He said, “The emergency physician told me I was at real risk for a stroke or heart attack. Luckily, I was sent to the hospital at the right time.” There I was, in complete shock at how a seemingly routine refill turned into a life-saving intervention. I began to see that pharmacists were not just supportive figures—they were essential healthcare professionals, often serving as a first line of defense in improving patient outcomes.Read: Dancing through my days: a pharmacists' vision for the futureTheir role became more evident during the COVID-19 pandemic, when pharmacists stepped up as accessible healthcare providers while much of the Ontario healthcare system was overwhelmed. They administered vaccines, triaged symptoms to manage medication shortages, and provided reassurance to patients. I witnessed pharmacists fill critical gaps in the healthcare system, fostering trust with every patient.Ultimately, I applied for the PharmD program in 2023 with the idea that I could be a pharmacist and provide exceptional patient-care. However, a lingering assumption I had was the scope of practice for pharmacists was limited. While I knew pharmacists played a vital role in patient-care, I still saw their role as mostly centered around dispensing medications. I also perceived a hierarchical gap between pharmacists and physicians. I had cold feet when applying to pharmacy school and thought to myself, “Maybe I should apply to medical school instead—physicians seem to have more autonomy and authority in making prescribing decisions.” I started exploring other healthcare fields outside of pharmacy. But I am glad I did not turn my back on pharmacy as I soon learned the reality was quite the opposite of what I had believed.Immediately in my first semester of pharmacy school, I learned that the pharmacist’s role had dramatically shifted from simply dispensing medications to providing clinical expertise. Some services are well known, such as medication reviews, which allow pharmacists to assess a patient’s medications, identify issues, and ensure safe, effective therapy—especially in those with multiple chronic conditions. Another significant example is the Minor Ailments Program in Ontario. Launched in 2023, this initiative allows pharmacists to assess and prescribe for approved acute ailments. Some of these include urinary tract infections, conjunctivitis, and dermatitis. The program has reduced walk-in visits and long ER wait times that often discouraged patients in seeking therapy. Pharmacists use their clinical expertise to do assessments and, if appropriate, prescribe for minor conditions and offer timely care—especially for patients without a family doctor. The expanding list of treatable ailments highlights pharmacists’ growing autonomy and evolving scope of practice.As for the hierarchical gap I once believed existed between pharmacists and physicians, pharmacy school taught me that the relationship is far more collaborative than I imagined. Physicians are not above or below pharmacists—they work alongside, interprofessionally, to achieve the best possible outcomes for patients. While physicians focus on diagnosing and creating treatment plans, pharmacists specialize in optimizing medication therapy, identifying drug-related problems, and ensuring safe, evidence-based care.This collaborative model was something I experienced firsthand when I was introduced to Family Health Teams, a setting outside of traditional community pharmacy. Family Health Teams are healthcare groups that bring together different healthcare professionals to collaborate and provide patient-centered primary care. I saw how pharmacists and physicians genuinely relied on one another to deliver the highest quality care. In some cases, when deemed appropriate by physicians, pharmacists work under medical directives—formal protocols that authorize them to perform clinical activities such as initiating, adjusting, discontinuing therapy, or ordering lab tests, without needing direct case-by-case approval from physicians. Likewise, when pharmacists encounter issues such as abnormal results or uncontrolled conditions during a medication review, they consult physicians to intensify therapy or request further investigations. This type of collaboration not only improves care but reflects the mutual respect and trust between healthcare professionals.Reflecting on everything I have learned so far, my experience in pharmacy has been nothing like what I expected—and I mean that in the best way possible. When I first registered for the PharmD program, I believed pharmacists were the healthcare system’s helpful sidekicks, quietly verifying prescriptions behind a counter. What I have experienced during my first year has far exceeded those expectations. From the launch of the Minor Ailments Program to the growing use of medical directives and interprofessional models like Family Health Teams, I have witnessed just how quickly the profession is advancing.I learned that pharmacists actively help reshape the healthcare system. Whether it is initiating treatment, identifying care gaps, working shoulder-to-shoulder with physicians or managing crises during another unexpected pandemic, pharmacists are no longer in the background—we are at hospital bedside, in the boardroom, and at the forefront of community health. I entered pharmacy school expecting to just become a medication expert; now I am studying to become a healthcare provider in my own right. Sixteen-year-old me thought pharmacy looked a little boring—turns out, she had not seen how it could unfold into a career full of challenges, purpose and impact.Laiba Mujeeb is a first-year Doctor of Pharmacy candidate at the University of Waterloo, where she also completed her undergraduate studies with honours.

Beyond the counter: discovering the clinical power of pharmacy

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