[dalbasal]

I think it comes down to whether you are comparing to ideals, or regular life.

Yes, medications carry risk. But, "without a doctor's prescription" does not mean randomly. People still take advice from doctors and pharmacists, they just aren't required to have proof that a doctor has decided something. In any case, a pharmacist is a pharmacology specialist and probably more knowledgable about drug risk and safety than anyone.

>> makes pharmacists de facto community doctors.

Again, depends on the ideal you are comparing to. You are implying an ideal community doctoring setup, where a local doctor knows people and is accessible to them. An ideal that exists for maybe 1%-2% of the world. The problem that pharmacist/nurse led care solves is that this ideal does not exist. GPs are inaccessible, cost $75 for 10 minutes or don't have appointments available. A pharmacist probably sees someone every time they're sick. Doctors... only if it's bad.

I feel like this sort of issue comes up often, when discussing primary medicine. The comparison isn't fair. When listing the pros and cons of pharmacist or nurse led care, we get a laundry list of real life issues. When listing pros and cons of doctor led care, we get an idealisation. IRL, most GPs prescribing antidepressives do exactly as much "holistic care" as pharmacists would. Patient asks for ADs. Doctor spends 2-3 minutes going through a checklist. Done. Whether or not that's ideal has little to do with who writes the script.

[Engineering-MD]

I practice in the UK. The system is far from perfect, but does to a certain extent work in the idealistic system you propose. It is not true for all GPs, and some don’t practice holistic medicine, but the system is created to allow (and encourage) this method, and in my experience holistic medicine is practiced by GPs. Perhaps things differ in the USA, but this system works well in the UK.

[dalbasal]

I live in Dublin, so not that far. GPs here are generally private, though kids, older people and lower income people are subsidized or free. Some other parts of the medical system are more like yours. It's an eclectic system.

Anyway, I don't have a problem with the way primary care works here. It works well. I didn't mean any of this as a slight on the job doctors do. But... I also think pharmacists and other trained people can prescribe medication, tests and such. There is value in accessibility. If they can (as I think some of these ideas take as premise) provide walk in service, there is good reason to do it.

I know people prescribed antidepressants from GPs, in the UK as well. 10 minute appointments several times per year.