There’s ‘no Time To Die’ If You Run A Pharmacy That Would Test The Resolve Of Even ‘the Bull’ Mccabe, Writes Fintan Moore
Most of you will be familiar with John B Keane’s famous story The Field, in which the main character ‘The Bull’ McCabe is obsessed with possessing the eponymous piece of land on which he had toiled all his life, as did his father before him. The family worked to remove rocks and weeds from the field, and fertilised it by carrying seaweed.
There is a famous scene in which ‘The Bull’, now an older, but still physically powerful man, tells how when he was a child he was working in the field with his parents to get hay saved before the rain started. As the three of them worked, his mother keeled over, and when his father realised she had died he said he’d fetch the priest, but the young ‘Bull’ said, “shouldn’t we save the hay first?” and his father looked at him “with tears of pride in his eyes, because he knew I’d take care of the land”.
There was a time when I thought that ‘The Bull’ was maybe a bit extreme, but if he owned a pharmacy, I reckon he’d really have gone over the edge. When you run your own pharmacy, every single life event from birth to death and all things in between have the potential to become obstacles to you getting the doors open and the PC turned on.
At this stage, I think that if I woke up some night to find The Grim Reaper standing at the end of the bed beckoning me to follow him into the endless dark, I’ll refuse point blank to go because ‘It’s completely impractical for me to arrange a locum for tomorrow morning at this ridiculous hour. And you can stop waving that scythe around — I’ve had enough of weapons being waved at me to last a lifetime. Really, Mr Death, if you want to turn up randomly to end my days, you’ll have to plan ahead a bit better than this. Let’s see — Mondays aren’t good because we’re busy after the weekend; Tuesdays have a lot of blister packs; Wednesdays are always awkward because the GPs finish early.
Thursdays aren’t bad, but not this one because it’s the last day of the month, and Fridays are a definite no-no because the hospitals let everybody out, no matter how sick they are — sure, if you came in to collect my soul on a Friday, you could end up with a few more by mistake.
Then Saturday is out because the locum rates are crippling — I couldn’t afford to die on a Saturday. I suppose a Sunday would work, given a bit of notice to make sure the week ahead was covered. So you can let yourself back out again, and I’ll get back to sleep.
Have a nice day, now — it’s a grand bit of weather we’re having.’
PHASES OF LIFE
Like probably every pharmacy in the country, I occasionally end up with claims for phased dispensing fees getting rejected because the required approval wasn’t in place for the patient.
Regardless of the fact that the GP has stated ‘Daily Dispensing’ on the prescription, the rules are the rules, and the PCRS will only pay as they say. Usually, I try to stay on top of the phased approvals and plan ahead to get the relevant GPs to renew them before they lapse, but it’s easy to let this fall through the cracks.
When this happens, the situation that arises is that we face a stark choice between dispensing a prescription in phases, even though we won’t be paid, or dispensing the entire monthly supply in one lot, even though the patient will overdose.
So I got to thinking — is there any other area in the health service with a black and white ruling saying that keeping a patient alive is the wrong thing to do? Do paramedics ever get told that some patients are not to be saved, and if they are, that the paramedics will be docked pay for saving them?
Do anaesthetists ever have to turn off the oxygen mid-operation unless they swipe their personal credit card into a payment terminal on the cylinder? Of course not, so why is this morally indefensible situation allowed to continue for our profession?
ONE SMALL CHANGE
The Irish Times is running a series at the moment called ‘One Small Change’, in which they invite members of the health service to email suggestions for one change they would like to see — ‘a small change in practice or attitude that would make life easier for everyone’.
It’s hard to know where to start with a list of changes to make life in pharmacy better, and some of the necessary ones such as abolition of the Hardship Scheme will make no sense to the average person. Similarly, extending the use-and learn period of FMD scanning is obviously essential, but meaningless to the public.
A requirement for High-Tech suppliers to deliver on Saturdays to all pharmacies, not just their number one account holders, is needed, but not too sexy either. Having said all that, the idea is a good one, so if you have any suggestions, you can send them to health@irishtimes. com with ‘One Small Change’ in the subject line.