Even with the best technicians and support staff, as we have, there still has to be significant pharmacist involvement, writes Ultan Molloy
So yesterday, I was thinking about how the day went, and the interactions I’ve had working as a pharmacist in the last few days with customers, patients, and the wholesaler experience.
Customer wise, there are a few happenings that stay with me. I had a gent we’ll call Mo looking for his Esomeprazole tablets on prescription rather than OTC because they’re a bit cheaper. He’s a private patient, and his GP practice, funnily enough, charges him by the month for “ordering” his prescription. (I’m sure there’s a comprehensive medical assessment, and doctory things that would be way above my head involved in his clinical care in this case). So, he’s not the greatest for providing up-to-date prescriptions for his “prescription only medicine”, when he requests a repeat of his prescription-only medicine. “You can contact them if you want a prescription” he threw in when we were accessing his PMR to see how we could help him. Perhaps he wants me to pay the private prescription charge on it also, I thought to myself.
I’d Mr M looking for 30s of everything anymore in his boxes, even though he’ll get a second supply one month a year free-of-charge. The pain in the a@*e, the time, resources and the likelihood of errors, and of being left with split packs if the patient changes off the meds, had me politely saying no. “That would be illegal in Sweden. It’s dangerous!” a colleague said to me. While our technician team would no doubt kindly remind me to “keep the customers happy”, and live our core values of “warm friendship” and “exceptional service”. I’m still a bit conflicted, to be honest. He seemed okay leaving, but there’s always my anxiety, given the possibility that he’ll just take his business elsewhere.
Mr S was asking that we add an item to his DPS from last month as the 31st was a bank holiday, and we weren’t open. Yes, we are now responsible for when the bank holidays fall. He lost his medical card recently, and surprisingly, himself and his family’s need for their regular medicines has dropped off considerably. Of course €80 a month is significant to a lot of people, but the medical card is means tested, so I’d assume there’s income or assets that mean they’re not eligible for free medication. We all must prioritise where we allocate our spend of course, and price inflation across the board is causing challenges for everyone. Who is responsible for what we prioritise, and what’s reasonable to expect in terms of state support, is of course a minefield not to be wandered into. Much like the one that involves interrelationship discussions around household financial priorities and control of same. We had a diabetic patient recently, who had been supplied several months of his meds on an LTI number that wasn’t valid (he had had 3/12 emergency registered, and hadn’t registered himself subsequently. He held off on getting his meds subsequently for the seven months it took him to organise a valid LTI, rather than pay the €15 monthly prescription fee, some of which would be paid by his wife. 50 cent a day seems like a reasonable investment in one’s health, but one never knows what’s going on behind the scenes.
Mrs McC has been in for regular ( free) blood pressure checks, as she “can’t get in to see the doctor”, although I’m wondering does the same level of availability apply to all of his patients. I know, I know… value your time etc, but we do offer occasional technician-led blood pressure checks free to our prescription customers. She’s a very assertive, and complicated character, the same lady. She’s also responsible for several hundred euro of turnover each month, between her own meds, and her husbands. So, when we got lambasted for dispensing “three different antibiotics” to her pregnant daughter, I was again weighing up her value to the business versus politely suggesting she may be happier getting her prescriptions elsewhere. What had actually happened is we had dispensed Keflex 500mg, which turned out to be short. We unsuccessfully phoned around several pharmacies to see could we get more, and there was not enough available to complete the course. We dispensed the remainder of our 250mg Keflex, doubling up to make the dose, and subsequently contacted the GP (several times) who eventually prescribed amoxicillin to complete the course. That was a thankless and hard earned €3.50 wasn’t it. Mrs McC subsequently stopped our technician to apologise about her humour, who had explained to her that we often don’t know a medicine is short until we go to order more of it. I reckon dealing with stock shortages and arranging alternatives, takes up to an additional hour a day at this point. Yet we have only two wholesalers and a selection of pharmacy colleagues, exporting products out of the country. Not ideal is it? Oh yes, and that’s one less hour we have to engage clinically with patients and their meds. Another one less. Even with the best technicians and support staff, as we have, there still has to be significant pharmacist involvement.
Mr MM has made six visits to us in the last two days. Lovely chap, in fairness, but not great on the organising and planning of his medicine needs. “You know the white ones, the pain killers… will you give me a few of them ’till I get a prescription?”. These were of course to join the other items we’re waiting on a script for, that he said he has ordered. Literacy and communication issues also means that we have prescriptions coming in from his GP in dribs and drabs. “Did you get the scription yet?” he asked again. We did eventually get three different prescriptions. “Them is not the ones I want” even though I’d given him reprints of labels to “order” the ones he was asking for, after extensive consultation on what it was, what it was for, who it was for, etc, concluding previously that “Them is the ones.”
We made up a couple of HealthMails that came in for a family, interestingly loaded with Epipens, Duac, Enstilar Gel, inhalers, etc, toward last month’s end. They still weren’t collected yesterday, so we rang the patient. “I never told you to make them up.” Two months of €80 was not what she had been planning of course. Is it unreasonable to think that when we get prescriptions off the doctor, the patient would want them made up at the time? Another twist on how to best use the Drugs Payment Scheme (DPS). Perhaps we should contact every patient each time a prescription comes in to see if they want it made up? “Sure it’s only another step in the dispensing process” someone said recently, when I was advising on the pain in the arse that FMD is for us. Sure what else would we be at like?
My other fond story of creative DPS patients, and thankfully they’re few and far between, was of a lovely lady called Patricia who graced us with her custom back in 2008, not long after we opened in Ballindine. Patricia was in her early 60s I’d say, with short hair and heavy glasses, and a smile as wide as the day. She regaled about how other people had told her what a “lovely lad” I was, and how I was so kind and helpful, and she would be “only delighted to give me some business”. Herself and her husband were on the drugs payment scheme, so she gave me her prescriptions, and her DPS details. I saw her now and again over the following six or seven months, although a counter staff colleague looked after her, and she didn’t seem to engage with myself as much with the chats. Head down, in and out, kind of a thing. So I took a notion one day to have a look at her PMR, only to discover that lovely Patricia had been coming to us at the start and the end of every second month to get her month’s supply of medicines. Lovely lady that she was, she never returned when I told her on her next visit that she was collecting the next month’s supply, and it would be €144, or whatever it was at the time. I had made a special exception in her case and dispensed 31 of each item, checking them twice, just to help her out. Lovely lady.
Much like the lovely lady that fell in the shop a few years back when I was away. “Did you complete an incident form?” I asked on the phone. “You know her, she comes to us all the time, she’s a lovely lady,” said my colleague. “Did you complete an incident form?” I asked again. It came in handy when she sued us a few weeks later for falling on a damp floor. One might think that one could get quite cynical very easily. Never.
So, anyway, what’s all this about at this time of year? We’re heading into the month of expectations aren’t we really. Every year I say around this time (I’m writing this early November!), I’m going to be on top of everything this year, super organised, and not have last minute stress. Let’s see how the plan works out this year.
Our kids are presently tearing through the Smyths catalogue cutting out all the presents they want. Rose is crying because she can’t decide which three things she wants from the 27 or so that she has cut out. She really does have it tough. It’s amazing what us human beings of all ages and types find distressing.
So, getting the basics done well in the pharmacy, along with trying to meet everyones expectations is challenging isn’t it? “You have to plamás them. That’s what community pharmacy is about” a colleague advised me recently. I’m really not much of a plamáser, I’m thinking to myself. I find “small talk” stressful for God’s sake.
Presently, my tension headache is back, just a couple of days into the week in the dispensary, and I’m resisting having a drop of the foxy bottle to help me on my way to slumberland. My REM sleep will suffer of course, and we’ll all be paying for it tomorrow if I’m not rested, so sleep must be prioritised. I know, sure that’s no craic is it!? Looking forward to the Christmas party in a few weeks. Thankfully that’s on a Saturday night, and I have a very slow Sunday planned, although the kids may have other plans. I best ask them. They’re in charge really.
I’m sure the new year will bring more changes. Among them, a new pharmacy contract, a changing workforce, and a changing economic situation for all of us. I’d like to be optimistic about the year ahead, so I best get working on that, and love and leave you to your own thoughts.
Wishing you and yours a very happy and healthy Christmas and New Year.
PS: In case you’re interested, we did manage to whittle down Rose’s gift requests to three moderately sized, and helpfully appropriate, presents through a process of “do you like this one more, or this one more…” elimination, so all is well in the world again. You can sleep easier now knowing that, I’m sure.