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The ability to give critical but constructive feedback has been diminished for fear of hurting someone’s feelings and this phenomenon also applies to GP surgeries, writes Ultan Molloy

We have had a lot of changes over the period of the pandemic in terms of how we operate as pharmacists and how pharmacies operate with our teams.  ‘Electronic prescribing’ has come to us in the form of Healthmail, which we unfortunately, and perhaps bizarrely, have to continue to then manually print and endorse. One step forward and then two steps back, but in any case, we have to put up with it as we’re in the unfortunate and powerless situation of having this stuff imposed on us, and we have to just ‘suck it up’. I appreciate that our representative body is doing their best to influence, but when change in the public service is predominantly borne out of necessity, rather than a cohesive vision on how things can operate better for everyone involved, I suspect the challenge is insurmountable. Why would you have a Chief Pharmaceutical Officer in the Dept of Health? This is why: To provide a vision for how pharmacy can be most effective in our primary care setting, and to influence progress positively for all involved. The Minister doesn’t see the need, however.  Yawn. I’m boring myself repeatedly thinking about this, and at this stage, I’m past frustration, and have moved on to despondency. Would you blame a donkey if it kicked you?

Interestingly, we have had a consultant prescription recently via healthmail, sent by a temporary secretary, as the regular consultant and their usual secretary are on holidays for the week. It was a repeat of a tapered increasing dose of a controlled drug. Apparently, the covering secretary was told that for the week, he could repeat any prescription that a patient had received previously, but not initiate any new scripts or treatment. Their temporary medical degree, unfortunately, didn’t cover that! It begs the question, who is behind these healthmails being sent to us as legally valid prescriptions day-to-day from surgeries? While I appreciate that the doctor whose name is on the Healthmail is responsible for their Healthmail account, and anything ‘prescribed’ out of the same, it’s clearly not always a doctor prescribing. So what can we do past take it at face value? I know if this is raised with the PSI, we’ll be reminded of our obligation to ensure we’re dispensing legally valid prescriptions, but past having an overhead camera recording keystrokes and computer screens in GP  surgeries, we cannot of course reasonably police this, or be expected to. 

‘They didn’t ask for it’ is another popular one when prescription queries are raised with one particular local surgery. No replies are given from the GP’s Healthmail address, so one has to email the surgery, and get replies signed from ‘Reception’. Apparently, the patients do the prescribing there a lot of the time, as when we query why a particular item isn’t on a prescription, we get ‘they didn’t ask for it’.  Yes, ‘they didn’t ask for it’. I wonder what they can ask for and get, as we can’t ‘ask for it’ on a patient’s behalf, as it happens. No, no, no — get back in your box you silly pharmacist, the patient must ‘reorder’ their own prescriptions (even though we’re repeatedly told they can’t get through on the phone, and emails are regularly missed).

‘Reorder’ is an interesting word when it comes to prescription-only medicines, isn’t it? Reorder, re-prescribe, sure it’s the same thing really, isn’t it? Or what is the difference in the case of this surgery?  I find them problematic to deal with, so the possibility of getting this sorted is unlikely, and seeing as I suspect they were directing patients to other pharmacies in the town in the past, it leaves us in a Catch-22 situation, trying to balance our obligations assertively, and not wanting to ‘upset’ them so much so that they start directing patients elsewhere. My last email asking, “what we need to know is if the patient is still taking the medicine or not, as the GP does the prescribing rather than the patient?” was of course ignored. Patients can’t leave the surgery in question, despite their own irritations with the service, as other local surgeries aren’t taking on patients.

This has, unfortunately, come up with another surgery that we deal with at a different location. Prescriptions have been coming over with several regular prescription items missing (ie, blood pressure, cholesterol and diabetes meds), and queries placed with secretarial staff received the answer, ‘they didn’t ask for it’.  I’ve raised the issue with the practice GP in a voice message and asked him to unpick it on their side, as it could be interpreted that the secretarial staff are doing the prescribing without GP oversight. God forbid! Newly-employed secretarial staff could be sending on prescriptions to us without GP oversight, and we get ‘they didn’t ask for it’. It is often clear from our conversations that they don’t know what the different meds are for. Not ideal, is it?  Are we like Holden in The Catcher in the Rye, trying to stop patients, in our case, from falling off a cliff? 

We walk a knife-edge when it comes to feedback in many areas of our lives, don’t we? With family, friendships, employees, employers, and also with GP practices.  Ass-covering and fragile egos are part of it, I’m sure. Fear of litigation perhaps, were some inadequacies exposed? An absence of trust, and a lack of appetite to collaborate? Yes, in many cases. Pure arrogance and conceitedness? Yes, unfortunately in some cases.

Feedback is something to consider in another piece. Tip-toeing around so as not to upset people who either don’t want feedback, or don’t want anything that could be construed as negative feedback, is I suspect increasingly commonplace.  We have a new generation of employees entering the workforce, with an employee’s market for many roles. It’s ultimately a lose-lose situation though, isn’t it. No-one is any the wiser in a situation where avoidance is the norm. Things don’t get better for anyone. It lacks authenticity, and the relationships ultimately remain more superficial than is wholesome; well, to my mind anyway. I hope in time that we will see more people who are hungry for feedback, in order to learn, develop, and collaborate with colleagues. Those who walk towards discomfort in order to improve personally and professionally make things better for everyone. ‘Mistakes are our friends’ we tell our kids, and yet when it comes to many adults in our lives, it’s all too much for our egos to bear.

It is often clear from our conversations that they don’t know what the different meds are for

We had some work experience students in recently. One of these we liberated a day early after I heard him repeatedly saying, “I’m bored”.

“Let’s leave it at that now today, and you enjoy your Friday.  Thank you so much for all your help.”

One of the team reminded me that their parents are good customers, and that we should give them the usual €20 voucher on departure, and tick ‘Good’ across the board for their assessment. I agreed, although afterwards I thought to myself we really did that young fella no favours, feeding his delusion that he was ‘Good’ and rewarding his lack of initiative and poor attitude. The alternative is of course thankless, and likely costly to our business if his parents were upset. 

Whose responsibility is it anyway? Maybe it ‘takes a village to raise a child’, but don’t be upsetting our little Johnny!  Have we gone from everyone telling us we’re useless, to now everyone obliged to tell everyone else they’re great, lest they get upset? Or rather, that we ‘make them’ upset, us being of course now societally responsible for everyone else’s feelings, rather than one being responsible for one’s own feelings and behaviours. That would be all too much to bear.

Have we a greater proportion of older children moving through secondary school molly-coddled, and then subsequently molly-coddled and rescued through their college years, only to be landed on us in the workforce looking for surrogate parents, rather than employers? I’m not sure this is any better than the corporal punishment, and incessant ‘must do better’ that I enjoyed through the 80s and 90s. I have three children at home, however, and don’t want to be dealing with adults behaving like children when I go to work. Who is going to be the Catcher in the Rye in this situation and save them from themselves? 

Perhaps however, to use a hunting analogy, it’s more ‘Beaters’ we need rather than ‘Catchers’, so as to drive us all toward the open ground that is adulthood.

Ultan Molloy is a business and professional performance coach, pharmacist, facilitator, and development specialist. He works with other pharmacists, business owners, and third parties to develop business strategies. Ultan can be contacted on 086 1693343.