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It is important when we interact with our patients and others that we are aware of where they are in their lives, writes Ultan Molloy

“You’re some article” my grandmother used to say to me and others when we were messing, or having done something stupid. Since she passed on nearly 10 years ago now, I’ve not heard that expression. She had a number of others that I try to remember from time to time. “That’s more than a chicken’s run from here,” ie, that’s a fair bit away. “It’s like herding mice at a crossroads,” ie, everyone is going in different directions on this. “Do you want me to keep going until I fit in the skin of a gooseberry,” ie, I’m getting older and smaller and I can’t live forever. “That fella thinks he could put an eye in a blind dog,” ie, They’re not as smart as they think they are. “Small is beautiful” was also put to me regularly by her when I was spouting ambitions about having a second pharmacy, and maybe a third.

She was right of course, but it was an itch I had to scratch and it seemed like a great idea and project to get stuck into a few years back. The opening week incidentally coincided with us moving house and the birth of our third child. What a busy week that was, and it didn’t get any quieter for the following three and a half years before we sold it on. A hostile business environment, and ongoing challenges with staffing cover, well and truly knocked the craic out of it fairly quickly. Gran had different priorities in her early 80s, which I couldn’t relate to, and “small is beautiful” just felt like giving in, or giving up, on ambition and building future assets and security. Most of what she said was on the money though, and as the years pass, I’m learning this to be the case. “This will all make sense when I am older” to quote Olaf in Frozen II. The wisdom of the ages, eh?

I saw another quote recently, which went along the lines of “To gain knowledge, add things. To gain wisdom, take things away.” I like this concept and immediately think of patients trying to cope at the pharmacy counter with a monolog of healthcare advice delivered to them. What’s the most important thing for them to understand and take away? It’s not that simple though is it.

“You’re meeting them where they are at” someone said to me yesterday in relation to my kids. For context, I’ve been fortunate enough to have some time for hands on parenting over the last few months. My relationship with the three girls, now nearly seven, six, and four has changed a lot. I think my experience of them as noisy and demanding pets of a sort has changed, having given them time to understand where they are at in their lives, and with their level of knowledge, life experience (ha ha!), and what constitutes stress and a big deal for them. They’re just trying to make sense of the world, and navigate their day- to-day existence, much like ourselves, Although with much more limited knowledge and experience. They’re in a vunerable position as dependents, and know that while they can say “I hate you” and throw a tantrum, they’re unlikely to have the means anytime soon to relocate and give themselves some space and the independence they seek periodically. They are aware of this unequal power dynamic also, and so we must be kind.

Meeting our patients “where they are at” is something we need to try and cultivate. Difficult of course given the increasing production line, administrative, and regulatory demands on our time, however. “To gain knowledge, add things. To gain wisdom, take things away” though isn’t it?

At 47 years old, my body is aching when I drag myself out of bed in the mornings. I’m now back in the gym periodically, and manually working occasionally, but that’s it. I’m 18kg heavier than when I completed an Ironman triathlon back in 2014, and that weight trajectory seems to be only going one way. “Sure, you’ve packed on muscle and it’s heavier than fat” from my friend, and “sure, you’ll need a few pounds on you in case you get sick” from my Gran, offer little comfort.

I have come to admire my father-in-law, who, now in his mid-70s, is regularly giving piggy backs to our 25kg six-year-old. Some going really at that age. He is the exception though when it comes to physical fitness and ability for someone in their 70s and long may it last for him. Again though, meeting our patients “where they are at” when it comes to our expectations of them, and their expectations of themselves, is important to consider for ourselves professionally. The over-70s are on the most amount of medicines and are the most dependent on us and the healthcare system, and their lived experience is so different to most of us who are caring for them and their medicines on a day-to- day basis. I have known this, of course, in theory and concept, for some time. The penny is only really starting to drop now though, when my own body is making its limitations known to me as part of my lived experience.

Bringing this back to pharmacy, I’m reminded that it’s important to be mindful of the differing life experiences of our colleagues in the pharmacy team, where some team members are on three or four times the hourly rate of some others. It’s important to be mindful, generous, and kind when considering how we manage and allocate our resources here also (as I say this to myself also). Considerations like getting a mortgage, or having a family, are significant challenges for many people, and not an option for our colleagues in some cases. Making ends meet from a business point of view, while supporting our team financially, in a high inflation environment, and where we’ve had pharmacy fees frozen since 2009 is not an easy task. Indeed, a net closure of pharmacies in recent quarters is telling this very tale. The Minister for Health allocating primary care resources elsewhere (eg, payments to GPs have gone up now over 50 per cent in this same period), and trotting out the same old smoke and mirror Department of Health media response around fees leaves us in an increasingly challenging business position, and the IPU with a difficult negotiation ahead. Given the powerful position the Department is in, reaching an agreement that will be good for, or even acceptable for community pharmacy, and by extension our communities, will be no mean feat. Those involved in said negotiations in the past have been doing anything but meeting pharmacists “where they are at”!

It’s great to see obligatory pension and sick pay supports coming in also, as they’re long overdue. It’s dishonest
of politicians, however, to claim credit for these, given that it’s private business owners that will be footing the bill. That being said, I can live with my arm being twisted on these things, and we’ll find a way to make it work.

Some of my team have been dreading our imminent long overdue appraisals. I think these have traditionally been used as an opportunity to berate staff in some companies. In fact I know they have, as I’ve worked with other companies in this area. I’m looking forward to spending some time connecting with them and seeing where they’re at, and how we can support and make things work even better for one another. I hope that mutual support and understanding will be the experience for more of us in pharmacy as we progress, and that we will have the resources to continue to do a great job in primary healthcare for our colleagues and our communities.    

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 086 169 3343.