‘It’s only words’, but how we use them to manage interactions at the pharmacy counter is important, writes Ultan Molloy
I’m reminded after a recent communication, and going for coaching recertification at present, the minefield that needs to be negotiated in order for effective communication to happen and not be ‘stymied’. Did I use that word correctly? Now, I love words, and their meaning, but that one had me heading for Google in order to educate myself on what turns out to have its origin as a golfing term from the mid-19th Century. I’m not one for golf mind you, although the thought of a four-hour uninterrupted walk, with or without golf clubs, very much appeals under our present circumstances.
I’m sure I’m as guilty as the next person for using unnecessarily verbose and convoluted language, and it is something that needs further work in some circumstances. Think of communications with our patients at the counter, for example. We have a number of people who do not read or write, do not have English as their first language, and other challenges to effective communication. It is said that people will take away a maximum of three pieces of information from an interaction at the counter, so when counselling, how do we figure out what are those most important three things in each situation? It’s not an easy one, is it? Possibly the worst thing we could be doing is diluting an ill-considered message further by adding non-essential information into the mix. How much time also do we spend on a discovery stage (if the patient is open to that, mind you!) in order to counsel them effectively on their needs, and how they vary from person-to-person.
I understand that a contributor on Maura and Daithi’s RTÉ show was somewhat baffled by the amount of paperwork required to be completed when getting her vaccine in her local pharmacy in recent weeks. Obsessing about cleanliness and sanitising also, and then having to wait for 15 minutes after the vaccine. A whole half-hour wait in the pharmacy. The injustice of it all! I think the profession’s ability to give extraordinarily efficient and accessible service has led some of those who are feeling more entitled to expect more than is reasonably safe or possible.
A good friend in the UK gets his single-item (allopurinol) prescription dispensed after a call, or calling to the pharmacy in the morning, later that afternoon at best, but more often is told to call back the following day. A major pharmacy chain in the UK is reducing opening hours in their stores by an average of 10 hours per store in order to manage costs vs the cuts in funding to the sector since 2016. Some recalibrating needs to happen in the near future, and expectations going forward need to be better managed with our customers and patients.
The thing about free advice is…
To my colleagues and others who keep going on about pharmacists being available for free advice at the counter, here’s the thing: It’s not free! I am paying for it. I am paying for customers being able to access the pharmacist, primarily though the dispensing fees I receive from the Government, along with some over-the-counter sales income. That’s what pays for everything. So the next time someone is asked why should the Government pay €3.50 to have a box of aspirin dispensed, then I do hope that it will be made clear that they are not paying that for that box to be dispensed. They are paying it in order for accessibility to the pharmacist, the professional oversight, staffing of the pharmacy, other overheads, and everything else that allows the pharmacy to exist, so that the person can come in with the prescription to be dispensed in the first place. That is the contract that keeps pharmacies open and accessible, and it is the primary business model at the moment in the Irish pharmacy market.
Applying the logic above, we should have an increased dispensing fee the more complex the medicine and treatment is. Maybe higher fees for medicines that are difficult to source. Fees for when we have to order minimum quantities of expensive medicines and get reimbursed for only parts of those packs. Fees to supplement the medicines that we dispense at a loss. Perhaps paid holiday, study and locum cover for the pharmacists who operate State schemes. Any sign yet of a minor ailment scheme, new medicine scheme, or a fit-for-purpose new contract? No. All of that would require an amount of vision, and foresight, in the Department of Health that is apparently sadly lacking. Why can’t pharmacists have strategic input into best practice, patient-centred, outcome-focused patient care in primary healthcare in Ireland?
We must be mindful daily of how we are presenting ourselves, and representing the profession, to patients, the PCRS, and other stakeholders, and also be aware of where the power lies. That is what we are responsible for, and what is in our control. I hope that in the near future, pharmacy contractors will be seen as being a significantly under-utilised primary care resource for patient care and service delivery, rather than, more apparently, an expense under the primary care drugs budget.
The vaccine debacle
Great to get the bump in fees this year, but sweet Jesus, am I the only one who’s stressed to the max not knowing how many bloody vaccines are going to land in the door next week? How can we plan a service for patients with what’s going on in relation to supplies, and now in the last week, the PCRS online site going down repeatedly. The whole HSE cold chain not running on pack replacement is bad enough, but now we have to try and manage patients’ expectations and predict the future, while taking dog’s abuse at times at the counter, as we’re misunderstood to be somehow part of the problem, rather than part of the solution. I deeply resent the implication in some communications that suggest that pharmacists are somehow squandering vaccines on patients who shouldn’t be getting them. Get your own houses in order folks, please, instead of propagating that rumour.
This loss-making service is disruptive when it is running properly, and there aren’t vaccine shortages, and repeated patient communications to manage. A 10-fold increase in uptake in pharmacies in Wales doesn’t surprise me under the circumstances. Perhaps it will all be sorted by the time this is published in a few weeks from when I am writing this.
A final thought
I am still somewhat traumatised after the recent IPU AGM that is no doubt providing subject matter for many articles and commentaries. Respectful communication on both sides appeared to be scarce as the day approached. There is clearly an appetite for more open and transparent communication with much of the membership, and it appears that many people are distinctly underwhelmed with the progress of the IPU in relation to our pharmacy contract and the venture. There will be some wounds to heal, and we will see in time if an appetite develops for some more transparent and positive engagement with stakeholders.
I was involved in some work internally in 2014, where we developed IPU core values of Care, Advancement and Togetherness. Unfortunately, these were developed in isolation by a small group of people, without the buy-in of the whole organisation, and apparently left to die, given how much we have heard of them since. The alternative is that they would be kept alive, and behaviours associated with them to be lauded and encouraged, and deviant behaviours called out. It is not too late.
