Amid the frantic work and sometimes difficult patients, there are little reminders as to why we do this job, writes Fintan Moore
If I may be allowed to borrow an opening line from Charles Dickens and completely butcher it, working with the public is the best of things, and the worst of things. We all know that the majority of people are fine, nice to deal with and reasonable, but the minority that aren’t pleasant can be a real blot on the working day.
It can be easy to let somebody’s rude, demanding or downright nasty behaviour leave you feeling upset to the point that at the end of the day you end up wondering why you bother doing the job at all. In my own pharmacy, I consider myself lucky to have a patient base that are mostly nice people, and I’m also lucky enough to have a personality that lets the bad stuff roll by instead of taking it to heart.
In my experience, the phrase ‘hurt people hurt people’ is particularly true in pharmacy — most patients that are hostile are suffering or unhappy in their own lives. That doesn’t necessarily excuse any bad behaviour, but it makes it easier for me to let it go.
On the flip side, it’s always encouraging when people go out of their way to show their appreciation for what we do, especially because we often put in extra effort to sort out problems for patients without them being even aware of it. We frequently send Healthmails to GPs to get alternative items prescribed due to the first option being unavailable, rather than passing the buck to the patient to chase it up. Similarly, if a GP has issued a prescription based on an old record because they weren’t notified of hospital-initiated changes, we will quietly get that rectified. We regularly have to go to extra effort to source stock rather than inconvenience the patient.
All of these ‘invisible’ actions add to our workload without in any way adding to our income, but I get the impression that a lot of patients do realise that we’re working hard behind the scenes to keep the show on the road. The occasional ‘Thank You’ cards are a nice touch, and every year at Christmas we end up with enough boxes of chocolates and biscuits to keep us nibbling through to April. I sometimes feel a little guilty that the supply of sweet treats means that we’re not putting out enough information on healthy eating, but I also find that chocolate works really well to suppress guilt.
On a more poignant note, we occasionally get told after patients pass away that our pharmacy was publicly thanked at the funeral, which is heartening.
It’s moments like that in particular that help you remember that what we do really matters.
In to lunch
Until Covid arrived, I was somewhat ‘old-school’ in my feelings about lunch breaks. In my previous employment before owning my own pharmacy, I had always worked through lunch, grabbing a sandwich or snack between prescriptions and surviving on cups of tea. I kept the same mentality when I became a pharmacy owner and never closed for lunch. I honestly didn’t feel the need for closing and reckoned that we all coped just fine.
This changed with the arrival of Covid, because we suddenly got busier in terms of patient numbers, workflow changed with Healthmail, and we were often down staff due to Covid absences. I introduced a lunchtime closing from 1pm to 2pm in order to let everybody sit down and relax with a proper meal, decompress a bit after a hectic morning, and catch up on loose ends without being interrupted.
The great thing about introducing the closure during Covid was that we said we were closing for sanitising surfaces (which was actually truthful, just not the whole truth), so none of the customers complained. We’ve kept the lunch break ever since, and having got used to it, nothing would make me go back to not having it.
We’ve got more versatile about doing food too — we always had a microwave, but I recently upgraded our George Foreman, and we also have an omelette maker. Being properly fed definitely helps our mood when the afternoon rolls in.
The acid test
A feature of patients who start taking PPIs seems to be that remarkably few of them ever seem to stop. A good few years ago I was talking to a GP about this phenomenon and he had one explanation, which probably holds water. He said that a lot of people taking regular PPIs also have other ongoing health issues, such as high blood pressure or asthma, etc, so whenever the patient is in for an appointment, the PPI is less important than whatever else is occupying the doctor’s attention. Therefore the PPI just gets rolled over on subsequent prescriptions and no attempt is made to reduce the dose or to phase it out.
Patients get used to taking it, and if they miss a few doses then the gut acidity often flares-up, especially after alcohol or spicy, fatty food, so they restart it and continue it on an ongoing basis.
Most PPIs come in two strengths and the majority of patients are on the higher dose, so a case could be made for stepping down to try the lower one, but this approach rarely seems to happen. It seems to be a case of ‘steady as it goes’.
