This is a chapter from a new funny pharmacy book called ‘Confessions of a Chemist’ by a lovely pharmacist called Jemima McCandless. It is available to buy from http://www.amazon.co.uk/gp/product/B00BCNQX00/ref=pd_lpo_k2_dp_sr_1?pf_rd_p=103612307&pf_rd_s=lpo-top-stripe&pf_rd_t=201&pf_rd_i=1905811128&pf_rd_m=A3P5ROKL5A1OLE&pf_rd_r=1Q8FP9PS7ZAVDCGWNP7B
Never attempt to catch a falling knife
Behind every silly safety warning is a person suing for not being warned otherwise. Not everyone bothers to read instructions. Similarly not all patients read the patient information leaflet supplied with their medication.
Not reading the leaflet can put patients at a disadvantage. The well-known example being: Remove the suppositories metal foil before inserting. Not reading the label is also a mistake. “But no-one told him not to swallow them!” Mrs Gulp shouted at Karen for not verbally telling her husband not to SWALLOW his suppositories. You might assume this advice is unnecessary. So why does the packaging on my thermometer read: Once used rectally the thermometer should not be used orally?
I’d like to think that even if your eyesight is poor, common sense might prevail on this one: Heat in the microwave for 3-5 minutes Alas, after 35 minutes the microwaveable wheat-bag was on fire! Evidently some directions are not clear enough.
Insert contraceptive cap at night, remove and wash every morning – she’d followed the doctors directions so why was she now pregnant? Her husband works nights!
As a pharmacist, I endeavour to help patients get the best from their medication. This can be in the form of a Medicines Use Review (MUR) where I sit down with regular patients and discuss how they use of their medication.
MURs are optional Advanced Services whereas all pharmacies must offer Essential Services such as dispensing and promoting healthy lifestyles. An MUR may be offered to a patient who has received prescriptions from us for at least three consecutive months and over 2 million MURs were conducted in England 2011/12.
An MUR is a medication review focussing on a patient’s understanding and use of their medication – with the aim of improving patient knowledge / adherence and reducing wastage. It is an opportunity for patients to ask questions.
Nowadays we need a signed patient consent form before an MUR. Naturally I’ll ask for your signature after the MUR or you’ll never agree to talk to me.
When as many as half of patients don’t use their medication as directed by their doctor, MURs potentially save the NHS money – they also result in funny anecdotes.
MURs can identify potential side effects:
For example: Taking senna laxative tablets in the morning rather than at night because ‘What if I shit the bed?’ no-one had explained how the tablets work overnight.
Problems using their medication:
For example: Using scissors every morning to cut capsules out of a blister pack because they are ‘Impossible to pop out’ until I demonstrate how to simply peel the foil back.
Medication they no longer need:
‘I order them every month because I don’t want the doctor to know I don’t take them or he’ll think I’m a bad patient’
Whether or not they understand how to correctly use their medication:
“Can you show me how you use your inhaler?” I asked one patient, who was allergic to a new dog and become slightly asthmatic. “I haven’t got the dog with me” he replied. Unbelievably, he’d been spraying the dog!
Why they need to take their medication:
One gentleman had not started taking his new blood pressure tablets because he thought they were ten times stronger than his old ones – and the weak ones made him ill “But these 50mg must be stronger. My old tablets were only 5mg” (Wrong!) Consequently his blood pressure had gone sky-high.
Mr Repetitive once had one ten-minute MUR with myself, and never let us forget it. Every month he’d hand his prescription in, and tell us he’d “already had the Spanish Inquisition.” I think he thought it was funny but Karen got tired of listening to his broken record and pointed out the MUR had been for his benefit “You won’t get that service everywhere you know” she told him. When he’d gone, I said “Look, this explains it Karen” pointing to his prescription including laxatives “He’s full of shit.”
It can be very difficult being patient-centric all day every day. We don’t offer these additional services because we’re all stood around doing nothing. Prescription volume continues to rise and at the same time we offer MUR’s, morning-after-pills, Ventolin inhalers, flu-jabs, cholesterol checks, smoking cessation clinics… Next thing you know (with the obesity epidemic) I’ll be walking round the supermarket advising customers what to put in their trolley!
We help Mrs Peg manage her weight. Karen weighs her every Monday and she’s lost three stone in as many years. She would have lost more if she didn’t go and celebrate a good weigh-in with a cream cake in the customer café. What we can’t help her with is her sense of smell. “Got a peg?” Karen used to ask me – for her nose. It’s a mystery how someone can be that urine-scented and remain oblivious to it. Bless her.
The human brain spends a lot of time on auto-pilot. Ever walked back to your car because you can’t recall pressing the key-fob to lock it? To avoid daydreaming when busy/tired/stressed/all of the above, I talk out-loud (to engage the left side of my brain) as I’m checking prescriptions. “Right patient. Right dose. Right tablet. Right strength. Right label. Right quantity. Right bag…” So should you hear me talking to myself, this does not indicate I’m a mad woman. Try it for yourself next time you leave the house. “Front door is locked”
Pressure turns into stress when you feel unable to cope. This usually happens when we are short-staffed, at which time I don’t know whether to laugh; cry; pull the shutters; or run away? The fact you have frozen food in your trolley, and a taxi waiting, will not make your prescription appear any quicker. What’s taking so long? It’s only a box of tablets! And if you’re rude, there’s every chance it’ll take longer so don’t be so quick to impatiently tap your fingers on the counter. This is not the Deli counter. If you rush me I might make a mistake then you’ll really have something to shout about.
One of the shopful-of-customers wants to ask me something. “I can see you’re very busy” she says. Yes. I’m full-bladdered-busy (meaning I daren’t go for a toilet break, and return to find the benchful-of-prescriptions has multiplied in my absence) but you’re going to tell me your life story anyway aren’t you?
Mrs Under-Tall is a middle aged mum wanting something for her teenage daughter. Her chunky legs are red raw at the tops from rubbing together when she walks I doubt she runs anywhere. We have an anti-chafing gel but it’s nearly £10 and I explain it won’t solve the problem. “Well I’m not buying something that won’t work” says mum. And I kindly explain she’ll have to buy it forevermore unless her daughter loses weight.
I offer them free diet and lifestyle advice. “I can’t stop her from eating” says mum. “No but you choose what foodstuffs to buy. Could you cut something out like cakes or crisps?” I suggest, looking at their trolley – full of all the wrong stuff. “What about the rest of us?” asks Mrs Under-Tall. “Small changes can make a big difference” I say, looking at her son tucking into a Mars bar as we speak. “How about only having chips once a week?” I suggest. “Once a week? I have chips twice a day. Once at school and once at home” admits the daughter.
I’m thinking to myself this is beyond my remit. But maybe, the doctor the school nurse and me, maybe we can have a cumulative effect and save this child from diabetes and heart disease? “Do you do any exercise? PE at school or anything?” I ask the daughter but I’ve visions of her sitting it out, while her classmates run around like children should. “Her legs hurt too much” claims mum and I give up – for today at least.
Everyone likes to feel appreciated. ‘Taking everything into account, was the service you received today very good/ fairly good / fairly poor / poor?’ One thing’s certain I don’t judge our patient satisfaction on the annual survey. We give them to the same 100 customers every year – regular customers we know and love. Well at least I don’t fill them in myself.
Most customers haven’t got time. To be fair, I never have time when the bank clerk asks me to do their questionnaire. Customers might agree to it if we’ve saved them time and/or money with a free cholesterol check or a free consultation for malaria tablets… The customers signed up to our ‘prescription collection’ service daren’t refuse my emotional bribery “Would you like us to collect your prescription from the surgery again next month? Well, could you take a minute to fill in a questionnaire for me please?” Patient satisfaction shows in the lack of complaints.
A customer announces that she has a complaint. Karen says “I’ll get the pharmacist” and tells me a customer wants to complain. My heart sinks. “How can I help” I ask the lady at the counter. “I’ve had a chronic stomach complaint for the last ten years…” says the woman. Oh great. I mean Oh no poor you.
The profession is calling for decriminalisation of dispensing errors but in the meantime we live in fear of criminal prosecution.
That’s the main reason we hardly use our mortar and pestle anymore. Older members of the public, who still remember chemists in white lab-coats, occasionally ask “Can the chemist mix me something up?” But pharmacists fear making a mistake and being liable. So to avoid risk, when it comes to lotions and potions with special formulations, pharmacists use specials manufacturers and the internationally recognised symbol of pharmacy – the mortar and pestle – sits on the shelf gathering dust.
Sometimes customers tell me I’ve made a mistake, but it turns out they’re mistaken. Take Mr & Mrs Trendy for example. Off to Goa they came to me for malaria prophylaxis. We sat together in the consultation room, Mr Trendy in his Lacoste top and Mrs Trendy with her Gucci handbag, calculating how many malaria tablets they’d need… One question to the female in the room always elicits the same raised eyebrow response from the male “Any chance you could be pregnant?” Does ‘No chance’ mean you don’t do it anymore?
The Trendy’s returned to the pharmacy five minutes after paying for their tablets. “I thought you said we needed 16 malaria tablets? This is a box of 12 tablets” said the young woman. “Yes but if you look, I’ve put an extra 4 tablets inside” I replied confidently, while she opened the box. “Oh yes I’m so sorry” she said. At which point the husband held up his bag, smiled and said to me “Look, I trusted you!”
One mistake I’ll never forget, was an easy mistake to make because father and son (Mr Smith and Mr Smith Senior) share the same first name. Labelled on the wrong Patient Medication Record in error, Mr Smith Senior was not happy when we delivered his ErectEase device to his son. Oops.
I learnt a lot that afternoon. For a start, I’d never seen a vacuum pump for erectile dysfunction before. They have constrictor rings to maintain the erection. Rings come in sizes 1-5 a choice of firm/regular and colour options of pink beige or grey. Grey I mused, is that for the Fifty Shades fan?