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Just another day in community pharmacy

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I’VE been a qualified pharmacist for over 20 years now and often wondered if people really know what we do day-to-day. I don’t mean the mindless drudgery of dispensing prescriptions and accuracy checking them – that’s another story it’s the patients we speak to that makes it worthwhile. And we see these patients frequently, very frequently. We get to know about their lives, their families, their experiences as well as their illnesses and they get to know about us. Spending time with patients is rewarding, no more so than when we are able to help.

An emergency, a christening and a funeral

I won’t forget Mary any time soon. She was a stroppy alcoholic with spider angiomas on her dry pale face; obvious ascites and she used a walking stick to hobble along. She was grumpy and rude, but needed help as she’d run out of her Ventolin: “you’ll need to give me some” she demanded in her raspy voice, using expletive peppered language as she stared menacingly at me through bloodshot peephole eyes. As the nearest surgery was 3 miles away (my pharmacy was in a village with no GP) I sorted her out with a supply and she left marginally more pleased than when she entered.

The next time I saw her she was clutching some paperwork that need to be witnessed and asked me to sign it for her. I saw her many times after that and each time she became more and more friendly, she had a good sense of humour and we all enjoyed her frequent colourful visits.

One of the last times I saw Mary, she was in a bad way – she’d managed to struggle to the pharmacy to pick up her medicines, but was very tired, dizzy and could barely stand. We offered to phone her a taxi, but she explained that she was banned – due in part to her somewhat abrasive nature. No surprises there.

As she only lived 5 minutes along the road I offered to drive her and we managed to help her into the front seat of my lovely new car. We got to her house and it was then that she confessed that during the short journey her bladder control had let her down and she’d inadvertently christened my car. I vowed that the next car I bought would have leather seats.

Not long after this episode Mary passed away and a colleague and I paid our respects at the church, it just felt right. I won’t forget Mary.

Your sore vein

I remember another day vividly. An elderly lady nonchalantly walks in to the pharmacy with blood spurting from her leg. As the blood soaked into the carpet (tiles) and dripped from the sales gondola she came up to the counter and asked for her prescription, completely unaware of the drama she was creating.

“Err, excuse me I think you’re bleeding,” my dispenser said to her. Understatement.
I came out of the dispensary, looked at what could have been a scene from Dexter and marvelled at the way her foot was almost floating in the blood that had accumulated in her shoe. “Are you OK?” I ask the lady. She confirms that she’s perfectly well. Blimey. I check for signs of Jeremy Beadle. Nope, it’s all clear, this was happening.
“I think you’d better sit down, you’re bleeding from your leg,” I advise her. Unfazed she sits down. Blood continues to decorate the pharmacy.

I then remember the advice I got in first aid training: “Stopping bleeding from a varicose vein is very easy, but it looks impressive.“ Magic. I spring into action, well my dispenser does. “Bandages and plenty of them please,” I say to her.

I reposition the lady on the floor, raise her legs and place them on a seat and proceed to mummify her bleeding limb. The blood soaks through the bandages. More bandages. More. Eventually the flow of blood is contained and the elderly lady seems to have enjoyed the attention. “I’m sorry for the fuss I’ve caused,” she says. “No problem at all,” I say.

We agree that it’s best she gets her leg checked out and so my other dispenser drives her to the local casualty department. I go back to checking prescriptions. My dispenser begins the extensive clean up of the crime scene.

Other days are less intense: we get calls from elderly patients telling us they’ve run out of medicine and that they need them for that night. Can we deliver it, oh and can we bring some bread and milk too? We patch up kids and adults with cuts and grazes, check kids for head lice, look at people’s feet on request (I try to avoid this…) and listen to them describe (unprompted and unedited) details of their bowel habits.

Poor relations

So amidst the routine of pharmacy: picking up prescriptions from GP practices and dropping off repeat requests; dispensing repeat and acute prescriptions; ensuring they are appropriate and don’t interact with any other medicines; chasing manufacturers for medicines that are in short supply; phoning GPs with prescription queries; speaking to reps and getting the best deal on drugs (to ultimately benefit the NHS); receiving, checking and packing away the many drug deliveries; supervising methadone and suboxone; providing the smoking cessation service; answering telephone queries; supplying medicines on the minor ailments scheme; undertaking emergency contraception consultations; and completing all the paperwork, we do spend a lot of time with patients. And those times are the best times.

Unfortunately there’s a sense that community pharmacists are the poor relations compared to their more clinical hospital colleagues just because we are based in shops often in high street settings. These are often daubed ‘commercial pharmacies’ by some, but anyone who thinks we’d put profit before patient care has never spent any time in a community pharmacy. In fact it’s these locations and the accessibility that make community pharmacy what it is, enabling us to provide care and support where and when it’s needed.

I urge all GPs to spend some time in community pharmacies and see what we really do and how we can work better together for the benefit of patients. But then, what do I know? I’m just a community pharmacist.

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