COMMUNITY pharmacists are a fascinating breed. I love meeting and working with people that have been in the profession for many years. These folks have had month after month of quietly spotting dangerous diseases, reassuring new mums, counselling those that are feeling down and sometimes just being asked directions to local amenities.
Answering some basic healthcare questions to playing a role in a serious intervention, this crop of talented, highly practical, professional people go quietly about their daily business.
Perhaps this quiet, risk averse approach is exactly what the profession needs to evolve away from…or is it hold on to?
With this in mind I thought I would give a flavour of some extremely common scenarios that any given community pharmacist comes across in day-to-day practice.
The panicky new mum
Whether it’s a young or more mature first time mum, the anxiety evoked by this new venture is always significant. The key here as a community pharmacist is to take a holistic approach and as you deal with the common childhood complaints like colic, formula milk choice, or perhaps reflux, consider how the mother actually feels.
Here lies the greatest potential positive impact pharmacists can have and perhaps then indirectly the greatest impact s/he can have on the overall care of the child. Using your close relationship to work out if she is depressed or perhaps smoking, could be the best thing you can do for the child, not the mother.
The depressed man who doesn’t want to talk
We already know that men are really not very good at presenting to the GP. I’m not sure why, but this group, in my experience, sometimes feel comfortable enough to have a quick chat in the pharmacy but will never ‘bother’ the doctor. The accessibility and close relationships community pharmacists can develop over time make this possible. A brief intervention with a man who is depressed might just be enough to make him avoid harmful behaviours or something worse.
I love the familiarity of this type of patient: they order their script from the GP on a Monday then call into the pharmacy everyday until it arrives. I always try to remember that the interactions that some people have with me or my team could be one of the few they have that week or month. I feel it is important never to underestimate the importance and significance of simply acknowledging or saying hello in this case.
We see all types of people:
- The uncontrolled asthma patient
- The elderly patient taking an NSAID with no PPI cover
- The child prescribed an overdose of dexamethasone for croup
- The Alzheimer’s patient who takes every tablet except their Donepsil
- The 45 year old smoker who presents with a cough and cannot sleep on one side because of an ache in the chest
- The cancer patient who is struggling to face their own mortality and comes for support
- The mother an ADHD child who has not slept properly for months who asks for help
- The asthmatic who wants to buy ibuprofen over the counter.
The list goes on, and we could see all these people in a single day. How many adverse drug reactions do we prevent? How many times do we spot an undiagnosed condition? How many hospital admissions to we prevent?
All this without access to patient records. The ability to see the full patient story and previous interactions with other clinicians previously would help us improve patient care, whether the pharmacist is a prescriber or not.
Proper training in diagnosis and a firmer grounding in clinical skills would have to accompany this shift, but in my view community pharmacists are in a great position to take on this role. Many of the skills nurtured in the traditional supply role by pharmacists are transferable to a more clinical role.
The move away from a technical role of dispensing has never been closer and the oversupply of pharmacists as well as the rise of automated supply could be just the nudge the profession needs to make the leap.
Johnathan Laird is a community pharmacist independent prescriber with a special interest in asthma. He is based in Aberdeen