I work as a pharmacist in general practice and this incident was a career-defining moment and one I will never forget.
I have been a pharmacist for over 20 years and this was the most professionally frightening situation I have ever found myself in. Whilst I cannot reveal my identity for obvious reasons I feel that there is a compelling need to share this experience to make sure others do not find themselves suffering similarly.
It was a Wednesday.
I came early to work to catch up on emails. The duty doctor was late so I decided to look through the triage calls to see if there were any patients that I could deal with. If I feel that the presenting complaint is something within my sphere of competence I will book patients into my afternoon clinic later in the day.
I saw a call logged on the list for a young patient who was reporting suffering with palpitations. As this was not a clinical situation I felt competent to handle I moved on to help other patients.
After helping some patients I got on with starting my clinic at 8.30am. In the afternoon every day, I have a number of slots that can be used by the duty doctor to give me patients to see. The presenting complaints must be within my scope of competence.
At 12.30 I realised I had some patients booked. It was at that moment that I realised that the patient who phoned in previously with palpitations was booked in with me.
My pulse quickened.
I swiftly looked to see who was here. I realised there was no doctor, nurse or healthcare assistant in the building. The duty doctor had left just after midday telling reception staff:
“I’m just popping out.”
I managed to catch the paramedic practitioner in the car park. I went through with him what I would do. What questions to ask etc. He told me that if the patient had any chest pains to immediately send them to A&E.
I asked the patient to come to the room. They presumed I was a doctor. I corrected them to inform them of my title. I asked if they had spoken to a doctor this morning and they said:
“No. The receptionist just asked me to come at 1 pm.”
I began asking questions related to their palpitations and realised they were not feeling well. On examination, the patient had a blood pressure of 171/121 and was currently feeling chest pains. I informed the patient they would need to go to A&E.
I asked the reception staff to phone for an eight-minute ambulance. As luck would have it the practice foundation year two doctor happened to come back from lunch and supported me in dealing with the situation. He stayed with me until the paramedic arrived. I arranged for the emergency bag/oxygen/GTN spray to be ready in the room.
The paramedics came within six minutes and I handed the patient over to them. The patient had an ECG and was taken straight away to the hospital.
One hour and thirty minutes later the duty doctor came back. I informed them about what had happened in their absence. I was clear that I felt that it was not acceptable to leave me on my own or ask me to deal with a situation like this which was out of my area of competence.
I asked them why they had not called the patient to triage them?
Why did they just lift and shift the patient to my slot?
How or when have I demonstrated any competence to deal with palpitations?
So what should I make of this situation as a pharmacist now working in general practice?
I was left without clinical supervision.
I was asked to deal with a situation outside of my clinical competence.
I was left with an acutely ill patient to deal with this on my own.
The situation felt unsafe and to be honest I was scared.
I have completed an incident form and submitted it to the practice. It will hopefully be discussed at the next clinical meeting.
The modules completed so far for advanced clinical practitioner (ACP) training have not equipped me for this. My indemnity does not cover me to deal with this. I have felt afraid and to be honest scared. I am questioning and rethinking my decision to pursue becoming an ACP.
I worry if I will be put in a situation out of my clinical competence.
I am sharing this to ensure colleagues speak up and make it very clear about the supervision of practice in their training. While general practice needs pharmacists to step up and see patients it has to be done in the correct manner within recognised training frameworks.
We have collectively decided to pause me doing slots until a change in the structure of my working day reflects the availability of close clinical supervision.
However, this incident highlighted how general practice and general practitioners are pushing me into areas outwith my area of competence.
On this occasion, I felt it necessary to stand up for what is right.
The author, who wishes to remain anonymous, has experience in medicines management, community pharmacy practice as well as five years in working in general practice. The author has a number of post-graduate diplomas in various clinical areas and has a track record of dealing with professional challenges in a coherent calm manner.
Good on you to raise this as an issue and hope this is discussed at the next practice meeting with input from you too!