COMMUNITY PHARMACY IN PRACTICE: WHAT’S UP, DOC?

COMMUNITY PHARMACY IN PRACTICE by David Amoroso

PART I

Community Pharmacy can be described as retail operations providing prescription services, OTC sales, and often, overlapping services of convenience store and cafeteria. The business may be a small pharmacist-owned and managed enterprise, or part of a large chain-store empire.  Either way, this type of business serves walk-in customers from the community, or at least people who have business in the neighbourhood.

In the rural district where I work, the Community Pharmacist occupies a unique position in the social system. Most customers live and work in the area and many have built close relationships with the Pharmacist and the rest of the staff. Friendships develop over time and truly one can say that the pharmacist and the practice are embedded in the community. The pharmacist is the most accessible healthcare provider, and besides acting in that capacity, is called upon to act as family counsellor, nutritionist, fitness instructor, and sometimes, just a listening ear.

As a healthcare provider, besides the filling of prescriptions and all that goes with it, the pharmacist is frequently called upon to recommend treatments for minor ailments, or make referrals for more serious ones. The pharmacist is obviously trained and qualified to deal with matters of this nature. And therein lies a certain matter of etiquette. A nurse or doctor can be addressed by their titles, but how do you address the Pharmacist? The whole word sounds abstract, and if you say ‘Pharm’ , one might think you are borrowing from Machel Montano’s ‘Famalay’.  So many people make a tentative approach with the  title ‘Doc’. And then the pharmacist has to explain nicely and gently, that the title is misplaced, and he can be addressed by name. But still some people choose to use the title, ‘Sir’, or the older version, ‘Druggist’.

The Community Pharmacist must be the provider most called upon to provide healthcare by proxy. It is not unusual to have a customer come in to request some remedy for a relative at home. Then what follows is a flurry of phone calls to and from home, relaying messages about the patient’s condition because the ‘gas pain’ could be something more serious and the child with the cough may require medical evaluation. To compound matters, the patient may already have had prior treatment with some ‘white tablets’, or syrup in a ‘blue box’, which may or may not have helped. With the proliferation of smart phones, Tele-Pharmacy may be off to a great start.

PART II

Apart from the very common self-diagnosis of ‘gas’, the next most common ailment is an inability to sleep. Sometimes this is put down to a matter of ‘nerves’, or some long-standing characteristic of insomnia. In some cases the patient would have become dependent on tranquilizers and would try to put forward a convincing case of having had his sleep aberration certified by prominent medical practitioners. Of course, on engaging the sleep deprived client, it would emerge the he is a chronic alcohol abuser, or otherwise has a dysfunctional relationship with his family. This is a difficult situation to resolve as counseling services of this nature are unavailable, inaccessible, or maybe unaffordable.

An interesting situation arises with those diabetic clients, who besides filling their prescriptions, would request a rapid finger-prick test to monitor their control. Inevitably, the question of diet comes up, and it is appalling to learn that many of them have never been counseled by a dietician, and those who have, may only have had a single session. Of course, the pharmacist can only counsel in general terms, such as portions, and regularity of meals. But this is certainly a step up from what obtained years ago, when the patient would say that the doctor told them to eat ‘green fig’, meaning, cooked green bananas in lieu of foods like rice and flour.

Hand in hand with the diet, comes the need for an exercise programme. If patients are truthful, many of them actually adhere to some sort of exercise regimen, mostly walking. Of course, those who look like they need it most, generally are quite delinquent in this area. But we still have to give them ‘the talk’ which they acknowledge graciously, if a bit shame-facedly.

But there are those that we have to refer to physiotherapy. They come with aches and pains from old injuries, or diagnosed pinched- nerve and consider analgesics as a way of life. These patients are ever hopeful that we can provide some remedy that would banish their pain forever.

But the people who occupy most of my time are, quite frankly, those who do not need any medicine at all. They come from all strata of society: old, middle-aged, young, rich, poor, male female. They come, ostensibly, to seek advice on some minor complaint or ongoing medical treatment. Advice is given and received without much fanfare, but the chat continues and soon evolves into a discussion on family life and relationships, work life, or overall contemporary issues, local or international. This type of interaction can span a bit of time and is curtailed only when duty calls either party away.

Being a Community Pharmacist is certainly an interesting role, to say the least. It combines the delivery of professional services within an informal setting, allowing for closer relationships to be developed between client and healthcare provider. One barrier to adherence to treatment is the patient’s intuition having a negative impact on the prescribed treatment regimen. Without being an active participant in the treatment plan, some patients are reluctant to place their lives and health unreservedly into the hands of their medical care providers. It is not that they do not trust the provider’s knowledge, but more the fact that there is a divide between what they are told to do and what they would prefer to do. The community pharmacist bridges that gap.