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Insight: Making the right call

By Alexander Humphries*

Experience tells me that it is never a good idea to answer the phone on a Monday morning half-an-hour before the pharmacy opens. Last week I broke the habit of a lifetime and picked up…

The caller, an ex-military man in his 80s, explained that he had been vomiting since 10pm the previous evening, but the last time “it looked like ground-up coffee”.

At this moment in time my focus was entirely on the patient, who was suffering not only a potential GI bleed, but was on rivaroxaban (which had replaced the warfarin he had been taking previously). It was only afterwards that I thought about those who try to differentiate between community and clinical pharmacists… but back to the story.

The patient had begun the call by saying he’d “been waiting for us to open for hours’’ and refused to hang up and dial 999. Clearly, this man’s ‘no nonsense’ military attitude was stopping him getting the help he needed. I persuaded him to hang up while I spoke to his GP.

The GP confirmed that calling 999 was the right course of action, especially with this patient’s multiple long-term conditions. Armed with my PMR records I dialled 999 on the patient’s behalf, arranging for an ambulance to take him to hospital. I then spoke to the patient again to tell him about the conversation with his GP, and the importance of him cooperating with the paramedics.

Unremarkable

Now, this story isn’t in any way remarkable because it is the sort of clinical intervention that goes on in community pharmacies every single day. Yet if you listen to the nonsense coming out of NHS England and the Department of Health, all we do is shift products from A to B.

The story continues a few days later, after the patient is discharged. He calls to say thank-you to the paramedic, the hospital ward, the consultant, the junior doctor, the GP – it doesn’t matter he never said thank-you to me; I was just doing what anyone would – plus it underlines to me the regard he holds us in. We are like a leg of his stool. He doesn’t think he needs to thank us because we are part of his everyday life.

When there is a problem, it isn’t the GP he rings – it is the pharmacy because we’re there when he needs us. When there was a problem with his discharge medication and he needed more advice, I was able to provide this on demand and for free, as thousands of us do every day. Crisis averted again.

If all this wasn’t completely unbelievable already, he rang back again the next day, experiencing the same symptoms as before and we had to go through the whole thing all over again!

Clueless

With all the talk about the value and the role of pharmacy from clueless civil servants and NHS bureaucrats, this patient has done more to show me what people really think of us. They don’t see us as ‘just’ suppliers of medicines. They don’t see us as non-clinical (or even clinical, come to that). They simply see us as an essential part of their everyday lives. The paramedic and the hospital doctor are important, but they are unusual – that is why he felt the need to thank them.

What would have happened to this patient if the pharmacy was not there? Would he have gone to A&E or the GP? Would he have sat at home, happily bleeding away until he was in a serious condition? We’ll never know. What is clear is that we are the “people’s professional”: accessible, knowledgable, competent.

Blinkered

The real shame here is not that the Government wants to cut pharmacy funding. It is that it doesn’t see the vast potential, or even recognise, what we actually do beyond the supply of medicines. This blinkered approach is why we are in the firing line.

We supply free healthcare advice every day, year in, year out. Just imagine the impact on GPs, A&E or out-of-hours if patients who would normally speak to their pharmacist, suddenly started turning up at these expensive services.

The quantifiable value of our advice stretches into the billions and is just as much a part of medicines optimisation as a MUR or a full clinical review. Such advice happens informally because most pharmacists view this as part of the package of care they provide. It is only fair and right that the true value of pharmacists, and the positive interventions we make every day in the lives of the public, are properly recognised. #lovemypharmacy

 It doesn’t matter that he never said thank-you to me

Pen name of a practising community pharmacist. Alexander Humphries’ views are not necessarily those of Pharmacy Magazine. Give us your examples of your everyday heroism. Email: pm@1530.com

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