My morning in practice

We talk a lot about the importance of focussing on the individual in healthcare and this was in the forefront of my mind when in the pharmacy this weekend. I was checking the regular repeat prescriptions and was puzzled by one for 3 x the regular amount of oestrogen for a woman of 45. Concerned for the safety of the patient, I needed to know more… I work in practice every other Saturday and so this patient was not known to me. A conversation with the lead pharmacy technician and the puzzle was solved – this lady was on medication as a transgender patient and under the care of a specialist. I was reminded yet again of the importance of being inquisitive and communication with my pharmacy team.

If we had not had the knowledge of the patient nor good dialogue, then that individual could have been subject to embarrassing questions and having to tell their ‘story’ yet again. The importance too of the Summary Care Record which would have been my next port of call.

This moment in practice reminded me too of the article I contributed to earlier in the summer – excellent writing from Sasa Jankovic.

My second moment of reflection involved a gentleman who was prescribed amitriptyline for the first time. He was also on sertraline and pregabalin and so clearly a need to engage with him further about the risk of enhanced (serotonin) side effects and understand more about why he had been prescribed it. The records indicated he was taking for anxiety and sleep rather than neuropathic pain. He shared with me his mental health issues and concerns about taking any medicines; over the next ten minutes or so, we agreed how he would take his new medicine to minimise side effects (building it up gradually) and to come back in if there was anything he was concerned about. Nothing unusual in this interaction other than his question back to me “is this new?” he asked. Meaning the conversation we had had. He then went on to say that in all his years of taking medicines (from being a teenager to 53) no pharmacist had ever spoken to him about his medicines and how he felt about taking them. Pharmacists – we MUST change this. Every single patient on a medicine deserves our attention at some time. PLEASE PLEASE take the time away from activities that others can do, and ask questions, listen and help. It’s one of the most rewarding things we can do – it will give you a glow and your patients will love it.

My final story is that of a young woman with a new Rx for amitriptyline (and co-codamol 15/500) and so I went out to find out more and give her some advice. Thinking this might be simple neuropathic pain, she shared with me (and showed me) the worst urticaria on her legs and arms that I have ever seen. She was beside herself with pain and itching but more disturbing for her was that she had absolutely no idea as to why this was happening to her. It had started about 8 days ago and was not getting any better – she could attribute nothing to this condition. She has a blood test and referral to a dermatologist as the GP was none the wiser but in the meantime, about ten minutes with her on some coping strategies, some empathy for her tears and she walked out feeling a little more in control. We are blessed with this opportunity to make a difference.