OPINION


loSIng oUr ProfESSIonAlISM? n


by Terry Maguire


ever liked working Saturdays - still don’t – yet, every Saturday, here I am twiddling


my thumbs for the first hour while the locals gently snore in their beds. Saturday’s a very different day; fewer prescriptions, periods of sheer boredom followed by moments of incandescent mania. That’s if I’m lucky!


The first Saturday of 2017 was no exception. Winter ailments brought a mid-afternoon oTC bonus and, what is becoming increasingly common on a Saturday, three ‘distressed patients’. A distressed patient is one presenting with a prescription they failed to have dispensed on friday afternoon or Saturday. They are in agitated need and pained frustration.


The ‘distressed patient’ is, I believe, a manifestation of our failing professionalism. It’s a tragedy that will, if unchecked, diminish our public standing and accelerate our replacement by clucking robots and micro-circuit algorithms.


The three ‘distressed patients’ that Saturday had each visited at least six other pharmacies; one had been to nine. given that many pharmacies are closed on Saturdays, this reflects a homeric commitment to obtain a medicine they believed essential for their health and wellbeing; so they should be taken seriously.


46 - PhArMACy In foCUS


The first, a woman in her 30s, presented a prescription for macrobid 100mg caps; one twice daily. A long- term item on the shorts-list (manufacturer cannot supply), I told her she would be unable to get macrobid and offered her nitrofurantoin 50mg four times daily for the same treatment duration. It was, I reassured her, the same thing. Why did other pharmacists not do that? not sure.


My second distressed patient was a 60-year-old Syrian gentleman seeking an emergency supply of enalapril 10mg tabs for his wife. They live in Dublin but were staying with family in Belfast for two weeks and she had forgotten her medicine. I supplied 30 tabs; one daily through the emergency supply mechanism and charged him. he was extremely grateful and, in broken, faltering English, asked why other pharmacists had not done that? not sure.


finally, and perhaps I was out of line here, a lady with a prescription for Tamiflu 75mg; one twice daily for five days. her sister was in bed very ill with flu and she had been to nine pharmacies. I explained that all I had were 30mg caps and 45mg caps, but that they were out of date. how much out of date? I explained that, in the worst-case scenario, we were looking at the dose diminished by perhaps five per cent – and so 95 per cent of the drug remained in each capsule. She said that she would take


them and, after some discussion, I supplied them.


oK, the last example seems a bit unreasonable. To supply out-of-date medicines, never mind a different dose to what was prescribed, would be too much for most pharmacists. It would constitute unprofessional practice and that’s why I returned the prescription having made a copy of it and registered my transaction as an emergency supply. I gained no fiscal benefit.


But was it really unprofessional? True professionalism is not complying with company SoPs. rather, it is looking after the interests of the patient first and foremost. Indeed, true professionalism is defying company SoPs when necessary. The question is; was it more professional to supply what I had or not supply at all; offering a supply on Monday morning – four days after the script was produced?


This should create an interesting debate – Monday supply for Tamiflu is too late - but few pharmacists see this as a professional question, so hemmed in are they by SoPs that they have become automatons. Each of the nine pharmacies visited on friday and Saturday had Tamiflu in stock – stock owned by the Doh – and all is currently out of date. SoPs and their company policies mean no Tamiflu.


But the nitrofurantoin refusal is just silly. If we are true professionals, capable of doing more than a qualified technician, then we should know that the blood levels from macrobid 100mg b.d. and nitrofurantoin 50mg q.d.s. is pharmaceutically and clinically the same. And the Syrian man? Well I can only think some are just too lazy sometimes.


As a profession, we have, over the last 20 years, been moving in the wrong direction. We have become risk-averse SoP junkies, more interested in protecting ourselves and the monolithic companies we work for, than truly looking after our patients and, if necessary, taking the flak when it comes. our regulators don’t help.


If pharmacists become too SoP obsessed and run mechanistically, then I believe we are risking the end of pharmacy as a profession.


With robots and other emerging technologies, many are asking why we need these expensive professionals, when suitably qualified technicians can do an equally functional job.


But then, if each pharmacist acted in a truly professional manner, my Saturdays would become really boring. •


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