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Kristoffer Stewart: Not just a man in a white coat

"Eventually, I managed to regain my wits and briefly explained the nature of this chronic condition"

Pharmacists should remember how much of a difference they make to patients, says Kristoffer Stewart

This week’s Update module focuses on patients with newly diagnosed conditions. Looking through the advice made me think back to my first experience of this ilk and how, at the time, I felt thoroughly unprepared.

During my pre-registration year, a patient asked to speak to the pharmacist. I was sent out to gain experience and guided the patient into the consultation room.

“How can I help you today?”

“I was at the hospital with my fiancé Karl this morning and he was diagnosed with Parkinson’s disease.”

I was lost for words.

“I was hoping to find out more because we didn’t really take on board what the doctor was saying.”

I had nothing to offer but silence.

“What will this mean for Karl and I?”

My silence was becoming deafening.

The patient was clearly upset and anxious about what the future would hold. As a pharmacist, I should have been supporting her but my panic got the better of me. Flashes of BNF monographs popped into my head; I remembered the lecturer droning on about dopamine agonists and the word ‘tremor’. None of this helped me discuss Parkinson’s disease with a real patient who had a newly diagnosed partner.

Eventually, I managed to regain my wits and briefly explained the nature of this chronic condition. I asked her to come back in with her fiancé at a time that suited them the next day, when I would sit down and talk to them about it in greater detail.

That night, I went home after work and started to gather information on the condition, while mentally preparing myself for the questions the couple would inevitably ask. When I saw them the next day, we discussed the condition, the consequences for them and how treatment would work. Afterwards, they thanked me and genuinely appeared to have benefited from the informal chat. I felt a huge amount of satisfaction from the consultation and hoped I would have more experiences like these in the future.

I can’t recall the last time I set aside time like this for a patient. I don’t know whether this is because I have more knowledge now and do not need spend so long researching a condition, or because the demands of community pharmacy mean I have less time for these ‘chats’. Either way, this week’s Update module has reminded me of the importance of pharmacy in patient care – especially for those with newly diagnosed conditions.  On that day, I wasn’t just a man in the dispensary wearing a white lab coat and putting stickers on boxes – instead, I was a trusted healthcare professional helping a family through a tough time.

Kristoffer Stewart is CPD and clinical editor of C+D, and a locum community pharmacist. Email him at [email protected] or contact him on Twitter at @CandDKristoffer

Read more by Kristoffer Stewart


How often do you have time to discuss patients' conditions in-depth?

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Shaun Steren, Pharmaceutical Adviser

Sounds slightly engineered for purposes of the C and D - yes we know the modules exist. I would be much more interested in the human component of the authors meeting with a Parkinson's patient. What was his manner? What was his disposition? What were his sensibilities? How did he feel? What were his worries? What was his understanding? How did he feel he had been treated by the NHS so far? How did/does the very high workload environment of community pharmacy impact the authors conversation/s? Did this patient make the author reflect on the nature of his own profession? Of course this is considered an eccentric position in the tick box culture that is punitively enforced in community pharmacy. Such questions do not deliver payment nor a rapid production line output. The theoretical side of clinical pharmacy is easy, it is easily available and it is my own responsibility as a life long student. A C and D article ought to be an opportunity to say something interesting and original about the reality of the shop floor. The authors situation is interesting and I suspect the author is much more interesting than the article published, it is unfortunate that we don't get to find that out.

London Locum, Locum pharmacist

I applaud you,however, if you work for multiples they wouldn't be happy unless you could squeeze out an MUR/NMS, smoking cessation sign up etc... or sell them something they don't particularly need. The time you spent would be deemed a waste and If your MUR numbers were lagging a disciplinary could easily be your next stop. And if you made a habit of this don't be surprised if you were sacked. I Suggest you'd be better off going to medical school. Not perfect by any means but most definitley better than pharmacy.

Harry Tolly, Pharmacist

"because the demands of community pharmacy mean I have less time for these ‘chats’." .......... The real issue is staffing pressure and lack of resources allocated for front line staff. We would all love to do this day in day out and make a real difference to our patients. What is stopping this ? In my opinion shareholders rights seem to NOW come first in community pharmacy and this is the root of the problem. The DoH , whose responsibility it is to ensure that community pharmacy resources are used wisely, is headed by an individual living in the past and he lacks the foresight, planning capacity , tenacity and toughness needed to ensure that resources are used (through contractual obligations) for front line care rather than lining the pockets of the shareholders from off shore multiples.

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