Every day I learn something about myself and my pharmacist practice. I keep a Pharmacy Practice journal to reflect on my day. What went well? What could have been better? What do I need to learn?
Talking to patients is a privilege. It’s also an art. I’m naturally empathic toward patients, but I need to work on being focused on the person in the moment when I talk to them. There are so many distractions and sometimes I find my mind wanders. I’m trying to do better. The following is an example of an interaction I felt good about. More importantly, I started to develop a relationship with this woman and her husband so I can know them and their healthcare needs better.
The dispensary is busy. The phone is ringing. There is a billing issue that needs to be resolved. A staff member asks for time off. I’m getting pulled in different directions with my new responsibilities as a pharmacist and owner. I’m feeling scattered and unable to focus well.
Then I’m asked to counsel a patient on a new medication. I walk to the counter with all these distracting thoughts running through my head. When I get there, it is the wife of the patient. She looks tired and worried. I’m pretty sure I’m the last person between her and her husband getting home. I greet her and I look at the hospital prescription and the number of bottles between us on the counter. I take a minute to review the prescription, but really I’m pausing to focus my thoughts on this women and her needs. Here is the conversation:
Me: Hi, I’m Catherine, your pharmacist. I see here that Jim [ not his real name] has just come from the Royal Jubilee [in Victoria]. That’s a long drive.
Her: Yes, Jim is in the car. It’s been a long couple of days.
Me: What happened?
Her: He had a couple of blockages in his heart. He had to have two stents put in yesterday.
Me: Oh, my, I’m sorry to hear that. How is he doing?
Her: He says he is alright, but I know that he didn’t expect any of this to happen.
Me: I imagine he is overwhelmed with everything that has happened in the last few days. [I pause for a moment to give her space to absorb my words.] So, what did the doctor tell you about the medications he has to take now?
Her: The doctor didn’t say very much but the nurse went over them in the unit. It’s a blur though. Jim was discharged yesterday. We stayed in a hotel overnight to be close to the hospital. I didn’t sleep because I was so scared he would bleed under his bandages.
Me: Getting a good night’s sleep in a hotel room is hard under the best circumstances, never mind this one.
Her: There are so many of drugs. I don’t know where to start.
Me: That’s okay, together we can figure this out. But first, tell me how he ended up in Victoria?
Her: He was having some chest pain so he went to the doctor. He wasn’t worried really, but the pain wasn’t going away. Then he was sent to Victoria for this test. Jim drove us there, but I had to drive us back. I don’t like driving in the city. At the hospital, they told us, if they needed to while they were in there checking his heart vessels, they would fix any blockages they found, but we were surprised. Jim is healthy and very active. He eats well and exercises. It’s not fair.
Me: It’s not fair.
I’m thinking to myself: Jim and his wife are not ready for this conversation about their medications. I doubt his wife is going to remember anything I tell her because she is anxious about her husband and tired from the drive. She just wants to get home.
Me: I can see that you are tired and I imagine Jim is too. While all of these medications are important and Jim needs to take them as they were prescribed, let’s focus on two right now: the baby aspirin and this medication called clopidogrel. You have the bottle of baby aspirin here. Okay? And here is what the clopidogrel looks like. It’s important for Jim to take these two medications every morning to prevent the new stents from becoming blocked. When Jim is on these medications, he needs to know that he is at an increased risk of bleeding since these medications reduce the ability of the blood to clot. Can you remember that?
Her: Yes, thank you. The baby aspirin and this pink pill. Okay. A risk of bleeding? What about his surgical wound?
Me: Yes, that could be a problem. Did they give you instructions in the hospital on how to take care of it?
Her: Yes, I have the information sheets in the car.
Me: Okay, follow those instructions. It should be fine, but you should know what to do if there is a problem. You’ve managed so far. You can do this.
Her: Okay. Yes, I think I can, it’s just so much.
Me: I know. Do you think you can manage for a day or two with the rest of these medications? I can call Jim or you, or you both can come back here and we can go over the rest of this list.
Her: Yes, I think we can manage for a day or two. That’s good, we can call back.
Me: You have had quite an ordeal so let’s get Jim home and we can talk again when he is rested. Make sure Jim takes the other drugs too. The directions are on the bottles. I’m only a phone call away. I’m also on call this week so here is my card and my cell phone number. Okay?
Her: Okay. Thank you.
Me: Anything else that you want to know right now?
Her: No – I’ll call, or Jim can probably call, tomorrow or the next day. Thank you.
Me: Get some rest and we will talk soon.
During this conversation, the dispensary is still buzzing, the phone is still ringing, I’m anxious about the pile of prescriptions waiting to be checked, but for a few moment, this woman and her husband are all that matters. I make a note to call her in a couple of days if I don’t hear from them. I make some brief notes about our conversation and what I need to cover next time.
It’s hard, but I’m learning to pause, centre and focus in the moment and on the person in front of me. This woman and her husband are all that matter right now. The rest can wait for a few minutes. It takes practices to not be distracted in that moment. I’m working on it, but I remind myself that this is what I do for patients. It matters.
While many folks already know this news, Darryl and I, and our partners, are the proud owners of the Medicine Shoppe Pharmacy 169 in Comox, BC. How we got here is a long story and material for multiple posts on this blog. I will tell you though that it was a great decision and I’m loving the work that I do.
Cheers, Catherine Location: Comox, BC
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