By: Charles George, Pharm.D.
Charles George, Pharm.D. is a recent graduate from the University of Florida in 2011. He currently works as a community pharmacist for Walgreens Pharmacy in the Central Florida area. Since graduation, his daily interaction with patients revealed the need for pharmacists to adapt to the evolving role of community pharmacy. Thus, he wrote this article to reflect on an emerging aspect of pharmacy.
Disclaimer: We have altered the scenarios and names in this article to protect patients’ privacies. The scenario is based on true events.
It is 6:30pm in the community pharmacy. The usual after-work rush is winding down. You can just feel the sense of relief in the air. The pharmacy technician takes a deep breath and slowly exhales. She looks out to make sure there is no one else waiting, but she soon hears footsteps coming closer. The technician hopes that it is someone just walking by or shopping for some vitamins. However, it is a woman maybe in her 40’s in disheveled clothing. The woman approaches the pharmacy counter carrying something in a white shopping bag. Releasing a big sigh of relief as she glares into the eyes of the technician, the woman states, “I hope you can help.” Watching and listening, the pharmacist, just three few weeks removed from licensure, takes a small gulp, murmurs under his breath, “Lord, I hope I did not miss-fill a prescription.” The white shopping bag contains about 10 medication bottles, and some have their labels fading and are barely readable. The woman at the counter, in a very tiresome voice, asks, “What are these medications?”
While community pharmacists are the most accessible health professionals, their presence is frequently invisible to patients. May be as far as six years ago, the pharmacist was “The Wizard” in the back, appearing to the window only if “summoned.” Today, it is common to see pharmacists engaging with every patient, and empowering patients to take control of their own health needs. Pharmacists are administering vaccines, providing health tests, and counseling on over-the-counter products. However, we still do not full realize the community pharmacists’ best assets. Pharmacists are medication experts, and have profound abilities to communicate with patients about their medications and disease states. Yes, medication therapy management (MTM) would be the best word to describe the new role of pharmacists.
As the above incident unfolds, the pharmacist steps in to help, and invites the woman to sit down in the pharmacy’s break room. The woman is the sole caretaker of her mother (the patient), who has Alzheimer’s disease. Until few months ago, a home nurse cared for the patient; however, the patient’s symptoms progressed and she moved in with her daughter. During the conversation, the pharmacist explains the medications’ indications and writes down the important counseling points. He also provides the woman with a pill organizer. The pharmacist discovers a few undertreated diseases, duplications of therapy, and symptoms of potential drug-induced adverse events. He also provides information about the disease states. Even then, there is something quite not right about the situation: the woman’s appearance. The pharmacist reaches his hand over her shoulder, and asks, “How are you doing Ms. Jame?” Her eyes swell with tears as she lifts her head up. She looks at the pharmacist sitting in front of her, and proclaims in a broken voice, “I am trying to be strong.”
MTM is an overlooked and valuable service that pharmacists provide. In the patient-centered healthcare model, MTM reduces healthcare costs. However, due to the lack of reimbursement for the time and other factors, many pharmacies and pharmacists are shying away from this important service. Ms. James, who walked into the pharmacy six years ago, may not have gotten a chance to see the pharmacist. The technician simply could have taken the bottles to the pharmacist and written their indications on the labels.
Medication and disease state knowledge are always involved in MTM. However, asking open-ended questions, being empathetic, finding the best way to communicate, and confirming patients’ understandings are the principles that bring everything together. When Ms. Jame arrived to the counter, I was able to utilize the lessons that my professors and preceptors repeatedly drilled me on. I have had several encounters with Ms. James, and I am glad that I can provide her with information about support groups for Alzheimer’s patients. Nowadays, she is in better spirits; we consolidated and explained her mother’s medications to her.
I believe that if you are ready to show your value as a pharmacist, the recognition will follow.