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Pharmacist - sometimes willingly

Dressing up for Death

Yesterday was one of those days that has been imprinted into my memory for life.  As most of you will know by now, the first of October 2011 saw the advent of a brand new service under the Pharmacy Contract, called NMS.  A short acronym, but it looks easier to say than what it really is, for the simple reason our minds have been conditioned to put ‘M’ in front of ‘N’ and not the other way around.  In any case, back to the topic.  NMS stands for New Medicines Services, and its inception has been brought about by the phenomenon of low adherence to newly prescribed medicines and the NHS’s brief to minimise waste and save money.  In truth, my description may sound flippant, but this is serious business, in that statistics show that between 30 and 50% of newly prescribed medicines are either not taken in accordance with instructions, resulting in less than favourable outcomes, or the user just stops taking it for a raft of reasons. Low or non-adherence costs the NHS millions and is ultimately a massive waste of the taxpayer’s money.

In short, the NMS process calls for the pharmacist and patient to meet up at least twice after the medicine was first dispensed.  During these consultations any threat to adherence is to be addressed.  It is also seen as an opportunity to ‘zero-in’ on any lifestyle issues.  This is of course a simplified and very watered down version of the process, but I thought I would include it for the benefit of my non pharmacist readers.  Off course it stands to reason, if you do want to know more about the service, please contact your local friendly pharmacist. lol

OK, so yesterday, DrugMagister was scheduled to do the first of the two ‘return’ interviews for four patients, and I would like to tell you about one of them.

My patient was a 73-year-old lady that you would be forgiven if you had guessed her age as 60 tops.  She was in the ‘tail end’ of a 3 week old chest infection and did sound if she still had some phlegm on the chest, but otherwise was in good form and spirits. Need to mention here that my patient, at her age, holds down two jobs at local charities, resulting in her logging no less than 30 hours per week.  Impressive if I may say so myself.

She had been recruited into the NMService by one of my locums, which, in hind sight was in error, as the prescribed Ventolin inhaler was not intended for the treatment of either asthma or COPD, but rather just to help her over the bout of chest infection.  But seeing that she had made the effort to come in see us, I could not find it in my heart to cut short the consultation, but decided to let matters develop naturally, and my god, was I blessed for having made that decision!

The patient reported that she had used the inhaler exactly as instructed but had failed to notice any real benefit.  Here is what she told me.

‘I sat down to take my first inhalation fully expecting to feel a buzz similar to what I suspect you would experience after having a gin and tonic.’ (need to mention that she is a teetotaler) ‘Well, I took the first puff and did not feel anything. This puzzled me as I had seen asthmatics use inhalers before, and after they had taken the puff, they normally sit back and with a big sigh say “Ah”.  Well I waited a while, wondering if it might be a delayed reaction but nothing happened.  I was quite excited to use this inhaler but now was disappointed as I did not experience any ecstasy.’

And that set the tone of the consultation.  I was in stitches most of the time as this dear old lady had me hanging on her every word.  It was like having my own personal sit up comedian.  As I did have a second pharmacist on duty, I will shamelessly admit that I allowed the consultation to last in excess of thirty minutes – I was just having such a fun time!

Somehow, the conversation did turn to her advanced years, and in that relaxed atmosphere she told me about one of her greatest concerns.  In order to understand the story I have to start right at the beginning of the topic.  Her morning routine starts by her ‘putting on’ her ‘face’. ‘The World can not see me without my ‘face”  This process is necessarily reversed at night just before she retires.

She then shared with me a conversation she had had with her daughter, where they had pondered the fact that the Grim Reaper normally visit the elderly at 2:30am when the body is at its ‘lowest’.  Not daunted by the impending visit of Death, she became most distraught by the very fact that the undertaker will then find her without her ‘face’ on.  She then continued to explain to me the details of her plans that will ensure that the undertaker will indeed find her with her ‘face’ on and fully shod to boot.  At this stage my sides where aching, and I was wiping the tears.  Here was a full-blooded human, unwavering in her determination to stare Death straight in the face, yet concerned by what the poor undertaker will find when he finally does visit her house.

I tell you what, Death beware, this one will give you your monies worth, and then some.

We never got to the bottom of her inhaler technique!