Our patients, our family

Whether you are a staff pharmacist, a locum pharmacist, or a pharmacy owner, ask yourself this: Why do patients come and see you? What makes patients come back to see you? What if you’re not there; how do your answers to the above questions change?What if you just have a PharmD, or a BScPhm? Does this make you less appealing to patients than, say, an oncology pharmacist at University Health Network or a diabetes educator pharmacist working in a community pharmacy practice with a high prevalence of diabetes? The short answer should be: No.In my opinion, the reason patients come to see you, the pharmacist, depends largely on their specific needs. Even a “general community pharmacist” belongs to a specialty in pharmacy, not unlike how family practice is a specialty in medicine. The skills and knowledge of a community pharmacist are different than those of a pharmacist working in a family health team specializing in acute ambulatory care for chronic kidney disease, for example. Any information you learned in pharmacy school, although can easily be re self-taught, very quickly becomes out-dated and, frankly, forgotten, if not used frequently.The real question is: what makes patients come back to see you? The answer lies, in large part, how you communicate and make the patient feel during the short interaction. I always believed that no matter how intelligent or specialized you are, if you cannot translate or relay that information in a way that the patient understands, internalizes, and feels good about, you’ve lost the battle before it starts. Let me explain.I have a 61-year-old male patient with type 2 diabetes with a most recent haemoglobin A1c of 9%. He was on Lantus, Trajenta 5mg, and Gliclazide MR 120mg, with severe intolerance to Metformin (stomach upset and severe diarrhea) and refuses to go on another injectable (his friend was on a once-weekly injectable and it made them loopy), or another “water pill” type drug because he was already on Furosemide and he hated how it makes him pee frequently. You, as the pharmacist, understand that in order to minimize micro- and macro-vascular complications, and given the age, he needs some form of intervention. By understanding what inhibitions the patient has, and by first acknowledging and listening to his concerns, you can work with him to overcome them.An intelligent clinician may recommend initiating a fast-acting insulin, or maybe discontinuing Trajenta and initiating a GLP-1 agonist first, along with an SGLT-2 inhibitor. But if you were too dismissive or did not listen to the patient’s concerns, would the patient come back to see you? Maybe, but only to “pick up” their medications. You've become their dispensing pharmacist—someone who they don’t want to speak with because of the gap in communication and understanding. I promise the second they need advice on something, you won't be the one they ask.In my case, I was quite frustrated with this particular patient, because I knew they did not understand nor realize the inevitable long-term negative implications of their current decisions. So I made a deal: We’ll try Jardiance 10mg for just one month. Benefits: Potential weight loss, lowered blood pressure, potentially improved leg swelling, heart protection and kidney protection. Oh, and it would also help bring down the sugars.“Wow, that sounds like a miraculous drug” he responded. I clarified that with anything good in life, there are downsides. Even if he drinks enough water, there is additional risk for people with heart failure. I explained the simple things to look out for, and explained why they happen to help him avoid them: Dizziness, so he'd need to be cautious driving or walking. There was also increased risk of fungal infections. So if he were having people over for dinner, with lots of sweets, I told him to be prepared to pee more and wipe his private parts clean with water so that fungus doesn’t latch on to the excess sugar. It may still happen, I told him, but at least he'd know the reason. If it goes well, I told him we could get rid of your low dose Furosemide too. “Sold!” he exclaimed.You may think these relationships aren't worth very much if you aren't in the pharmacy but I don't think that's true. Consider the way employees make decisions. They tend to apply and accept jobs in places for various reasons like remuneration, prestige, benefits, a company’s vision, etc. But employees almost always leave a job if they are not satisfied with management and how they make them feel (e.g. unwelcome, not appreciated, no room for growth, negative reinforcement, among others). Patients are similar, I’ve found. Even in your absence, if the general pulse of the pharmacy staff is the same as yours, the patients will happily come. I have so many patients that refuse to go to the same ER or self de-roster from their GP because they had a poor experience.Patients are vulnerable, and if they come in frustrated, simply acknowledge it. It's rarely personal. Also, if you are in a position to do so, have a value proposition for your business, believe in it, follow through, and get your staff onboard. They will end up embodying your vision, because patients don’t just see you, they see a reflection of your vision through the people they encounter in the pharmacy.The title of this article is engraved on two custom-made side panels at prescription drop off and pick up in our pharmacy. It's a gentle reminder, for both the staff and the patients, of what matters most.Samier Kamar is a lead clinical instructor at the Leslie Dan Faculty of Pharmacy, University of Toronto. He currently practises in an independent primary care setting in Peterborough, Ont., as the pharmacist, designated manager, and owner of High St. Guardian Pharmacy.

Our patients, our family

Register for free access or login.

More Blog Posts in This Series

The importance of holistic recommendations as part of a patient’s treatment approach

The power of primary prevention in community outpatient practice

Torsades de pointes vs. sepsis—can you avoid both?

Blog Author

Samier Kamar