A few weeks ago, I learned a brand new imperative about pharmacy practice. It was an ah ha moment and my job has been made much easier knowing this. My entire relationship with the patients I counsel has been redecorated. I have either broadened my archetype or I have created a brand new paradigm for my practice of pharmacy. Either way, I am better off for it and I can now walk away from a patient and not feel that I am inadequate. It is not me. It is them.
I have been faced with all of the evidence for a transformation for decades, but I just did not get it until I was counseling a boomer on the youngish side on the warnings and side effects of his medicine. He had wrenched his back lifting a truck tire with his knees locked and his back bent.
This guy professed to hate doctors and that he had not seen one until that day. He had listened to his wife for the first time in over 30 years about doctors. He had to. He works for a tire company. Hauling around monster truck tires is his job.
The prescriptions were for hydrocodone/APAP and tizanidine. Simple right?
Two drugs. He takes nothing else since he hates doctors and has not been a patient until now. Just take a quick detour on your way to go to the bathroom.
“Spike,” you say hello and he struggles slowly to stand up from the chair. He is bent over and, when he raises his face, you think, this guy is hurting. He sits down suddenly. His face screws up tightly.
“I can’t get up.” He tries again.
“No, sit sit. Don’t get up.”
“I hope you made me some damned good medicine.”
“Are you driving home?”
“No, I am gonna go to my mother’s. I always go to my mother’s when I don’t feel good. She’s better than any doctor.”
“No, Spike, I mean are you the one driving the car?
“Well, yah, I am. Why?”
“You shouldn’t be driving, Spike?”
“You can’t even stand up, man.”
“I’ll be okay.” His eyes dimmed. “I’ll take some of my medicine and then I can drive.” He looked at me. “It’s good medicine right? Norcos?”
“No, you can’t drive. Trust me.” I answered his question. “They are generic Lorcet. Don’t take more than 6 a day. It could harm your liver.”
“How can I tell?”
“If my liver is hurt? Can I feel it?”
“Trust me on this,” I said. I made him promise to have his wife come and get him, to take him to his mother’s I guess. Then we got down to the routine counseling about his prescriptions. I gave him the quick, standard rap. This is a narcotic. It can impair your ability to drive or work with dangerous equipment. No chain saws tonight. Hardy har har har. It is my standard little joke when I counsel on pain medicine. For a female it is No electric carving knife with the roast beef tonight. Oh, yuck yuck yuck. You are such a card, Plagakis.
Spike had a blank gaze. I had lost him somewhere.
“Tonight is bowling night,” he said.
“How the hell are you going to bowl when you can’t even get out of the chair?”
“I can still go if the medicine is good enough. I can still be one of the team, have a few beers.” He sort of smiled. “You ever had that chili cheese nachos bowl at the bowling alley?”
I told him that I had never been so lucky. As I was looking down at him, I had the awakening.
This guy was a lot dumber than I was and I believe that this is a general rule. Pharmacists are simply a lot smarter than most of the people they see in a work day. Of course there are people we deal with who are just as intelligent as we are. I was going along thinking that everyone could understand what I was saying. Not so!
Let that settle for 30 seconds. Take a deep breath. Now listen. You are a highly educated professional. Just getting through pharmacy schools says this about you: A smart cookie, this one is. The is a good chance that many of the people you deal with on a daily basis are just not as smart as you are!
Many of the people you deal with on a daily basis just do not get it when you are trying to connect. Some of the girls at the doctor’s office likely can’t get it. There are people who will never get it no matter how hard you try.
So, what should you do? Try this. I sat down beside Spike and buoyed by the realization that I was not connecting, we pared down the counseling to the core. I limited it to no alcohol, no driving, possible drowsiness and don’t take it if you don’t need it.
My paradigm before Spike did not include the notion that I deal daily with people who have no idea of what I am talking about. If you look carefully, you can see in their eyes that they have gone away. What you have said is so impossible for them to understand that they just check out. They go away. They say things like okay and Yes I will and I understand when all they want to do is get the hell away from you.
As I was returning to the pharmacy, Spike said to my back, “If I let my mother drive me to the bowling alley, then I can have a few beers, right?”
I did not even turn around. I had done my job