Pharmacy. Jim Plagakis. Pharmacist

I have been floating the idea that pharmacists are at “point” for triage in many cases.  Especially for poor people.  Even families making a living wage can end up on our doorsteps because we are the most accessible health professional and we are FREE.

We are also at THE BOTTOM OF THE FUNNEL.  After they realize that they need medical care, they go to see a physician, MD or DO or another primary care provider.  They have tests performed, the see a nurse to get their prescriptions.  Often they see no one.  The Rxs are called in, faxed in or sent by Email.  They have questions and the next medical professional they see IS YOU, at the bottom of the funnel.    

More and more, the primary care provider will be a PA or an ARNP.  That is just the way it will be.  The best primary care could be at a CVS “Minute Clinic”, a “RedyClinic” at Wal-Mart or a Nurse Practitioner at a Walgreens location  “Take Care Clinic”.

“RedyClinic” is an endeavor that leases space from Wal-Mart.  “RedyClinic” pulled their operation from 14 Wal-Mart stores in the Houston area.  I wonder if patients pulled out a four dollar bill before they pulled down their pants.  Wal-Mart likes to make the appearance that they are on the high road, but they really are not.

Last Tuesday an elderly woman handed me a bottle that was SMX/TMP DS.  She did not look good.  Her skin was pasty.  Her eyes wild.

“I don’t want this,” she said.  “I want the real thing.  Bactrim DS.”

I asked her why and she said that she was having side effects.  She did not have swelling around her neck.  No rash.  She was breathing fine.

“Maam, if you are having a reaction for this, the same thing would happen with Bactrim DS.  What exactly are you experiencing?”

Look out, Mamey, and listen to this.  She said that she could not feel her feet at times, that she had trouble picking up things with her left hand.  Her short term memory was impaired.

“Maam,” you need to contact your doctor immediately,” I said with attitude.  “What you described could be serious.”

“What could it be?”  Her eyes were on fire. “I want the brand name.  I do not want the generic.  It is inferior to Bactrim.”

I answered her question.   “It could be a TIA or even a stroke.”  I asked her to do all of the tests.  Raise her arms, stick out her tongue, Recite Peter Piper picked a pack of pickled peppers. 

She got pissed off.  “I did NOT have a stroke.”

I got pissed off.  I said strongly, “Contact your doctor right now.”

She left in a huff only to come back later to accuse me of being rude.  While she was telling me that was a bad-mannered and boorish druggist, she dropped the bottle of water that she was holding in her left hand.  She failed to pick it up with the left hand and had to use the right hand.

That is when I offered to call 911 and that was when she spun on her heel and marched out of the store.

Five minutes later, she came back and said, “I can’t unlock my car door.  I can’t remember how to unlock my car door.  Can you help me?”

“All I can do, maam, is call 911 for you.”  My hand was poised over the phone.

“I just need a little help.”

I gave it my best.  Strong, loud.  I jabbed my finger at her with every word.  “Please go sit in the waiting area.  I am going to call 911.”

“No you are not.”

“Maam, you absolutely need to get medical care RIGHT NOW.”

TRIAGE?