Commentary: Patient counseling? Customer assistance? You're kidding, right?

August 15, 2010

During a typically busy day in the pharmacy, counseling every patient may be tough. But is it too much to answer questions politely - or help someone standing helpless in the OTC aisle?

An elderly woman was staring at her pill bottle. She asked the cashier, "What is this for?"

"That's hydrocorzide." The cashier smiled smartly. "I know what it's for, but I can't tell you." She turned to the pharmacist, who was blazingly busy at the prescription mill. "Hey, Tonya, what should I tell this lady hydrocorzide is for?"

"But I was supposed to get medicine for my blood pressure," the patient protested. Her voice was suddenly high-pitched.

"She said that she needs blood-pressure medicine."

"Tell her that it is blood-pressure medicine." The pharmacist finally looked up. She managed a tight smile. "Tell her to read the literature we hand out with every prescription." That was Good Enough, I suppose, for a $4.00 prescription.

Low expectations

Since June 1, 2010, when the Texas State Board of Pharmacy promised to send plainclothes investigators into pharmacies to write citations for noncompliance with counseling requirements, I have done everything I can to make sure that I counsel on every new prescription. It can be as quick as "You've taken plenty of Vicodin recently. Any questions?" to something as detailed as combining a warning about constipation with an OTC recommendation of senna with docusate, along with another warning never to take more than eight tablets a day.

I believe that we do live up to the task of fulfilling the patient's expectations - and I'm gonna tell you that expectations are not very high. Because we haven't been counseling, patients think I am giving them extraordinary service when I am just doing what I am mandated to do by law, ethics, and pharmacy standards.

Doctors don't always know

I thought a faculty member at UTMB was going to invite me for a weekend at his beach house over on the Bolivar Peninsula because I counseled on temazepam the way I always do. Just because he's a physician is no reason to expect him to know that temazepam is long-acting and that he might wake up with a hangover. I added that he should be careful not to fall down when he got up during the night.

"He fell down last month," his wife said. "He always has a hangover."

"Nobody ever told me that," the doctor said. "Thank you. I needed to know that."

Good enough? Really?

I was in a store not called Three Pee Ex a while back. It was running a terrific ad on some items that I use. While I was there, I heard a frail voice ask, "Where is the valerian root?"

The voice belonged to an elderly woman. She was standing in front of the regular vitamins, not where the herbals were, looking bewildered.

"You're there," a pleasant but heavily accented voice called out. "Just a little ways down, left of where you are."

The woman moved to her left, but not far enough. "I don't see it."

A technician got into the act. Her voice was not accented and also not agreeable. It had a bite to it. "Ma'am, he just told you to your left."

The poor woman leaned to her right and the technician spat, "Not that left, Ma'am. Your other left."

The pharmacist laughed. "Your other left. You crack me up, Millie."

Apparently, as service went in this store, this was Good Enough.

I ended up counseling this woman. I was a customer, but I was still a pharmacist. I answered her questions about valerian. I found it for her and suggested that she take the one marked Buy one, get one free.

She asked where I worked. The pharmacist gave me a dirty look. I shrugged.

Since when has "Good Enough" become good enough?

JIM PLAGAKIS is a community pharmacist in Galveston, Texas. You can e-mail him at jpgakis@hotmail.com
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