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This issue is a milestone for Drug Topics, with the publication of the 200th column by Jim Plagakis to appear under the heading "JP at Large."
Jim has been listening and counseling as a pharmacist for almost 45 years. At his first job, in a downtown drugstore that still had a lunch counter, patients received a coupon for a free cup of coffee to drink while they waited for their prescriptions. Jim would join patients for a sip of coffee and ask whether they had any questions about their medications. He called it "stealth counseling in the 1960s."
Fast-forward to 1993. Jim explained in a column that he took "3 focused minutes" to listen to a father's grief for his 9-year-old son, who was near death from brain cancer. He wrote, "I was his sponge. He released the poison, and I sucked it up. Not required by law, but I think it's part of my job, even if the next person up for an Rx had to wait 3 extra minutes."
"If the drug really needs extensive counseling, I move the patient over to the counseling window and we really talk," he told Drug Topics. "I have serious issues with benzodiazepines, because they are a dangerous class of drugs if used for a long period of time. Patients hardly even know that they are taking that stuff, because it works so well. However, for most people, a certain part of their personality is lost to them, and it can be the best part of their personality - the passion, the anger, stuff that normal human beings have."
In fact, Jim recently told one of his patients, a young medical student who had been taking a benzodiazepine regularly for 6 months, that she was too young to continue with this drug for so long. He warned her of the risks of terrible withdrawal and the need to manage the stress of medical school differently.
"This is the kind of extensive counseling that pharmacists can do, although most don't. Younger pharmacists don't give themselves permission to do that. I'm older, so I actually can intrude like that. It helps a lot to make eye contact and let patients know that you are serious," Jim said. "I love it. It's the best part of my job."
Jim also believes in taking the time to counsel patients about over-the-counter medications. He works part-time, approximately 2 to 3 days per week, as a relief pharmacist for a national chain. While some pharmacists direct all their attention to the "prescription mill" behind the counter, Jim's patients know that if they come in on Tuesday or Friday, he is accessible and knowledgeable about the OTC products that look so benign on the drugstore shelves.
With the need to fill ever-growing numbers of prescriptions, pharmacists may be worried that technicians will take over their jobs, Jim said. "Qualified technicians will be legally empowered to do more of the filling tasks. The idea is to allow the pharmacist more time for counseling and MTM, as well as the various professional tasks that will define us in the 21st century. We must, however, be ever watchful. It's our profession. We will have it our way."
Thank you, Jim, for sharing your perspective and insight.