Can I Speak To The Pharmacist Please?

• A guide on how to deal with over the counter queries as a Pre-registration student (and eventually a pharmacist).

Hey guys hope everyone is doing well, and as this is primarily aimed at Pre reg students (although any audience will suffice…. It’s only second blog with the Pharmacist Co-operative) I hope you are looking forward to starting you training year in the next couple of weeks (I know it’s all very exciting). Hopefully you guys had a look at my blog on what to do on your first day, if not please do check it out. (https://beta.pharmacistcoop.co.uk/articles/pre_reg_day_uno/) 

 An essential part of being a pharmacist is having a clear understanding of over the counter products, licensing and also how to structure your patient consultation (or when a friend during a BBQ shows you a hideous wart on his finger and wants some advice on how to treat it...).

If you are doing your pre-reg in a community setting, then your tutor will probably shift any patient queries on to you. Don’t take this personally, it’s actually a very helpful exercise for you to do, as being confident in dealing with over the counter queries is a skill that is commonly overlooked.

Even though it may be daunting especially your first few consultations, hopefully this blog will allow you to get a head start !

Structure

So, during your time at Uni, you guys probably did OSCEs (and stressed half to death about them). During your revision for these OSCEs you all probably studied a variety of different consultation methods. Essentially, they are all very similar and what you are essentially trying to find out is: What the problem is? Have they tried anything for it? Has it happened before?  What other medications is the patient on?
Now a very common and a very heavily used form of questioning is WWHAM.

A.) Who is the medication for? 

•  Customers may come into the pharmacy on behalf on someone else: children, partners, parents etc. But you still need to ask the follow up questions, to ascertain if there is anything you can provide for the patient, medication or advice or otherwise.

B.) What are the symptoms?

• In most cases, you will be able to identify hat condition or illness a patient has by finding out about symptoms (we will look at identifying these conditions once we have finished WWHAM).  However, some serious conditions may be hidden by symptoms that appear to be associated with less severe problems. For example, conditions like malaria and meningitis can present flu-like symptoms but can both be fatal and so need to be identified quickly. 

• If you are in any doubt about your patients’ symptoms or you feel that you can’t identify anything from the symptoms or you feel there may be something more dangerous at play, then you should use your judgement and refer patients relevantly. 

C.) How long have the symptoms been present?

• Usually, minor symptoms clear up quite quickly. Diarrhoea, for example, is known as a “self-limiting” illness, as it will usually resolve within a couple of days. If symptoms do persist, then it could be a sign of something more serious. It is highly important that you relevantly refer certain patients who are having prolonged symptoms and those which constantly reoccur.

D.) What action has already been taken?

• Some people will have already tried to get help for their symptoms from say a GP or another pharmacy; but still may not feel better. You will need to find out if they have tried any other products and what advice, if any, they have been given. 

• You do not want to offer the same product if it didn’t work during their current episode.

E.) Are they taking any other medications (Including inhalers, herbal medications or any supplements !!)?

• Be aware that people who are taking long term medications, dietary supplements, other OTC products or alternative remedies may not class them as relevant to any other problems they might have. You will need to reinforce this question to make sure you get all the details.

• For example, some people with cold like symptoms may think you are asking whether they have already taken anything for their cold and will ignore the fact that they’ve been taking several different prescription medications for arthritis or heart problems for years. But you have to find this out because taking certain medications can cause serious consequences. For example, medicines for high blood pressure can react dangerously with OTC decongestants, and people with stomach ulcers can cause more damage if they take an OTC product containing Aspirin.

• Depending on what the patient says, you can either recommend a certain product or refer them for more specialist advice.

Over the counter (OTC) knowledge 

This is actually very important, and most pre-reg trainees often overlook this especially when revising for the final exam at the end of the year. It is important that you source solid, up to date knowledge about common OTC products and their licensing as well as being able to identify certain conditions. 

1. Counter Intelligence Plus

• This is something that I personally used when I first started my pre-reg, just to get a brief idea of common ailments and how to treat them. For those visual folks, this is quite good as it breaks down common ailments and queries that you might face in the pharmacy setting into small bitesize videos. So, a decent resource to look into.

• They also have a small book they release each year, which essentially is a small OTC revision guide, you might have to speak to your pre-reg provider to see if it’s possible for them to obtain it. 

2. Resource Pharma

• Again, this is another resource I heavily used during my pre-reg. I used their responding to symptoms section on their website to get a brief idea of red flags and get to know what products you can and can’t give to patients with certain common conditions, for example, Diabetes or asthma. This resource if definitely worth checking out!

So, there we have it guys, another day another blog. I hope these blogs will be coming thick and fast over the next few weeks as you guys start to prepare for pre-reg. We want to make sure that you guys have the best experience ever while on pre-reg!

If there is anything in particular you would want me to cover, please hit us up on our social media sites or email :)

Zain Ahmed