When the customer isn’t always right

So, I’ve probably got away with not posting for a long time, and got away for an even further length of time with not posting about my own college course. As some may know, I’m now in my second year of Pharmacy at UCC. Recently I also started part time work in a pharmacy, and through both of these aspects of my life have come to one conclusion: the customer is rarely right in a community pharmacy setting. Now, before people jump to conclusions about that kind of statement, it has to be said I mean not that there is a complete lack of knowledge on the part of the customer, but that there is a perceived “same level of knowledge” in the mind of the patient.

Let’s face it, pharmacists are one of the most undervalued people in the health sector. 99% of people outside of the industry (and about 90% of those still inside) would consider the job nothing more than standing behind a counter all day counting manufactured pills and following the instructions of the all-powerful, all-knowing doctor to the letter. It takes about ten minutes work experience to realise that is rarely the case. On a fundamental level, the job exists to provide a link between a doctor’s diagnosis and the resulting therapy for the patient. The doctor can tell what is wrong with someone, and based on their own studies suggest a suitable course of treatment. How that treatment works however is an area that falls far outside of the expertise of a general practitioner. Why is that?

Because, well really, it is far too unfair to demand a doctor to not only be able to come up with the causation and symptoms of an illness, but to then also have to be able to provide accurate and sufficient information on how the agents used in treating the problem will come into action. From a patient safety point of view, it is far too risky to shoulder that much responsibility onto one person. The biological aspect of a disease takes enough of a toll on somebody’s skill set. Having to mix this in with the chemical and pharmacological terms of a treatment requires large amounts of study. An inherent fault in our health system is the split that occurs in identifying our problem and then working against it. That being said, a far more catastrophic approach would be to demand the two jobs out of one person. In any case, an ample solution is to have both pharmacist and doctor have a key understanding of their own field, while also having a working understanding of the others. In my own course, the touches I’ve made into the fields of physiology and anatomy would not rival a doctor’s, where as their own studies in terms of drug action would also be far different and more diffuse to my own.

The real issue then is not the merits of both occupations, but the viewpoints of each and how the wider world thinks both fit into the system. Patients tend to place a far greater emphasis on the role of the practitioner, while only seeing the pharmacist as the hand with the drugs at the other side. As a result, it follows on that any attempt by a pharmacist to try mesh both sections of the person’s care comes off as flaky, interfering and just meddling where their intellect clearly can’t succeed. Any reasonable doctor/pharmacist knows that neither betters the other, but both have to be complementary; the vitality of this increasing as the disease state becomes more serious in nature. However, based on a patient’s above attitude in select cases, the problem then can become that the patient places the doctor in prime position, and then in a strange twist of faith elevates their own expertise to that of the pharmacist. This has come about in a number of ways.

Primarily, pharmacists are more readily available than doctors, and most will go there first for treatment of an acute, non-threatening ailment. As only painkillers, flu remedies etc are purchases, eventually a point is reached where someone questions what really is the purpose of the pharmacist, if they only really serve to hand out drugs that most shopping centers now have in stock. This increase in drug availability adds to the in-and-out nature of buying OTC products to give an image that pharmacists in general have it easy.

As well as this, a more dangerous and under recognised cause is the emergence of the internet as the new port of call. Nowadays, people will happily buy their medication online. Not only that, but a large part of the population now find it imperative to evaluate their own illness themselves, leading to huge misinterpretations, drug purchase and worry. Over the last century the number of new chemical entities available to regular sales has skyrocketed. This give the customer a bigger pool of potential toxins, while diluting their own knowledge to the point where Ibuprofen and Nurofen are very, very different in their eyes. The self evaluation problem has made pharmacist consultations far more tricky, and it is only a matter of time before the same scenario is widespread in the offices of GPs.

It comes to a stage where the battle is fought on two fronts. Beyond all else, it is vastly important that the patient has as much knowledge about their disease, treatment, and the drugs in question. That being said, the healthcare sector is now fighting a losing battle to prevent people sucking up as much misguiding information as possible, so much so that the nature of dispensary drugs has now been brought down to the general public’s view on illegal street drugs. With only snippets of info, a drug can come off as much more harmful than reality. Such is the case with narcotics, and now we see the same ghost haunting the legal sector.

Working both academically and on the scene, examples of where this misguidance leads us become increasingly apparent.

1. “My doctor knows what I am taking…”-Look, you need to tell the pharmacist what you are taking. A doctor’s job circles around treating whatever you have now. He can only make educated guesses as to whether whatever else you are taking interferes with that. If you went to a doctor and he told you had liver disease, you would never say “Nah pharmacist says it can’t be that”. Because that is their job. The doctor never asked you to champion him as a drug expert, and even if he did, a pharmacist would still demand to know what you were taking.

2. “I’ve been on those for years….” Things change. If you told me your car worked ten years ago, I’m not gonna take that as gold that it still runs now. Age changes drugs, and so does your condition, and if both the doctor and the pharmacist can see your dose or drug needs to change, you need to follow up on that advice.

3. “I don’t like the other ones, they are different…” Generics are the same thing my man, same drug made by a different company. Everyday you change water subtly, and food subtly and just about EVERYTHING else in your life. This is the one thing that is not changing, so stop trying to convince someone who is trying to give you your medication that they;re is a problem. In a select few rare cases, this is an issue. If it was, the pharmacist would tell you so.

4. “The internet told me…” The internet is as useful a back up as your “friend recommended them”- it counts for nothing. Your five minute google search before you went to the pharmacy does not suppress someone’s years of education and practical experience in the subject.

5. “The doctor said that strength…” God forbid the doctor was ever wrong about a field outside of his own. If the pharmacist says they’re wrong,they’re wrong, and yes..they will be wrong again. It’s nothing against their credentials, it just occurs now and then. You have to be on board with this.


“So can I really not drink on these?”-Nobody is trying to be a buzz kill here. If it says no alcohol, don’t have your friend studying english literature you convince that of course “one or two will be fine”.

“I’ll just take five, not four”-The dose is the dose. Increasing it rarely is gonna work out for you. Otherwise I’m sure the really smart scientists who tested this for years would have told you so.

“I didn’t finish my antibiotics” Just finish the course. Please, just follow the instructions.

“I missed one, will I take two the next time”-unless the pharmacist told you to do that, you can assume it has absolutely no effect like the second question.

“Can I really, REALLY not drink on these?”-No….no you can’t.