One of my reflective case studies

PATIENT’S PRESENTATON: One of the cases, the patient who was aged and a regular customer with poly-medications. When I reviewed his record in the computer and during my counseling with him, he has been suffering from type 1 diabetes, chest conditions (pneumonia), heart conditions, back pain and reflux disease for years. He came to the pharmacy with scripts to collect all of the medications shown below: Duride and Lasix were presented as new scripts with no strength and quantity.

THE MEDICATIONS INCLUDED:
Coversyl 4mg daily
Somac 40mg daily
Diamicron 80mg bd
Seretide two puffs bd
Spirival 18mcg daily
Digoxin 250mcg mane
Warfarin 5mg mdu
Protophane 10 units mdu
Duride ?? mane
Lasix ?? bd

He is independent, being able to express well, giving injection himself; having an oxygen masks on for a few hours at night while going to bed. He has been suffering from persisted nausea and vomiting from time to time (nearly two years)…and a bit of faintness; however, he never reports them to his doctor...
He stated that his random sugar level for him was between 4- 8 mmol/L.

CHOICE OF ACTION:I was stunned since he has been suffering unwanted side effects like nausea and vomiting. I stressed out and suggested that it would be better for him to have a daily report for recording what happens during his regimens;…and should report to his doctor for advice …in addition it might be of use for him to have an appointment with his diabetic educator who could help him a bit with handling his unwanted side effects and diabetic management.

Since the scripts for Duride and Lasix with no strength, I asked the pharmacist for advice. His final act on this case was bit a funny and didn’t seem right to me. He just went straight to ask the patient if the doctor told him any changes of his medications. OK! This still made sense to me. The patient said he was not sure…it seemed there was communication’s problem between the health care worker and the patient but no one has noticed it so far. The pharmacist then looked at his past medical record, and thus got his doses for Duride (a month ago) and Lasix (a few months ago) in the previous script that were 60mg mane and 40mg bd, respectively.

OUTCOME:Until that moment I knew what the pharmacist would do next…he asked me to follow the old regimens shown in our record, to keep following the case and to do dispensing for him; and a clear message I got from him is that he would really get on his nerves if the staff at the pharmacy made any delay on serving customers. Perhaps he was afraid of losing customers or something. I did what he told and kept dispensing and finishing the case with more than ten scripts in six or seven minutes.

REFLECTION:There have been many patients on poly-medications; their remedies look complicated, and therefore it should be important for us to make rational and appropriate decisions on checking their medications, as the second person who can improve their overall health outcomes apart from their doctors, through reviewing their medications if they are appropriate to be prescribed in some respect, in terms of unwanted side effects and indications; especially the strength and the quantity of the medications that are significant to influence the therapeutic effects of the medicines.

I thought the first few approaches initiated by the pharmacist still kind of made sense to me; however, the proper way to solve this problem should not look at the time delay to provide the customers with medications, but how we could do to minimize the risks of using wrong strength and quantity of the medicines for them. I don’t know why the pharmacist didn’t contact with the doctor by phone to firm about the right regimens for the patient.
Does it really matter to interrupt someone’s work (the doctor)? It would make the doctor have kind of bad impression on the pharmacy? I think it wouldn’t. Really, I don’t care how someone might look about us…Most importantly, we should do our works properly, bring light to their health through the primary measure for treatment of diseases, drug therapy, like the dawn that we all look forward to seeing in the dark.