During the 75 th Annual Conference at Durham, I received an email about an exciting opportunity for final year students on the MPharm at my university. If it wasn’t for the excitement, enthusiasm and inspiration of the BPSA, it would have been all too easy to persuade myself that there wouldn’t be time in my fourth year for anything in excess of my core studies and that what I would gain wouldn’t be worth the time spent. Several friends of mine had those thoughts, but were then shocked when I demonstrated my extra knowledge in workshops and study sessions throughout the year.
Buoyed up by BPSA induced confidence, I instead applied straight away, as the opportunity was for final year pharmacy students to work alongside final year medical students in conducting GP style consultations in the community. It wasn’t to be missed. Several weeks later I met with the other students who had been successful and the academic lead from both the pharmacy school and the medical school. We started the process of preparing for the placements by role playing GP and patient scenarios, and looked more in depth at communication, listening, advice giving and how to extend the WWHAM questioning for a more detailed consultation. The most important thing I learnt at this stage was that there was a fine balance between giving the patient enough opportunity to explain their ailment so they felt listened to and involved, and leaving enough time to find a solution. We discussed the downsides and merits of open and closed questioning and concluded that both were useful and the trick was knowing when to use either.
We were sent away for the summer with a large amount of preparation work to do so that academically speaking we were equipped with enough knowledge to be able to contribute to the patient’s experience. One exercise was to learn about the ‘Top 40’ drugs seen in community. For each one I needed to have a rough understanding of mechanism, indication, usual dose etc. Therefore, when I was exposed to a patient’s medical record, I had a general understanding of what they were taking, why and any likely issues that could surface. We were also asked to brush up on our examination skills we had been taught in the third year, and to be familiar with the first six chapters of the BNF. During the summer I worked nearly every day so finding time to prepare for the placement was a challenge, however spending half my lunch break every day on the work soon added up and by the end of September I was ready for the test by the placement leads. Although the test was fairly casual, I realised the importance of the preparation work in a study session at the beginning of fourth year. Working with case studies and practising writing prescriptions I had a large knowledge of common medicines and complaints at my fingertips, so could give a good guess at what medications each patient might be taking. One of my friends turned to me and exclaimed, ‘How do you know that?’
The GP placements started shortly after, and I was pleased to discover that what I knew was extremely helpful to the patients that the medical student and I saw. What surprised me most was that my knowledge of non-pharmalogical advice was superior to the medical student’s. For example, discussing sleep hygiene with a patient who was severely sleep deprived. As well as this it is important to note that many of the patients we saw were not very different to those we see over the counter in community pharmacy, such as nappy rash, eczema and chesty coughs. At first I felt fairly overwhelmed by the medical student’s confidence in the setting and although willing, I felt unable to interject and add my advice to theirs. However, when they were unable to identify a urinary tract infection from the symptoms given, and I could as well as suggest to the doctor what to prescribe, my confidence soared. The GP who was overseeing our patients was impressed with my knowledge and prescribed exactly what I suggested, and allowed me to close the consultation giving the appropriate advice for the antibiotic.
Working in a GP practice was strikingly different to working in community pharmacy. Used to the fast paced environment of community pharmacy, where the patient or customer standing in front of you is priority and the staff work non-stop and flat-out throughout the day to ensure medicines get to patients as quickly as possible, I was shocked at the gentle attitude towards timekeeping at the practise. The practice ran usually an hour behind schedule, and even then was not pushing to catch up. However, the patients didn’t complain once as they would have done in community pharmacy! Instead they thanked the Doctor for their time at the end of the consultation with a reverence that I have never seen in pharmacy. I have often wondered if this is due to a different perception of value by the general public, or because pharmacy is seen as more of a business than a service. Either way, it is apparent to me that the public don’t have an appreciation of what pharmacists and pharmacy staff do, so can’t imagine why it takes so long!
Despite loving working in the fast paced setting that is community pharmacy, I would relish an opportunity to work in a GP practise in the future, as I felt I was able to use my clinical skills and knowledge more in the GP environment. Perhaps in the future I will be able to become a prescribing pharmacist like many others.
By the end of the scheduled placements, I realised that the main difference between myself and the medical student was not knowledge or ability, but confidence. I wish that every pharmacy student could experience what I have done, so everyone can realise what we know and how useful we can be if given the right opportunity. I urge you to grasp every opportunity that is open to you with both hands, as it will benefit you and your professional development eventually even if it’s not going to help you pass your next university exam. Utilise your summers, develop your contacts and invest in yourself. The sky is your limit!