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The
session that really stimulated my grey cells was one that I was
asked to chair-late on a Saturday afternoon in competition with
the Caulfield cup, cricket and the lure of the bar-a session on
‘Communication and Swallowing problems, How these affect
medication’. Megan Hanley, a speech pathologist who is a
communication and swallowing consultant, presented this session.
A small but dedicated group of Pharmacists attended this session
and found it both stimulating and interesting.
First
off, Megan gave us all a variety of food, small and soft or hard
or gooey and then she set us various tasks to perform while trying
to swallow the food.
As Pharmacists we all sit in our ivory tower dispensaries and
tell patients and carers how to use food thickeners and that there
are liquid formulations available, BUT have you ever tried it
for yourself??
Try hunching up your shoulders to your ears with your head bent
forward and take a liquid dose of paracetamol (you can use cordial)-not
easy huh!!
Now try eating something like a carrot stick with your head extended
backward-that went down well didn’t it. It takes just as
much work to bring a liquid to a bolus and then swallow-try not
being able to use your tongue to aid swallowing your cordial-did
you choke!!
We
then moved on to communication and Megan played us various tapes
of what people hear when they have difficulties and how hard it
is to decipher what we are saying for some patients with cognitive
disabilities.
We give instructions at the rate of a gattling gun to these people
and sometimes we may back it with a CMI/pamphlet but are we sure
they can read??
In a large migrant population, the children of the family can
read but what about the elderly-English is not their first language.
How many dementia cases have you seen where the patient has reverted
to their natural language and no longer communicates in English.
Megan
led the group in a discussion on what we as Pharmacists do poorly
in communicating with patients and what we do well-I did communication
at university but this was a completely different slant to what
I learnt.
Megan made us step into our patients’ bodies and see life
from their eyes and ears.
Have you ever asked your patients to reiterate what you have just
said to them-have you really made it through the haze to them
or do you ask the same old closed questions-do you understand?
Is there anything else we can help you with?
I
have had the pleasure of supervising many student Pharmacists
this year and they have all been wonderful and eager.
One of their favourite activities is to see how many of the APF
warning labels they can stick on a prescription packet or bottle.
They have covered their duty of care to warn of alcohol, sunlight,
ceasing, driving etc to the nth degree but have they really thought
about what the patient reads.
For example, I would visit a darling 90 yr old in her home at
least once a week for a chat and see how her diabetes management
was going (she also made the best pumpkin fruit cake).
One day she told me about her friend had been taking these antibiotics
and that she had not made any improvement as she had been taking
them with milk and that the Pharmacist should have warned her
about this.
I agreed and this comment stayed at the back of my mind so I diligently
put every little label on her bottles until one day I went to
see how she was going as she had pneumonia.
She told me that she had been unable to take the antibiotics I
had sent over as her chooks would starve, the garden would not
be watered etc as the label said ‘Avoid sunlight’-she
was not going to perform these chores in the night hours so she
just did not take them!!
My communication with her had been very poor-she could read it
but I had not explained and reinforced it to her-a poor effort
on my part but one that potentially occurs every day especially
with my distance supply patients.
I
have had two patients recount absolute horror stories to me that
can be related to communication problems.
One patient drank methyl salicylate liniment and the other eucalyptus.
When encountering these errors you say to them the bottle says
POISON, NOT TO BE TAKEN and has ribs down the side to indicate
POISON.
As the latest patients’ carer pointed out to me the ribs
down the side mean nothing to them-they were never educated that
this is the universal tactile sign for poison!!.
Both of these patients had poor eyesight and had gone to the Doctor
with the flu.
The poor understanding, poor eyesight and poor communication comprehension
had allowed these errors to occur-their mind fixation was treating
the flu with what Dr gave them.!!
The fact that the eucalyptus had been pulled out of the cupboard
in error instead of the cough mixture with all of the warnings
attached indicates that even tactile warnings like ribs are only
warnings in pharmacists minds not the consumers.
The lady who drank the two bottles of methyl salicylate liniment
said it tasted terrible but the Doctor told her it would make
her feel better.
He had diagnosed the pain in her back as a pulled muscle but she
was still thinking that he was treating her flu!!.
For
those of you who missed PAC, you should try to ensure that you
try to attend in 2003 in Sydney.
This will be a joint conference with the Federation of International
Pharmacy (FIP) and promises to be bigger and better again.
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