Have you ever walked into a pharmacy looking for a quick fix to a relatively common condition, let’s say dry eyes or a bout of constipation, only to be asked a series of questions by the pharmacist? Ever wondered why did the pharmacist have to ask so much?
Let us share with you what runs in a pharmacist’s head during the questioning process and why this is important.
Jane (a fictional character) walks into a community pharmacy looking for a quick fix to her current bout of constipation before heading off to her office. She is greeted warmly by the pharmacist on duty and the following conversation ensues.
Jane: I need something for constipation.
Pharmacist A: I see. Is this for yourself?
Pharmacist A: May I know how long and how frequent have you experienced such condition and I hope you don’t mind me asking, what is your normal bowel habit like?
Jane: I have not passed bowel motion for the past 4 days and I have not experienced this for years. I usually pass motion at least once a day.
Pharmacist A: Perhaps you can tell me a little more about your symptoms, if any?
Jane: I don’t really feel much other than just the mild stomach ache, bloating, little to no stool during each toilet visit and…… constant farting *feeling shy*
Pharmacist A: Have you already tried anything for it?
Jane: Not yet.
Pharmacist A: Are you allergic to any medicines or do you have any dietary restrictions?
Pharmacist A: Are you currently pregnant or breastfeeding?
Pharmacist A: Are you currently taking any medication for any medical condition?
Jane: I have been taking aluminum hydroxide antacid for my gastritis for about two weeks now, if that counts… *getting impatient*
Pharmacist A: I see. Can you describe more about the gastritis symptoms?
Jane: Wait a minute, why are you asking so many questions?? Why can’t you just give me something so I can be on my way? I am already running late for work! It’s my first month on the job and it has been really stressful! Please do not add to it – I barely have time for sleep!! *raising her voice* Forget it! I am going to another pharmacy!
Many of us could probably relate to this especially when we are in a hurry. It is entirely understandable why Jane would lose her temper after being bombarded with a series of questions by Pharmacist A. After all, she is going through a stressful time.
However, we would like to highlight the fact that Pharmacist A is actually doing what is known as a history taking that would allow him/her to get a full picture of Jane’s condition before deciding on the next best course of action.
Never underestimate the importance of history taking. A brief conversation as depicted above has already enabled us to gather some very crucial information:
- The person the medication is for: This may seem trivial but it is actually very important since the type of medicine and/or dose to be given may differ among individuals based on age, weight, medical and medication history, pregnancy and breast feeding status etc. Often, people walk into a pharmacy to purchase medication for someone else, who may be an elderly or even a child. Imagine the disaster if the adult dose for a medication is given to a child!
- Condition based on description of symptom(s): Jane’s constipation is further confirmed based on the symptoms described and the lower frequency of defecation relative to her normal bowel habit. Pharmacists don’t want to be giving you medications for the wrong conditions, or miss out on something more sinister – haemorrhoids, irritable bowel syndromes or even cancer. A chronic or recurrent condition would also warrant further investigation as opposed to an isolated episode.
- The possible cause(s) of the condition: Generally, this is established based on the chronology of event described by a patient. Certain medical conditions, medications or supplements taken can lead to constipation. In this case, Jane’s constipation could very well be caused by the aluminum hydroxide antacid used for her gastritis (which may or may not have been triggered by stress) and perhaps the lack of exercise and sleep due to her busy lifestyle.
- Medical and medication history, present health status: This will enable the selection of the most appropriate medicine that will not interact with any existing medical condition(s) and/or any other medicine(s) used as well as to rule out other possible causes of the present complaint. For example, diabetics can be offered sugar-free laxatives. Since Jane already experiences gastritis and is taking an antacid, she will need to be advised on proper timing if she is dispensed with enteric-coated laxatives to ensure that treatment remains effective.
- Medicine already used by Jane for her constipation: This will enable the pharmacist to further assess her condition based on the present treatment (if any) and also to avoid possible dispensing of the same or similar medicine later. Moreover, laxatives should not be taken indefinitely for constipation without further investigation of the actual cause.
- Known allergy to any medicine or dietary restrictions: Pharmacist will avoid dispensing the same medicine or same class of medicines (or any other chemically-related medicines) to specific patients with known allergy reaction. Since Jane has no known drug allergy, selection of appropriate medicine is made easier.
By now, you can probably appreciate the necessity for questions asked by Pharmacist A. If only Jane would allow Pharmacist A to probe further, an even better understanding of her condition could be established. Therefore, it is often advisable for patients to furnish as much information as possible to healthcare providers when prompted, in order to facilitate disease assessment and treatment.
Frankly speaking, would you rather be given a medication without any questions asked? Let’s work together, patient and health care provider, to ensure that you get the best care you deserve!
Lau Hui Ling
PhD, M.Pharm, R.Ph