Counselling

[Nik]

I seem to see this problem more often - patient counselling gets drilled into us left, right and centre at uni, but in practice, I hardly see it done. The exceptions to this being advising patients not to take alcohol with penicillin and metronidazole, and to complete antibiotic courses (even this isn't always told). I know its on labels and I don't expect pharmacists to counsel patients on everything they dispense but from what I've seen a lot more could be done.

[Jeff]

Re: Counselling

I seem to see this problem more often - patient counselling gets drilled into us left, right and centre at uni, but in practice, I hardly see it done. The exceptions to this being advising patients not to take alcohol with penicillin and metronidazole, and to complete antibiotic courses (even this isn't always told). I know its on labels and I don't expect pharmacists to counsel patients on everything they dispense but from what I've seen a lot more could be done.

I'm old, confused and well past my prime, but why no alcohol with penicillin?

Jeff

[Pharmanaut]

Re: Counselling

I seem to see this problem more often - patient counselling gets drilled into us left, right and centre at uni, but in practice, I hardly see it done. The exceptions to this being advising patients not to take alcohol with penicillin and metronidazole, and to complete antibiotic courses (even this isn't always told). I know its on labels and I don't expect pharmacists to counsel patients on everything they dispense but from what I've seen a lot more could be done.

Probably because there aren't enough hours in the day to give everyone with a prescription the time that they deserve.

Most prescriptions are repeats, so that's probably why.

My system is to write a note and stick it on the bag to remind me to do it.

[JonF]

Re: Counselling

The exceptions to this being advising patients not to take alcohol with penicillin and metronidazole,

Quote from Stockley's Drug Interactions 5th edition

'No adverse or undesirable interaction normally occurs between alcohol and most antibiotics, with the exception of some cefalosporins, griseofulvin, and possibly doxycycline and erythromycin succinate'

Metronidazole interaction is mentioned elsewhere in the book

[JonF]

Re: Counselling

Quote from Stockley's Drug Interactions 5th edition

'No adverse or undesirable interaction normally occurs between alcohol and most antibiotics, with the exception of some cefalosporins, griseofulvin, and possibly doxycycline and erythromycin succinate'

Metronidazole interaction is mentioned elsewhere in the book

One of those urban myths that alcohol should be avoided with ALL antibiotics.
I usually advise that the odd drink in moderation will have no harmful effect.

[the old merlin]

Re: Counselling

Once upon a time I "made some inquiries" about this. It appears that it arises from the time that Penicillin was first introduced, in the latter stages of WWII. It was used to treat VD. The Army Command were concerned that, because it worked so quickly soldiers might, especially if they were under the influence of drink, go straight back to the sources of the infection, get re-infected and consequently have to have more time off from fighting.

Hence "You can't drink while you're taking this!"

And:

One Christmas I recall emphasising the dangers of alcohol to a middle-aged male patient. (As I usually did, having come across someone hospitalised as a result of the combination.) His response was to ask why the (expletives deleted) doctor had prescribed him something like that at Christmas, and to tell me that he was going straight back to sort him (the doctor) out!


It's all part of life's rich pattern!

[Nik]

Re: Counselling

Most prescriptions are repeats, so that's probably why.

Thats probably most likely true, but there are plenty of people who come in maybe for the first time with prescriptions for stuff like statins, antidepressants/etc who may not know a great deal about their meds and for whom an MUR is not indicated.
Being experts there's surely opportunity to show off your knowledge (making you look clever , and maybe keep a new customer to the shop ?

[Rafael]

Re: Counselling

work in a pharmacy that dispense >400 items/day with >20 methadone patients, with MUR targets to meet and you will know the answer.

[Nik]

Re: Counselling

I don't mean pharmacists should stand in front of a patient and produce a 2 minute presentation of the patients medication. Most will be told what their meds are for, the dose + frequency, but for extra important things like simvastatin + grapfeuit juice, warfarin + alcohol, anticoags + OTC aspirin, etc they won't have been told.
I don't see doctors and nurses fulfilling this role so who else does that leave ?

[Jeff]

Re: Counselling

but for extra important things like simvastatin + grapfeuit juice

It's on the label and will a 200ml glass of grapefruit juice at breakfast make a difference to a dose of simvastatin taken in the evening?

warfarin + alcohol, anticoags + OTC aspirin, etc they won't have been told.

Yes they will - by the doctors, nurses and pharmacists running the anticoagulation clinics.
They'll need to be reminded to stop their statins while taking various antibiotics though - and a check is in order for an antibiotic/anticoagulant interaction.

Jeff

[shan]

Re: Counselling

I seem to see this problem more often - patient counselling gets drilled into us left, right and centre at uni, but in practice, I hardly see it done. The exceptions to this being advising patients not to take alcohol with penicillin and metronidazole, and to complete antibiotic courses (even this isn't always told). I know its on labels and I don't expect pharmacists to counsel patients on everything they dispense but from what I've seen a lot more could be done.

I don't mean pharmacists should stand in front of a patient and produce a 2 minute presentation of the patients medication. Most will be told what their meds are for, the dose + frequency, but for extra important things like simvastatin + grapfeuit juice, warfarin + alcohol, anticoags + OTC aspirin, etc they won't have been told.
I don't see doctors and nurses fulfilling this role so who else does that leave ?

Young Man/ Woman,

By the way of doubt, it looks like you are are a Pre-reg Trainee.

If yes, then, ask your tutor what to do. Explain to him what you think should have been done, and ask him can it be done?

If he says yes, then go ahead and talk to the patient. If he says no, then you know what is your next question If you dont know then you are not serious about your future as a Pharmacist

Good Luck

Shan

[jaymags]

Re: Counselling

Why does it have to be the pharmacist that gives this counselling? On many occasions we (dispensers) have given the counselling unless the pharmacist wants to personally speak a particular patient reguarding a particular medication. If we are not careful counselling could border on patronisation ( I know there's no such word yet but there ought to be).
Lighten up Shan.

[Tony Schofield]

Re: Counselling

Perhaps a tad harsh Shan...........?

I think the opportunity for counselling patients will present itself at the time you believe it to be appropriate. However, those pharmacists and nurses who do prescribing courses are frequently shocked, when filmed in action, at how bad their counselling skills are.

This is to be expected. I prefer to use the term "consultation skills" as opposed to "counselling" as counselling is a subject of it's own demonstrating it's effectiveness quite spectacularly. Techniques such as motivational interviewing and cognitive behavioural therapy are in increasing demand in the NHS and no way could a pharmacist absorb their nuances and complexities whilst also being a pharmacist unless they studied "on the side" for decades.

I work in a drug service with counsellors and sit in on consultations. A skilled counsellor is a joy to behold and I think we could all improve our practice significantly by watching some at work. Beware however, counsellors don't have a robust professional body so not all are of equal ability as they aren't regulated.

As pharmacy develops and we get more clinically oriented we will have to acquire more skills and some basic counselling techniques, which despite our claims, we don't yet have. You can get a flavour by enrolling on short (say one or two day) courses and I find motivational interviewing a particularly helpful tool in my addiction work.

[shan]

Re: Counselling

I didn't mean to be harsh.

I was just trying to encourage the person to stand up to the right way of doing things.

For example, if he/ she feels the patient needs counselling then he should bring it to the notice of the Pharmacist, as a dispenser cannot counsel a patient without the approval of the Pharmacist, i think. Also when it comes to drugs, it is the Pharmacist who is responsible to inform the patient of any potential side effects / interactions. So as a pre-reg student the first thing is to ask the Tutor can he counsel the patient? if he says no, then ask him why not? I am sure by this time at least you will get the answer. Fine, when you become a Pharmacist and practice on your own, do what you feel is appropriate, but will there be time for all the counselling is the big question???

Shan

[Rafael]

Re: Counselling

he is still a uni student shan, not a pre-reg. take it easy mate.