Posted by: Rory Wemyss30 AUG 2019
Source: JL / The Pharmaceutical Journal
Early in my career, with lots to prove, I was checking a prescription for a patient with chronic pain. Tramadol, dihydrocodeine and co-codamol: 24 individual doses daily. I couldn’t believe my eyes.
Was this what my five years of training had been for? All those lectures in dusty amphitheatres finally made sense. After some pharmaceutical calculations, dose conversations and adjusting for tolerances, I was faced with a frighteningly high oral morphine equivalent dose.
I could feel the sweat gathering in the small of my back. I needed to get this patient on better pain relief and fast, but they were not around to discuss it. No matter; I’ll just phone the surgery and talk directly to them about it. We agreed that the patient needed a change and set up a review.
I had done it. I had identified a patient in need and taken real steps to improve their life. I felt like the pharmacist I had always wanted to be — a superhero in plain clothes.
When the patient came back in, I couldn’t wait to tell them the good news.
The patient, however, couldn’t have been less happy. What business of mine was it to meddle with the medicines they were perfectly happy taking? Sure, they weren’t completely controlling the pain, but a small amount of pain is better than the great unknown. “Isn’t morphine for people who are dying?”
What had I achieved if the patient wasn’t comfortable with the decision?
The patient — against their better judgment, I’m sure — went along to the review at the surgery anyway and stopped all three of their step-two analgesics and replaced them with two forms of morphine.
The process was tough on them; I learned that the patient had many sleepless nights owing to their body struggling without the three opioids they had survived on for ten years. The patient spent many days housebound, writhing in pain, as they slowly increased their morphine dose.
I couldn’t believe what I had done. Instead of helping this patient, I had crippled them and possibly destroyed all trust they had in the healthcare system — all so I could feel good about myself.
Several months down the line, a family member of the patient asked to speak to me. I dreaded the worst. How could I forget what I had done? What will I say?
To my surprise, they thanked me on their relative’s behalf. For the first time in ten years, the patient was able to go on holiday as their pain was finally under control. They couldn’t believe it had taken this long for someone to notice that their pain could have been managed better.
But my success was hollow. I still think about that patient I almost let down. All because I couldn’t wait two hours to include them in their own care. Five years of training, all to forget the most fundamental of principles — to provide patient-centred care. It turns out that even superheroes have flaws.
Rory Wemyss, Pharmacy Manager at Walgreens Boots Alliance, Glasgow
Rory’s piece is the winner of our 2019 writing competition ‘The Patient Who Changed My Practice’. Read more entries here.