Posted by: Nana Tomova13 MAR 2019
As a pharmacy student, I spent more time in a laboratory than with actual patients. I was trained in pharmacology and mechanisms of actions, and to know the answers and think critically. But it took me years to realise that this is not enough. Patients need more from pharmacists.
I am a specialist mental health pharmacist in community teams, and the way I work now is very different to the way I used to work seven years ago. Then, I gave advice to our clients and tried to convince them to take their medicines. Somehow I was surprised that people didn’t do what I advised; today I know why this is.
After training in motivational interviewing and non-violent communication, life lead me to the arts, which was very unfamiliar to me at the time. I became a photographer, a published poet, a storyteller and someone who has fun exploring creativity. I have learned a lot from my partner, an occupational therapist, about working therapeutically with people using creativity, and I slowly mustered the courage to try.
I now use storytelling in medication groups or during one-to-one interactions; I lead mindfulness exercises with a medication focus; and I have facilitated groups in which people can explore their medication using art. Often, people who want to find out more about possible treatments or those who are considered ‘difficult patients’ when it comes to their medicines — an unhelpful term — are referred to me for a medication review. Sometimes people seem nervous and anxious, and come with preconceived ideas of the appointment, which is often the first time the person has actively seen a pharmacist. People often expect to be lectured, told off, and advised without being asked if they want or need advice. Some patients may have experienced this before, but this is not the service I provide: I like to engage people through means tailored to them and their situation.
At a time when technology and phone apps can provide almost as much information about medicines or illnesses as healthcare professionals, our knowledge is no longer enough. Anyone with £40 can become a so-called ‘accredited’ herbalist, naturopath or nutritionist through an online course, and many clients in mental health seek these services. They use the services not necessarily because the providers are highly trained, but because they provide a space where people can express themselves without fear of coercion or a power dynamic.
And this is what we need in pharmacy practice; we need to practise not only the theoretical and practical aspect of our profession but also take a humanistic approach. We can do this by embracing creativity in our work in whatever small or large way we can.
We are all innately creative, and we can start working creatively with as basic an activity as drawing a medication timeline together, asking the person to tell you their medication story, or creating a medication tree that encapsulates all the elements that help someone live meaningfully, from the ability to self care, to the ability to participate in leisure, work and relationships.
In England, around 42% of adults are unable to understand or make use of everyday health information; this staggering statistic rises to 61% when also accounting for numeracy skills. Often people need other means of understanding and exploring their health and medicines, beyond using just words. If someone has trouble verbally expressing how they feel about their medicine, they might be able to draw or paint their feelings. As long as pharmacists practise in a safe and client-centred way, there should be no boundary to embracing creativity in our work with patients.
Nana Tomova, lead pharmacist, mental health community teams, Sussex Partnership NHS Foundation Trust
 Public Health England and UCL Institute for Health Equity. Local action on health inequalities: Improving health literacy to reduce health inequalities. September 2015. Available at: https://www.gov.uk/government/publications/local-action-on-health-inequalities-improving-health-literacy (accessed January 2019)