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Ten Commandments for Prescription Practice*
for prescription practice •••
ten commandments* by Robert A. Walsh ne of the most vital functions influencing the professional relations between the pharmacist and the patient is that involved in the proper handling of the prescription order. While the time involved in both accepting the prescription order and dispensing the prescription medication may not exceed more than 15 minutes, these few minutes can well mean the difference between the pharmacist as a real professional man and the pharmacist as just another clerk motivated, if you will, by automatic reflexes. The failure of many pharmacists to capitalize on the proper method of accepting a prescription order and dispensing medication might be traced to one of the following reasons-
O
1. Lack of proper training 2. 3.
Sheer indifference Failure to appreciate the position of the patient or patron 4. A dislike for the task or for the profession.
Of these reasons, the third one stands out quite prominently for, like our medical brethren who are said to be the world's worst patients, the average pharmacist would probably be the world's worst prescription patron. Speculate momentarily, on how many pharmacists have ever had a prescription dispensed in a strange pharmacy by a pharmacist they did not know . Just how would we feel as patients and what would be our opinion of pharmacy as a profession if we had a prescription handled in the crude nonprofessional manner practiced in far too many pharmacies today. Every pharmacist should realize that the prescription patron has, in the majority of cases, come directly to the pharmacy from the physician's office or has just recently had contact with the physician at the bedside of a sick
*
Presented to the section on general practice of pharmacy at the annual meeting of the AMERICAN PHARMACEUTICAL ASSOCIATION in Detroit, Michigan, March 29, 1965.
536
member of the household. The pharmacist is, then, the next person of the prescription triad of the patient-physician-pharmacist team to be encountered. He falls in line immediately after the professional contact at the physician's office or the professional contact at the patient's bedside. Here is an opportunity for the pharmacist to present a remarkable contrast or comparison either favorable or unfavorable. The physician by his professional manner has laid the foundation; the pharmacist can either build upon, solidify or undermine this foundation by applying or failing to apply a professional approach. Let us remember that the patron has called upon the skill of the physician to diagnose and treat a specific condition. The prescription order of the physician is for the relief of a particular symptom or syndrome from which the sick individual will get relief only when the medication is dispensed and administered and the condition alleviated. The prescription order is an all important document; a most important contribution to the progress of healing. The medication may involve an agent that is most commonplace in the medical armamentarium or stock of the pharmacist such as the so commonplace APe with codeine which is just another analgesic to the pharmacist or the frequently prescribed penicillin, now regarded as just an ordinary agent. But no matter how trivial or commonplace these may be to the pharmacist, they are probably the hoped-for panaceas needed by the worried and apprehensive patron. We should bear in mind the excellent quotation from the text of one of the earliest and most respected pharmacologists of our era, Walter A. Bastedo. l In the introduction to his book, he writesMedicine sometimes cures, it often relieves, it always consoles.
The
rapport
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
between
pharmacist
and prescription patron, both at the initial handling and the final dispensing of the prescription, shows how we have applied our professional abilities. Here is where we can add to all of the prestige built up by a well planned advertising or other type of promotional campaign or "pull the rug" out from under a plan tha t has otherwise been very carefully thought out and executed. The commandments that I enumerate are not new and certainly not original on my part. I believe they represent good plain common sense and are intended to act as guide posts along the road to better professional conduct and better professional relations. 1. Do not let anyone but a pharmacist handle a prescription either by accepting the order or dispensing the medication. Handling of the prescription by a stock boy, cigar or fountain clerk tends to lessen the professional importance of the prescription. Surveys have shown that almost 75 percent of patients object to giving their prescription orders to anyone other than a pharmacist. This attitude reflects the confidence and trust that inherently belongs to our profession. 2. Remember that a kind word or courteous remark made when you have received the prescription order will act as a sort of therapeutic approach and aid your professional prestige. Apprehensive individuals would rather hear the 'courteous invitation, "Won't you please be seated while we prepare this medication?" than the simple statement, "I'll have this out in a few seconds." Sick people are lonely people, needing help. Try to spend some time with each patron. Make him feel at home and aware that you are interested in his well-being. 3. Do not make any comment relative to the nature of the medication or the physician. Remember that you are a mem-
4.
5.
6.
7.
ber of the professional health team and that the physician has made a diagnosis and has prescribed on the strength of his findings and his ability to translate them into the pharmacologic needs of the patient. Facetious or adverse comments could ruin any psychologic value offered by the medicine and are a serious breach of professional ethics. Do not divulge the nature of the medication. Some patients are naturally curious about the type of medication the physician prescribed. Their questions about the nature of the medication or the intent of the prescriber should be parried. Any other course of action would be a severe breach of professional ethics. You can tell the patient, "Pharmacy's professional code of ethics does not permit me to discuss this with you." Remember the prescription medication should be dispensed in a quiet, professional atmosphere. Blaring radios, juke boxes or a noisy soda fountain detract from a professional atmosphere. The patron should have a quiet place to relax. If possible this should be a part of the pharmacy set off from the rest. This area should also offer a chance for the pharmacist to display his diplomas, membership certificates and a few books. These will add to his prestige and improve his professional stature. Prepare a neatly wrapped, professional-looking package. It follows that this could only be dispensed by a neat, professional-looking pharmacist. Whenever possible, present the package by calling the person's name, saying, e.g., "Mr. Smith, your prescription is ready." In this way you impress upon the patient that the medication has been prepared expressly for him and that it is not just a routine transaction. Do not engage in arguments about the price of a prescription. Remember that you seldom win an argument without losing a patron and if you have set a fair prescription fee, you have nothing to hide. Accept resistance to the charge as a normal reaction from a sick or depressed individual who did not want to be sick or have anyone in his household sick. Dr. R. Wallace Teed sums this up quite well by statingAlmost every sick person believes, probably unconsciously, that his illness is the worst thing that has ever happened to anybody and that the physician should drop everything else and attend to his needs.
Since the sickness was not "planned," any expenditure might be considered as too much.
Be prepared for price resistance. Calmly and carefully explain why some drugs today are somewhat expensive. There are many facts and figures that you can use to show that today's medical care has cut down the death rate and the duration of some sicknesses that were formerly incurable. Your failure or reluctance to explain a high price may be interpreted as an inability to explain it. 8. Advise the patient relative to any storage requirements and changes that might take place in the physical nature of the preparation. Many companies very carefully point out on the labels of their preparations that certain changes might take place under certain storage conditions. If we fail to tell the patient about these changes, he may feel the medication has been compounded improperly and as a result lose confidence in the pharmacist who compounded it. A few words of advice while dispensing such prevent pharmaceuticals can such loss of confidence. 9. Be sure the patient is fully prepared and equipped to take the medication. We are all aware that the prescribing habits of many physicians often lead to confusion on the part of the patient. The too frequently used signa of "take as directed" can lead to serious dosage errors and undesirable side effects, particularly with patients who take more than one type of medication. Surveys show that many elderly patients fail to have their prescription orders dispensed or fail to take the medicine after receiving it from the pharmacist because, very often, they are confused. They do not remember how to take the medicine or when to take which tablet or what liquid. Be sure to suggest such necessary adjuncts as sterile cotton for the application of lotions or other necessary equipment such as thermometers or syringes for the sick patient. 10. Suggest special services which may be most important to the patron. Calling his attention to a delivery service or a private incoming phone can help to build and maintain good public relations. If you do not have special services available, a kind word of encouragement can serve as good "psychosomatic medicine." Wishing the patient a speedy recovery in a warm, sincere, professional voice can do far more for you than can a routine and hurried "thank-you."
There have been many methods suggested for attracting prescription practice and improving our professional stature as pharmacists. Some pharmacies enjoy an increase in prescription volume through no effort of their own
Robert A. Walsh, APhA member, is currently teaching public health and professional relations at the Massachusetts College of Pharmacy. He has had 20 years of experience as a community pharmacist, was pharmacist-in-chief of the Peter Bent Brigham Hospital in Boston and was executive vice president of E.L. Patch Company. Besides teaching and directing public relations at his alma mater, Walsh has appeared on professional programs and has authored many papers. Walsh is former grand president of the Phi Delta Chi fraternity and holds membership in ASHP, the Massachusetts State Pharmaceutical Association and the Rho Chi Honor Society.
but through neighborhood population growth or the presence of a new physician or clinic in the area. Such increases are in the minority, however. The majority of increases in prescription practice come through modest or extensive promotional plans. But all increases in patronage, whether effected by well-planned campaigns or fortuitous circumstances, ultimately lead to a meeting between the prescription patron and the pharmacist. The past, present and future of community pharmacy has been, is and will continue to be built around our prescription practice. While the kind and number of drugs and chemicals involved in medical usage has changed, the professional standing of the pharmacist has remained fairly permanent during the last 20 years. If we are to increase our professional stature, we must think and act like professional men. The ten commandments for prescription practice are offered as rules that can be followed on the road to better professional relations. • references 1. 2.
Bastedo, W.A., Materia Medica, Pharmacology and Therapeutics, Saunders, Philadelphia, 17(1937). Teed, R.W., "Public Relations Begin in the Doctor's Office," J. Mich. State Med. Soc., 57, 334(1958).
Vol. NS5, No. 10, October 1965
537
ten commandments* by Robert A. Walsh ne of the most vital functions influencing the professional relations between the pharmacist and the patient is that involved in the proper handling of the prescription order. While the time involved in both accepting the prescription order and dispensing the prescription medication may not exceed more than 15 minutes, these few minutes can well mean the difference between the pharmacist as a real professional man and the pharmacist as just another clerk motivated, if you will, by automatic reflexes. The failure of many pharmacists to capitalize on the proper method of accepting a prescription order and dispensing medication might be traced to one of the following reasons-
O
1. Lack of proper training 2. 3.
Sheer indifference Failure to appreciate the position of the patient or patron 4. A dislike for the task or for the profession.
Of these reasons, the third one stands out quite prominently for, like our medical brethren who are said to be the world's worst patients, the average pharmacist would probably be the world's worst prescription patron. Speculate momentarily, on how many pharmacists have ever had a prescription dispensed in a strange pharmacy by a pharmacist they did not know . Just how would we feel as patients and what would be our opinion of pharmacy as a profession if we had a prescription handled in the crude nonprofessional manner practiced in far too many pharmacies today. Every pharmacist should realize that the prescription patron has, in the majority of cases, come directly to the pharmacy from the physician's office or has just recently had contact with the physician at the bedside of a sick
*
Presented to the section on general practice of pharmacy at the annual meeting of the AMERICAN PHARMACEUTICAL ASSOCIATION in Detroit, Michigan, March 29, 1965.
536
member of the household. The pharmacist is, then, the next person of the prescription triad of the patient-physician-pharmacist team to be encountered. He falls in line immediately after the professional contact at the physician's office or the professional contact at the patient's bedside. Here is an opportunity for the pharmacist to present a remarkable contrast or comparison either favorable or unfavorable. The physician by his professional manner has laid the foundation; the pharmacist can either build upon, solidify or undermine this foundation by applying or failing to apply a professional approach. Let us remember that the patron has called upon the skill of the physician to diagnose and treat a specific condition. The prescription order of the physician is for the relief of a particular symptom or syndrome from which the sick individual will get relief only when the medication is dispensed and administered and the condition alleviated. The prescription order is an all important document; a most important contribution to the progress of healing. The medication may involve an agent that is most commonplace in the medical armamentarium or stock of the pharmacist such as the so commonplace APe with codeine which is just another analgesic to the pharmacist or the frequently prescribed penicillin, now regarded as just an ordinary agent. But no matter how trivial or commonplace these may be to the pharmacist, they are probably the hoped-for panaceas needed by the worried and apprehensive patron. We should bear in mind the excellent quotation from the text of one of the earliest and most respected pharmacologists of our era, Walter A. Bastedo. l In the introduction to his book, he writesMedicine sometimes cures, it often relieves, it always consoles.
The
rapport
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
between
pharmacist
and prescription patron, both at the initial handling and the final dispensing of the prescription, shows how we have applied our professional abilities. Here is where we can add to all of the prestige built up by a well planned advertising or other type of promotional campaign or "pull the rug" out from under a plan tha t has otherwise been very carefully thought out and executed. The commandments that I enumerate are not new and certainly not original on my part. I believe they represent good plain common sense and are intended to act as guide posts along the road to better professional conduct and better professional relations. 1. Do not let anyone but a pharmacist handle a prescription either by accepting the order or dispensing the medication. Handling of the prescription by a stock boy, cigar or fountain clerk tends to lessen the professional importance of the prescription. Surveys have shown that almost 75 percent of patients object to giving their prescription orders to anyone other than a pharmacist. This attitude reflects the confidence and trust that inherently belongs to our profession. 2. Remember that a kind word or courteous remark made when you have received the prescription order will act as a sort of therapeutic approach and aid your professional prestige. Apprehensive individuals would rather hear the 'courteous invitation, "Won't you please be seated while we prepare this medication?" than the simple statement, "I'll have this out in a few seconds." Sick people are lonely people, needing help. Try to spend some time with each patron. Make him feel at home and aware that you are interested in his well-being. 3. Do not make any comment relative to the nature of the medication or the physician. Remember that you are a mem-
4.
5.
6.
7.
ber of the professional health team and that the physician has made a diagnosis and has prescribed on the strength of his findings and his ability to translate them into the pharmacologic needs of the patient. Facetious or adverse comments could ruin any psychologic value offered by the medicine and are a serious breach of professional ethics. Do not divulge the nature of the medication. Some patients are naturally curious about the type of medication the physician prescribed. Their questions about the nature of the medication or the intent of the prescriber should be parried. Any other course of action would be a severe breach of professional ethics. You can tell the patient, "Pharmacy's professional code of ethics does not permit me to discuss this with you." Remember the prescription medication should be dispensed in a quiet, professional atmosphere. Blaring radios, juke boxes or a noisy soda fountain detract from a professional atmosphere. The patron should have a quiet place to relax. If possible this should be a part of the pharmacy set off from the rest. This area should also offer a chance for the pharmacist to display his diplomas, membership certificates and a few books. These will add to his prestige and improve his professional stature. Prepare a neatly wrapped, professional-looking package. It follows that this could only be dispensed by a neat, professional-looking pharmacist. Whenever possible, present the package by calling the person's name, saying, e.g., "Mr. Smith, your prescription is ready." In this way you impress upon the patient that the medication has been prepared expressly for him and that it is not just a routine transaction. Do not engage in arguments about the price of a prescription. Remember that you seldom win an argument without losing a patron and if you have set a fair prescription fee, you have nothing to hide. Accept resistance to the charge as a normal reaction from a sick or depressed individual who did not want to be sick or have anyone in his household sick. Dr. R. Wallace Teed sums this up quite well by statingAlmost every sick person believes, probably unconsciously, that his illness is the worst thing that has ever happened to anybody and that the physician should drop everything else and attend to his needs.
Since the sickness was not "planned," any expenditure might be considered as too much.
Be prepared for price resistance. Calmly and carefully explain why some drugs today are somewhat expensive. There are many facts and figures that you can use to show that today's medical care has cut down the death rate and the duration of some sicknesses that were formerly incurable. Your failure or reluctance to explain a high price may be interpreted as an inability to explain it. 8. Advise the patient relative to any storage requirements and changes that might take place in the physical nature of the preparation. Many companies very carefully point out on the labels of their preparations that certain changes might take place under certain storage conditions. If we fail to tell the patient about these changes, he may feel the medication has been compounded improperly and as a result lose confidence in the pharmacist who compounded it. A few words of advice while dispensing such prevent pharmaceuticals can such loss of confidence. 9. Be sure the patient is fully prepared and equipped to take the medication. We are all aware that the prescribing habits of many physicians often lead to confusion on the part of the patient. The too frequently used signa of "take as directed" can lead to serious dosage errors and undesirable side effects, particularly with patients who take more than one type of medication. Surveys show that many elderly patients fail to have their prescription orders dispensed or fail to take the medicine after receiving it from the pharmacist because, very often, they are confused. They do not remember how to take the medicine or when to take which tablet or what liquid. Be sure to suggest such necessary adjuncts as sterile cotton for the application of lotions or other necessary equipment such as thermometers or syringes for the sick patient. 10. Suggest special services which may be most important to the patron. Calling his attention to a delivery service or a private incoming phone can help to build and maintain good public relations. If you do not have special services available, a kind word of encouragement can serve as good "psychosomatic medicine." Wishing the patient a speedy recovery in a warm, sincere, professional voice can do far more for you than can a routine and hurried "thank-you."
There have been many methods suggested for attracting prescription practice and improving our professional stature as pharmacists. Some pharmacies enjoy an increase in prescription volume through no effort of their own
Robert A. Walsh, APhA member, is currently teaching public health and professional relations at the Massachusetts College of Pharmacy. He has had 20 years of experience as a community pharmacist, was pharmacist-in-chief of the Peter Bent Brigham Hospital in Boston and was executive vice president of E.L. Patch Company. Besides teaching and directing public relations at his alma mater, Walsh has appeared on professional programs and has authored many papers. Walsh is former grand president of the Phi Delta Chi fraternity and holds membership in ASHP, the Massachusetts State Pharmaceutical Association and the Rho Chi Honor Society.
but through neighborhood population growth or the presence of a new physician or clinic in the area. Such increases are in the minority, however. The majority of increases in prescription practice come through modest or extensive promotional plans. But all increases in patronage, whether effected by well-planned campaigns or fortuitous circumstances, ultimately lead to a meeting between the prescription patron and the pharmacist. The past, present and future of community pharmacy has been, is and will continue to be built around our prescription practice. While the kind and number of drugs and chemicals involved in medical usage has changed, the professional standing of the pharmacist has remained fairly permanent during the last 20 years. If we are to increase our professional stature, we must think and act like professional men. The ten commandments for prescription practice are offered as rules that can be followed on the road to better professional relations. • references 1. 2.
Bastedo, W.A., Materia Medica, Pharmacology and Therapeutics, Saunders, Philadelphia, 17(1937). Teed, R.W., "Public Relations Begin in the Doctor's Office," J. Mich. State Med. Soc., 57, 334(1958).
Vol. NS5, No. 10, October 1965
537