- Email: [email protected]
The One Minute Counselor
A Pharmacist's Guide to Sexually Transmitted Diseases More than one million cases of gonorrhea and four million cases of cWamydial genital infections are reported annually. One in six adults is infected with herpes simplex virus. Human immunodeficiency virus (HIV) infection is a rapidly growing epidemic among sexually active people. Control of sexually transmitted diseases (STDs) requires a comprehensive approach. General prevention and control measures include education of people at risk; detection of asymptomatic infections; effective diagnosis and treatment; and a system to evaluate, treat, and counsel sexual partners. The presence of one STD is a risk factor for contracting other STDs. Other risk factors include many sexual partners, frequent change of sexual partners, casual sexual behavior, and specific high-risk sexual practices. Factors associated with decreased risk of acquiring or transmitting an SID include use of condoms, early consultation for diagnosis and treatment, compliance with therapy, and partner referral. Pharmacists can help to prevent and control STDs by raising awareness about risks and providing education and counseling about avoidance behaviors. Risk reduction includes changes in behavior, as well as use of condoms during risky sexual practices. The current pharmacotherapy recommendations for various STDs were developed by the Centers for Disease Control and Prevention (CDC). These recommendations resulted from sever-
Contributing author: Dennis M. Williams, PharmD, assistant professor, University ofNorth Carolina at Chapel Hill School ofPharmacy .
al influences, including the availability of new agents and changing patterns of pathogen resistance. Pharmacists should encourage compliance with treatment to enhance efficacy and minimize risk of failure and development of resistance. Untreated STDs can result in serious local and systemic complications, including sterility and risks to newborn infants. Gonorrhea
Gonococcal infections are caused by Neisseria gonorrhoeae. For urethritis or cervicitis, several treatment options are available that are highly effective (> 95%) and can be administered as a Single dose (Table 1). Treatment choice should be based on cost, history of allergies, previous experience, and convenience. If pharyngeal infection is present or likely, ceftriaxone or ciprofloxacin are recommended on the basis of proven efficacy. Because of the frequency of chlamydial infections in patients with gonorrhea, a regimen that is effective against chlamydia should also be given. Chlamydia trachomatis
Chlamydial infection is the primary differential diagnosis when evaluating urethritis or cervicitis. Diagnostic technology has significantly improved over the past few years; both culture and nonculture techniques (antigen detection) have been developed. These technologies are expensive and not universally available in all practice settings. Therefore, empiric treatment is frequently given in symptomatic patients with either positive or negative gram stain or culture results for gonococcus, because the two organisms frequently coexist. The most common agent is doxycycline , which is preferred over tetracycline because of better tolerability and fewer drug interactions. Erythromycin can be ,
This program was developed by :.i:V.i\
, Mtf
~
and
a~~p
and is supported by an educational grant from
3M Pharmaceuticals
~".
Table 1
Regimens for Gonococcal Cervicitis/Urethritis Ceftriaxone 125 mg intramuscularly, or Ciprofloxacin 500 mg orally, or Cefixime 400 mg orally, or Ofloxacin 400 mg o rally, each with a regime n effective against Chlamydia
© 1995 by the AmelLcan Pharmaceutical Association . All rights reserved.
used for patients who are pregnant or those unable to tolerate d oxycycline. Single-dose azithromycin therapy is also an effective treatme nt and is associated with improved compliance, but it is Significantly more exp e nsive. Genital Herpes
Genital herpes is a viral disease that may be recurrent; it has no cure. Genital herpes infections are most commonly attributed to HSV-2 (herpes simplex virus), although an increasing number are attributed to HSV-l. Oral acyclovir therapy is most effective in reducing symptoms from the initial episode (Table 2), although it is also used for recurrences. Suppressive therapy may decrease recurrence rates by 75% and is recomme nded for patients who experience more than six episodes annually. Topical acyclovir therapy is less effective than oral therapy, and it is generally not recommended. Syphilis
Syphilis is a systemic disease caused by Treponema pallidum. Syphilis infection rates have risen over the past decade, associated with HIV infection and increases in "sex for drugs" practices. The disease presents in various stages with long-term complications frequently affecting the skin, central nervous system , and cardiovascular system. Penicillin, procaine or benzathine salt, is the treatment of choice for syphilis. Patients who receive penicillin therapy during the early stages are more likely to develop the Jarisch-Herxheimer reaction, an acute febrile reaction accompanied by headache and myalgias. Patients should be warned about the possibility of this reactio n , w hich can usually be managed with antipyretics. -'
Table 2
Genital Herpes Therapy Primary episode
Acyclovir 200 mg orally five times daily for 7 to 10 days
Recurrence
Acyclovir 200 mg orally five times daily for 5 days
Suppressive therapy
Acyclovir 400 mg twice daily
A Patient's Guide to Sexually Transmitted Diseases What Are Sexually Transmitted Diseases?
Any disease that can be spread from one person to another by sexual contact (oral, vaginal, or anal) is called a sexually transmitted disease (SID). More than 12 million Americans each year contract STDs. Human immunodeficiency virus (HN), which causes acquired immunodeficiency syndrome (AIDS), is perhaps the best-known STD and is a rapidly growing epidemic-but this is not the only risk you face from unprotected sex. Each year, one million Americans contract gonorrhea and four million contract chlamydial genital infections. Genital warts, herpes simplex, and syphilis are also found in this large family of diseases. How Do I Know if I Have an STD?
You will need to see a doctor to fmd out if you have an SID. Talk frankly with your doctor about your concems--and about your sexual practices. If you have any of these symptoms, call your doctor: • Discharge from the vagina, penis, or rectum. • Pain or burning during urination or intercourse. • Blisters, open sores, warts, rash, or swelling in the genital or anal areas or in the mouth. • Pain in the buttocks or legs. What Happens if I Get an STD?
SIDs are serious. AIDS has no cure and is nearly always fatal. Other Sills can damage the major organs of your body-your heart, kidneys, and even your brain. Women can contract cancer of the cervix as a result of an STD. Both women and men can become sterile as the result of an SID. Some women who have had an STD are prone to tubal pregnancies-the fetus grows in the fallopian tube instead of the womb. Tubal pregnancies are sometimes fatal to the mother and always fatal to the baby. Early treatment of an SID is very important. But staying with the treatment and follOWing your doctor's orders are just as important.
How Can I Avoid STDs?
The best way to avoid STDs is to avoid the risks. Total abstinence from sex is the only certain way to avoid an SID, but certain risky behaviors can also be avoided. Such behaviors include use of intravenous drugs, sexual relations with several partners, and unprotected sex. Using the right kind of condom in the right way can greatly reduce your chances of becoming infected. Which Condoms Are Best?
• Always choose latex condoms. Do not use natural skin condoms. Natural skin condoms have tiny holes (pores) that are large enough to allow viruses that cause some Sills to pass through. The package label will tell you which kind you have chosen. • Choose condoms with these words on the label: "For disease prevention. " • Do not buy or use condoms that have passed their expiration date. The package label will have "EXP," followed by a date. This is the expiration date. Older condoms may not provide protection. Be sure to store condoms in a cool, dry place, out of direct sunlight. The glove compartment of a car is not a good place to store condoms. Do not store condoms in pockets, purses, or wallets for more than a few hours.
• If you need a lubricant, use K-Y Jelly or another water-based lubricant. Do not use Vaseline (or another brand of petroleum jelly), baby oil, lotion, cooking oil, or cold cream, because these products can weaken the condom and cause it to tear. • If the condom breaks, withdraw from your partner immediately and put on a new condom. • When intercourse is over, hold the condom against the base of the penis and remove the condom while the penis is still erect. Be careful not to spill semen. Wrap the condom in a tissue and dispose of it in a place where others will not handle it. Wash your hands with soap and water. Where Can I Get More Information AboutSTDs?
Your doctor and pharmacist can answer many of your questions about STDs. You can also call these toll-free numbers: • SID Hot Line-(800) 227-8922. • HIV/ AIDS Hot Line-(800) 342-AIDS. • HN/ AIDS Clearinghouse(800) 458-5231. You are at risk for geHing an STD, including HIV, if you: • Have oral, vaginal, or anal sex without using a latex (rubber) condom.
What Is the Right Way to Use a Condom?
• Have sex with someone who has an SID.
• Use a new condom with each act of intercourse. Use condoms for all types of sexual activity, including oral and anal sex, as well as for vaginal intercourse. Whenever body fluids are exchanged, you are at risk of contracting an STD. • Handle the condom carefully to avoid puncturing it with a fingernail or other sharp object. • Put the condom on while the penis is erect and before you have any contact with any part of your partner's body. • Make sure that no air is trapped in the condom tip. If the condom does not have a reservoir tip, pinch the tip enough to leave a half-inch space for semen to collect.
•
Photocopy th is page and give it to appropriate patients.
Have sex with many partners.
• Have sex when you are drunk or high (and not using good judgment). • Share needles, syringes, or "works" (needles, syringes, cookers, water, or cotton) to take drugs.
H you think you have an STD, you: •
Should stop having sex at once.
•
Should not try to treat yourself.
• Should visit your doctor or local health department. • Should talk to your sex partnerCs) about your condition (after receiving a diagnosis from your doctor).
© 1995 by the American Pharmaceutical Association. All rights reserved.
initial orientation is not to be confused with continuing education, which will be necessary to keep staff current in their jobs.
Determining the Need for Change Examining your philosophy about employer-employee relationships really entails exploring your philosophy and vision in two areas. The first is personal: What do you want from life? The second relates to business: How does your business philosophy compare with your personal vision? If the two are not congruent, you may have a problem. Would you change what you are doing? Would you change how you are doing it? Would you change where you are doing it? Answers to these questions may help you examine your current strategies. If your philosophy and vision are congruent, examine whether improved employer-employee relations could help bring the vision to fruition. Are your current actions clearly leading you in that direction? Self-examination is critical, as are personal development and employee mentoring. Continuous personal development will be a key to career survival in the information-based 21st century. If the convergent business model predicted for the future is accurate, the reward systems will be clear: work smartly and produce highquality goods and services, and the company will give you personal recognition, continuous training, and a good living. Pritchett2 emphasizes the importance of personal development: "Today's world takes no pity on the person who gets lazy about learning. Either you take personal responsibility for continuing your education, or you end up without the knowledge you need to protect your career." Personal development will be the watchword in the mix that makes each employee more valuable to the organization. Another tool for the continual education of employees is the use of senior employees as mentors. Mentoring is defmed as a developmental, caring, sharing, and helping relationship in which one person invests time, know-how, and effort to enhance another person's growth, knowledge, and skills, and responds to critical needs in that person's life in ways that prepare the person for greater productivity or achievement in the future. 21 Mentoring can help employees reach their full potential. Mentoring creates a helping environment that facilitates knowledge flow and breaks down compartmentalization. A mentor should not be considered as a protector, a key to advancement, or a coddler. Mentoring probably works best when senior employees are encouraged to mentor new employees voluntarily, although in some cases employees With seniority can be mentored as well. Mentoring produces many positive outcomes: • Mentors learn from new employees who may have recently acquired technical skills in school or college. • Mentors achieve recognition and a sense of contribution. • Mentored employees can try out new ideas and present them in a friendly forum. Vol. NS35, No.8
August 1995
• Mentored employees learn about the organization's structure and gain insight into the company's vision. • Mentored employees receive insights and reinforcement of behaviors that support the organization's goals and actions. 21 Large companies often have successful, formal mentoring programs with assignments and rewards, but such programs are probably too complex for the average pharmacy. A consultant can help you if you are considering this option. A word of caution: not all senior employees make good mentors. Common sense and personal knowledge of your employees will tell you which ones are best suited for the role. Good mentors are persons who provide positive counseling. The biggest problem with poor mentors, by contrast, is negative counseling, often done unwittingly. Shea21 calls this the "Fagin factor," from the character Fagin in Charles Dickens's Oliver Twist. He writes that Fagin was portrayed as a criminal beyond redemption. He took in a number of homeless boys, fed them, gave them a place to stay, and taught them survival skills such as thievery. Although he was serving his own best interests, he was helping boys who had few prospects before he came along. A negative, Fagin-type mentor is worse than no mentor at all, in pharmacy or any other profession. Be sure that your mentors have appropriate characteristics and training for the job.
SUlTllTlary and Conclusions Building good employer-employee relationships is not so much following a set of rules as it is forming a philosophy of professional practice that encompasses your customers (patients, clients, patrons) and employees. The philosophy must come first. Everyone in your pharmacy must share it. Once employees understand your philosophy, they can better help your organization accomplish its goals and realize its vision. It is tempting to try to develop a master list that will tell us how to do everything. Rules do help. Pharmacists who have increased their skills and knowledge in interpersonal areas will tell you, however, that the key to realizing goals is not a list of rules but a body of knowledge that enables them to keep learning and developing their philosophies and interpersonal skills in various areas, such as employeremployee relationships. These interpersonal skills are valuable professional tools. Managers should realize that they do not interact with their employees in a vacuum. Each employer-employee interaction is unique and is based on both parties ' experience with other employees, family, friends , and the world in general. The role of the pharmacist manager can best be described as that of a facilitator of good customer relations, because it is the employee who will ultimately deliver quality and service. Within this context, the following general guidelines are recommended: AMERICA PHARMACY
1. Provide training to new employees. Golf instructors tell you that it is best to instruct new students from scratch, before they develop bad habits. The same holds true for employees; however, more is at stake than a golf score. 2. Maintain support through continued training opportunities. People have a need to reconfirm original decisions. Employees might change behavior over time if presented with conflicting information from a co-worker or friend . Make yourself available by asking employees how things are going and if they have any questions. To be effective, training and education must be continuous. 3. Create an environment conducive to quality and service. Do all you can to improve the obvious, such as your personal image and your store layout. Be aware, however, that the single most powerful action you can take is to be a role model and lead by personal example. 4. Involve employees in designing jobs. Let your employees suggest new ideas. So long as they are congruent with your desired outcomes, make any reasonable changes to accommodate these suggestions. 5. Start a mentoring program. Use senior employees as mentors, but watch out for the Fagin factor.
6. Make training relevant. On-the-job training is extremely effective. Other forms of training that may be necessary include trips to vendor sites, seminars, and computer conferences. Training may sometimes be used as a reward for achievement; however, make sure the rewards are for extras. Everyone needs necessary basic training. Training should emphasize the positive ("do's"); emphasizing the "don'ts" creates distrust. 7. Reinforce good behavior through praise. Tell employees when they are doing a good job. Do not, however, offer praise when it is not due; it dilutes the effect. Highly visible forms of praise such as certificates and employee-of-themonth awards should go only to those who have really earned them. 8. Link rewards and performance. When giving tangible rewards such as bonuses, pay raises, trips, or other items of monetary value, be sure they are based on an objective merit system and that all employees understand that system. Encourage employees to make suggestions for improving the merit system. 9. Identify factors that promote positive behavior. Identify employees' goals and what they need to attain them. Help them formulate realistic goals . They will work harder to achieve goals that they have set for themselves. Offer precise AMERICAN PHARMACY
guidance about how they can accomplish their goals within the organization. 10. Focus on patient communications. Techniques that make sound business sense usually make good professional sense as well. Be sure you and your employees get all the tr.lining possible to enhance your communication skills. Make it a policy that no customer is to leave the pharmacy with an unanswered question or, at the very least, without the assurance of a quick follow-up. Techniques should not become the central focus in employer-employee relations, however, because the manager who overuses techniques will be perceived as artificial and uncaring. An undue concentration on technique can interfere with listening and communication. The quality of the relationship between the pharmacy manager and the employee is important. If that relationship is good, chances of successful customer relations are greatly enhanced. It has been said that we often explain things to others in order to better understand them ourselves. This is true for employer-employee relationships. The more we work at communicating our philosophies, the better we understand them ourselves. In the process, we will achieve professional and self actualization as well. Work hard at communicating, especially listening. It is not easy, but you can and will improve. The bottom line is: If patients always leave your pharmacy feeling good, regardless of how ill they are, because you and your employees have taken good care of them, you will have patrons for life. Buford T. Lively, BS Pharm, EdD, is professor and head of the Division of PharmaLY and Health Care Administration, College Of Pharmacy, The University of Toledo, Toledo, Ohio.
References 1. Peters T. Thriving on Chaos. New York: Harper & Row; 1988:6. 2. Pritchett P. The Employee Handbook of New Work Habits for a Radically Changing World. Dallas: Pritchett & Associates, Inc; 1994:21-38, 48-9. 3. Peters T. The Tom Peters Seminar: Crazy Times Call for Crazy Organizations. New York: Vintage Books; 1994:3. 4. Kahn R. Lessons from Wal-Mart: business strategies for the 21st century. Bottom Line. June 1, 1994;15:11-2. 5. Dwyer P, Engardio P, Schiller Z, et al. 21st century capitalism. Business Week. Nov. 18,1994; 3399 (special issue):80-90. 6. Anderson MD. Creating loyalty. Success. November 1994;41:18-22. 7. Peters T, Austin A. A Passion for Excellence. New York: Warner Books; 1986:237-48.
8. Peters T. A Passion for Excellence [videotape]. Pittsburgh, Pa: WQED, Public Broadcasting System; February 21, 1988. 9. Peters T, Waterman R. In Search of Excellence. New York: Warner Books; 1982:235-78. 10. Covey S. The Seven Habits of Highly Effective People. New York: Simon & Schuster; 1990:46-62, 96-144. 11 . Kriegel R, Patler L. If It Ain't Broke .. .Break It. New York: Warner Books; 1991:21-51. 12. Bagin D, Grazin F. As we see it-today's tough new customers. Communications Briefings. 1994;13:1--8.
August 1995
Vol. NS35. No. 8
13. Howard J. Customer service is more than a department. Working Smart. September 1994;20:4.
7.
Which of the following terms is a "bottom-line" focus? a . Empowerment b. Mentoring c . Leadership d. Vision e . Management
8.
Which one of the following terms deals with the "top line"? a. The Fagin factor b . Firehosing c . Leadership d . Barriers e. Management
9.
Which one of the following statements about leading by example is not correct? a. It includes what you say and do. b . Expect as much of yourself as you do of others. c . Do what you say you will do. d . Double standards cannot be hidden from the people you supervise. e. Reacting more slowly than others is a cause for concern.
14. Leadership: it's a natural. Working Smart. September 1993;19:1. 15. Becoming a leader: working smart strategy file. Working Smart. March 1993;19(suppl):2. 16. Openness: it helps you manage. Working Smart. May 1993;19:1. 17. Fine line between empowerment and chaos. Working Smart. January 1993;19:4. 18. Thompson C. Lessons in better interpersonal communications. Bottom Line. March 15, 1994;15:13-4. 19. Southly S. How I motivated my staff by changing my behavior. Working Smart. March 1994;20:4. 20. Kushel G. Peak performers: their secrets of winning. Bottom Line. March 15, 1994;15:1-2. 21. Shea G. Helping Employees Reach Their Full Potential. New York: American Management Association; 1994:13.
Assessment Questions
Instructions: For each question, blacken the letter on the answer sheet corresponding to the answer you select as being the correct one. Please review all answers to be sure you have blackened the proper spaces. There is only one correct answer to each question. 1.
2.
3.
4.
5.
6.
A business organization needs a philosophy because it: a. Follows strategic planning. b. Decreases dependence on employees. c. Decreases the need for mentoring. d. Guides all of its procedures. e. Slows the rate of change. Philosophy is defined as: a. The correct use of technology. b. A love of wisdom. c. The key to career survival. d. A strategy for your business. e. A procedure for your business. Statements of desired accomplishment are known as: a. Dreams b. Goals c . Vision d. Procedures e. Empowerment Which one of the following statements is not true? a. Goals can be limiting. b. Goals that are based on short-teml results enhance creativity. c. Goals may change during the pursuit of a vision. d . Goals provide us with specific targets. e. Goals give us feedback. Which one of the following answers does not describe today's tough new customers? They: a. Are well informed. b. lnsist on quality. c . May link purchases with a variety of causes. d . Closely resemble customers ofthe 1980s. e. Want quality and service on their own terms. The original idea of internal customer focus was not intended to: a. Make employees happy. b. Eliminate turf battles. c. Eliminate artificial barriers. d. Stimulate a tlow of ideas. e. Assist companies in improving the quality of service.
Vol NS35, No.8
August 1995
10. The ingredient that binds the leadership attributes together is:
a. b. c. d. e.
Call1U1ess Leading by example Openness Punctuality lnternal customer focus
11 . Which one of the following items is linked to a continuous, reciprocal commitment to honesty? a. The Fagin factor b . Openness c. lolage d . Punctuality e. Firehosing 12. Empowerment embodies all but which of the following? a . Openness b . Communication c. Internal customer focus d. Firehosing e. Responsibility
13. Which one of the following items does not describe peak performers? They: a. Always take responsibility for their own performances. b. Inspire others to produce . c. Are effective thinkers. d. Are willing to ask for help even after reaching the top. e. Do what others want them to do. 14. The weapon of choice for firehosers is: a. Rigid goals b. Killer phmses c . Inner flfehosing d. Negative counseling e. Short-term goals 15. Which one of the following terms is not an advantage of mentoring?
a. b. c. d. e.
Protection Recognition Contribution Learning Insight
AMERICAN PHARMACY
Instructions
To receive two hours of continuing education credit (0.2 CEUs) for successful completion of this program, you must: 1. Complete answer sheet and type or print your name, address, and Social Security number in the space provided.
16. Which one of the following terms best describes the Fagin factor? a. Rigid goals b. Communication d. Internal customer focus d. Negative counseling e. Responsibility
2. Mail your completed answer sheet with the correct handling fee ($5 for APhA members; $15 for nonmembers; no additional charge for current 12-exam continuing education program members) to: Processing DesklEducation American Pharmaceutical Association 2215 Constitution Ave., NW Washington, DC 20037-2985
17. Creating an environment conducive to quality and service can
Certificates will be issued to those who score 70% or higher. Those who score below 70% will be notified, and no credit will be recorded. Allow four weeks for processing.
Which one of the following guidelines for enhancing employeremployee relationships would be least likely to work? a. Giving award certificates to boost morale. b . Praising truly laudable efforts. c. Starting a mentoring program. d. Involving employees in the design of their jobs. e. Emphasizing the positive ("do's") during training.
Expiration date: August 31, 1998
best be done by: a. Polishing your personal image. b . Improving your store layout. c. Leading by personal example. d. Awarding certificates. e. Concentrating on techniques.
Answer Sheet 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
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© © © © © © © © © ©
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11. 12. 13. 14. 15. 16. 17. 18. 19. 20.
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© © ©
Which one of the following types of employees is best suited to leverage knowledge in an organization? a. Middle managers b. Peak performers c. Mentors d. Trainers e. Supervisors Business leaders develop effective habits on the basis of their clear understanding of: a. Company procedures b. Organizational goals c. Personal philosophy d. Mentoring programs e. Empowerment programs
Employer-Employee Relationships APhA provider number for this program is: 680-202-95-014.
o o o o
Make checks payable to "APhA ":
$5 fee enclosed (member rate). $15 fee enclosed (nonmember rate). $45 12-exam continuing education program fee enclosed. $45 12-exam continuing education program fee paid earlier.
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p(i1renteralls; productprepara..'fh~ hist portion cif the patients needing Tf:N,
qf
course will ,on .the .t~erapeutis, pain m{ag~ment, c~eIl10therapy, and ., The cours~ Js t1;iught by experts in th~c. 4~liv~rY of IV home services, including representatives frqID corporat~and consul~t organizations, as well as university faculty.
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August 1995
Vol. NS35, No.8
Contributing author: Dennis M. Williams, PharmD, assistant professor, University ofNorth Carolina at Chapel Hill School ofPharmacy .
al influences, including the availability of new agents and changing patterns of pathogen resistance. Pharmacists should encourage compliance with treatment to enhance efficacy and minimize risk of failure and development of resistance. Untreated STDs can result in serious local and systemic complications, including sterility and risks to newborn infants. Gonorrhea
Gonococcal infections are caused by Neisseria gonorrhoeae. For urethritis or cervicitis, several treatment options are available that are highly effective (> 95%) and can be administered as a Single dose (Table 1). Treatment choice should be based on cost, history of allergies, previous experience, and convenience. If pharyngeal infection is present or likely, ceftriaxone or ciprofloxacin are recommended on the basis of proven efficacy. Because of the frequency of chlamydial infections in patients with gonorrhea, a regimen that is effective against chlamydia should also be given. Chlamydia trachomatis
Chlamydial infection is the primary differential diagnosis when evaluating urethritis or cervicitis. Diagnostic technology has significantly improved over the past few years; both culture and nonculture techniques (antigen detection) have been developed. These technologies are expensive and not universally available in all practice settings. Therefore, empiric treatment is frequently given in symptomatic patients with either positive or negative gram stain or culture results for gonococcus, because the two organisms frequently coexist. The most common agent is doxycycline , which is preferred over tetracycline because of better tolerability and fewer drug interactions. Erythromycin can be ,
This program was developed by :.i:V.i\
, Mtf
~
and
a~~p
and is supported by an educational grant from
3M Pharmaceuticals
~".
Table 1
Regimens for Gonococcal Cervicitis/Urethritis Ceftriaxone 125 mg intramuscularly, or Ciprofloxacin 500 mg orally, or Cefixime 400 mg orally, or Ofloxacin 400 mg o rally, each with a regime n effective against Chlamydia
© 1995 by the AmelLcan Pharmaceutical Association . All rights reserved.
used for patients who are pregnant or those unable to tolerate d oxycycline. Single-dose azithromycin therapy is also an effective treatme nt and is associated with improved compliance, but it is Significantly more exp e nsive. Genital Herpes
Genital herpes is a viral disease that may be recurrent; it has no cure. Genital herpes infections are most commonly attributed to HSV-2 (herpes simplex virus), although an increasing number are attributed to HSV-l. Oral acyclovir therapy is most effective in reducing symptoms from the initial episode (Table 2), although it is also used for recurrences. Suppressive therapy may decrease recurrence rates by 75% and is recomme nded for patients who experience more than six episodes annually. Topical acyclovir therapy is less effective than oral therapy, and it is generally not recommended. Syphilis
Syphilis is a systemic disease caused by Treponema pallidum. Syphilis infection rates have risen over the past decade, associated with HIV infection and increases in "sex for drugs" practices. The disease presents in various stages with long-term complications frequently affecting the skin, central nervous system , and cardiovascular system. Penicillin, procaine or benzathine salt, is the treatment of choice for syphilis. Patients who receive penicillin therapy during the early stages are more likely to develop the Jarisch-Herxheimer reaction, an acute febrile reaction accompanied by headache and myalgias. Patients should be warned about the possibility of this reactio n , w hich can usually be managed with antipyretics. -'
Table 2
Genital Herpes Therapy Primary episode
Acyclovir 200 mg orally five times daily for 7 to 10 days
Recurrence
Acyclovir 200 mg orally five times daily for 5 days
Suppressive therapy
Acyclovir 400 mg twice daily
A Patient's Guide to Sexually Transmitted Diseases What Are Sexually Transmitted Diseases?
Any disease that can be spread from one person to another by sexual contact (oral, vaginal, or anal) is called a sexually transmitted disease (SID). More than 12 million Americans each year contract STDs. Human immunodeficiency virus (HN), which causes acquired immunodeficiency syndrome (AIDS), is perhaps the best-known STD and is a rapidly growing epidemic-but this is not the only risk you face from unprotected sex. Each year, one million Americans contract gonorrhea and four million contract chlamydial genital infections. Genital warts, herpes simplex, and syphilis are also found in this large family of diseases. How Do I Know if I Have an STD?
You will need to see a doctor to fmd out if you have an SID. Talk frankly with your doctor about your concems--and about your sexual practices. If you have any of these symptoms, call your doctor: • Discharge from the vagina, penis, or rectum. • Pain or burning during urination or intercourse. • Blisters, open sores, warts, rash, or swelling in the genital or anal areas or in the mouth. • Pain in the buttocks or legs. What Happens if I Get an STD?
SIDs are serious. AIDS has no cure and is nearly always fatal. Other Sills can damage the major organs of your body-your heart, kidneys, and even your brain. Women can contract cancer of the cervix as a result of an STD. Both women and men can become sterile as the result of an SID. Some women who have had an STD are prone to tubal pregnancies-the fetus grows in the fallopian tube instead of the womb. Tubal pregnancies are sometimes fatal to the mother and always fatal to the baby. Early treatment of an SID is very important. But staying with the treatment and follOWing your doctor's orders are just as important.
How Can I Avoid STDs?
The best way to avoid STDs is to avoid the risks. Total abstinence from sex is the only certain way to avoid an SID, but certain risky behaviors can also be avoided. Such behaviors include use of intravenous drugs, sexual relations with several partners, and unprotected sex. Using the right kind of condom in the right way can greatly reduce your chances of becoming infected. Which Condoms Are Best?
• Always choose latex condoms. Do not use natural skin condoms. Natural skin condoms have tiny holes (pores) that are large enough to allow viruses that cause some Sills to pass through. The package label will tell you which kind you have chosen. • Choose condoms with these words on the label: "For disease prevention. " • Do not buy or use condoms that have passed their expiration date. The package label will have "EXP," followed by a date. This is the expiration date. Older condoms may not provide protection. Be sure to store condoms in a cool, dry place, out of direct sunlight. The glove compartment of a car is not a good place to store condoms. Do not store condoms in pockets, purses, or wallets for more than a few hours.
• If you need a lubricant, use K-Y Jelly or another water-based lubricant. Do not use Vaseline (or another brand of petroleum jelly), baby oil, lotion, cooking oil, or cold cream, because these products can weaken the condom and cause it to tear. • If the condom breaks, withdraw from your partner immediately and put on a new condom. • When intercourse is over, hold the condom against the base of the penis and remove the condom while the penis is still erect. Be careful not to spill semen. Wrap the condom in a tissue and dispose of it in a place where others will not handle it. Wash your hands with soap and water. Where Can I Get More Information AboutSTDs?
Your doctor and pharmacist can answer many of your questions about STDs. You can also call these toll-free numbers: • SID Hot Line-(800) 227-8922. • HIV/ AIDS Hot Line-(800) 342-AIDS. • HN/ AIDS Clearinghouse(800) 458-5231. You are at risk for geHing an STD, including HIV, if you: • Have oral, vaginal, or anal sex without using a latex (rubber) condom.
What Is the Right Way to Use a Condom?
• Have sex with someone who has an SID.
• Use a new condom with each act of intercourse. Use condoms for all types of sexual activity, including oral and anal sex, as well as for vaginal intercourse. Whenever body fluids are exchanged, you are at risk of contracting an STD. • Handle the condom carefully to avoid puncturing it with a fingernail or other sharp object. • Put the condom on while the penis is erect and before you have any contact with any part of your partner's body. • Make sure that no air is trapped in the condom tip. If the condom does not have a reservoir tip, pinch the tip enough to leave a half-inch space for semen to collect.
•
Photocopy th is page and give it to appropriate patients.
Have sex with many partners.
• Have sex when you are drunk or high (and not using good judgment). • Share needles, syringes, or "works" (needles, syringes, cookers, water, or cotton) to take drugs.
H you think you have an STD, you: •
Should stop having sex at once.
•
Should not try to treat yourself.
• Should visit your doctor or local health department. • Should talk to your sex partnerCs) about your condition (after receiving a diagnosis from your doctor).
© 1995 by the American Pharmaceutical Association. All rights reserved.
initial orientation is not to be confused with continuing education, which will be necessary to keep staff current in their jobs.
Determining the Need for Change Examining your philosophy about employer-employee relationships really entails exploring your philosophy and vision in two areas. The first is personal: What do you want from life? The second relates to business: How does your business philosophy compare with your personal vision? If the two are not congruent, you may have a problem. Would you change what you are doing? Would you change how you are doing it? Would you change where you are doing it? Answers to these questions may help you examine your current strategies. If your philosophy and vision are congruent, examine whether improved employer-employee relations could help bring the vision to fruition. Are your current actions clearly leading you in that direction? Self-examination is critical, as are personal development and employee mentoring. Continuous personal development will be a key to career survival in the information-based 21st century. If the convergent business model predicted for the future is accurate, the reward systems will be clear: work smartly and produce highquality goods and services, and the company will give you personal recognition, continuous training, and a good living. Pritchett2 emphasizes the importance of personal development: "Today's world takes no pity on the person who gets lazy about learning. Either you take personal responsibility for continuing your education, or you end up without the knowledge you need to protect your career." Personal development will be the watchword in the mix that makes each employee more valuable to the organization. Another tool for the continual education of employees is the use of senior employees as mentors. Mentoring is defmed as a developmental, caring, sharing, and helping relationship in which one person invests time, know-how, and effort to enhance another person's growth, knowledge, and skills, and responds to critical needs in that person's life in ways that prepare the person for greater productivity or achievement in the future. 21 Mentoring can help employees reach their full potential. Mentoring creates a helping environment that facilitates knowledge flow and breaks down compartmentalization. A mentor should not be considered as a protector, a key to advancement, or a coddler. Mentoring probably works best when senior employees are encouraged to mentor new employees voluntarily, although in some cases employees With seniority can be mentored as well. Mentoring produces many positive outcomes: • Mentors learn from new employees who may have recently acquired technical skills in school or college. • Mentors achieve recognition and a sense of contribution. • Mentored employees can try out new ideas and present them in a friendly forum. Vol. NS35, No.8
August 1995
• Mentored employees learn about the organization's structure and gain insight into the company's vision. • Mentored employees receive insights and reinforcement of behaviors that support the organization's goals and actions. 21 Large companies often have successful, formal mentoring programs with assignments and rewards, but such programs are probably too complex for the average pharmacy. A consultant can help you if you are considering this option. A word of caution: not all senior employees make good mentors. Common sense and personal knowledge of your employees will tell you which ones are best suited for the role. Good mentors are persons who provide positive counseling. The biggest problem with poor mentors, by contrast, is negative counseling, often done unwittingly. Shea21 calls this the "Fagin factor," from the character Fagin in Charles Dickens's Oliver Twist. He writes that Fagin was portrayed as a criminal beyond redemption. He took in a number of homeless boys, fed them, gave them a place to stay, and taught them survival skills such as thievery. Although he was serving his own best interests, he was helping boys who had few prospects before he came along. A negative, Fagin-type mentor is worse than no mentor at all, in pharmacy or any other profession. Be sure that your mentors have appropriate characteristics and training for the job.
SUlTllTlary and Conclusions Building good employer-employee relationships is not so much following a set of rules as it is forming a philosophy of professional practice that encompasses your customers (patients, clients, patrons) and employees. The philosophy must come first. Everyone in your pharmacy must share it. Once employees understand your philosophy, they can better help your organization accomplish its goals and realize its vision. It is tempting to try to develop a master list that will tell us how to do everything. Rules do help. Pharmacists who have increased their skills and knowledge in interpersonal areas will tell you, however, that the key to realizing goals is not a list of rules but a body of knowledge that enables them to keep learning and developing their philosophies and interpersonal skills in various areas, such as employeremployee relationships. These interpersonal skills are valuable professional tools. Managers should realize that they do not interact with their employees in a vacuum. Each employer-employee interaction is unique and is based on both parties ' experience with other employees, family, friends , and the world in general. The role of the pharmacist manager can best be described as that of a facilitator of good customer relations, because it is the employee who will ultimately deliver quality and service. Within this context, the following general guidelines are recommended: AMERICA PHARMACY
1. Provide training to new employees. Golf instructors tell you that it is best to instruct new students from scratch, before they develop bad habits. The same holds true for employees; however, more is at stake than a golf score. 2. Maintain support through continued training opportunities. People have a need to reconfirm original decisions. Employees might change behavior over time if presented with conflicting information from a co-worker or friend . Make yourself available by asking employees how things are going and if they have any questions. To be effective, training and education must be continuous. 3. Create an environment conducive to quality and service. Do all you can to improve the obvious, such as your personal image and your store layout. Be aware, however, that the single most powerful action you can take is to be a role model and lead by personal example. 4. Involve employees in designing jobs. Let your employees suggest new ideas. So long as they are congruent with your desired outcomes, make any reasonable changes to accommodate these suggestions. 5. Start a mentoring program. Use senior employees as mentors, but watch out for the Fagin factor.
6. Make training relevant. On-the-job training is extremely effective. Other forms of training that may be necessary include trips to vendor sites, seminars, and computer conferences. Training may sometimes be used as a reward for achievement; however, make sure the rewards are for extras. Everyone needs necessary basic training. Training should emphasize the positive ("do's"); emphasizing the "don'ts" creates distrust. 7. Reinforce good behavior through praise. Tell employees when they are doing a good job. Do not, however, offer praise when it is not due; it dilutes the effect. Highly visible forms of praise such as certificates and employee-of-themonth awards should go only to those who have really earned them. 8. Link rewards and performance. When giving tangible rewards such as bonuses, pay raises, trips, or other items of monetary value, be sure they are based on an objective merit system and that all employees understand that system. Encourage employees to make suggestions for improving the merit system. 9. Identify factors that promote positive behavior. Identify employees' goals and what they need to attain them. Help them formulate realistic goals . They will work harder to achieve goals that they have set for themselves. Offer precise AMERICAN PHARMACY
guidance about how they can accomplish their goals within the organization. 10. Focus on patient communications. Techniques that make sound business sense usually make good professional sense as well. Be sure you and your employees get all the tr.lining possible to enhance your communication skills. Make it a policy that no customer is to leave the pharmacy with an unanswered question or, at the very least, without the assurance of a quick follow-up. Techniques should not become the central focus in employer-employee relations, however, because the manager who overuses techniques will be perceived as artificial and uncaring. An undue concentration on technique can interfere with listening and communication. The quality of the relationship between the pharmacy manager and the employee is important. If that relationship is good, chances of successful customer relations are greatly enhanced. It has been said that we often explain things to others in order to better understand them ourselves. This is true for employer-employee relationships. The more we work at communicating our philosophies, the better we understand them ourselves. In the process, we will achieve professional and self actualization as well. Work hard at communicating, especially listening. It is not easy, but you can and will improve. The bottom line is: If patients always leave your pharmacy feeling good, regardless of how ill they are, because you and your employees have taken good care of them, you will have patrons for life. Buford T. Lively, BS Pharm, EdD, is professor and head of the Division of PharmaLY and Health Care Administration, College Of Pharmacy, The University of Toledo, Toledo, Ohio.
References 1. Peters T. Thriving on Chaos. New York: Harper & Row; 1988:6. 2. Pritchett P. The Employee Handbook of New Work Habits for a Radically Changing World. Dallas: Pritchett & Associates, Inc; 1994:21-38, 48-9. 3. Peters T. The Tom Peters Seminar: Crazy Times Call for Crazy Organizations. New York: Vintage Books; 1994:3. 4. Kahn R. Lessons from Wal-Mart: business strategies for the 21st century. Bottom Line. June 1, 1994;15:11-2. 5. Dwyer P, Engardio P, Schiller Z, et al. 21st century capitalism. Business Week. Nov. 18,1994; 3399 (special issue):80-90. 6. Anderson MD. Creating loyalty. Success. November 1994;41:18-22. 7. Peters T, Austin A. A Passion for Excellence. New York: Warner Books; 1986:237-48.
8. Peters T. A Passion for Excellence [videotape]. Pittsburgh, Pa: WQED, Public Broadcasting System; February 21, 1988. 9. Peters T, Waterman R. In Search of Excellence. New York: Warner Books; 1982:235-78. 10. Covey S. The Seven Habits of Highly Effective People. New York: Simon & Schuster; 1990:46-62, 96-144. 11 . Kriegel R, Patler L. If It Ain't Broke .. .Break It. New York: Warner Books; 1991:21-51. 12. Bagin D, Grazin F. As we see it-today's tough new customers. Communications Briefings. 1994;13:1--8.
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Vol. NS35. No. 8
13. Howard J. Customer service is more than a department. Working Smart. September 1994;20:4.
7.
Which of the following terms is a "bottom-line" focus? a . Empowerment b. Mentoring c . Leadership d. Vision e . Management
8.
Which one of the following terms deals with the "top line"? a. The Fagin factor b . Firehosing c . Leadership d . Barriers e. Management
9.
Which one of the following statements about leading by example is not correct? a. It includes what you say and do. b . Expect as much of yourself as you do of others. c . Do what you say you will do. d . Double standards cannot be hidden from the people you supervise. e. Reacting more slowly than others is a cause for concern.
14. Leadership: it's a natural. Working Smart. September 1993;19:1. 15. Becoming a leader: working smart strategy file. Working Smart. March 1993;19(suppl):2. 16. Openness: it helps you manage. Working Smart. May 1993;19:1. 17. Fine line between empowerment and chaos. Working Smart. January 1993;19:4. 18. Thompson C. Lessons in better interpersonal communications. Bottom Line. March 15, 1994;15:13-4. 19. Southly S. How I motivated my staff by changing my behavior. Working Smart. March 1994;20:4. 20. Kushel G. Peak performers: their secrets of winning. Bottom Line. March 15, 1994;15:1-2. 21. Shea G. Helping Employees Reach Their Full Potential. New York: American Management Association; 1994:13.
Assessment Questions
Instructions: For each question, blacken the letter on the answer sheet corresponding to the answer you select as being the correct one. Please review all answers to be sure you have blackened the proper spaces. There is only one correct answer to each question. 1.
2.
3.
4.
5.
6.
A business organization needs a philosophy because it: a. Follows strategic planning. b. Decreases dependence on employees. c. Decreases the need for mentoring. d. Guides all of its procedures. e. Slows the rate of change. Philosophy is defined as: a. The correct use of technology. b. A love of wisdom. c. The key to career survival. d. A strategy for your business. e. A procedure for your business. Statements of desired accomplishment are known as: a. Dreams b. Goals c . Vision d. Procedures e. Empowerment Which one of the following statements is not true? a. Goals can be limiting. b. Goals that are based on short-teml results enhance creativity. c. Goals may change during the pursuit of a vision. d . Goals provide us with specific targets. e. Goals give us feedback. Which one of the following answers does not describe today's tough new customers? They: a. Are well informed. b. lnsist on quality. c . May link purchases with a variety of causes. d . Closely resemble customers ofthe 1980s. e. Want quality and service on their own terms. The original idea of internal customer focus was not intended to: a. Make employees happy. b. Eliminate turf battles. c. Eliminate artificial barriers. d. Stimulate a tlow of ideas. e. Assist companies in improving the quality of service.
Vol NS35, No.8
August 1995
10. The ingredient that binds the leadership attributes together is:
a. b. c. d. e.
Call1U1ess Leading by example Openness Punctuality lnternal customer focus
11 . Which one of the following items is linked to a continuous, reciprocal commitment to honesty? a. The Fagin factor b . Openness c. lolage d . Punctuality e. Firehosing 12. Empowerment embodies all but which of the following? a . Openness b . Communication c. Internal customer focus d. Firehosing e. Responsibility
13. Which one of the following items does not describe peak performers? They: a. Always take responsibility for their own performances. b. Inspire others to produce . c. Are effective thinkers. d. Are willing to ask for help even after reaching the top. e. Do what others want them to do. 14. The weapon of choice for firehosers is: a. Rigid goals b. Killer phmses c . Inner flfehosing d. Negative counseling e. Short-term goals 15. Which one of the following terms is not an advantage of mentoring?
a. b. c. d. e.
Protection Recognition Contribution Learning Insight
AMERICAN PHARMACY
Instructions
To receive two hours of continuing education credit (0.2 CEUs) for successful completion of this program, you must: 1. Complete answer sheet and type or print your name, address, and Social Security number in the space provided.
16. Which one of the following terms best describes the Fagin factor? a. Rigid goals b. Communication d. Internal customer focus d. Negative counseling e. Responsibility
2. Mail your completed answer sheet with the correct handling fee ($5 for APhA members; $15 for nonmembers; no additional charge for current 12-exam continuing education program members) to: Processing DesklEducation American Pharmaceutical Association 2215 Constitution Ave., NW Washington, DC 20037-2985
17. Creating an environment conducive to quality and service can
Certificates will be issued to those who score 70% or higher. Those who score below 70% will be notified, and no credit will be recorded. Allow four weeks for processing.
Which one of the following guidelines for enhancing employeremployee relationships would be least likely to work? a. Giving award certificates to boost morale. b . Praising truly laudable efforts. c. Starting a mentoring program. d. Involving employees in the design of their jobs. e. Emphasizing the positive ("do's") during training.
Expiration date: August 31, 1998
best be done by: a. Polishing your personal image. b . Improving your store layout. c. Leading by personal example. d. Awarding certificates. e. Concentrating on techniques.
Answer Sheet 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
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Which one of the following types of employees is best suited to leverage knowledge in an organization? a. Middle managers b. Peak performers c. Mentors d. Trainers e. Supervisors Business leaders develop effective habits on the basis of their clear understanding of: a. Company procedures b. Organizational goals c. Personal philosophy d. Mentoring programs e. Empowerment programs
Employer-Employee Relationships APhA provider number for this program is: 680-202-95-014.
o o o o
Make checks payable to "APhA ":
$5 fee enclosed (member rate). $15 fee enclosed (nonmember rate). $45 12-exam continuing education program fee enclosed. $45 12-exam continuing education program fee paid earlier.
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p(i1renteralls; productprepara..'fh~ hist portion cif the patients needing Tf:N,
qf
course will ,on .the .t~erapeutis, pain m{ag~ment, c~eIl10therapy, and ., The cours~ Js t1;iught by experts in th~c. 4~liv~rY of IV home services, including representatives frqID corporat~and consul~t organizations, as well as university faculty.
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August 1995
Vol. NS35, No.8