Antidepressant or bust(ed toilet)

This Friday is World Pharmacists Day…whatever that actually means. But I love a theme, so in honour of it I thought I’d share on of my favourite stories from my Pharmacist interview study (names changed to keep it anonymous)…

“She doesn’t need an antidepressant, someone just needs to fix her toilet”

This was not the recommendation expected from the medication review, but it was life changing for Mrs Jones. Her doctor had asked Sam the pharmacist to see her, in part because they were thinking of starting her on an antidepressant. They wanted to know if it would interfere with any of her other medications, of which she was taking many. Mrs Jones was elderly and had metastatic ovarian cancer amongst other things. Sam was confident a review would be helpful, but he never imagined this would be the reason why.

Sam isn’t the type of pharmacist who sticks a label on a box and sends you on your way. He’s a health professional who happens to know a lot about drugs. You could call him an advanced generalist. He thinks about the patient as a whole and he is used to working collaboratively in a team.

When Sam arrived in Mrs Jones’ home he found her sitting quietly in a chair in her front room. He cleared space to sit on the sofa opposite and started putting Mrs Jones at ease with gentle conversation. The usual questions about medicines and how she was going with them. She started to tell Sam how she’d lost her up and go. She wasn’t engaging in her usual craft activities and this was really getting her down. This perplexed Sam who was sitting literally surrounded by craft supplies. He’d had to move them to clear a place to sit. He wondered how it were possible for her not to be engaging in craft activities while she was sitting in that chair.

Over the course of an hour or so as they talked about her medicines, Sam began to realise that she very rarely sat in that chair. She was actually spending most of her time in bed. When he asked her why, she spoke about the toilet. She had become unsteady on her feet and it wasn’t safe for her. She had a commode, but she didn’t want to place that in the living room, and understandably so. Instead she kept it in her bedroom and stayed in their to ensure she had easy access. And for this reason, she hadn’t been sitting in her front room with her craft activities. Because she was worried about going to the toilet.

When Sam asked her, “If we could get the toilet fixed and you could sit in this front room, would you do your crafts?” Mrs Jones replied “Probably. I’m sitting here now”.

Sam might not have fixed the toilet himself, but he was a big help to Mrs Jones that day because he was able to provide her medical team with the bigger picture. Rather than start her on another medication that would likely make her feel worse and even more unsteady on her feet, they could arrange for an occupational therapist to install safety rails in her home. Mrs Jones’ doctor didn’t have the opportunity to find this out herself because she didn’t have the time to dig deep on just one specific issue during their clinic visit. But Sam could afford to take the time to understand the problems that lay beyond the surface. The medication review enabled Sam to work with Mrs Jones and her care team to address what was a major quality of life issue.

As Mrs Jones’ medication review drew to a close she said to Sam “Well you’re not just a pharmacist, are you?” Sam responded, “well you’re not just your tablets. I can get a couple of your tablets stopped, but the thing that is going to make the biggest difference to you right now is actually getting your toilet fixed.”

Medication reviews are not about telling people off for taking their medicines wrong, or condemning doctors’ prescribing habits. They are about making people’s lives better. They are about making sure that the medicines being used are resulting in more good than harm. Because too often that’s not the case.

One in every 25 people will be admitted to hospital because of a problem with a medicine they are taking. For cancer, it’s more like one in ten. And those are just the problems that make it to the hospitals. So many people are suffering because of side effects of medicines they are taking, or failing to control a condition because their medication regimen is letting them down. Sometimes, because a medicine is prescribed as a quick fix intervention to manage the symptoms of a problem that has deeper causes that need to be understood. Like the need to fix a toilet to enable a woman who is house bound to keep doing her crafts.

1 Like

I should add a big thank you to the pharmacists who shared their experiences with me as part of this project. So many stories of contributing to patient care in meaningful ways.