By Dr. Terry Maguire, a Northern Irish Community Pharmacist, senior lecturer at School of Pharmacy (Queens University Belfast) and Belfast LCG member.
Doing the things we do?
Unlike the tattoo, her second marriage had only lasted two years but as a witness to hope over experience she was again taking the plunge, this time for good, this time with Mr Right. The wedding was this weekend and there would be over 200 guests. So the pharmacy-counter-conversation progressed in a sanguine fashion and having brought Annette up to date with her world she asked if she could have a word with the pharmacist.
She had two problems, well three really, and because she was so busy with the wedding she was unable to get to the GP; could I help? Firstly she could not hear in her left ear, no pain, but she had been using an ear-bud and nothing was shifting could I give her something “on prescription”. Secondly she had a chest infection with a sore throat; could I give her some antibiotics until she sees the GP. She was worried it would “settle on her chest”. Her last request was more unusual. She had a “personal tattoo” of her ex-partner’s name and was wondering if I could suggest a cream cover to mask it. Her husband-to-be had off course seen it but given the impending nuptials she felt it would be appropriate to do something and anyway after the wedding she would have it removed and his name tattooed on her person as he would have her name tattooed on his. It was the ultimate gesture of commitment Annette said but I struggled with my cynicism and my cold view of reality.
To correct these abnormal views I have recently become a student of human behaviour and rather than become stressed, disappointed and angered with my fellow man and women, as I use to, I now use observation and reflection as a foil in my day to day community pharmacy interactions. And it’s working exceptionally well and perhaps in time I will amass sufficient information to gain a deep and satisfying insight to the bizarre beliefs, cultures and behaviours that enrich our society.
As our health service in the North struggles to deal with increasing demand at a time when additional money is not available I increasingly reflect on why my customers, such as this young woman, do what they do. It is here, in these behaviours and attitudes that the current NHS demand problems start. Warnings of imploding Emergency Department and over worked GPs have their origins in the demands of a generation removed from the reality of a health service based on the principle of being free at the point of access. She wants to see her GP and if he cannot see her she will go to the Emergency Department. I am only consulted as a last resort yet I had a minor ailments scheme (MAS) that would address one of her problems and I can sell her medicines to manage her chest symptoms.
I advised her on management of ear wax and wrote a Pharmacy Voucher for ear drops which I supplied free of charge getting a HS fee for my time and expertise. I explained that, in a healthy young woman such as she, a viral upper respiratory infection did not require treatment with antibiotics so no need to visit the GP. Above all she should stop smoking cigarettes. She was grateful for the ear drops, wanted antibiotics and unwilling to pay for the ibuprofen and Strefen lozenges I recommended and she told me she could do without the stop smoking lecture. I looked to Annette and she returned her usual wry smile that always suggests it’s me who really doesn’t understand.
How much more I respect those who have a mature, more reasoned and insightful view of their responsibilities for their actions; people like Mr Yashido whose obituary appeared in the Times on the same day. Most of us never heard of him but in Japan he became a national hero for his role in tackling the Fukushema nuclear disaster. After the tsunami destroyed 12 of the 13 generators in March 2011 and the reactors were overheating and in danger of exploding- some did- he decided, against orders from his superiors who were communicating from a safe distance, to use sea water to cool the system. His actions stopped a disaster turning into a catastrophe. When Mr Yashido was diagnosed with cancer in 2012 it was automatically assumed that his proximity to high levels of radiation as he battled to save the surrounding environs was the cause. The true cause was rather more prosaic. Mr Yashido was a life-long smoker and his oesophageal cancer was more likely to have resulted from his forty-a-day habit and this was something he accepted.
Apart from the national hero designation Mr Yashido had much in common with my father. Both died at 58, both had most likely smoking related cancers and both were thought initially to have developed their cancers as a result of industrial poisoning. My father worked for Dupont at Maydown and when he was diagnosed with a small cell lung carcinoma with brain and bone secondaries, his trade union were vociferous in there condemnation of the company’s pollution record. They blamed the myriad chemical solvents used to manufacture the synthetic fibres for his disease. After his death the union approached my mother to progress a case for compensation but she refused accepting, as he had, that his illness was due to his own behaviour.
I thought of them again the next day at a meeting of the N. Ireland Malignant Melanoma Strategy Committee of which I am a member. The meeting was held at the offices of Cancer Focus in Belfast following an unusually sunny weekend. Sitting by the sea I had got significant sunburn; my face was tight and burning and at the start of the meeting the chairwoman, looking at me with disgust and disdain, told the public health professionals who make up the committee, how she had easily avoided getting too much sun over the weekend. I was indeed embarrassed but my blushes could not usurp my sunburn. Taking responsibility for our behaviours is honourable but is only useful when we use our insights to do things differently.
