George’s Corner

I received a nice note from one of ComputerTalk’s readers regarding my comments about how face-to-face conversations are so important to patient care. They are what generate the positive emotional responses that are so important.

Some thoughts about what has happened and how things look now:

The Old and the New

The old focus was often thought of as the “bedside manner.” It emphasized the empathy that must be felt and expressed by the caregiver when recognizing and explaining the care that the patient would be receiving. It placed the responsibility for doing this on the physician, because only that person was capable of understanding all of the factors and explaining them.

Today, the new focus emphasizes all caregivers focusing on the patient. It is often called “patient-centered care.” As if that is a new thing. If it is, it’s about time. The implication is that caregivers have been focusing on other things. Come to think of it, that’s true. The radiologist looks at the x-ray taken by a technician. The cardiologist looks at the EKG. The internist looks at the lab tests. The pharmacist looks at the patient profile (maybe) and thinks about the effects and dosage of the drug.

I’m old enough that I have a few ongoing medical issues that need attention, so I am one of those patients. There are lots of people in the system who take care of my needs. Some of them just say, “Don’t worry, that’s not a problem. Call us if something happens.” Others get to know me and dig deeper in my total medical profile. I have to admit that I excuse myself from the pharmacist consultation, saying, “I am one.” Need to stop doing that. Since I’m not practicing, my drug knowledge is deteriorating. (I wonder what the half-life of my drug knowledge is?)

One of the interesting factors is that patients are seldom seen at the bedside because they are less often in bed when they are seen. When they are seen they are too often called the “lung tumor in 503A” or the “A-fib in ER9” or “the druggie waiting by the antacids.” It is forgotten that they are Susan, Bill, and Tommy. Three people, not three diseases.

What Happened?

Technology happened — and more will happen. We are all being endangered by technology because we pay attention to it (often because it demands our attention) and we don’t pay attention to the more important things. For most people, it is the child crossing the street when we are texting while driving. For medical caregivers, it is often just as simple.

This is not new. In one of my pharmacology classes (mid-1950s), one of the university’s top anesthesiologists demonstrated general anesthesia on a dog. He had a number of monitoring devices attached to the dog, and he was watching and adjusting them while putting the dog under and explaining to the class what was going on. All of a sudden he stopped, very distressed.

The dog had died. The anesthesiologist stumbled around, trying to find words. And he finally said, “I stopped watching my patient.” I will never forget those words.

Every caregiver must always watch the patient, no matter what the circumstances are or what else is going on. Distractions must be ignored. And we are getting more distractions every day. Learn to ignore them. Oops, my cell phone Bluetooth stuck in my ear just beeped that I have a new email. I am ignoring it. It can wait. This column needs to get done. Or, this patient is having trouble breathing.

Pharmacy’s Issues

Every time I go someplace that has a pharmacy, I take a look at what is going on in the pharmacist’s domain. What do I see?

  • The pharmacist is behind a glass wall or barrier and at least 10 feet away from where the patients are.

  • A clerk is getting stuff from, or giving stuff to, the patient or representative.

  • The pharmacist’s head is looking at the dispensing counter or a computer screen. Once in a while a quick glance up to find out how many people are waiting. Just the number, not the patients.

  • Questions are first fielded by the person at the sales counter. Some are simple and should be handled there. Some have implications that are scary, like, “Is the blood pressure machine working right?” I heard that one once, and a little follow-up identified a patient who had very high blood pressure. I ordered her husband to take her directly to the ER. A clerk likely would have answered, “They checked it last week and it was ok.”

  • Consultations are patient care opportunities. Too often they are just set pieces that are said once again in the same monotonous, uninterested voice — if they happen at all. Too often everybody in the pharmacy is relieved when the patient says, “I don’t need a consultation.”

The pressure is always to get as many prescriptions filled as possible. Ignore the patients, count the pills.

Remember that tail-wagging dog. And remember what happened.

“I stopped watching my patient.” CT

George Pennebaker, Pharm.D., is a consultant and past president of the California Pharmacists Association. The author can be reached at; 916/501- 6541; and PO Box 25, Esparto, CA 95627.