Apparently this is my M.O. Title an article with one word then expand on the word using 500 other words. Whatever, I’m comfortable with that. (See what I did there?)

Anyway, as pharmacists, we are in the business of providing comfort. We have to do so within our own comfort zones. It’s all very “Inception-esque.” How to help our patients to the best of our ability while being comfortable in the act and with the results. It’s a balancing act, a thin line, a dance with heavy consequences if we have a misstep.

Recently, my comfort zone has been stretched with our new found ability to prescribe. Before the new regulations, I always took solace in the following sentence: “let me call your doctor to double check this.” That sentence holds comfort. Call the doctor, have her tell you everything is fine or she’d rather change to drug X. Then document all over town and everything is good. I’ve helped the patient and provided care, all very much within my comfort zone.  Now, we have many other ways that situations can be resolved. We can adapt a prescription. We can substitute one drug for another. We can prescribe for a situation where we would normally have to refer (hello, hemorrhoids).  So, we are now faced with a decision. Do we refer? Do we call the doctor? Do we offer one of these new services? If we are all being honest, we would all love to stay in our previous comfort zone. Call the doctor, refer, whatever. Problem solved, patient happy, move on. However, this would not allow for progress in our profession, nor is it in the best interest of the patient.  So, we expand our comfort zone.

The first time I offered one of these new services, I was extremely nervous. I broke out in a cold sweat, my hands were shaking and it took me 45 minutes to assess my patient and decide that yes, it was appropriate to substitute Fucidin H for Hyderm and Fucidin creams to allow the prescription to be covered by MSI. I was decidedly not comfortable. Like, lost sleep that night, called the patient for the next three days to make sure she was ok kind of not comfortable.

The patient was fine. Her wound healed up nicely. She was thrilled that I was involved in her care and able to get her prescription covered without having to wait to hear back from her notoriously hard to contact doctor. Everything was A-OK.

Since that first shaky experience outside my comfort zone, I’ve had lots of experiences with prescribing and I find myself shaking and sweating less each time. This is a classic sign of an expanding comfort zone.

The moral of the story? Dive in, my friends. Dive in. It will suck the first time. It will be hard. You may not be able to eat your lunch due to nausea. But you will do it. You will provide the patient with comfort even though you distinctly lack comfort at the time. Then, you will look back at the experience and realize it didn’t suck as much as you thought. The patient is happy and healthy and you lived to tell the tale. What you’re left with is a new definition of personal and professional comfort and a happy patient. What’s wrong with that? Absolutely nothing.

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.

Even writing the title made me squirm a little bit.

My guess is many of the readership will associate the term suicide with an event or an individual that evoke deep-rooted emotions. If you’re like me, you’re used to seeing people at their worst: in severe pain after day surgery, coughing up one of those pesky ‘lungs’ due to pneumonia, or being hit with a head-spinning diagnosis along the lines of diabetes or cancer. Unfortunately, suicide is a whole other monster to have nightmares about.

At some point in our professional careers, we will face a situation that none of us want to see happen: a person, -not a patient per se- , but a person is exposing their emotional core and saying in some way that they are giving up. If you already have a relationship with this person, the impact is devastating, if you don’t, I almost find it surreal to think that there’s a real threat that your interaction may make the difference between holding on and following through.

Let’s be fair and say we’re waaaay too hard on ourselves.

Although the threat is serious and real, it’s very doubtful that this person woke up that morning and suddenly began plotting. There is almost always a progression, either initiated by a single traumatic event, or perhaps a caustic home environment that has been chipping the layers away for years. I’ve found myself doing lots of listening, and not able to say very much due to my fear of saying ‘the wrong thing’. Is there really a wrong thing to say? I repeat often that I’m concerned and want to help. I try to determine if this episode is fleeting or intermittent. Have there been previous attempts? How much planning has been done? Have preparations been made? Do they know what kind of support they need? I also make sure they know that my expertise is limited and at this stage, having crisis numbers available to call is often the best  way to connect them to experienced professional help.

My solace, regardless of outcome is that I made myself available to this person in their time of need. Working in community, we pride ourselves on being accessible. When this kind of thing happens, everything else takes a back seat. Working with the ‘More Than Meds’ project http://morethanmeds.com , I find that I am much more composed and realistic with my ability to be a positive light in such black pitch. Even a soft candle may be enough to illuminate the way out of the dungeon; whether I am the right one to make them move in that direction is out of my control, but I’m learning to be okay with that.

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.

http://morethanmeds.com

This is more than just another website with links and resources. It’s more than one or two folks with a really good idea to share. It’s also asking pharmacists to do more than they’ve ever been asked to do before.

It’s a paradigm change in the approach to mental health.

As pharmacists, when we tackle our studies in school, CNS is either loads of fun in 3rd year, or frustrating as hell. Diagnoses that don’t fit patterns, therapies that aren’t well-understood, and a general absence of neat black-and-white boundaries to confine decision-making. It would be great if we could measure objective targets for mental health: ‘You’ve been on citalopram for 6 weeks now and this blood test says your libido level is up to eleventeen mmol/L from a low of forty-threeve”. Alas, all cases are subjective and unique, requiring discussion, education, and support for the journey to improved mental-health. Medications that were once seen as ‘the answer’ are now better recognized for what they are: complements to a patient-centred approach.

A good friend of mine offers a counter-point that deserves mentioning. On the topic of objective metrics, he says:

“Of course I’d argue that for other areas of medicine people look to the surrogates too quickly, being fooled by them as being accurate indicators of “clear sailing” (a good blood test) or doom (a bad blood test). With medications for mental illness it is what the patient experiences that matters. We can get feedback from the suitability of treatment pretty quickly, from symptom management, progress toward personal goals and recovery, treatment tolerance and side effects, etc. You can’t get that from a statin or diabetes medication. You can only hope that you are the one to see the measurable benefit vs. all the others who took it and didn’t need to, or took it and still had the thing they were trying to avoid.”

Having said that, pharmacists are often the first point of contact when patients are seeking help with their experiences and may provide opportunity for early intervention. A recent article in the Capital Beat – June 2013 (http://www.cdha.nshealth.ca/media-centre/news/more-meds-pharmacists-and-communities-partner-better-mental-health) outlined the MoreThanMeds project. Dr. Andrea Murphy, one of the co-founders of the project, captures the opportunity by stating, “Pharmacists are often underused or are not working to their full scope of their practice when providing services for individuals living with mental illness. (They) are well positioned to help individuals with lived experience of mental illness, and especially those who often have difficulty getting the right care at the right time.”

<…the right care at the right time…> This phrase really makes you think. Those with longstanding mental illness will report feeling ostracized, or judged, or helpless. Depending on the day, there may be a brief window of opportunity for an individual to be receptive to conversation. Many days this may not be the case, however knowing the pharmacist is available can help build up that trust.

I’m only beginning this journey, but so far it’s been extremely rewarding to scope out community mental health resources from a consumer point of view. I can’t wait to share my experiences with other pharmacists; we can be much bigger part of the collaborative mental health team in the communities we serve.

I aspire to be More Than…a conventional community pharmacist when it comes to mental health support for patients and families…much more.

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.