There is no doubt that, only for the last minute, nothing would ever be done. I am certainly guilty of living according to this golden rule, but I am glad to see that I am not alone. The effective dismantling of State payments for most forms of phased dispensing has been flagged for a while. Indeed, most of us who read the recent, and not so recent, communications from the IPU would have seen the writing on the wall. While most pharmacists have finally separated phased dispensing from blister packing, it would be fair to say that it is only now that people are appreciating the implications. If I had had a euro for every recent post that I have seen on pharmacist WhatsApp groups, wondering if their previously approved phased patients payments would continue, I would have enough to fund a modest retirement plan.

However, recently one particular post piqued my interest. It was an encounter that we have all experienced at some stage. To my mind it illustrated a fundamental issue that needs exploration. The story was simple, a pharmacist dealing with a concerned relative who wanted a blister pack for their loved one. We have all had this conversation a hundred times. The family finding tablets on the floor, some packets empty, others unopened. Someone told them that the answer was blister packs. The pharmacist’s concern was simple; they felt that blister packing the patient’s medication wasn’t going to make any difference to the patient’s compliance. They suspected that the real problem was supervision. No amount of blisters were going to help a severely compromised patient become compliant. The question arises, how do you deal with this type of situation? More importantly, how do you look after the best interests of the patient without falling out with the family? This is the essence of a professional interaction. You could take the path of least resistance, supply the blister pack, and allow the inevitable to play out. Or you could take a professional stand. Obviously, this is a delicate one. The chances are that the patient is living alone. The family member is only around for a limited time and is both concerned and probably stressed. Things could go south fairly quickly. Most of us have seen the sign in the pub, ‘please don’t ask for credit, as a refusal often offends’. Refusing to blister pack is likely to cause an extremely tense situation. The challenge is to get what is best for the patient. In these situations, language is important. People can easily feel that they are being treated in a condescending manner.  This is where the pharmacist has to clearly demonstrate that they agree there is a problem, but the solution is not what is being demanded. The patient clearly needs extra supports. The IPU have a range of guides and tools to help to manage these type of situations. It is critical that you, and your staff, make use of these supports.

Speaking of communication issues, an equal, but important truism, is that we are all guilty of not reading much of what is sent to us. Long before we had AI generated slop, we had the full forces of the State, its agencies and a host of commercial entities throwing literary tornadoes at us on a consistent basis. Guidelines, new procedures, protocols, safety bulletins, ‘Dear HCP’ letters, the list goes on. Within all these encyclopaedic entries, after a suitable period, there was always a level of ‘did I see that or did I simply imagine it?’ As AI may finally become useful, it could actually provide genuinely useful information at the point of need. So, I have been interested to see that some of the newer AI offerings will trawl through all your emails and files. It can create your own personal AI agent that works on your local files only. While this sounds brilliant, it sure creates a privacy challenge. Given that we are dealing with health data, you have some serious privacy and data protection concerns. Yet, we are all in an era where we need all the help we can get. Whether we like it of not, these tools are going to be ubiquitous. From a professional point of view, it is getting the best guidance that will keep us between the tracks.

Finally, this month I feel that honourable mention should be given to the State and their current inability to deal constructively with the shortage of a key drug, bumetanide. Officially, it has been in short supply since early May, with a return date for the end of the year. Tens of thousands of prescriptions are written for this medicine every month. Many patients using this drug have heart failure and are extremely vulnerable. Is it not beyond the State’s ability to provide a temporary solution for what is, in this case, a very cheap drug? Yet, it begs the need for a more fundamental change; the absence of therapeutic substitution, where a pharmacist could make a simple decision to swap in an equivalent medicine, has never been more clear. Pharmacists are medicines experts and it has never been more urgent that we are given the legislative tools to help address this key issue. Shortages are predicted to grow, we are part of the solution.