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SoWhoCaresAnyway E7 When the drugs don’t work · SoWhoCaresAnyway

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Hello and welcome to So Who Cares Anyway, the podcast that shares learning, innovation and ideas from the world of health and social care and beyond.
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My name is Ruth Germain and I'm inviting you to join me each week with my inspirational guests to hear about who cares.
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What they do, their passions, their knowledge and ideas, and importantly, the difference they are making to improve the health and wellbeing of people in our communities.
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I consider each of my guests to be incredible individuals working with people in new ways or with key messages to share.
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People from healthcare, social care, the voluntary sector, community groups, and more.
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To join me each week to find out, so who cares.
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Anyway, to find out more about me, who I am and what I do, please head over to my website, www.reflectiveruthconsultancy.com,
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where you can also catch up with previous episodes and read my blogs.
Hello, and I'd like to welcome you today to Sarah Trust, who's a pharmacist working in general practice.
for those of you who work in general practice, you'll know, but some people might not be quite so aware, that pharmacy in general practice is a relatively new role.
I was working in general practice myself up until 2014 and at that time we'd just got a pharmacist into primary care and as I moved into my new role it was around developing primary care workforce.
So I've seen the growth of primary care and being multi professional and lots more new professions coming in.
So I'm really excited to have a pharmacist here today and I'm particularly excited to have Sarah because Sarah contacted me on LinkedIn when she saw that I was first having a podcast to tell me about some of the work that she's been doing.
in primary care, which sounds quite innovative and different what I want to do now is just pass you over to Sarah.
So that you can introduce yourself, please.
Thank you for that, Ruth.
I'm Sarah Trust and I'm a lead pharmacist in a primary care network.
And I work.
across five surgeries.
So that's the role that I do.
I've been a clinical pharmacist for 25 years now and I've worked in hospitals.
I've worked as specialist pharmacist in those roles and now I find myself in primary care leading a team.
That's wonderful.
And for those people that aren't familiar, before I delve in a little bit more, a primary care network is something that's happened really since 2019, where general practices have come together to look after groups of patients, usually of around 30 to 50, 000, so that it's easier for them to work together.
And there's lots of positive to that, but I'm sure, there's also some difficulties and things because obviously it's quite a new way of working, but just for those people out there.
So sometimes it might just be one very big general practice, or sometimes it might be groups of general practice.
So it's interesting to hear that you're working across five, Sarah, and presumably that's the role.
Before we go there, I just want you to tell me a little bit about because you've mentioned that you've been a clinical pharmacist for some time, so not everybody would understand what a clinical pharmacist is, and really your passion, why you wanted to become a pharmacist in the first place.
What was it, that drove you to that route and to look after people in that way? And that's an interesting point actually.
I, always say that I fell into pharmacy because I worked in boots when I was a teenager.
And so I had firsthand experience of working with patients and understanding, what their health needs were and helping them through that trajectory.
And I really wanted to be a physiotherapist.
And then when the time came, I didn't follow that passion for one reason or another and I actually, thought, well, what about pharmacy? and so I went into pharmacy, studied pharmacy and Developed my passion over my career really.
So nobody that works with me would consider that I'm not a passionate pharmacist I work with exceptional passion in what I do and I really love Helping people, helping people to understand medications, helping people to understand their health care.
I was once asked, actually, if I wasn't a pharmacist, what would I do? And I said I would be in sales without a heartbeat of thought.
And I think it was quite, it was received quite negatively, actually.
But then I turned it around and I said, if I wasn't in, my everyday role in pharmacy involves sales.
I'm selling what it is to live healthily.
I'm selling what it is to take medication.
I'm selling lifestyle.
I'm selling, how you could better yourself in some way.
And so I would consider it entirely a sales role, actually, in a lot of ways.
But that's where I find myself.
It's really interesting.
And I wonder if it's the fact that you worked in boots, first of all, that gave you that bit about that.,
becoming a pharmacist.
And it's interesting you say sales because I've actually said that to people before now, particularly when I've worked into my workforce development roles.
But when I got there, I was thinking, Yeah, actually, all the time you're teaching people and telling people about things and trying to advocate for ways of working or ways of living and, promoting health and well being of the people to really understand the impact of what you do.
I think that's sometimes what it is.
The impact of you living in this way, the impact of you understanding that will make such a vast difference.
So yeah, I have said that myself.
So that's really interesting.
So you have, you've said a little bit about your clinical pharmacy, or a little bit about what you do, but it hasn't completely given me the full picture.
I don't suppose of what a clinical pharmacist does.
So would you like to elaborate on that for me a bit more, please? Yeah, of course.
I work, across five surgeries and what I find myself often doing is population management.
So I would, for instance, take a special subject, something of interest to me.
Let's take, for example, dapagliflozin.
Well documented as being the most prescribed drug in the UK.
Why? Because it's used in heart failure.
It's used in renal protection, it's used in diabetes, really common things that are found in primary care, really common moments of treatment in primary care.
And so I did a survey across, across the PCM, across five practices of how many people weren't prescribed dapagliflozin, who qualified for dapagliflozin, and then I put them on it.
So, thereby improving their health outcomes, getting them on the best treatment, getting them on the highest regarded treatment, and using therapy appropriately, improving long term outcomes for those patients.
Then I got involved in cholesterol management, for example, as part of QOF, but also across the PCN.
And there's been a new drug, Inclisiran, and that actually has brilliant outcomes on LDL.
And I started prescribing that across the PCN as well.
So, I've set up little clinics across the PCN and quite often will use the population management strategies that I do just across five practices to get objectives in health met.
I also ran an opiate clinic, and this was deprescribing opiates.
I did this in one specific surgery, but I also then did this in every surgery that I've ever worked.
And it's kind of made me a specialist, a specialist that I don't want to be in this area.
Because it's actually quite a conflict ridden area, a very difficult area to work in.
But, this sales, I just have the right sort of aptitude to let it roll down my back to understand that I'm doing the best by patients to understand that I have a specific mandate to help you.
And therefore.
I, somehow find it a role that I found myself in.
So opiate reduction, and it becomes an ethos.
Everything I do, I want it to be an ethos across the practices that I work in.
Can you explain that to bit more? What do you mean by an ethos? Well, I've sold the dream, to everybody that, we, I really don't understand what the need is for an IPU in primary care.
For example, I really cannot find a patient who qualifies for opiate management and I would happily go to PCN meetings and speak about this, go to education sessions and speak about this, every GP I meet I speak about this, so I, want it to be A standpoint, an ethos that I have, that I've developed, that I roll across everywhere that I work, because it is, in the end, quality.
It's a quality metric, from my perspective, it's a quality, metric from the NHS perspective.
And it's a cost saving, ultimately, to the NHS.
So it's something we should be doing, diligently, to provide the right care, and also to manage the costs in primary care.
Another thing that I've done, mostly motivated by the ICP, but it's something I would have had a passion about anyway, was to look at drugs that are used in primary care that are high cost, for example.
Things that we shouldn't be prescribing, things that perhaps are outmoded and costly because of that, things that don't have the proper monitoring, things that could be swapped to cheaper alternatives.
That's the kind of things I involve myself in, and I motivated my team to get involved in this.
And we together all worked and saved 150, 000 across my PCNF5 practices, just without breaking a sweat, Ruth.
So I'll tell you, if everybody could be working in this way.
I don't think we'd have the cost pressures that we have in primary care, being that the budget has actually superseded hospital this year for the first time.
That sounds an incredibly interesting and diverse role.
And it's amazing that how by having a pharmacist there with the type of knowledge and skills that you have, along with what are obviously very good people skills, because presumably all of these changes come about by working with the individual people that you care for.
You have managed to have such a massive impact.
So there's a couple of things really that I want to ask you about.
The first is, think about on these projects, particularly maybe the one around opiates, because although you say it's complex and perhaps you don't want to do it, I can see from your face you're really passionate about this.
So I'd like to hear a bit more about the people that you care for and how you've done that in a way that works for them, because obviously I'm sure that if you've got somebody on an opiate who are, medication for a long time that they've been on them, they believe that they need, that's really quite difficult.
So you must have had a lot of challenges.
So how did you personalize that to the individuals? So that's my first question and I'll come on to the other one afterwards.
Okay, well, I would start the conversation most commonly with tell me about your pain.
People would love to chapter and verse about their pain and where their pain came from, how it started, etc.
Then I would pivot the conversation into, so you're experiencing that pain in the context of taking quite a lot of dangerous medication.
What is your feeling about whether these are adding any value? And, there we would get into conversations around that.
Quite often, patients are addicted to these.
They're addicted physiologically addicted, but also psychologically addicted.,
where they feel that they need this to be able to move.
They need this to be able to live their lives.
They need it.
And, I've been really motivated by seeing lots of things on Netflix surrounding this.
Opiate use in America, for instance, the crisis, and opiate use, impropriety in America.
And I think we've done well in this country, largely.
But I do think the surgeries that I've worked in have largely been in socio economically deprived areas.
And I'm starting to see that this is a prescription for poverty.
This is a prescription that coexists alongside poverty and patients in a situation of poverty don't have the skills to understand that what they're being given could be addictive, don't often have the knowledge base to understand around health care and navigating health care, don't often aren't able to weight and balance aren't able to find self help routines to help them around pain and are quite solitary in some circumstances.
So, I understand all of this.
I personalise it by understanding your context in which you're living.
But also understanding that we're not best serving you with what we're doing.
And really, we could have best served you by setting up a clinic so that you had support from other people.
By setting up an exercise.
routine involving other people in pain by helping, not doing that in the first place, not putting that prescription on there, by helping you to find other ways to manage your pain.
And I'll give you an example.
Now I find people, people refer to me in the practice that I'm in, where I spoke to a 21 year old.
The other day, and she said to me, I'm getting a lot of pain, I have fibromyalgia and, I just, I'm getting a lot of pain with it.
I said, I'm sorry to hear that.
There's nothing that's pharmacologically that we can do to change that.
It's not in our gift pharmacologically to change your pain.
But here is a website.
For instance, Live Well with Pain is a brilliant resource.
And I would say to you, try and swim.
Try and swim, do, what exercise do you enjoy? Try and do that.
three times a week, and we'll chat in a month and see how you're doing.
So, just sometimes offering, and, this is the joke I have with people I work with, that the more experienced I get, the less I like to prescribe.
Because I honestly don't think, I honestly think, a lot of the primary care concerns with just decent population management could be eradicated.
For instance, losing weight.
Maintaining a healthy lifestyle.
Exercising three times a week.
You know, most concerns.
Mental health concerns would be addressed by this.
Cardiovascular concerns would be addressed by this.
Diabetes would be addressed by this.
Pain would be addressed by this.
What else do we see, really? It's the groundswell of work, isn't it? It is, and It's really interesting hearing this from a pharmacist that you're a pharmacist, you understand these medications and I like the way that you've presented to the people that you care for that actually you're on a high risk medication that might not even be doing anything because you're telling me this, about this pain in the context that you're taking them.
And of course, the other side to that is actually though, to do this with people.
It's probably a lot quicker to give a prescription than it is to sit down with somebody and take that time to speak with them, to seek them out, find out who they are, particularly if they're already on it, and really work with them about how that happens.
And you've given that lovely story about the lady that you've spoken about and how reviewing her later on and then the way you spoke to her.
But I'm sure there's some people that are probably more resistant or not so keen.
And all of those things take time and pressure.
And of course, one of the things that primary care We all know doesn't have because so many people are waiting for appointments or can't get an appointment to see somebody and perhaps they don't think to go to the pharmacist.
They think they need to see the general practitioner, for instance, or, they're not aware of the multi professional workforce that's there is that there's that pressure all the time to get things done.
When I was in primary care, one of the things that moved me on in my career was get them in and get them out, which was never, ever my ethos as a nurse.
So what is it that's allowing you? What do you think is allowing you within your work, and your employment across those five practices to work in that way? And to advocate that others work in that way? Well, I conduct a lot of structured medication reviews, that's my mandate as part of the PCN, that I do that.
And a structured medication review is getting really behind, why do you take the medication, what benefit is it giving you, what harm is it potentially giving you, and do, does it earn its place on the drug treatment that you're getting.
This is what I'm a big advocate for, if it doesn't earn its place, get rid of it.
and this Allows me to stop, and I promise you Ruth, two, three drugs on every person that I review.
And, so, I have advocated to give myself half an hour and my team half an hour for that.
To unpack that fully with patients, because often we're starting with people on ten plus drugs.
People with, frailty.
People with health conditions, like opiates.
Where actually it takes time to unpack that.
But I want to just challenge you a little bit.
Because that 21 year old that I just exampled, that I spoke to, that conversation took me 10 minutes.
Okay.
Wow.
And, that is the time, that is the golden time that everybody has.
So if we're just working a bit smarter with the time that we've got, if we have these skills to be able to talk to patients.
If we all understand the mandate, the sort of landscape that we're working in and the need to not prescribe, then that leads us to a ten minute consultation in which we are the knowing other.
We are the person who's able to say, there's just nothing we can give you.,
but here's other things that I can help you do.
Here's other ways that you could help yourself.
And starting that way, it would have been very easy for me to give that patient some amitriptyline, some tramadol perhaps.
But no, this is not in my ethos.
And so for me, there's nothing I can give you.
But I will help you in other ways.
And that's a really nice way to put it.
I will help you in other ways.
And the fact that you've taken that time to listen.
And I suppose you're talking about the fact that took 10 minutes.
Actually, it is that fact of just reframing and thinking about how you Do that consultation and what you say and how you get that to work in a way that works for the people that you're looking after.
So maybe not everything is about time and what you're describing there, I suppose, is you've obviously got, not only a passion.
and an ethos, as you say, but you've obviously got a host of skills and capabilities to have those conversations.
So working in really quite an advanced way, that advanced level of practice to be able to draw on all of that sort of leadership, the research that you understand, but also those communication skills to have that with somebody, to start to have those conversations in a way that.
They understand and also helps you to start to, for the one of your words, to use that sales to say, actually, this isn't really doing anything for you anyway, because you still come back to me today with pain.
So, but that's a massive amount of skill.
And I think quite often people don't understand those skills that people have, because listening to you at the beginning, I heard very much about a pharmacist doing, making pharmacological, decisions.
Listening to you now, I'm hearing about a pharmacist working collaboratively with the people that you care for to make a difference to them in a way that works for them.
And it quite often irks me, actually, that I hear that, uh, opiate reviews,, or that we should be focusing on patient centered reviews.
And of course I'm a patient centered pharmacist, of course everything I do with, is with the patient at the center.
But in that, sometimes it becomes that I have to be the knowing other.
I have to say, Actually, this is not an appropriate treatment for you.
Actually, I think you're addicted to it.
Actually, let me help you come off this in a way that's right for you, but also does not keep paying into your addiction.
Because we become no less than dealers.
I have had patients saying to me, I was on heroin before I got onto this morphine.
Well, you've just swapped one dealer for another here.
It's not appropriate.
It's not appropriate that you use this as a supplement.
There are well, defined strategies for coming off of heroin.
Morphine is not one of those.
Not on a 10 year prescription.
So, I would always argue that sometimes it can't be patient centered.
Sometimes it has to be, that you are the knowing other.
And some, and I think this is the rub that people have with this sort of thing.
That, it's somehow not supportive.
That it's not patient centered.
But we are where we're at.
We're, where we're at because of Misuse in my opinion of the acute pain guidelines against chronic pain.
And this is decades worth of, it's entrenched practice, isn't it? And yet we have a bit more of an understanding now that chronic pain is a completely different beast.
Often melded in with mental health.
And socio economic depravity, and I think those three things seem to be, in my opinion, the things that lead to an opiate prescription.
And so, I would be, like I say, back to this, a very big advocate for not starting them in the first place, because getting people off them is the absolute devil's amount of work.
And As I say, a massive area of conflict.
You know, I like being nice.
I like looking after people.
It's not what I want to do to constantly have conflict conversations with people.
But in the end, the project that I did was a very specific project in one specific surgery who had stupid amounts of opiate prescriptions being prescribed every month.
And so I went in and my mandate was to just get rid.
So that's what I did.
I rang everybody and I never came off the conversation, not having one reduction in place.
And I think that makes me unique.
It makes me.,
tenacious.
And with that tenacity,, I've achieved a thousand patient reduction in one surgery in eight months.
But I would say you were saying that you're not always being person centred, because you're being the knowing other.
But actually, is that not part of being person centred? Because you're not, I know you said about there, about your tenacity, actually each time you've informed them.
So actually what you're doing is giving them the information that they might not want to hear.
I definitely don't want to hear.
No, but once they hear it, then actually They're hearing something and you are giving them support to something else.
So whether or not that's person centered, I would question that.
I would say that perhaps that is person centered.
We won't answer that one here.
So I'm just wondering because you've spoken about that social economic factor a little bit.
So I wonder if you can give me a example or a story that about where you've seen that have a real impact that you've worked with somebody and you've seen that impact on their life positively.
So I had one patient, who was using a fentanyl patch, 50 micrograms every month.
And when I rang her to discuss this with her, it's turned out she was putting it on her knee.
Fentanyl works through the skin.
And it works into muscle and gets into the vascular joint that way.
I mean, putting it on your knee, you're not going to be getting much resolve from your fentanyl patch.
So, took it off and there we go, she never called back.
She never had any problems associated with the pain in her knee.
It was how it was before the fentanyl and after the fentanyl.
So that was a really positive story.
As well as moving to another patient I reviewed.
He Unfortunately, was getting, dementia, and was on 75 micrograms of a fentanyl patch when I met him.
And with his wife's collaboration, I reduced this down to nothing.
I then spoke to her, followed up with him, how are you doing, is everything okay, is everything understood? And, the wife said, I've got my husband back, he's talking to me, he's now engaging with me, he's a completely different person, not under the influence of this fentanyl patch.
And Actually, some of his memory came back as well.
Another patient I spoke to, her father was taking oxycodone.
I said, he was 82.
I said, everybody, do we understand that there's a risk that he'll fall having oxycodone? Yes.
And what would we consider as the bigger risk? We need to weigh it up.
Do you want him to be in a little bit of pain or to potentially have a fall, which at his age could be catastrophic? Okay.
When given that weight imbalance, properly understood.
Properly understood, Ruth.
That's the key here.
They opted, of course, to stop the oxycodone.
But sometimes it's just in the information giving.
And then I've spoken to other patients where they really did not appreciate what was being given to them.
They didn't understand.
I had one patient swear blind.
Well, I would never take anything that was heroin or anything like that.
And I said to them, This is what this is, you're on oxycodone, this is re wrapped heroin.
What do you feel about this now? Well, if I'd understood that I wouldn't be on it! You know, and absolute, cross about that.
So, obviously we're not properly coached in the first place into understanding why we were doing that or why we're understanding in a weighted, balanced way.
what the risks and benefits of doing this were.
And it sounds to me like you were giving him or that person the tools to make an informed decision to get then about whether or not they wanted or need it.
Obviously they had some sort of thought about what, how they felt about being on it, but they hadn't been given that in the beginning.
So again, I think giving information is patient centered, just out of interest, that person that you, I think you said it was a gentleman that you.
Stop the oxycodone for also again, a type of, opiate was a, what was the difference for them when you stopped it? Because obviously you were worried about falls.
How did they get on and how were they? I mean, absolutely fine.
The daughter said to me, he's not even reporting pain.
Okay.
So they didn't even need it, which is a really interesting story.
So one of the things I want to ask again, I've asked it before, but I'm going to just delve into it a little bit more is I want to understand what is it about, The teams you work with the team.
So maybe the team culture or maybe the way that you work that dynamics that allows you to work in this way because general practice hasn't always had pharmacists.
This type of work hasn't always gone on.
I'm not saying it hasn't gone on anywhere.
It's less, and this is a new way of working, bringing in a pharmacist to work in these things.
What is it about the team that's allowed you to work in this way? It sounds like you would probably push it, but hopefully there's enablers the other side.
So that's what I'm really interested in.
What's enabled you to be able to work in this way? Both you, but also from the team around you.
Well, Ruth, I mean, I do like people.
You know, you might've got that from me.
I really love people.
And so I would always form relationships with everybody that I work with and I have relationships 25 years of practice, people I still reach out to on a regular basis who I like to keep contact with and who are in my life because I've worked with them in the past.
So I would say it's that relationship building that I do.
It's that getting to know the people I work with.
And understanding them, and understanding what drives them, what motivates them, and helping them to see what my skill set is as well.
And therefore, there's a mutual acceptance that we're both different skilled practitioners.
And that allows me to do largely the projects that I'm interested in.
And With the support of the people around me, I manage those projects, and I'll give you an example.
I have wanted to run a frailty clinic, and so in running that frailty clinic, I have reached out to key people who I've worked with who I would consider movers and shakers and I have co opted them into this project and I've managed to get a couple of practices signed up who want to get involved in review of frail patients who live in their own homes because I would consider that a health inequality in the NHS where if you live in a care home You get two reviews a year from a pharmacist, more reviews if you include the whole multidisciplinary team.
In a primary care setting, you probably don't even get one review a year, actually.
And I would consider that, stopping falls in that group is a key outcome and therefore preventing hospitalization.
And so I have sought to set up a frailty clinic.
And like I say, I just speak to people and, sell the vision that I have for this health inequality.
And I'm allowed to just get on with what I want to, really.
But, it's always with population health in mind.
It's always with the specific mandate of structured medication reviews.
what I'm paid to do, essentially.
So it's within, very much my job description.
But, following my passions has always been something that's important to me, and at this level in my career I would consider myself multi faceted, multi skilled, and I have done the thing that a lot of people don't do in my profession is change my job every few years, because I just get, I don't want to say bored, I don't get bored, I never get bored, but I get good at what I do and it just fails to ignite my passion anymore.
So I move job to find something that does ignite my passion and so I've been a specialist renal pharmacist, I've worked in surgery, trauma and orthopedics.
I've been, a stroke pharmacist.
I've been a general pharmacist.
I've been an AMU pharmacist.
I've been an HDU pharmacist.
I've worked in general practice.
I've worked in four different general practices.
And I've worked across loads of different specialties and I've also locumed in community pharmacy.
So I have a really clear understanding of what it is to be a pharmacist in those different domains and I drag with me constantly experience from each domain to help.
inform the practice, the particular domain that I'm in.
For example, I'll be referring patients to community pharmacies to get their blood pressure checked because I know that's what community pharmacies do.
And I will refer to community pharmacies, for minor health concerns and things like that.
And I will ask doctors in letters, in advice and guidance letters, secondary care practitioners, could you please put blood pressure? That's really helpful to the GP if you put a blood pressure when you see them in clinic, that's really helpful to the GP, for example.
So, those kind of things help to inform each landscape that I work in.
And because I understand what happens in secondary care, it allows me to collaborate with them.
in a, integrated care way.
So back to this frailty clinic I've set up, I've also got a frailty consultant involved in that from secondary care to get that skill level, to get that sort of patients being seen in the right setting, getting their healthcare where they need it, at the time they need it in a sort of Wrap around way so that patients aren't appearing, several times at a GP surgery, for example.
Or nipping them in the bud before that, trying to get rid of all the risk factors that might mean that they come repeatedly back to the GP surgery.
And, reviewing them so that, I call it a robust review, i.
e.
get you down from seven medicines to nothing review.
And listening to you there, you can.
You've talked about how you move on, but the question I ask you, which you've answered nicely, is what allows you to do that.
And it is the fact that you have talked about the fact that you have a vision.
You have a passion about something, and from that passion you have a vision, and you've sold that vision.
Certainly sounds that you've built trust then.
Which is something that's so important, that building of trust.
And then people have just said, actually, do you know what, Sarah knows what she's doing and therefore they allow you to get on with it.
And I suspect that's actually quite a positive and dynamic culture that you're working in for them to allow you to do that.
But also the fact that you're able to sell that vision makes it happen as well.
And my other thoughts are the fact that you're saying that you don't stay in the same place.
And as you say, not so much because you don't get bored, but because you see, well, I've done this now and I need to move on to the next thing.
And, I should imagine, obviously I don't know, but listening to you that as you leave, you're probably leaving behind a whole lot of experience that other people Can continue to use.
So you actually, you're not leaving them high and dry because you've spoke at the beginning about how you do protected learning times, where you go along and talk about whatever it is that your passion is at the time.
And you educate other people, you explain to people why it happens.
So you leave them with an understanding and potentially for tools to.
work in that new way.
So when they get somebody in, you know, I would have loved you to have been the pharmacist when I was working back in primary care, because I would have been there saying, so what do I do in this conversation? Because you've obviously got that tools, those capabilities, those skills, and you're passing them on.
So in moving.
I'm sure there's probably times where people say, Oh, Sarah, we'd really like you to stay.
But actually, you've already given them so much.
So almost starting to succession plan behind you by making sure you're doing that teaching.
And that's why one of those things is about that power of networking.
Networking to share learning.
But also what you've come on to next is that networking to actually work with other people.
So you've talked about that integrated care, primary care.
working with a consultant from the hospital to actually deliver care to the people that are in your community in a way that works better for them.
So it sounds absolutely fascinating.
an amazing what you've, what you do and the difference of the impact that you're having.
So I'm just going to ask you for one last thing and what I want you to think about is what message would you like to give people that are listening today? Think about the fact that we might have quite a broad audience.
What would you like them to take away? What would be your key message from today? I think it's education.
It's education, education, education.
I think patients need to understand what they're taking.
I think they need to be fully appraised of what we're doing to them.
It's not okay to just say, this is best for you, you need this.
It's, got to be a collaborative decision.
And that collaborative decision has to be weighted and balanced in best practice.
So, I'll give you just one last example, one last example to, to lay your hat on.
I reviewed a patient, 46 years old, yesterday, that had a heart attack.
No, had a TIA, actually, he'd had a mini stroke, and was not taking his atorvastatin, was not taking his aspirin, was not taking anything.
Still smoking.
And I rang him and I said, You're 46, you've had a TIA.
Do you understand that that is a warning sign? Do you understand that the big stroke that will be life disabling is around the corner? That's why we're giving you these medications.
To prevent you from having that disabling event.
Do you see that smoking affects your vasculature? It makes that stroke more likely to be forthcoming.
You're asthmatic as well.
Can you understand that smoking definitely affects your lungs? If I talk about the next 10 years for you I'm not sure you'll make your 60th in a very healthy way.
Now I presume you want to make your 60th in a very healthy way.
He said nobody has ever spoken to me about that, about why I'm taking them.
I want a blood test.
I'd like to get that now.
I'm very motivated.
And I will start taking these medications.
Can you send them to the pharmacy for me? And that just highlighted to me why I do what I do.
Wow.
And I'm sure if you are still working there when he's 60, by the sounds of it, you'll be somewhere else doing something else.
He'd want to come and say thank you to you, I'm sure.
So, that's incredible.
So I just want to say thank you.
There's a few things that you've said here.
One is about having a passion.
One is about having a vision.
The other thing is sharing it and selling it to other people.
Whether that be the people you care for through education, but you've also educated those other people that you're working with so they can start to understand and really make use of having a pharmacist.
within their general practice, and that they work with as well by working in with the hospital.
So building and developing those links with people.
So I think what you do really shows that you're someone who definitely cares anyway.
So thank you so much for being on my podcast.
Thank you for having me.
You're more than welcome.
So thank you very much.
Bye.
Bye.
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