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Independent proprietor Sid Dajani admits that sometimes one just has to say no to bizarre patient requests

It seems that not everyone is keen to look after their health as much I want to look after them. Health is obviously a partnership between us and the people who use our pharmacies, but when some
of them don't want help it is a fine line between being seen as proactive and as an interferer.

The last thing I can ever be accused of is meddling, and I find my public health hat is knocked off particularly by die-hard smokers (pardon the pun) and binge-drinking twenty-somethings. There are some who think life should not be a journey to the grave with the intention of arriving safely in a well-preserved body, but rather that they should skid in sideways €“ champagne in one hand, strawberries in the other €“ in a totally worn-out body screaming €woo-hoo, what a ride!€

"One lady complaining of alcohol poisoning told me if she wanted a lecture on alcohol she would come back"

One lady complaining of alcohol poisoning told me if she wanted a lecture on alcohol she would come back. All I had said to her was that prevention was better than cure and she was suffering from dehydration. I suppose when some people are ill they are more impatient or intolerant and only want treatment, not a health message.

Experience is the only thing that can be useful at times like these and I imagine being proactive in lifestyle management could put off many in our profession, but we shouldn't let the negative experiences make us forget all the positive ones or prevent us from carrying on with our valuable public health role.

Something afoot

On the other hand, we can be asked to help and have to abjectly refuse. One elderly patient, whom I had never met before, asked to see me by name and requested privacy. Once the consultation room door was closed he explained he had just bought a new pair of shoes and couldn't walk in them comfortably. I asked him to repeat what he had just said as I was having difficulty connecting what I was hearing with what any pharmacist could do in this situation. He repeated what he had said and proceeded to introduce me to a raft of dry skin emanating from the sole of his foot to his heel.

He explained that he had just bought a new pair of shoes and this dry skin was making walking uncomfortable. He asked me to 'shave' a bit of skin off. I declined politely, saying it was a chiropodist he needed to see and that I had no experience at all in removing hard skin. He said he was desperate for help, and I replied that I was desperate to help but this was beyond anything I could do. He insisted I help him as he didn't know where else to go and didn't want to spend any money at the chiropodist I recommended.

I suggested using a cream as a last resort, which I wouldn't normally recommend to cover such a large area, before I was opportunely called out to check prescriptions. I told him I would be back shortly. Five minutes later he came out, saying he had someone waiting in the car for him and he couldn't stay any longer.

Pharmacy has always suffered from being the poor man's doctor but the cheek to think he could use my pharmacy as a while-you- wait cheap podiatry service, or me as a bare- foot doctor is beyond belief. I haven't seen him, his foot or his dry skin, since and wonder how he resolved the problem. I don't mind being an emergency service for people €“ in fact it's my job and I genuinely find great satisfaction in helping the mentally ill, the disabled or the most vulnerable in our society €“ but I have yet to find anything on my list that covers seriously ignorant mickey-takers!

A gap in service provision

I am still receiving requests for minor ailments services and chlamydia screening €“ 26 for the former and 38 for the latter over the past few months. I am sure more would use us if the service were available. I've been applying for training and accreditation ever since March 2009, with ever more dwindling patience as time goes on. In February of this year I asked why only the LPC members or the multiples in my area were accredited to date and said this was a governance issue I would like to follow up.

By not being accredited I am not helping my patients, but I am helping my competitors by referring these people to them. I was assured that more pharmacists would be accredited by last December. I argued about this with the powers that be and each one proclaimed their innocence by charging guilt on others or resources. I inquired in November for a status report and was told there'd be no accreditation for the near future. I have decided to take this further as I refuse to be, at worst, the victim of political accreditation scams or, at best, hindered by the professional incompetence of those I am supposed to bow down to.

The Marx brothers could do a better job and at least when they messed up I would probably laugh about it because they're funny. However, I am not laughing now and nor are the people trying to access these very important services through me.

Mandarins and hypocrisy

It's funny that when there are no resources in the Global Sum we get paid less, yet we still have to deliver the same quality service. When the NHS runs out of resources, its services to us drop below par and patients suffer, and that's apparently OK. But I do not ever recall seeing mandarin hypocrisy as standard in our contract. Maybe it would help to be as thick-skinned as the man who came to see me because then I may not get so wound up!