In all of our careers, we’ll come up against a symptom that makes our eyes pop open, our heart beat fast, and our minds rifle through the years of experience and all the guidelines we’ve ever read.
On the MPharm and further courses, consultations are laid out impeccably. No doubt it’s for our own benefit, but we quickly realise that this is not the case in real life. People don’t always wait for you to finish your question, they’ve come in with an agenda that is difficult to explore, they may not even answer the question you ask them.
Humans are complex, and whilst it’s essential to approach them with a holistic view, sometimes, when something is mentioned, we have to focus on it and get it sorted.
These symptoms are known as red flag symptoms, and contrary to popular belief, they don’t always need an A&E visit right at that moment.
When I was a very newly-qualified pharmacist, I covered a busy pharmacy. Most of the team had gone for lunch,, so I spoke to the patient who walked in that day asking for some ibuprofen.
She divulged that she had started with a sore throat the day before, and that she had no other symptoms. She had been taking ibuprofen for it, but had run out, and that was the only reason she popped into the pharmacy.
I asked her if she was allergic to anything (she was not), whether she was asthmatic (no) and if she had any known digestive issues (she didn’t).
I then asked her – at this time, she was getting a bit frustrated with the questions – if she was on any regular medicines.
Reader, she was taking carbimazole.
She had started carbimazole a few months prior, and she came to our pharmacy with a sore throat. That side effect, the one you always read the warnings about, the one you can count on for a mark in the registration exam… What did I do?
I took the patient to the consultation room, and asked her if the nurse or consultant who started her on the carbimazole had told her anything about possible side effects. She did say they went through something, but she couldn’t really remember what they said.
I then explained to her that her medicine can cause some white blood cells to drop, and if caught and treated quickly, she was likely to be fine.
This patient became rather worried, but I explained that she would need to stop taking carbimazole, and go to the emergency department to get some blood tests.
I assured her that there are ways the blood cells can come back up, and that although the side effect was a rare one, it was known and so were its management regimes.
Furthermore, I thanked her for coming in and taking ownership of her health. She left much calmer, and went next door to the local hospital (yes, we were that lucky in location).
I would have loved to share a story where I could tell you that she popped back in to tell me how she was doing, but that’s the reality of some consultations and conversations.
Read the MHRA warnings and prescriber/carer information in the BNF monographs. Read prescribing information in the NICE guidance.
Always check if you’re not sure. I chose to tell you this story because something that doesn’t cause obvious alarm (like bleeding or bruising) can be brushed off to a non-urgent GP referral, but that would make it too late for this patient.
For isolating and managing red flag symptoms in the community and other sectors, join our minor illnesses course at https://www.apcgservices.co.uk/minorillnesscourse
Have you any stories similar to this one?
Comment below – we’d love to read them.
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