9 Responding To Symptoms - Lecture

RESPONDING TO
SYMPTOMS
Community pharmacy practice I
PHARMACSIT ROLE IN RTS
• The pharmacist’s role in responding to symptoms

and overseeing the sale of over-the-counter (OTC)
medicines is substantial
• This requires mix of knowledge and skills in the area
of diseases and their treatment
• Pharmacists are responsible for ensuring that their
staff provide appropriate advice and
recommendations
WORKING WITH PATIENTS
• Patients are not blank sheets or empty vessels
• They are experts in their own and their children’s health.
• The patients ;
may have experienced the same or a similar condition in
the past
may have tried different treatments already
will have their own ideas about possible causes;
will have views about different sorts of treatments;
may have preferences for certain treatment approaches.
WORKING WITH PATIENTS
• Enable the patient to participate by actively eliciting their
views and preferences
• Not all patients will want to engage in decision-making

about how to manage their symptoms
• What the pharmacist needs to do is to find out what the

patient wants.
RESPONDING TO A REQUEST FOR
A NAMED PRODUCT
• Need to establish that the person making the request might be an expert or
a novice user
• Pharmacists and their staff need to ensure that the requested medicine is
appropriate
• Strategy
 Ask whether the person has used the medicine before
 check on whether other medicines are being taken?
 Has it been recommended by a friend or family member?
• Use your pharmacy records for regular customers

• Investigate for new patients
KEY AREA FOR RTS
• General communication skills
• What information is gathered by pharmacy staff?
• How is the information gathered by the pharmacy staff?
• Issues to be considered by pharmacy staff before giving advice.
• Rational content of advice given by pharmacy staff.
• How is the advice given?
• Rational product choice made by pharmacy staff.
• Referral?
• Key skills
• Differentiation between minor and more serious
symptoms.
• Listening skills.
• Questioning skills.
• Treatment choices based on evidence of
effectiveness.
PHARMACIST ROLE PLAY IN RTS
• Step 1, Introduction
• Introduce your self
• Confirm Patient
• Establish privacy/comfortability
• Step II, Information gathering
• Ask for symptoms
• Quantity and Quality of symptoms
PHARMACIST ROLE PLAY IN RTS
• Quantity of symptoms
• Frequency of symptom, temperature?, pain scale, duration
of symptom?, part of body involved?, lab values, if any
• Quality of symptoms
• What makes it better, what makes it worse, type of pain?,
color of sputum (productive cough) etc
• Step III
• Based on symptoms establish a diagnosis or refer
• If treatable, proceed to Medical history taking
• Step IV Medical History taking
• Name, age, occupation
• Presenting complaint
• History of presenting complaint(HPC)
• Co-morbid condition
• Past medical history (PMH)
• Family history (FH)
• Social history (SH)
• Drug history/ Drug interactions
• Drug allergies
• Review
APPROACHES FOR PATIENT
HISTORY TAKING
• In a busy pharmacy, interruptions may interfere with dialogue between
pharmacist and patients. use of mnemonic may REMIND pharmacist of the
critical steps involved in assessing the clinical significance of symptoms
• Use of mnemonic will minimize the risk of missing important information
• 1. WHAM
• 2. AS METHOD
HISTORY TAKING
• 1. WHAM
• W Who is the patient and what are the symptoms?

• H How long have the symptoms been present?
• A Action taken?
• M Medication being taken?
HISTORY TAKING
• W Who is the patient and what are the symptoms?
• The pharmacist must first establish the identity of the patient:

the person in the pharmacy might be there on someone
else’s behalf.
• The exact nature of the symptoms should be established:
• patients often self-diagnose illnesses and the pharmacist
must not accept such a self-diagnosis at face value.
HISTORY TAKING
• H How long have the symptoms been present?
• Duration
• In general, the longer the duration, the more likely is the
possibility of a serious rather than a minor case
• Most minor conditions are self-limiting and should clear up
within a few days
HISTORY TAKING
• A Action taken?
• use of any medication to treat the symptoms
• About one in two patients will have tried at least one remedy
• Treatment may have consisted of OTC medicines bought from the
pharmacy or elsewhere, other medicines prescribed by the doctor on this or
a previous occasion, or medicines borrowed from a friend or neighbour or
found in the medicine cabinet.
• If the patient has used one or more apparently appropriate treatments

without improvement, referral to the family doctor may be the best course of
action
HISTORY TAKING
• M Medication being taken?
• Should ask medication used concurrently to avoid
possible interactions and potential adverse
reactions
HISTORY TAKING
• ASMETHOD
• A Age/appearance
• S Self or someone else
• M Medication
• E Extra medicines
• T Time persisting
• H History
• O Other symptoms
• D Danger symptoms
HISTORY TAKING
• A: Age and appearance
• Appearance of the patient can be a useful indicator of whether a minor or
more serious condition i.e. pale, clammy, flushed or grey
• As far as children are concerned, appearance is important, but in addition
the pharmacist can ask the parent whether the child is generally well
• A child who is cheerful and energetic is unlikely to have anything other than
a minor problem
• whereas one who is quiet and listless, or who is fractious, irritable and
feverish, might require referral.
• Ask for age
• Mouth ulcer in children are uncommon
• Diarrhea in elderly or children leads to severe dehydration
HISTORY TAKING
• S: Clarification as to who is the patient
• M:Medication regularly taken, on prescription or OTC
• E: Extra medication tried to treat the current symptoms
• T: Time, i.e. duration of symptoms

HISTORY TAKING
• H: History
• Concurrent/ presenting history
• Previous history i.e diabeties, hypertension etc
• In asking about the history, the timing of particular
symptoms can give valuable clues as to possible causes
• The attacks of heartburn that occur after going to bed or on
stooping or bending down are indeed likely to be due to
reflux, whereas those that happen during exertion such as
exercise or heavy work may not be
HISTORY TAKING
• O: Other symptoms
• Patients generally tend to complain about the symptoms that concern them
most.
• The pharmacist should always ask whether the patient has noticed any other
symptoms, or anything different from usual.
• D: Danger symptoms
• Blood in the sputum, vomit, urine or faeces
• unexplained weight loss.
PHARMACIST ROLE PLAY
• Step V
• Based on medical history, recommendation
• Rationalize for medication
• Dosing / dosage form
• Adverse effects
• Interaction
• Storage
• Non-pharmacological measures
PHARMACIST ROLE PLAY
• Step VI, Closing
• When to expect relief
• Precautions with self medication
• What to do if not feeling better
• Summarize
• Check for understanding
• Offer to call
• Say thank you
RISK ASSESSMENT AND REFERRAL
• As a general rule, the following indicate a higher risk of a serious condition
and should make the pharmacist consider referring the patient to the
doctor:
• long duration of symptoms
• Recurring or worsening problems
• Severe pain
• Failed medication (one or more appropriate medicines used already,
without improvement)
• Suspected adverse drug reactions (to prescription or OTC medicine) .
danger symptoms
SCENERIO 1
SCENERIO II
QUESTIONS

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RESPONDING TO

• The pharmacist’s role in responding to symptoms

• Not all patients will want to engage in decision-making

• What the pharmacist needs to do is to find out what the

• Use your pharmacy records for regular customers

• Use of mnemonic will minimize the risk of missing important information

• W Who is the patient and what are the symptoms?

• The pharmacist must first establish the identity of the patient:

• If the patient has used one or more apparently appropriate treatments

• M:Medication regularly taken, on prescription or OTC

• E: Extra medication tried to treat the current symptoms

• T: Time, i.e. duration of symptoms

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