As one reflects on the evolution of pharmacists over the past half century one cannot help wondering how it was possible for community pharmacists to meet adequately and safely the needs of patients whose prescriptions they dispensed without the help of manufacturers to provide the "specials" we hear so much about nowadays. Older members of the profession must be wondering what it was about their extemporaneously prepared medicines which resulted in patients' recovery and return to good health. One might even ask whether there could have been an element of faith in the healing process in those days, because most patients survived and overcame serious illness with simple medicines prepared by their local chemist.
Most pharmacists who qualified in the early postwar years - the years of change and antibiotics - used galenicals in their daily "extemporaneous" activities. Most dispensaries had shelves bearing bottles of liquids in a variety of concentrations. The choice was confusing to the inexperienced newcomer to the dispensary. For example, rose water was available in different strengths: rose water, concentrated rose water, stronger rose water and triple rose water. There were many commonly used concentrated waters and emulsions, eg, anise water, peppermint water and emulsion, and dill water, all of which were regularly used, demonstrating how much the practice of pharmacy has changed and how the advancement of modern techniques has removed the mystique that surround the chemist in his dispensary.
People had faith in the chemist and in the medicines he prepared for them. In many ways the medicines conveyed a feeling of magic to the recipient. People were attracted by the smell or the colour of the medicine, and they were usually reminded that the medicine would not be as effective if they omitted to shake the bottle before measuring the dose. As for children - well, the more unpleasant the taste the more quickly they would get better, so they were often told. People treated medicines with respect; perhaps it was because of the signs of relief and recovery after taking the magic potion for a few days. (Or perhaps because they had paid for it in the pre National Health Service days. There is little doubt that people have less respect for something which is free.)
Many of today's patients are unimpressed when they receive nothing more exciting than "little white tablets" in a box to which the pharmacist has affixed his label before handing them out - sometimes, regrettably, without even uttering any words of advice to his customer. Such casual disrespect for "little white tablets" fails to convey the potential benefits or any of the possible adverse effects to the patient, who is usually unaware of the cost of his medication. How much more respected and effective the "little white tablets" might prove to be if, when the patient received them, he had some idea of their cost or how effective and up to date they were. There is no easy answer to the question of cost, but there is little doubt that many people would place a higher value on their treatment, if they were aware of how much they would have to pay if they were buying it themselves - even more so if they knew that if they lived in another post code area they might be denied some medicines.
So much for the magic which used to pervade the old-fashioned chemist's shop. It is sad nowadays that many older people are unable to visit a pharmacy. There are fewer pharmacies in some areas and many elderly people lack mobility. Instead they tick off the items on their repeat prescription forms, leaving nothing to chance, almost like ordering their bread, milk and potatoes. Someone delivers their bag of tablets leaving them to sort out the good from the bad - all free of charge. They take out the bottles of tablets which they think do them most good and the remainder are consigned to a drawer.
The fate of the unwanted medicines stirs the imagination. One can understand an elderly woman, not wishing to "upset" her GP by failing to request repeat prescriptions for everything, imagining it was safer to ask for everything rather than ask for the wrong items. However, if she was helped when ordering her repeat prescriptions, the resultant savings could release millions of pounds for other services sometimes desperately needed by NHS patients, for example, by elderly kidney dialysis patients, who are too old to be included on the transplant list but who cope with parenteral dialysis at home as well as having problems in getting some expensive drugs which might improve their quality of life.
A community pharmacy research project I carried out a few years ago in Lancashire highlighted the practice of assisting elderly people when they were placing their order for repeat prescriptions each month. Elderly people, particularly those living on their own, often have little idea of which drugs to order or not to order. Many identify their tablets by colour or by shape and size rather than by name; this may be due to failing eyesight or simply because they cannot read. Being unable to read can be an added problem for some patients because some are too proud to admit it, and such patients need extra help. Local community pharmacists should be able to spend time building up a rapport with such isolated people, helping them with their repeat prescriptions each month, particularly in cases such as one that I uncovered of one elderly man, hard of hearing, with poor eyesight, living alone since the death of his wife some two years earlier. I discovered on my third monthly visit that his regular supply of Ventolin and Becotide inhalers had remained untouched. He reluctantly admitted that he did not know what to do about them. His wife had always managed his medicines, and it emerged that since he no longer required them, he buried them in his garden when he received them each month because he was frightened to tell his doctor he no longer needed them - "in case he was cross with me".
The profession is very slowly making progress towards the provision of personal patient care as far as medicines management is concerned. However, when the Government finally realises that the waste which occurs following the almost "free for all" system for repeat prescriptions could be minimised by the allocation of funding to cover domiciliary pharmacy services, the resultant savings would more than adequately cover the cost of funding the community pharmacists required to provide this service. The growth of the repeat prescribing industry is phenomenal; it has gone on for too long.
Jean Rothwell is a retired pharmacist from Bolton, Lancashire