Community Pharmacy FAQ

Introduction

Time really flies. It has been over 8 years since I graduated from university.

Reflecting my first community pharmacy placement, I cannot help but remember the mix of excitement and nervousness.

Looking back, I wish I had more information about what to expect, so I am writing this post to share my experience and answer some basic questions for future community pharmacists.

What can I expect or prepare once I embarked on a community pharmacy journey?

Community pharmacy operations often demand long working hours.

Moreover, pharmacists may be required to work weekends and public holidays.
Due to its fast-paced environments, pharmacists also need to multitask efficiently to handle diverse customer needs and demands.

Generally, a community pharmacist plays 2 important roles.

Management and inventory control

Involves ordering, receiving, storing, dispensing and disposing of medications

Provide services to customers (sales and professional health advises)

It is crucial to develop clear communication skill to explain complex information in a way patients can understand.

Nonetheless, the truth is, in a community pharmacy, you also need to handle everything, including fixing paper jams in the printer.

In an overview, public comes to a pharmacy for a number of reasons.

First, he may come to purchase a named medicine based on prescription or just help their relatives or friends to purchase certain common OTC products.

In these circumstances, pharmacists may or may not need to provide a detailed medicine counselling depending on the customer's needs and preferences.

Second, he may come to request advice about symptoms and appropriate treatment for common conditions.

Hence, you should be familiar with common ailments, such as common cold, cough, styes, skin itch without rash, fungal skin infection, onychomycosis, constipation, diarrhoea, acne and allergy.
Clinical decisions should be made upon the patient scenarios, either referral to a doctor or recommending a product.
Sometimes, lifestyle or dietary changes can be suggested as well.

Certainly, customers may also look for dietary supplements.

Learning up supplements is a must in community pharmacy, regardless of whether you believe in them or not.
Be familiar with the range of supplements available in the pharmacy, especially the indications and contraindications.

What supplements can you suggest for diabetes mellitus?
Before suggesting red yeast rice for management of cholesterol, you should have checked if he is on any statins.
Similarly, we should not recommend ginkgo biloba to improve blood circulation if customer is already on warfarin.
Both glucosamine and chondroitin may enhance the anticoagulant effects of warfarin too.

Well, do you think it ends there? Actually, it does not.

You may meet customers who ask you: what is the difference between the oats/milk formulas, which moisturizer is the best, does this deodorant stain the cloth, which hair shampoo is good for dandruff and alopecia, what is the smell of this body lotion, or what is the differences between blood pressure machine/ thermometer/ glucometer.
The question list goes on. You are not just a pharmacist, but a product expert too.

NOTE: Nonetheless, your provisional registered pharmacist training experience will be hugely subjected to your preceptor.

What to do if I did not know the answer to my customers question?

It is okay not to know during your first week, but you should not leave the customer hanging. On the other hand, you should apologize first and find someone who can assist him or her, such as a senior pharmacist or a more experienced colleague.

Afterwards, you should put effort in learning up the answer.
It does not matter how much you know at the start, but more importantly your motivation and effort in learning it up.
With times, you will gain more experiences in recommending common ailments.

Regarding availability of products, you may be able to check through the retail system if a product is available in your system catalogue.

Alternatively, you should familiarize yourself with the range of products available by browsing through the shelves when it is not busy and also volunteer yourself to stocking up products.
When you are stocking up products, you shall try to learn the various product names and then looking at the constituent ingredients of these unfamiliar products.
Never be a stationary statue at the pharmacy counter!

Where can I read up information on minor ailments?

Different from hospital pharmacy setting where diagnosing and prescribing is doctor's job, community pharmacists is the person responsible to handle minor ailments.

Few key important questions to ask should include:

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?

Apart from Google, my personal recommended readings are

NOTE: Alternatively, you may also read family medicine medical textbooks to learn from the perspective of a physician in dealing with these common ailments.

Regardless how prepared you are, you may still encounter unfamiliar scenarios, such as cough-induced headache or post-nasal drip.

Keep calm and learn to be a competent pharmacist!

How should I choose which products to recommend for minor ailments?

To be a great community pharmacist, you need to be very familiar with all the products sold in your pharmacy, being a drug or supplement.

For a starter, you may stick with a particular brand range and slowly expand your selection range.
With times, you may eventually need to know all products available.

On top of that, you should have some ideas on factors that could affect your product recommendation, such as patient's symptoms, medication history, age, pregnancy, breastfeeding, medication effectiveness and price.

Is it the most expensive antihistamine best for hay fever?
What differences in terms of time onset that you can foresee if you recommend Ravin enema instead of lactulose syrup?
If a 2 year old child is experiencing diarrhoea, is it safe to use Smecta?

Many pharmacists limit themselves to a specified range of products that they prefer to recommend because they have experience with them, but there is no real reason for not using an alternative.

In other words, you may come up with your own personal product range from which you make your own recommendations. However, you should also stay informed about new innovations and be adventurous in product suggestions.

Regardless the final recommendation that you may make, always ask yourself, if you are the patient, will you take it?

Product recommendation should always be on the best interests of patients, not based solely on personal bias or financial incentives.

Which medicines do I need a prescription for dispensing?

In accordance to Poisons Act 1952, Group B Poisons need a prescription, whereas Group C poisons can be dispensed by a pharmacist without a prescription. There are also poisons fall under the Exempt list (i.e. can be sold over the counter in community pharmacy), such as

Clotrimazole preparation for external use
Paracetamol except for parenteral administration
Terbinafine preparation for external use
Vitamins except for parenteral administration

Where to check the brands of medicine available on the market?

Generally, I will suggest to use NPRA Quest 3+ Product Search.

A detailed discussion on brand name search is available here.

Is it very different from what I learnt in university and real practice?

University has prepared you to not only work at a community pharmacy, but also at industry or research settings. Nonetheless, at community pharmacy, I see little needs that we need to explain what is meant by cholinergic pathway to a patient.

However, we should apply the clinical knowledge in our daily practice, for example explaining anticholinergic side effects to your customers (e.g. dry mouth, drowsiness and blurry vision).
Another example will be if a customer complaining dry cough after started on ACE inhibitor, you may refer patients to doctor to review hypertension management.

In practice, there are various formulations, brand names, generic and over-the-counter products.

Plus, new medications and supplements are constantly entering the market, demanding continuous learning and adaptation.

Also, community pharmacy is a business that aims to generate profit to sustain long-term growth.

What is the career pathway of a community pharmacist?

At private sector, employers will expect you to be more proactive in learning and making justified decisions.

Your salary is based on your working performance (i.e. sales), not based on grading system.

After working for few years at community pharmacy, you can either

Explore other pharmacy-related job opportunities, such as production pharmacist or medical science liaison.
Become an owner to operate your own pharmacy - the ULTIMATE goal

Remember, dreams are evolving and changing directions as we age.

Your dreams may not be the same when you are at 20, 30, 40 or 50 years old.

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