For a pharmacy appointment. When to avoid the doctor? Episode 5

Monika Rachtan
I invite you to listen to the podcast. First of all, the patient. Good morning. I'd like to welcome you to Martyna's podcast. First of all, a patient who is creating to show some myths. And today I think we're going to address that. But before I introduce you, I would like to give you another very warm welcome.

Martyna Pasik
Good morning and welcome.

Monika Rachtan
Thank you so much for accepting the invitation to be on this podcast, as I think we're going to give a lot of important information to patients early on today. Your body of work is amazing despite your young age, so let me read everything and read it as it is. You are a graduate of the Warsaw Medical University, Faculty of Pharmacy. I received my diploma in 2015 and already that year and the following year you were nominated as one of the 100 best pharmacists in Poland chosen by patients in the 2015 and 2016 Pharmacy Angels poll. Are you the manager of Open Pharmacy? We are about to explain what Open Pharmacy means and coordinator of Women's Vaccination Points 19 and against influenza, also coordinator of Mass Outbreak Points 19. You are the national influenza vaccination leader in 2020 second year for completing the highest number of influenza vaccinations in the pharmacy in the 2021 2022 season. Pharmacist of the year 2022 of the Mazovian Voivodeship in the Hit Hippocrates 2022 plebiscite. When do you have the time to do this and why do you want to?

Martyna Pasik
In fact, it is the organisation of time. Pharmacists are good organisers of time both at work and in their personal lives outside of work, which is also often work.

Monika Rachtan
OK, fine. We're going to start our conversation with very difficult, very challenging topics. At least that's what I think. And right away I wanted to apologise to you for these questions, but I think these are questions that a lot of patients would like to ask you, and they don't, so I'm speaking on their behalf here. But it's not at all that I'm judging your work somehow badly, because I really know how hard you work during those 5 years of study, and I think it's time for us to talk about it, so that the patients also know what it's like to be that pharmacist. So excuse me and here we go. Okay.

Martyna Pasik
Please.

Monika Rachtan
When I go in, it's currently to a pharmacy, especially an open pharmacy, so what does open pharmacy mean?

Martyna Pasik
An open pharmacy is one where patients can make purchases. There are also closed pharmacies. These are usually located on hospital premises and then the pharmacist simply deals with the direct contact with the doctor and the wards. Here, the pharmacist has direct contact with the patient and can make his or her purchases and needs there.

Monika Rachtan
And now that's how I enter the pharmacy and it's such a candy shop, well because there are shelves set up there now, There used to be patients standing there and now there are these open shelves set up. Tea, bath salts are lying on them. What's worse, there are also non-steroidal anti-inflammatory drugs lying around in some of these now typical chain stores, which the patient can just throw into the basket. That's right. And is this a good direction for the development of pharmacies?

Martyna Pasik
This is no longer a direction. It has already happened. Yes, we have to accept that such pharmacies are there. Here you also have to separate the pharmacy from the drugstore part of the pharmacy and there is actually more going on there. Yes, there is more of a range available. On the other hand, if a patient walks in under a similar slogan, décor and de facto one separate room that they have, they think it is all a pharmacy, So here you always have to divide yourself into a pharmacy and a pharmacy with a part of a drugstore, where more can happen than in the pharmacy itself. This is due to legislation. It just happened already, whether it is good or not. Well, yes and no. Patients can simply do more things in one place, make a sort of broader purchase or simply stock up on things that are not strictly pharmaceutical related, but sometimes supportive of therapies. Like this bath salt, it sometimes simply supports therapies. Here one would have to wonder what this is due to. Yes, because it has not happened without a reason. Pharmacies, despite being just such a health facility, are also a business.

Martyna Pasik
They are simply a private company that has to prove a result. Yes, unfortunately so, and sadly so, because it gives a bunch of people jobs. But that is what it is all about. And now another factor that really influences such. Expanding the range of products is the law on reimbursed medicines. And here we have to say that the truth is brutal. Roughly speaking, statistically, in a Polish pharmacy, the turnover of reimbursed drugs is 30 32% to earn per litre of petrol. The conversion is, unfortunately, 10 packs. Such reimbursed medicines for hypertension have to be sold. Further maths says that just one such bath salt has to be sold to get the same. And here, unfortunately, we simply have to compensate with something. This is also due to the fact that this law on the reimbursement of medicines has not changed for a long time and there are rather no plans to change it for the time being. At least, that's what my information shows. And pharmacies are always at a disadvantage every two months when loading a new list of reimbursed drugs, in fact, and at a point in time as if it were a year to year. And this margin also decreases when a new list is loaded, because the margin on these reimbursed drugs is 5%, which is not much.

Monika Rachtan
So just save yourself. Yes.

Martyna Pasik
It looks a bit like we have to compensate with something for such low margins on reimbursed medicines, because non-prescription medicines, supplements statistically are 30% margins, 100 per cent prescription medicines with 100 per cent non-reimbursable payment are 20% on average, well reimbursed medicines are 5%.

Monika Rachtan
So really not much. I'm still going to go back to the old and new anti-inflammatory medicine techniques, because when I imagined this patient with this basket between these shelves, I imagine him coming up to you these windows and does he treat you like this kind of cashier that he has to pay, to leave. Do you sometimes react there with 5 medicines he shouldn't have, or a whole medicine cabinet?

Martyna Pasik
I don't get into how he perceives me, I do my own thing. He can just take that basket, he can sew everything there. Whereas, in my experience, it's like, never this sale and the fiscal itself, the action of it all happens with one question of card or cash, whether it's handled by a pharmacy technician or a master pharmacist. I am fortunate not to have worked with such people who. Those whose patient service looked like this. And this is also where you have to get into the patient a little bit.

Monika Rachtan
Well, I have to ask, if I'm sorry, It's these patients. Do you get the impression that they treat you like a salesman? We also talked about how to quote such an anecdote from my life that I used to have the impression that my mother, when she went to the pharmacy to buy medicines, she. She was making a visit to Mrs. M.D. Mrs. M.D. who advised her, who said this syrup can't be the one. And now it's the case that we go into pharmacies usually in a market and it's so fast paced and I feel that just the authority of the pharmacist is no longer there with patients.

Martyna Pasik
I have been working for 8 years and so I would say that actually the older people always address you as Mrs magister, well you are not a magister. Don't they address Mrs magister to all the staff in the pharmacy? Yes? Yes it is, in terms of just making these and putting it in themselves, the patient can put it in, but there is always just the question of who is it for? Is the dosage known? Is it known that this cannot just be taken together? Is there an interval or are we just restocking the medicine cabinet and for two different people we buy this as if this dialogue is always there? Do we know that you can't go out on radiation now with this medicine? So that message is there and then it comes out like Even if the patient doesn't want to talk, when asking these questions he starts to say yes and eventually oh gee, or thank you, or can you write that down so I can remember it? It comes out, it just comes out in conversation with the patient. I would say more than that it varies in range. Yes, because, for example, it's about intimate situations and not everyone has that openness or wants to talk about it, or seeing the queue wants to talk about it.

Martyna Pasik
And so when he puts something in the basket as he walks up, we already know what's wrong with him. A little bit. And seeing the sort of restraint, looking at himself like that, you can just point to something. Is there a probiotic for this? Is there something for intimate hygiene at home? As if by not using such words, which I may offend him, maybe a little embarrassed in relation to the queue, sometimes the patients will supply and this dialogue will go without using such difficult words, and at the same time with the patient getting along. In an age of inflation, too, everyone can see for themselves if they can afford it. Yes, also those shelves that he can pick something for himself. Well, if we are, so to speak, just an assortment of this behind us, behind our backs, he'll ask for up to three things more he didn't ask for, he'll be embarrassed that he doesn't take, he just chases us around like that. After this pharmacy, too, patients have apps, us checking for ourselves the composition of medicines, the composition, whether nobody is allergic to them, cosmetics. So it has its pros and cons. But like this service definitely never happens.

Martyna Pasik
Just like that, without making some kind of contact and what would a patient like how he treats me? I don't get into that. I just do my job as I should. Of course, out of 10 patients, someone will not be happy with that. It's hard, but I have a clear conscience. When I go home, that's how I made that contact, that's how I informed Yes, I wanted to write it down to tell the patient, but will he use it? Well it's kind of like he may or may not. Yes.

Monika Rachtan
I understand. What I would also like to ask is, if it is the case that I have some such embarrassing problem and I need to talk to this pharmacist after all, because I don't know what to take of the company, is there a place in the pharmacy to buy your MA? I come with such a problem that I would not like to talk about on the forum. Could we go away somewhere, hide to talk?

Martyna Pasik
I'll say this, we didn't have this before, it's just that Wit 19 has analysed these pharmacies of ours a little bit in a good way. Some of the employers have sort of created pharmaceutical care rooms for us and they are such a safety buffer for us in that case, because we can wait until there is actually no one in the pharmacy. Yes, that's what we did before. We can lower the tone of voice as much as possible, but that room, despite the fact that it is supposed to be used for vaccinations, is used precisely for a cluster of such conversations, where the patient simply wants to talk about some embarrassing problem, wants to show something in his groin that is going on, because he doesn't know how to define it or what it is like. He doesn't have the access to take a picture to show us actually what's wrong with him. So yes, as much as possible. I use the confidences room very often.

Monika Rachtan
So there is nothing to be afraid of either.

Martyna Pasik
No, as much as it is for patients, Well and it is a step towards pharmaceutical care in general.

Monika Rachtan
Now I'm going to ask you about such a question because. When I go into a pharmacy, I often see T-shirts like this. A month ago, the advertising slogan bargain of the month was Vitamin Sunshine 1 99. Is there a poster in your staff room like in McDonald's with a sales target of 50 packs in June? And does someone tell you afterwards that if you haven't met that target, I don't know, you won't get a bonus. Well, at that point I didn't get a bonus. So I am doing my job wrong. Or you get it because you are super salesmen. You have sold 120.

Martyna Pasik
PLN. I will start with the baskets And here again such baskets can be in the drugstore part and with the words promotion, bargain today only discount. Here, there may be only information about the price at the pharmacy. So here again, it's as if we need to demarcate that such words should have no place in a pharmacy, which somehow encourage the patient to buy those things that they didn't necessarily come for. In terms of targets. Well, yes, here I will return again to what we were talking about. This is a business that is supposed to generate a profit and there are targets to make a bonus. A pharmacist does not get a bonus for good advice, for patient recognition.

Monika Rachtan
A pity.

Martyna Pasik
Yes. No, he doesn't get such bonuses simply because he did a good job, he was recognised for the awards these also don't get bonuses from his employer. I will say maybe as a manager that sometimes these targets and all these tables help me a little bit. I will say perversely, because people are different and we come to work with different people. And now it is the case that this chart a little bit causes some mobilisation in providing and taking care in the patient. I mean. And there is not some kind of medicine, prescription. Well, thank you, there isn't. On the other hand, as this card hangs, can I offer the restorative market? Can I order the one for tomorrow? Any solutions just then actually stimulate the workers. So it has good and bad points. You have to find the golden mean somewhere in all of this. The golden mean, yes.

Monika Rachtan
Now I would also like to ask about this work of the pharmacist and about this kind of advising, because also such an interesting element of the work are these medicines that you create in the pharmacy, that is, they are called medicines, prescriptions. And now what are the benefits for the patient that the doctor prescribes? Because I also know that there are different reimbursement rules here. It's not always so zero-one.

Martyna Pasik
Personalised care. In fact, the doctor as a result of how he writes this prescription actually converts per kilogram PMA and converts age gender. This is very important with some drugs so for a given kilogram it is a therapeutic dose and for another it is already an overdose. Yes, and here it is actually such a targeted treatment. These are unique formulations. This is not found in the prescription drugs that we are able to get. In most cases, it is actually a formulation that is selected for a particular condition and they happen to be these medicines, they still sort of exist. Today I was also making an ointment made in such a way that the patient had to come at the time we are meeting now to collect such a medicine. This prescription is just such a bit of a springboard for us. We go into this room. There is complete silence, concentration, recalculation. It's like it's coming down a bit. It's not so fast. First of all, we have to calculate whether the doctor has made a mistake, because a doctor can make a mistake. On the other hand, we have to catch whether these doses are exceeded using a copy then, but we have to order, formulate this medicine.

Martyna Pasik
Some drugs take 15 minutes, some take three hours. So it varies. To package, to describe, to signpost, to price. So there is a bit of work involved. On the other hand, it is such a use of knowledge, that brought from the study of drug form technology.

Monika Rachtan
Well, that's right, I also think that the ability to make such a drug raises Pharma's profile. In the eyes of the patient.

Martyna Pasik
Yes. Patients are grateful to have this medicine made. Often they just come to the person to have that person perform the medicine for them, because they can see the difference between the different performances of the medicine. Also then patients actually come back with such a positive perception.

Monika Rachtan
And I'm still going to ask precisely about this authority of the pharmacist, because I think I once talked about the fact that every, every pharmacist. The patient's master. And now it is the case that practically. A pharmacist in inverted commas can become anyone. How does that affect your work and is that in your opinion? A person who has a degree in pharmacy and a pharmacy manager? OK, almost anyone can become a pharmacist.

Martyna Pasik
I don't think it's easy for any of us, and there was already a period of time when there was really little difference between the qualifications and the actual work done between us and pharmacy technicians. A pharmacy technician can be anyone at this point. You don't even need a baccalaureate for that, so the people who end up are at a very different level. There are people who wanted to do it and are very good at their profession, and there are people who just ended up there by accident. We, in order to finish these studies, rather nobody got there by chance. You had to go to a profiled high school first. You didn't have to, but in order to pass the baccalaureate as the studies require, it was more like that for the most part. There are unified studies of probably 11 majors. Only in Poland are there unified studies.

Monika Rachtan
This is also a testament to their stature.

Martyna Pasik
Now, fortunately, a little bit of these entitlements are beginning to be demarcated by adding new entitlements or adding what we were always promised. What we were taught about, what we were supposed to do. But it's always already, soon, in a momentum. And finally, that momentum. One by one, tiny steps are being taken and it's moving towards the good.

Monika Rachtan
Well, you said about these new powers coming in. I'm very happy for you and maybe you could talk about these new powers of the pharmacist that the Act has recently given you? What can you do more for patients?

Martyna Pasik
In fact, it all started at 19, when there was no rescue left. So we came with a rescue. We were the only ones who weren't even closed for a day, we didn't do tele pharma advice and we actually had the lift as if to help the whole system. And the law that we had been hearing about for years came out. And we've been waiting for the Act on the Pharmaceutical Profession, and it has introduced a quantum leap in terms of pharmacy, even though it's not perfect, some things still need to be clarified. However, it is still a very big success for us and it is simply a matter of time when the rest of the things will happen. It has given us a mandate for pharmaceutical care in general, for pharmaceutical care, broadly defined.

Monika Rachtan
What does it mean? Because it's such a mystery concept to me. Pharmaceutical care.

Martyna Pasik
Pharmaceutical care and pharmaceutical services, which is what we are able to offer the patient. And here, vaccinations may have been used in the pharmacy.

Monika Rachtan
I didn't, because I was vaccinated at a time when this vaccination was still so little available and I was vaccinated at the clinic, but yes I know you can at the pharmacy.

Martyna Pasik
That's definitely the next one referred children. So then the flu vaccination came out, then the smears came in as well, and the Act goes on to sort of talk about medication reviews. Well this service is one of the most difficult services.

Monika Rachtan
It's a total mystery to me too, what are these browsers?

Martyna Pasik
Drug review is about. The pilot is over, but what does it consist of? A patient who is taking a large amount of medication. And here in the drug review it was either people in their 60s, actually having at least 10 medicines, dietary supplements, whatever they are actually taking, or just younger people who have more than five medicines. And here we divide into patients who actually have something wrong, they have a problem and they don't cope, they don't know what it's due to, they either already go from doctor to doctor or they don't go because they don't have the strength any more and they just leave this kind of information about what their drug problem is, what their life problem really is, what's bothering them now? When it comes to health He receives this and that at this and that time from this and that doctor and we carry it out. It's a three-way visit, the first visit is the interview. We find out everything about the patient. Yes, weight, height, material status, exactly what problems the patient has, what medicines they take, at what times they take them, where they get them from, who they get their recommendations from, whether it's a neighbour or a doctor.

Martyna Pasik
Also, this is still very important. And we acquire this information and then there is our own work. Yes, we have to go through the drug Pole, check all the interactions, whether any drug with any drug has significant interactions clinically, because at 10 years there will definitely be interactions, but some we are able to eliminate by splitting the time of administration, shifting the time, changing simply to another drug from the group. And we always work that out sort of first and foremost, focusing on what the patient has complained about. Most often it's constipation and that's caused by certain drugs. You just have to push back, or swap, or introduce some pharmaceutical advice about style, health, the amount of liquids a day, the foods he's supposed to be taking. And that's a little bit. Patients are being helped. Contractions No different. The patient has pains. So often they succumb to the patients and like it can be done. And then we invite such a person, where they get guidelines from us and the patient gets these guidelines, but also the doctor gets guidelines as if there are recommendations for the patient and they are so simplified, they lighten up, they usually level out something a little bit, but there are patients who.

Martyna Pasik
So it's all right, because they just came to do this inspection, but it's as if there's nothing wrong with them and there's actually nothing going on there. Well, but most like somewhere this goblin is creeping up. And that comes from the fact that the patient is treated by several different doctors, and they don't necessarily tell everyone what they are taking beforehand.

Monika Rachtan
This is so often the case in Poland.

Martyna Pasik
It's all about time, where the doctor doesn't have as much of that time to question. This patient is not prepared for this visit and says that something in a yellow packet takes a low price.

Monika Rachtan
Sometimes I'm sorry to interject, but isn't it also the case when I hear about situations like this where a patient goes to one cardiologist, he prescribes something, he goes to another one to check if the first one prescribed him something right, the second one prescribes him something else and he takes these two medicines at the same time and, for example, their effects overlap, and in addition he goes to see his primary care doctor at these first two cardiologists, because he waits here privately with a referral, so he can't tell the pauses that he's already been there privately. And it becomes such a mess.

Martyna Pasik
And there is a mess in these medicines. And we are there to sort them out. We are specialists in the drug, we don't go into the diagnosis as it were, we don't direct patients that please do tests. We just and exclusively check the drug. And that's where a lot of the information really goes. Then this information still goes to the doctor. It's not like we've changed something, we've made something up or we've given something away and it stays in our knowledge, or just to the patient. And the doctor has no awareness. We inform the patient of this, but also the doctor that an interaction has been detected. We ask for a verification of the dose or we ask for a verification of the treatment. Our opinion is that it is a therapeutic dose, or that we have definitely separated it because the patient is taking one drug from the endocrinologist from. 2 Ola Kasza. 2. And they can't be together because they just go into bonding. And that's how it's done. The results of this pilot even surprised me. Very positively I must say. 75 pharmacies in Poland carried out this pilot and about 855 50 patients of these reviews after performed and at 82%. So 500 is 11 people.

Martyna Pasik
Today, until I recalculated, an average of two drugs were reduced from those ten.

Monika Rachtan
Savings for the system.

Martyna Pasik
Exactly for the stomach it is for the liver, for the kidneys, for our body. Simple. The patient mostly or less complained. Then there is a third follow-up visit. What happened so after that? What has happened? And in fact 80% patients say that they are better, that their problem has been solved or eliminated appears less often, or they feel some benefit again that they did not realise. It's a bit of a myth in Poland that old age has to hurt, it has to be lonely, it has to be sad, and it's not like that at all. And we need to disenchant it a little bit. And since the system is so overloaded, we will take this information about the cure. Because we want to, we can have it.

Monika Rachtan
Also his skills.

Martyna Pasik
Yes, exactly.

Monika Rachtan
And tell me, how do doctors react to such meddling in their affairs?

Martyna Pasik
Differently, but I thought it would be worse. On the other hand, I see such a positive reception. This may be due to the fact that I myself had to learn a bit about communication, and even when I was 100% sure about something, I had to put it in the right way so as not to offend someone. And this communication has to be worked out, and if you actually communicate a certain message in the right way, the doctor receives it differently. I already have such doctors who themselves come and ask from another department. Yes, someone is an ophthalmologist and doesn't necessarily know anything else, and they just ask themselves what to discharge themselves, what to advise patients. These are exceptions, but a drop drills the rock.

Monika Rachtan
And tell me more, because you said that the pilot has ended. So I take it that eventually it's going to be that it's going to be standard and that I'm going to be able to come to you and show you my first aid kit and you're going to tell me what I'm doing wrong and what I'm doing right?

Martyna Pasik
Yes, we are waiting. In fact, we are waiting with great impatience now for the legislative solutions, so that all this can work. It has to be, so that patients can benefit from it, so that they start using it. It has to be put into the reimbursement basket. The valuation is done and now we are simply waiting for the legislation. Who is going to be able to do this single-payer allowed in the pilot. But here is the problem. The law versus the pilot Who can actually perform, who should and what courses, what training, or whether it can be approached at all without training, so here we are waiting for legislative solutions. Well, hopefully in the weeks to come.

Monika Rachtan
And I think it is very important that later on the Ministry of Health or the National Health Fund will carry out appropriate communication activities to inform the patient about this, because I firmly believe that every patient who goes to the pharmacist's window and is informed by the pharmacist about this possibility, because I know that you very much want to do this, but on the other hand I think that this communication must be strengthened by messages from the decision-makers.

Martyna Pasik
Yes, that's for sure, But we also need to focus on standardisation, so that it's a trained, qualified person, because these things from studies are forgotten. It just needs to be fresh. Someone has to approach it so that it's not like that, because it's one thing to introduce a service, but to actually maintain it and not announce after a year that we're rolling it back because it doesn't save money for the system. The National Health Service will introduce it when there is a saving, and there will be a saving when it is done in good conscience and in good order by pharmacists. So here a little bit, I have to say that I these drives such that let's all do our thing and it should be done by trained people, how it will adapt to how the ministry wants, Yes, as much as possible, I will proceed with that. At this point I have sort of completed the geriatric care that they required. If there are further things that will condition the care and the execution of that, then by all means I will accede to that. I'm an advocate of just standardising it so that it's on a level.

Monika Rachtan
And tell me, because you also mentioned recently that another pilot is starting and it's a unit in the hands of pharmacists and I know you're implementing the pilot. What can you offer patients?

Martyna Pasik
Yes, this diagnosis. The purpose of this diagnostics is to catch people who may have civilisation diseases but are not yet aware of it, or who are at high risk and should control the relevant factors, and here they can benefit from such diagnostics. The diagnostics are just appearing in the Pharmacy Profession Act. We are just waiting for training and legislation in connection with this diagnostics. This is also something that is eagerly awaited. However, we have started with this diagnostics and it relies on the patient. I am, as it were, responsible for the diagnosis of hypertension, 30% of Poles have adult hypertension, and here he comes to measure his blood pressure, measure himself, I measure his blood pressure, we tell him how this measurement should actually look at home. And we just make little mistakes. There is some awareness. In fact, it may not be the worst thing to do at home, but once again it is systematic. We issue a measurement diary and the patient fills in a questionnaire. I care most about these patients. I will measure everyone's blood pressure if I need to, to verify, for example, my blood pressure monitor is pointing well. But here, this service focuses on those people who don't measure their blood pressure, don't know what their pressure is, don't know that they have hypertension and I want to catch them.

Martyna Pasik
Yes, they do a sort of questionnaire in which they answer such standard questions about their state of health. And the first time it's all measured three times, like this measurement and this first visit. And then in six weeks' time the actual diagnosis is there, they patient comes back for a second visit, they also have their blood pressure measured by cheque. Yes? I hope so most of the time. But if he doesn't come in, well I have a note of what his last one was as well. So it's not a problem for me. On the other hand, here we already do blood glucose diagnostics. And some of the patients have a glucose meter, but a lot of them still don't, and they don't have the equipment at home so I can check my glucose level once every three months. The next one, which is very popular with patients, they actually wait for this, for this test. It's total cholesterol, it's total cholesterol, which if the standard we're going to have, exceeded, there says something. Yes.

Monika Rachtan
In a pharmacy, you draw blood for a patient.

Martyna Pasik
And yes and no. I draw the speaker's blood. Yes, just from the capillary, just from the finger. That's actually how it is, it's not from a vein just locally drawn here.

Monika Rachtan
I had to ask what would happen if I passed out.

Martyna Pasik
In this pharmacy, this is not newsworthy which does not make me faint. But I'll still finish about those tests. That's the total cholesterol, right? And the next test is a uric acid measurement. So there's some cool stuff going on at this second appointment, because there's actually three blood tests and one test of the patient's blood pressure. And if this is where the data comes out worrying us, we interpret it again. We as pharmacists on How are they worrying or alarming that please come back in a month, two months, because it's high normal, but still normal. Is it already? Please speak to your doctor about this. Pauz with these results, which are, will turn to the primary care physician, because here it is actually as if further diagnosis by a specialist is already indicated. And this is simply supposed to be screening? It's supposed to be a screening of the public to detect those sick and those diseases that the patient is not aware of and doesn't know they have.

Monika Rachtan
And how do patients react?

Martyna Pasik
Very well I would say. In fact, the perception is. The perception in general of pharmacists has changed a little bit since vaccination came in for the better. Patients have understood that we know a lot about medicines and they can get something done a lot quicker, get professional advice and interpretation of these results really and what to do about it, where to go and when Already the alarm should go off that after. Something with their health condition to do. And when to still just or make sure that everything is fine, that we have the correct results.

Monika Rachtan
That's right. And we also trust these pharmacists. I saw that she recently published an opinion poll that says that the pharmacist is the person that Poles really trust. If he or she says that everything is fine, or if he or she even says that it's not fine just the doctor, that's the kind of signal that mobilises that it's worth going after all.

Martyna Pasik
Yes. And patients actually come, they say they make these appointments for these consultations, yes, to doctors not so much advice anymore, but they actually make these appointments and they just deal with it. Sometimes married couples come, so even if one side a little bit has this dismissive attitude.

Monika Rachtan
That she brings her husband along so thoroughly.

Martyna Pasik
Then the wife takes over and gets in touch. And she can be trusted too.

Monika Rachtan
And please tell me more believe in these vaccinations. And this is also an interesting issue in general, because in Poland the attitude to vaccination. It is difficult for me to consider here what it is, because some people are convinced, others are not convinced, but I think that this is not a topic for our conversation today, but let us talk more about the advantages. That is, I can go to the pharmacy and get vaccinated for Kuwait and get vaccinated for the flu.

Martyna Pasik
At this point for women and for influenza. This can even be done in one visit.

Monika Rachtan
But what does it look like? Wait, I come I don't have to go to the doctor for a prescription at all. I don't have to go through this whole pathway, registering, I just come to the pharmacist lady, the magistrate lady, and I say to the magistrate lady, I would like to be vaccinated against flu and the magistrate lady does everything.

Martyna Pasik
And yes and no. The way it works is that someone just walks in off the street, says to me they want to get vaccinated and as much as possible we go and do that vaccination. Yes, the referral is automatically on the patient portal. I see it, I see the whole history and I do that vaccination. A certificate is generated. The patient is simply organised from start to finish. It was different with the flu vaccination and now it was both easier and more difficult. Patients had prescriptions to arrange from their doctor and we could vaccinate them. Then it was that patients had free of charge, without any prescriptions. They just walked up to the window and I could vaccinate them. Then it changed again to the disadvantage that they had to come with their prescription. But we've already got it sorted out for this moment in March, that for next year there won't be such a mess anymore. And it's as if a patient will walk into a pharmacy, walk up to the window, say they want to be vaccinated and they won't care any more. We just have it in writing already. Joy of life. Yes, that's really probably the most enjoyable part of the job for me in terms of vaccinations and that contact in the surgery and what patients say there.

Martyna Pasik
There, apart from the fact that there has been a sort of vaccination, there is really a lot going on there, a lot of melanoma-like lesions have been seen and patients have been guided that it's just that you should be concerned about how this mole looks, like its here.

Monika Rachtan
Hang on, hang on. I'm very happy to hear what you're saying because I don't know if you're following or not, but I communicate a lot about Melanoma and I always talk about how I really can't understand that a patient comes to a primary care doctor with a cough. And this doctor, whether he wanted to or not, has to undress him. And I often ask the doctors, but listen, then you're already looking at the patient. Well, when he undressed, took off his shirt, well, during the examination, you can see that there is a disturbing change and that the patient should be referred to a dermatologist. And I hear, unfortunately, doctors don't do that, but do you? Do you want to do it?

Martyna Pasik
Yes? That's how it comes out. It's not like collecting mushrooms by the way. It comes out actually by the way, but that's kind of the idea is the point of the job at all. Well yes, because all of us GPs know how the appointment is done, it's all probably not that difficult and lack of time or not getting into the competence of dermatologists as well. Well, it is a difficult subject, but what can you do? Well, you just have to. And actually these patients from the problems, the way their elbows look, well it's not strictly a visual problem as some people think and it's caused by something and most often it's also caused by medication. And even when someone tells me I'm not taking any medication, in fact after one arm I most often say you're not taking it, I think this and that. And it turns out I am. But I didn't know it was a chronic condition. I didn't know I was supposed to mention it, that it was important, that I've been taking it forever, so I don't treat it as a medication, it's just meant to be.

Martyna Pasik
And what does this have to do with my elbow? And what does it look like? Well it has to do with the fact that here in these different fields this conversation is happening there and sometimes the grafting takes two minutes and sometimes 40 two minutes. It really depends on the patient.

Monika Rachtan
But I'm glad you are. You already have these new powers. And tell me, because when I talk to you, I get this sense that you take these patients terribly, terribly. You care terribly about them, if only the doctors.

Martyna Pasik
Surely somewhere the thought was where to just actually direct that future of yours whether it was into medicine, dentistry or pharmacy. Like those three majors would come into play. Probably from the age of middle school I would probably say that it was such a decision made as to what to do with myself next. But it fell through. It fell on pharmacy, It was a conscious choice. It wasn't a random choice. It was a conscious choice because the work gives you a broader spectrum. I found myself in pharmacy and in services really. In some training, that sort of thing. But a lot of my friends have also found their way somewhere very attractive, working in clinical research in industry. And here it's like a wide spectrum of where you can find that job and what you can actually do with your life. There is also the frontier of medical informatics, where these specialists are also needed. Here, too, there was such a wide spectrum that you didn't have to decide what I wanted to be in 10 years' time and what to actually do on a triathlon.

Monika Rachtan
Not quite everything when I know.

Martyna Pasik
And I liked chemistry a lot. And chemistry was closer to me and those science subjects were closer to me. And just most of that chemistry. More chemistry than in chemistry maybe not more than in this pharmacy, so I decided that this would be what I wanted to do.

Monika Rachtan
And how do you recall your studies?

Martyna Pasik
There were hard times, yes? It wasn't that I wasn't a primo at university and a student.

Monika Rachtan
Only now you are a primate.

Martyna Pasik
And it wasn't always so easy. I also passed the September campaigns, although even deeper friendships were established then. Such friendships I would say. And there were moments of doubt. But you have to say that the sun always comes out after the storm, and somewhere this passion and this stubbornness, which was such a positive stubbornness here, won out. And now I'm happy that it all turned out this way, that I didn't give up and it all worked out the way it was supposed to. It got easier and easier every year. In the fifth year it was actually that we didn't really know what to do with our time. All of us, because it turned out that we didn't have to sit in school for 12 hours and study for 12 hours afterwards. So in the fifth year we did.

Monika Rachtan
It has turned out that shrinks already.

Martyna Pasik
You know from these results of these.

Monika Rachtan
Notek, and before that it was very difficult. I'm very happy with our meeting and I think the patients will benefit a lot too. Because just to summarise, before we get into the Facebook questions and the Facebook groups, because I've written you that I've got these, I've been collecting these questions and I'd like you to answer them, I'd like to summarise our conversation and say that we need to benefit, that we patients, we should benefit, that today we have really nice people who want to help us, who have time for us, and we keep complaining that the doctors don't have time for us. So let's go to that pharmacy and just talk to that pharmacist. What cool thing could we do together? For me.

Martyna Pasik
Yes, and even more so as more services continue to come in, because there is a new medicine service. Anyone who has been prescribed a medicine for the first time is entitled to a free consultation, also reimbursed and by the National Health Fund to be consulted on how to use that medicine. Are there simple medicines? Yes, a tablet to swallow doesn't seem to be complicated, but there are inhalers in asthma and each one is different and it's like a complication and a big patient goes to that appointment and finds out the diagnosis. It's like he's already got such confused thoughts and he's not able to do everything, even when the doctor has explained it to him and he's really getting into it, he's just so confused in his head after that one visit when he gets the diagnosis that it's all got to be systematised, opened up, because it's one thing to watch an instructional video and it's another thing to take the medicine and actually do it.

Monika Rachtan
Take to the hand.

Martyna Pasik
How to make a correct inhalation. Then it comes out that it doesn't work like that. It doesn't work because it is taken incorrectly, because we take too little incorrectly. Not in this way. Not in that position, not holding. So it's actually like this is also a very important service, it's a prescription that continues in just a few moments. And it's a prescription that's a prescription from a specialist and he's sort of going to send that documentation online to the pharmacy and the pharmacist is going to be able to continue the ongoing treatment for up to a year. And in fact, if we complain about going to the monologue fields once a year, these things will be able to be dealt with in the pharmacy with this prescription. It will also relieve the pressure on pauses.

Monika Rachtan
Because you go all out.

Martyna Pasik
This is exactly what a pharmaceutical prescription is, it is the right of the pharmacist, but not the obligation to issue this prescription. On the other hand, there are times when there is actually a threat to life, a threat to health, that this service is also used. There is a pharmaceutical consultation, and it is a kind of a broad spectrum of what it might actually be, but patients require this consultation, and then we also come, it is documented, it is not something that I just say and nothing comes of it. It is a service that is actually supposed to be documented and both the patient knows what has happened to the doctor. Yes, yes, as much as possible. Also, there are a few services that we are just waiting for. They are already there, just outside the door, knocking and we are waiting for them. But the law has given them to us. And now it is just a question of additional training, training, training.

Monika Rachtan
And also patient interest. But I think that here you will generate this interest yourself, because this enthusiasm of the pharmacist to work is enormous.

Martyna Pasik
We cannot advertise these things, we can only inform. On the other hand, this message simply has to be told to the patient, because up to now patients do not know about all these services. So this information will certainly go from every pharmacist, that everyone knows their patients. Most of the patients are our regular patients and we just know if this is actually the first time and such a consultation and such help and such an explanation is required.

Monika Rachtan
Now let's get to those questions. I'm asking you to give such minute answers as you would tell in a comment. OK, Imagine it's hard to be such an expert on a group You sit down in the evening, you have nothing to do and you think to yourself and the pharmacist is always suggesting substitutes, are they as effective? Or e.g. he tells me I have the same medicine only ours, Are they sure they are proven?

Martyna Pasik
They write like this. Here I think there are two questions. The first is substitutes, replacements, generic equivalents. This is just creative and it is the same composition, the same amount of active substance and the same active substance. So de facto we have the same action, but a different manufacturer. What can the differences be due to? The differences can be due to the packaging, the filling, the preservatives, some flavouring. If it is a syrup, for example. All these things around that substance. They may change, but as if our therapeutic effect does not. And they, in order to come in as a replacement drug, a reconstituted drug just generic, they have to actually show this equivalence. They have the same as the original.

Monika Rachtan
The written out validity please for patients mark it is.

Martyna Pasik
That it dissolves, releases and starts to work at the same time as the drug actually prescribed by the doctor. He has to be between 80 and 120 per cent. And so it is difficult to get it into this place. This is very important, because some of the drugs are actually hard to get and there are deficits. And we have no choice. We just have to take what's there and offer equivalents to patients, because otherwise they won't take any medicine at all, because they don't have it. Or that original medicine and always the most expensive. He is always the most expensive. And here the patients, if they have to give up some treatment, it is better for them to take a cheaper one, but to continue this treatment, because again the doctor will not know that it is not the medicine that is not working, but the patient is not taking it at all. But he won't always admit that he hasn't bought it, this medicine and he's not taking it at all. So here we have to sort of always consider the benefit at the bottom, the benefit is what follows. Well, but there is a cluster of drugs like for example for arrhythmia, which I don't swap, because here these 80 and 120% don't make a difference.

Martyna Pasik
Here there is actually a difference, but there are such as gastric cover, and here there will be as little impact. So here you always have to think like this, not have a ready-made prescription for handling this patient and actually proposing just to approach the individual here and now. What happens?

Monika Rachtan
OK, I'm not being inconsistent because I said you've got a minute, but I'm going to ask you a little bit more about these medicines of ours, that is.

Martyna Pasik
Our medicines, our medicines. I suspect that here it is all about brands, own brands, own pharmacy chains. It is now the norm, so that every pharmacy chain has its own brand. And now the question is, again, is pharmacy just a very strict and specific science, is it a medicine, is it a supplement. And here we have, because it is our medicine and from another medicine we want to offer our medicine, which is registered as a medicine, then we can talk about a guarantee of the same quality. So that this vitamin D actually has the same quality as what you wanted. It is at a more favourable price in a more favourable offer. However, when it comes to replacing medicines with our supplement, we are not so sure. It is simply a different marketing scheme and there are no more studies.

Monika Rachtan
I understand another question. My mother is 75 years old, She comes back from the pharmacy every time with new, new vitamins. I want to wean her off this because I seem to be spending half my retirement on vitamins. These vitamins are in inverted commas. What to do?

Martyna Pasik
Send her for a drug review to detect if there is a cascade going on here as if saving. Yes, she has a stomach ache, stomach ache because of some other medication, but she takes something again for pain. As she takes for pain it generates another renal again. So here we have to her. Send her for a lactational review so that all these vitamins, all the supplements, all the things that she comes in with, whether it's once a day, whether it's once a month, whether she's taking them less often or more often she said and whether they actually just need to be done so that there's not and actually all that, that is. In adding medication. What we are really concerned with is that we don't add medication for some ailment that is made by other medication that is already ok.

Monika Rachtan
I just wanted to vaccinate my child against flu with the bonus vaccine, but it was not available in the nearest pharmacies. Is there a chance to look further afield? The pharmacy lady told me it might not be back as the season is over. This is only January. And they said you can be vaccinated until April.

Martyna Pasik
We vaccinate adults for flu in pharmacies, but here this nasal vaccine is just for children and it is such a slightly different vaccine, because this vaccine is live and its expiry date is very short. It oscillates around 19 21 January. As far as I remember, due to the fact that it is a live vaccine, after that date it is simply to be disposed of and for this season the manufacturer will no longer produce it, because he has produced it, but its expiry date is very short due to the fact that it is a live vaccine and after that date it is out-of-date and in fact you have to wait with this particular nasal vaccine until the next season, that is until the end of the holidays. So somewhere in September it all starts to move.

Monika Rachtan
But I will elaborate that if the doctor wrote us a nasal vaccine he probably had a reason for it, But maybe he just wrote it that way because it was convenient? It might also be worth going back to the doctor and saying dear doctor. But maybe we could ask for another form that is available at the pharmacy?

Martyna Pasik
And this is where I wanted to say that this vaccine is a new vaccine. It is the vaccine most commonly used in children. However, intramuscular vaccines can be given to children and have been given to them for years, so they have been tested, proven and used for many years longer than this particular vaccine. Therefore, if there is a risk that the flu season may have shifted a little, these vaccines are nevertheless available in the autumn. As a result of this postponement, it is also worth vaccinating later, so I am very much in favour of the idea of vaccinating in January. But this vaccine is simply not available any more, so go back, go back to the doctor and maybe he will prescribe one of the two vaccines for the muscles.

Monika Rachtan
OK, and one last question. Question number 4 In the adverts recently they say it's a medicine not a dietary supplement. When I buy a vitamin, do I have to ask about this? And is it always the case that a medicine is better than a supplement in a medicine?

Martyna Pasik
We know what's so, because a drug is supposed to treat a condition, it's supposed to cure a disease or prevent a disease or prevent a condition. And that's sort of the demonstrated pharmacological effect and the marketing. Well, we just have to show these studies that talk about it so that the Office for Registration of Medicines, Medical Products, Medical Devices can put it on the market. So here we have a strict, legal pathway with evidence when it comes to a supplement, it's not registered by this office and there we don't have to show what we actually have inside and how it works, because a dietary supplement is supposed to supplement our food. Its purpose is not to cure, but to supplement nutrition. And here the question is, as it were, what are we addressing? Do we actually have an identified deficiency? In view of this, should it be supplemented with a medicine? Do we want to supplement our nutrition, supplement our diet, because we are vegan and then we supplement.

Monika Rachtan
But isn't that also the case? Because if we're vegan, if we were tested for that deficiency, it would probably come out that we're deficient and we would need that much instead of a supplement.

Martyna Pasik
Yes, yes and here we are bouncing around again. Some of the things we can buy in the pharmacy are both registered as medicines from company X and as supplements from company Y. Pharmacists tend to be guided by the drugs, because here we can talk about the quality and the certainty of what we are actually dispensing and what is there. There is a specific dosage, and it is as if the dosage is so strict as to how it should be used and in what kind of conditions. However, a supplement simply supplements our diet.

Monika Rachtan
Martyna The Patient First podcast is a podcast that has the patronage of the Institute for Patients' Rights and Education and the Institute communicates a lot about the humanisation of medicine. What is this humanisation of medicine for you?

Martyna Pasik
Establishing the correct relationship between the pharmacist patient and the patient. Other medical professions Actually the doctor, the nurse, the paramedics. And that proper relationship, and one based between In fact, for me, I think what I care most about with the patient is based on trust, based on respect, based on that sense of privacy, of individuality. And this has a big impact on pharmacotherapy, I would say, on actually effective pharmacotherapy, because these patients trust us and are able to either trust us or turn to us with the fact that they can't do something, they don't know how to do something, they don't understand something and they want some specific information from us, they will tell us about it and this will have an impact on their pharmacotherapy, the effectiveness.

Monika Rachtan
Thank you very much for answering these questions. Thank you very much for your work. And thank you very much on behalf of the patients for all the very important information you have given them. I hope that your audience will benefit from it.

Martyna Pasik
Thank you very much. Thank you for the meeting and for the invitation.