Symptoms in the Pharmacy A Guide to the Management of Common Illnesses

Symptoms in the Pharmacy A Guide to the Management of Common Illnesses

This is the seventh edition of our book and appears 25 years after the first. Among the changes since the sixth edition is the move of more medicines from the prescription-only medicine (POM) category to the pharmacy (P) medicine category. New sections and case studies on orlistat and tranexamic acid are thus included. Important safety advice about the use of OTC medicines in chidren has been incorporated. We have updated and extended information about common infectious diseases to reflect changing patterns of illness.

There have also been further changes in the National Health Ser-vice (NHS). The importance of self-care continues to increase recog-nized and the public health role of community pharmacies has become more prominent. NHS-funded community pharmacy minor ailment schemes have spread to more areas in England as well as in Wales, Northern Ireland and Scotland. Under these schemes patients who are exempt from NHS prescription charges can obtain free treatment from the pharmacy. The schemes are well used, particularly for children’s minor illness and we have further expanded our explanation of com-mon childhood illnesses to enable the pharmacist to manage where appropriate, to reassure and refer when necessary.

A strength of this book has always been its evidence-based approach. The findings of new systematic reviews of published evidence together with evidence-based treatment guidelines have been incorporated and updated throughout. We have continued to introduce evidence on com-plementary therapies. We have strengthened our advice on working in partnership with patients.

As for previous editions we have received positive and constructive feedback and suggestions from pharmacists (undergraduate students, pre-registration trainees and practising pharmacists) and have tried to act on your suggestions. We have continued to add more accounts by patients to our case studies. We thank all the pharmacists who sent us comments and we hope you like the new edition.

We once again thank Kathryn Coates and her network of mums, who provided advice on childhood conditions and on women’s health, and on the sort of concerns and queries that they hoped their pharma-cists would answer.

Every working day, people come to the community pharmacy for advice about minor ailments. For the average community pharmacy a minimum of 10 such requests will be received each day; for some the figure is far higher. With increasing pressure on doctors’ workload it is likely that the community pharmacy will be even more widely used as a first port of call for minor illness. Members of the public present to pharmacists and their staff in three ways:

  • Requesting advice about symptoms
  • Asking to purchase a named medicine
  • Requiring general health advice (e.g. about dietary supplements) The pharmacist’s role in responding to symptoms and overseeing the

sale of over the counter (OTC) medicines is substantial and requires a mix of knowledge and skills in the area of diseases and their treatment. In addition, pharmacists are responsible for ensuring that their staff provide appropriate advice and recommendations.

Research on the appropriateness of advice giving in community pharmacies has identified a set of criteria that pharmacists can use to consider their own pharmacy’s approach;

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.


(Reproduced from Bissell P, Ward PR and Noyce PR. Appropri-

ateness in measurement: application to advice giving in community pharmacies. Social Science and Medicine 2000; 51: 343–359, Copy-right 2000, with permission from Elsevier).

Key skills are:

  • Differentiation between minor and more serious symptoms
  • Listening skills
  • Questioning skills
  • Treatment choices based on evidence of effectiveness
  • The ability to pass these skills on by acting as a role model for other pharmacy staff

Working in partnership with patients

In this book we refer to the people seeking advice about symptoms as patients. It is important to recognise that many of these patients will in fact be healthy people. We use the word ‘patient’ because we feel that the terms ‘customer’ and ‘client’ do not capture the nature of consultations about ill health.

Pharmacists are skilled and knowledgeable about medicines and about the likely causes of illness. In the past the approach has been to see the pharmacist as expert and the patient as beneficiary of the pharmacist’s information and advice. But patients are not blank sheets or empty vessels. They are experts in their own and their children’s health. The patient:

  • 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

The pharmacist needs to take this into account in the consultation

with the patient and to enable patients to participate by actively elic-iting their views and preferences. Not all patients will want to engage in decision making about how to manage their symptoms but research shows that many do. Some will want the pharmacist to simply make a decision on their behalf. What the pharmacist needs to do is to find out what the patient wants.

Much lip service has been paid to the idea of partnership work-ing with patients. The question is how to achieve this? Health care professionals can only truly learn about how to go about working in partnership by listening to what real patients have to say. The list below comes from a study of lay people’s ‘tips’ on how consultations could be more successful. Although the study was concerned with med-ical consultations many of the tips are equally relevant to pharmacists’ response to patients’ symptoms.


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