Thursday, June 2, 2016

Dear Pharmacist

On the surface, this seems like it's not a big deal.  But it's part of something really problematic, and that's why I want to talk about it.

I was picking up some prescriptions at the King Soopers pharmacy the other day and the pharmacist came over and said something like "we're doing a thing where we make sure to let all of our diabetic patients know about the importance of exercise."  To which I responded.  "I don't have diabetes, I'm on that medication for another reason."  And then she said "Well, anyway, exercise is important."  And then I spent the next thirty minutes shopping for our weekly groceries and fuming about that interaction.

The job of a pharmacist is to provide medications ordered by the doctor, in the amounts ordered by the doctor, and to answer questions about those medications and any interactions or side effects they might have.  Pharmacists do not need to know the diagnosis or reason the meds are prescribed (as proven by the fact that she thought I had diabetes), and they are not involved in the treatment plan.  Those things are outside the scope of their knowledge and responsibilities.  (Fyi, I'm also on a medication typically used to treat breast cancer, which I also don't have.  My doctor and I decided to try it to help with something entirely different, and that's between us.)

We've gotten very comfortable giving diet and exercise advice to anyone and everyone we come into contact with.  It's not unusual for a friend to recommend a specific diet to another friend based on their personal experience alone, and the internet is full of exercise recommendations.  But there's a difference between getting these recommendations from someone you know is doing it based on personal experience and getting them from someone who seems to be giving professional advice.  That's where it gets dangerous.  Medical professionals without the training in nutrition and exercise have gotten very comfortable giving advice in these areas even though they have no training in them.  I've had an ultrasound tech recommend a specific diet based on her personal experience with it, not her medical training.  It contradicted the advice my doctor had given me, and it made me very uncomfortable.  And now my pharmacist is recommending that I exercise without knowing anything about my medical history, how much I currently exercise, or whether it's a safe thing for me to be doing.  We need to draw a line between friendly advice and medical advice and maintain the distinction.

Furthermore, pharmacy windows (especially in a grocery store) are not a private place.  In the privacy of my doctor's office I am happy to discuss my diet and exercise, my medical history, diagnosis, and treatment plan.  At the pharmacy, I don't feel comfortable discussing those things openly.  I don't want a customer (or even the other pharmacists) to overhear a discussion about my diagnosis.  It makes me really uncomfortable.  Furthermore, I did not choose my pharmacist.  I research my doctors before picking them, and there are a lot of doctors that I've only been to once because I just wasn't comfortable with them.  It takes a while to build that relationship and to trust them enough to do what they say.  I don't have that relationship with my pharmacist, and I shouldn't need to.

The discomfort related to picking up medications should not be underestimated.  Some people don't have a problem with it, but some people do.  I'm somewhere in the middle.  It's normally alright, but it definitely makes me uncomfortable to even say the names of the medications where someone might overhear, or to discuss any questions with the pharmacist.  For some people, this interaction could be enough to tip the balance and cause them to become less compliant with their treatment.  If they're very sensitive about the subject of exercise (and some people are), they might lose trust in their pharmacist or think that it's not worth the embarrassment of being publicly recognized as a diabetic and having someone assume that they don't know about the importance of exercise.  Honestly, I feel uncomfortable at the thought of returning to this pharmacy after that awkward interaction.  I don't want it to happen again, but there's a good chance it will.  I don't know how to respond without destroying my own sense of privacy and discussing my medical treatment somewhere I'd rather not.

Now, before we get sidetracked, we are only talking about informing people of the importance of exercise, which is something that isn't really in dispute.  I don't disagree with the information.  Everyone knows that exercise is important.  That's sort of my point.  Pinterest is full of posts about it and the First Lady talks about it ad nauseum.  It's on Sesame Street and it's on the news.  So I don't think that anyone, not even diabetics, are in the dark on this point.  Someone who has been diagnosed with diabetes and prescribed medication is already on a treatment plan.  Their doctor has talked to them about exercise, probably somewhat forcefully, so they are either already exercising or they're not and it's a pretty sensitive subject.  And so the result is that you're either insulting someone by telling them that exercise is important (because, duh) or you're making them feel judged by their pharmacist for something they're struggling with.

You can't tell what's really going on with someone by their appearance.  It's really dangerous to tell all diabetics that they should be exercising.  Many of them are quite sick, or have co-occurring conditions, both of which could make exercise dangerous.  They need to work closely with their doctor and possibly a physical therapist in order to attempt any exercise.  The result is that you're guilt-tripping people who may not be able to exercise as much as they'd like to and even undermining a doctor who may have told them to do only a few simple exercises to build up their strength.  I fall into this category.  I'm only 30, and I don't have diabetes.  I'm genetically prone to it and I'm working really hard to make sure that I don't end up with it.  I also have chronic pain in my neck and back from a car accident a few years ago.  I'm working with three different medical professionals every week, and two others on a monthly basis to try to fix my body.  I do physical therapy and walk when I'm able to.  It's a constant struggle not only to do what I can, but to not feel guilty about the things I can't do.  This brief conversation with the pharmacist left me with so much guilt for not exercising as much as I should be, but can't.  It frustrated me because I wasn't able to, and didn't really want to, tell her all of this.  I know that I look like a healthy, if overweight, young woman.  But my body is a mess, and it's my primary goal right now to improve my health.  Being flippantly told that "exercise is important" is offensive and condescending.

I also want to mention that part of the reason I have a problem with this is because diabetics are being singled out.  Exercise is important for everyone, not just sick people, not just fat people.  Exercise is not less important for people with heart disease, or asthma, or with no diseases whatsoever.  It would be better (though still not great) to tell everyone about the importance of exercise than to just pick a particular diagnosis. People have the right to prioritize their health and choose their treatment plan as they see fit.  The amount of exercise that includes is up to them and, if they choose, their doctor.  Ultimately, this isn't something that should be done by a pharmacist.  If pharmacists want to remind people to check the expiration dates on their medication or warn them about a medical device being recalled, these are things that fit within the scope of the profession.  They could give out stickers for breast cancer awareness or offer free cholesterol check kits.  All of these things would be helpful and completely appropriate.

I'm pretty sure that this was mandated by higher up, and not something that my particular pharmacist decided to do.  I also trust that it was done with only good intentions, and with the hope of encouraging diabetics who were struggling with exercise to commit to it and thereby improve their health.  For the reasons detailed above, I don't expect it to have the desired effect.  I think it should be stopped immediately in favor of something more appropriate.  I would absolutely switch pharmacies to avoid this confrontation, and I expect that other people would too.

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