Diary of a Neighborhood Pharmacist, Entry #20

I still work for one pharmacy services agency on a per diem basis. The agency is a national operation that provides contract pharmacy services to military personnel, and they have two locations near my house. Other patients are free to use the pharmacy, but because the pharmacies are located in clinics, there are few walk-ins. The first location serves active duty and retired military personnel, while the second location primarily sees patients that come from the outpatient clinics of the hospital. The second location was once one of the premier hospitals in its area, and the building itself is a model of art deco architecture, but it's closing down, and now, the most active clinic is the psychiatric service.

The first location, which serves the military and retired military, is fun. Perhaps there's something about the military life that makes people amenable to dealing with rules and limits, with knowing what's possible and what's not. The patients range from the very young to the elderly, some even wearing caps noting service in Korea, and, rarely now, World War II. We can talk. There are mandates that require pharmacists to counsel patients about medication – uses, adverse effects – and with this population it's possible to do the job properly. There's a good degree of satisfaction here.

The second location is different. The patients are, for the most part, poor, their drug costs covered by Medicaid, their poverty the result of either mental illness or a collection of medications which, while controlling the worst aspects of their conditions, forces them into a state of limited function. It can take longer to provide warnings, and sometimes I'm not sure they understand. We speak slowly, repeat, try to find different ways to say the same thing. At times, I get impatient, with myself more than anyone, because I can't seem to find the words to break through – and I'm not there on a regular basis, just as a fill-in for the regular pharmacist. But these patients also provide a level of job satisfaction.

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