Meet the pharmacist who wants to reduce patients’ drug intake


Joanne Vella.

A Western Sydney pharmacist has created a business helping her customers understand that medicines aren’t everything

Joanne Vella loves it when her customers ask her about dodgy health information they’ve found online.

“These people are proactive!” she says. “I like these patients. They’re the ones who want to help themselves, and so they’re the ones I can help the most.

“They’re inquisitive, they’re looking for answers. Unfortunately, Dr Google is overwhelmed with lots of information, and not so credible information. I love working with these patients because we can have a conversation about it.

“It’s the people who aren’t interested, who don’t go looking for that information, that probably need a bit more help but are harder to reach.”

Many patients are keen to reduce their intake of medicines or stop taking them, but turn to the Internet to look at non-evidence-based ways to do so.

Ms Vella was inspired to create The Practical Pharmacist, offering “practical health and weight loss solutions,” by her mother Maria, who began searching for ways to stop taking her medicines by unearthing less-than-credible information online.

“Mum was born with a heart defect that wasn’t detected until she was in her 20s,” Ms Vella, who also works at the Chemmart Pharmacy at Narellan Town Centre, told the AJP. “The doctors had her on Valium, thinking she had anxiety, so it took a very long time to detect.”

In later years, Maria Vella began telling her daughter that she didn’t want to take medicines at all to manage her health.

“She decided to do her own research, and so she was finding the dangerous type of information on the internet, and was looking into a lot of worrying things,” Joanne Vella says. “She spurred me on to do my own research to keep her on track and not go to extremes! She needed those medicines to keep her alive.”

Ms Vella says that because medicines work best when a person takes good care of themselves in other ways, she was able to find a middle ground for her mother and prevent her from ceasing her medicines regimen.

“She’s on three medicines now, but was only on one until recently – when you’re in your 70s the blood pressure tends to go up. I look at her, and I look at so many patients I see in a similar boat and they’re on many more medicines than she is.

“The basic things we did to help her make such a huge difference, and it’s incredible to see the difference between her and other clients.”

The Practical Pharmacist is based on the concept that some consumers can avoid ending up on medicines by maintaining their health in a way that is going to work for them.

When a customer has signed up, Ms Vella Skypes with them at a mutually convenient time to take them through their concerns and ways to address them.

“Watching my customers go downhill rather than up got to me,” Ms Vella says. “So I put together a basic program to help maintain best health; everybody’s different and has their own challenges, and so I bend the recommendations depending on each person’s ability and problems.

“This is about getting them to do what they’re willing to do. It’s not about slapping someone with a strict diet and saying, ‘Do this’.

“People get overwhelmed with information when you start saying, ‘Buy this, you can’t have this, you have to do that’. They need to take a step back and look at what we can do first. Once that’s a regular habit, they can move onto the next thing.

“So it’s a slow, progressive approach to help people make new habits.”

Ms Vella says that part of The Practical Pharmacist is about looking for underlying conditions and referring appropriately.

“Probably the most common issue I’m approached with is from women, who have weight and fatigue issues. They’re the most motivated to seek out help.

“We look at underlying causes, such as a thyroid issue, or it could be a bit of insulin resistance. If I suspect something like that, I send them to their doctor with a list of blood tests to discuss with them and see if we can eliminate those as causes.

“And then in the sessions – there’s a lot of slides and visual stimulus to learn from in there too – I can do things like teach them how their choice of food can impact fatigue, for example, and progress in that way.”

Ms Vella says that with pay for pharmacists not progressing, it’s natural that some look at entrepreneurial ways to use their clinical skills and help patients.

“It does concern me, whether the pay is going to be up there with the skills we’re required to have and the service we provide,” she says. “This is a private venture and it helps, but it’s a shame it’s not something I can do in a subsidised way.”

In the meantime, she hopes to help many more patients understand that medicines aren’t a quick fix or full solution to many problems.

“A lot can be controlled with just diet and lifestyle,” she says. “Some will need medicines, and of course that’s fine, but by getting the basics right some can be avoided.

“When I came out of uni I thought drugs were pretty much the answer: there’s a drug for everything.

“But experience shows you that it’s not always the best way. They can help symptoms, and manage some conditions very well, but helping people with their general health can make a big difference, and that’s important too.”

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14 Comments

  1. Debbie Rigby
    05/07/2017

    Deprescribing and lifestyle interventions should be part of the medication management pathway. It’s what every pharmacist and GP should be considering for patients with chronic conditions especially towards end-of-life. There are great resources on deprescribing available at http://www.cpsedu.com.au/posts/view/47/2016-Deprescribing-Resources and http://deprescribing.org/

    Well done Joanne! This story should be highlighted to the naysayers in the medical profession who think community pharmacy is all about sales, and patient care a distant second.

    • United we stand
      05/07/2017

      Debbie you are so out of touch with what’s happening on a day to day basis in an actual pharmacy. Pharmacists are under huge pressure to upsell. I have seen first hand and heard from my friends how they get called in to the head office or get told off by management when they dissuade patients from taking 2 expensive complementary medicine to replace their statins or when they tell patients not to bother with lozenges if they’re getting cold and flu tabs anyway. Pharmacists are constantly battling these queries on a daily basis. Naturopaths and floor supervisors are constantly on the lookout and report up to management whenever this occurs. A young store manager with no medical training gave a warning to one of my colleagues once and then said “we’re not saying fish oil is as good as lipitor. All we’re saying is, you can tell them to take them together. Who knows it might even be better for them!”.
      Welcome to the corporate pharmacy of 21st century.

      • Jarrod McMaugh
        05/07/2017

        If you’re working in this environment, then resign.

        If you are morally opposed to this practice, yet continue to work in that environment, then you are endorsing it.

        Your description may be the case for a portion of the industry, but it’s far from the standard expected of pharmacists and isn’t the way the majority of pharmacy “brands” operate.

      • John Sikiotis
        05/07/2017

        I think you have little or better no idea how in touch that Debbie actually is with community pharmacy . HMR pharmacists are never forced to
        deprescribe but it can be part of the HMR brief and lo and behold if when the HMR commences that the consumer should ask can I stop taking some of these medications . Deprescribing routinely happens in hospitals particularly to not overprescribing antibiotics to prevent antibiotic resistance . The infection is treated within the appropriate time frame .

        • SocksFullOfTears
          06/07/2017

          John, I think you misunderstood United.
          I myself, have personally clashed with management over recommending a patient not take a particular herbal supplement. These issues are rampant if you work in a high turnover, discount pharmacy.

  2. Red Pill
    05/07/2017

    She is mad. No sane business person would actively divert their customers away from their own products. Her shop will be up for sale in 2 years when she declares bankruptcy.
    HMR pharmacists get paid to do that. You don’t. Period.

    • Jarrod McMaugh
      05/07/2017

      You’re so far from right.

      You don’t have a successful business from selling something today; you have a successful business from being trusted to give the right advice when it’s needed.

      • Andrew
        05/07/2017

        Please expand on this, Jarrod….I’d like to see where you’re going with this. Perhaps an entirely new commercial paradigm?

        • Jarrod McMaugh
          05/07/2017

          There are two paradigms of marketing in the Australian community pharmacy sector – price and reputation.

          If you aren’t positioning yourself on price, you must position yourself on reputation.

          My patients come back again and again because I know what I’m talking about, and that includes recommending that a patient doesn’t need to purchase something when it’s not required.

          I don’t need to be convincing people to buy unecessary products, I just need to show them that when they do need something, that I’m the right person/business to purchase it from.

          • Michelle Franco Gerrie
            12/07/2017

            Well said Jarrod – my reputation and patient health comes first and YES they do trust my advice and come back over and over again There are plenty of products if you know you stuff that one can recommend if required that have a decent mark up

      • Red Pill
        05/07/2017

        Believe it or not, I used to think like you Jarrod. For what it’s worth, I think you’re a great moral voice here in our forum.
        But unfortunately, I’ve been proven wrong time and time again. I saw decent, advice based pharmacies sell up year on year only to be replaced by the discounters pushing complementary medicines in bulk. Perfume stands and Iris scans being better staffed than the dispensary counter. Pharmacist managers replaced by high school dropouts. Pharmacist’s quality being attributed to the number of scripts dispensed. Owners who cry poor but then operate a vaccination boothe that loses money everytime we give an injection.
        It’s a dog eat dog world out there and cut throat business approaches is all that keep these shops afloat. The concept of discounting and high sales volume has become the DNA of Pharmacy ownership. And unfortunately I don’t think there is any going back.

      • Red Pill
        05/07/2017

        Believe it or not, I used to think like you Jarrod. For what it’s worth, I think you’re a great moral compass here in our forum.
        But unfortunately, I’ve been proven wrong time and time again. I saw decent, advice based pharmacies sell up year on year only to be replaced by the discounters pushing complementary medicines in bulk. Perfume stands and Iris scans being better staffed than the dispensary counter. Pharmacist managers replaced by high school dropouts. Pharmacist’s quality being attributed to the number of scripts dispensed. Owners who cry poor but then operate a vaccination boothe that loses money everytime we give an injection.
        It’s a dog eat dog world out there and cut throat business approaches is all that keep these shops afloat. The concepts of discounting and high sales volume have become the DNA of Pharmacy ownership. And unfortunately I don’t think there is any going back.

      • United we stand
        06/07/2017

        You obviously haven’t been giving advice while the patient is holding a fresh CWH bag full of drugs. And then you take a quick glance in the bag and the drug in question is already in the bag.

  3. JimT
    05/07/2017

    professional vs retailer…..this is the constant debate………good intentions don’t always pay the bills……….all I can say I’m glad I got out of business when I did as it is a dod eat dog environment we have at the moment……..

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