by

Six legged learning

I don’t often visit pharmacies, I only go there if I have to. And this week I had to, because our household was facing a problem that only pharmacy strength solutions can tackle. Head lice. Our first encounter with them, and no doubt not our last.

Now I have what I would confidently say is a better than average theoretical knowledge of how to treat head lice. When I worked on the drug information line at the Women’s and Children’s hospital we would regularly get calls asking for advice. I can still recall the go to lines about using any conditioner to wet comb, and the eggs make a popping sound if your squeeze them. I have sat through countless mock scenarios with students and pre-registrant pharmacists, listing their signs and symptoms and counselling pretend patients on appropriate treatments. And yet I still found myself standing in the head lice aisle of the pharmacy, staring at the wall of available treatments in front of me, feeling perplexed.

I didn’t even try to hide my confusion. I quietly stood there studying the labels of the different treatment options to make sure I didn’t accidentally pick one that only contained eucalyptus oil (which, incidentally, were the most prominently displayed). I checked out the different formulations available to see which one would be easiest to apply on children that have hair that always seems to make its way into their eyes. I checked out the different volumes available so that I wouldn’t have to return to the pharmacy to buy more to complete the follow up treatment (or forget the follow up treatment). I stood there for an uncomfortably long time. And nobody offered me any assistance. Nothing. At all.

The selection of treatment wasn’t the only thing I found more challenging than I anticipated regarding the overall head lice management strategy. What I didn’t say earlier was that while this was our first encounter with head lice, it wasn’t actually our first treatment. Our battle with head lice began at the beginning of the school holidays.

First came a delay in the identification phase. Despite my theoretical understanding of how to check for head lice and identify them, I had never actually done it. In my mind, an infestation would be pretty obvious to identify. I didn’t realise that it might only be 3 tiny little lice hiding in a head full of hair. I didn’t realise how hard tiny light brown creatures and their off white eggs are to identify in a head full of dark blonde hair. I didn’t realise that the head isn’t necessarily all that itchy. Not beyond the normal itches and scratches of a primary school aged child who gets hot and sweaty from playing all day. So when I heard that kids in my daughter’s class had head lice I did check my her head and do the ‘right things’…I just didn’t see anything. I was unconsciously incompetent in terms of head lice identification.

Once I did eventually identify them (using the wet combing method BTW – in future I’m just going to do this periodically if it’s going around) I got my husband to go to the pharmacy near his work to get some treatment. He came home with a small bottle of an appropriate treatment which we applied straight away. In order to repeat the treatment we needed to make another trip to the pharmacy, a job which quickly fell off of my to do list. Until I noticed the itching again. Oh shit. I totally forgot to do the repeat treatment. Which brings us back to the present day, and me standing in the aisle of the pharmacy.

As much of a nuisance as this whole experience has been, it’s taught me some pretty valuable lessons. It’s so easy as a pharmacist to get caught up in the theory and forget about the practicalities, but it’s the practical stuff that can really interfere with effectiveness. People need help with the practical stuff, even the people who should know better. And not just with head lice, with most things. We have opportunity to add real value here. To contextualise treatments for people; understand their world and influence their behaviour to give the treatment the best possible chance of being effective. Stop them from throwing money down the drain and perpetuating the problem.

This experience also reminded me of the importance of practical experience. In terms of pharmacy practice, I haven’t been practising clinically over the past few years. That’s been counteracted somewhat because I’ve still been talking with patients and have been somewhat obsessed with understanding their world view. But even so, there’s something about maintaining an element of practice involving direct patient care that I believe is of great value. And unless you’re the world’s greatest empathiser (I’m pretty sure if you’re a pharmacist that immediately rules you out of that category) then I think everyone can benefit from it, regardless of what your role is. There’s a big gap between work as imagined and work as done. We need to start reducing it.