Pharmacists and Flu Shots

Maybe I'm just not ready for this brave new world of retail healthcare, but it is disturbing to me when you stroll into a store and pay money directly to the person giving you a shot. The person administering the treatment should have some distance from the financial end of the transaction. My perspective of the entire situation is probably distorted from being trained at charity hospital. There was no money changing hands here.

Fifty years later, the Giant Eagle Pharmacy where I live is even offering a fuel perk or discounted gasoline with a flu shot. If  I could have charged piece rate fees for every IM administered, I would be a millionaire.

I wish my favorite nursing instructor, Miss Bruiser,  could have lived to see healthcare today. She would begin by giving the pharmacists a dressing down for administering IMs in the deltoid. I can just hear her screeching voice, "Listen up Linda (she could not remember all our names and called just about everyone Linda) the deltoid  is a terrible site. You are going to wind up injecting the subdeltoid bursa. What kind of antibody response will you get there?  The correct initial site to consider would be the dorsogluteal site and I do not want too see any of you attempting to give the injection without the site adequately exposed. This means pants all the way down with the patient completely supine and the needle inserted at an exact right angle to the counter table."

She would really emphasize that selecting the correct site trumped all other issues. "This is not about modesty, and if you are hesitant or shy about doing the right thing you can leave immediately because you are nothing more than a tin angel."  Whenever a student nurse looked for an easy way out or did something like taking an oral temperature instead of a rectal, they were a "tin angel." It was the ultimate insult. If anyone verbalized being uncomfortable or embarrassed they were a "tin angel." We quickly learned how to maintain a stoic demeanor even when Miss Bruiser insisted on "demonstrating" an invasive procedure on a fellow student nurse. It was tough to look stoic with a bright red blushing face, but we tried.

I think these pharmacists maybe onto something with limiting their IM injections to deltoids. This notion of choosing the most convenient or comfortable way of doing things should have occurred to me many years ago in my nursing heydays. One thing that bothered me as a scrub nurse was cautery smoke. I should have said, "Dr. today I would like you to utilize ligatures only on all bleeders.  My eyes are irritated by all that  Bovie  smoke and please don't even think about burning your way into that abdomen, here's a #10 blade." I probably would have been fired, but what's good for the goose should be good for the gander. If pharmacists can do it the easy way, scrub nurses should have the same option.

Miss Bruiser may have been a bit of a radical, but I can appreciate some of her points. Whenever there is a situation where everything is done the same without individual consideration, something is probably wrong. Giving all flu shots, even though the injected volume is small, in the arm is probably  not prudent. Oldsters and kids can have really miniscule deltoids. It might be wise to at least consider gluteal or vastus lateralis sites.

The other big thing in healthcare today is patient choice. Instead of asking which arm would you like this in, ask what site would you like this in?  If  Miss Bruiser were giving the flu shots she would be ordering all patients customers to assume a supine position with their pants to their knees. She was not a big advocate of patient choice and who wants to be publicly belittled and humiliated by being called a tin angel?