If you work in the pharmacy sector and have been diagnosed with, or suspect you have, obsessive compulsive disorder (OCD), you are not alone. OCD is estimated to affect up to 2% of the population.
Olivia Bamber, youth service and communications manager at the charity OCD Action, says that “many people in the healthcare field will be affected by OCD or another mental health condition in their lifetime”. For pharmacists with OCD, the symptoms can be an added stressor to an already challenging job.
“There have been instances where pharmacists have been unable to sleep at night as they go over and over the items they have dispensed during the day,” said Diane Leicester-Hallam, chief executive of Pharmacist Support. “They have also gone into work on their day off to try and retain control and to re-check work they may have done the previous day.
“From our experience, the concerns driving these compulsive behaviours stem from patient safety and a fear of causing harm as well as the threat of legal action and fitness-to-practise proceedings.”
Heather Call, a GP pharmacist prescriber, has a form of OCD called Pure O. “People mistakenly believe that Pure O differs from traditional OCD, because it features no outward compulsive manifestations,” Call said. “However, someone with Pure O will still have compulsions, which mainly manifest as unseen mental rituals, and they will usually engage in compulsive behaviours like seeking reassurance from loved ones, and avoidance of particular objects, places or people.”
Call’s symptoms began during the second year of university, and there was, she said, “very little awareness or help available at the time.”
Without a diagnosis, Call continued to experience symptoms over the next few years. When she began work as a locum pharmacist, Call found herself repeatedly checking items before dispensing, and was consistently worried that she had caused harm. “I hated checking, which caused me to hate being a pharmacist. Fairly soon into my career, I decided to give up work and have children.”
Call’s symptoms worsened while she was pregnant with her third child, and soon after her daughter was born she made a private visit to a psychologist. “He diagnosed OCD. It was actually such a relief to get a diagnosis.” Call’s GP prescribed sertraline, and referred her for cognitive behavioural therapy (CBT). “Taking [sertraline] is one of the best things I have ever done. In combination with further reading about OCD and exercise, CBT helped me recognise OCD-type thoughts for what they were.
“I was able to return to pharmacy and able to start enjoying it. I became able to check prescriptions with an appropriate checking regime and know that it was sufficient. I gradually increased my hours and managed a busy community pharmacy. I have now moved to working in a GP surgery, have recently become an independent prescriber, and am working towards a Master’s in advanced practice.”
Jane (not her real name) began experiencing symptoms of OCD when she was 13 years old; these were mainly around fear of contamination. By the age of 14 years, she would wash her hands 60 times in a row.
“I didn’t want to get any help — I thought it would impact on me registering as a pharmacist, so I didn’t tell anyone for a long time,” Jane said. “Handwashing and showering would take such a long time. I would think about touching door handles, using books in the library, and using computers. It was impacting my studies, it was impacting everything, and I kept it a secret.”
Jane began to seek help when she started her A-levels. “I was just at breaking point. My rituals were taking up far too much time.” At university she accessed psychotherapy and CBT. While Jane said that CBT “didn’t really work for me”, today she has managed to reduce her handwashing from 60 to 6 times, through what she describes as “work that I’ve done for myself”.
Jane currently works in a pharmacy and says that her thoughts around contamination do not affect her during the working day. “I have absolutely no problem going into work. I can manage things within an environment. But I can find it difficult when I then leave that work environment, or go to my car. I need to wash my hands before I leave.”
Jane finds her symptoms become worse when she has had a long or difficult day. “I make an effort to go to bed early when I’m working the next day. Checking if the door’s locked can take me longer if I’m tired or stressed,” she said. “Things like ‘did I lock the controlled drugs cabinet?’ are in my mind more then. I have to say to myself “That’s it: it’s done. You know it’s done.”
These days, Jane says: “If you looked at me, you wouldn’t know that I have OCD. I try not to let it hold me back. In fact I think it’s pushed me to be more successful, and to want more.”
Umer Ayyaz has not been diagnosed with OCD, but feels that he experiences symptoms of it “quite frequently throughout the day”. He describes a need to tick the expiry dates on medicine packs: “Even if I can see the expiry date is OK, I will not pack away the medicine until I have placed a tick next to it. At times I have tried to just continue, but have then resorted to opening the bag and ticking next to the expiry date before continuing.”
Ayyaz also bags up medicine boxes in numerical order. “If I did not, then I would feel uneasy and would not continue until it was sorted.”
Ayyaz feels that he is able to manage his symptoms, and that they do not have an impact on his work or colleagues. “At times I may want to repeatedly check a prescription or medicine, but this can help in the safety aspect. There have been times when the pace of my work has slowed, but if I am ever in a busy store, I try to ensure I quicken my pace and not “obsess” as much as normal.
“Although last week my colleague, who I have a humorous relationship with, suggested she would buy a Countdown-style timer as I was over-checking a simple prescription.”
There are effective treatments for OCD, and Bamber encourages anyone worried about their symptoms to talk to a GP. “Explain the impact that your suspected OCD symptoms are having on your life. If you feel more comfortable talking to OCD Action first of all, please get in touch. Alternatively, you can take along our GP card to an appointment which may help aid your first conversation.”
Bamber emphasised that no-one should be ashamed to discuss their thoughts or behaviours with a GP. “Remember that obsessions within OCD — often referred to as intrusive thoughts — commonly revolve around taboo subjects, such as the fear of causing harm, or sexually abhorrent thoughts, but these are a result of the OCD and are not a reflection on you.
“In fact, they are usually the opposite of your morals and beliefs.”
The recommended treatments for OCD, Bamber said, are CBT with exposure and response prevention (ERP), and medication. “It is vital that ERP is used within the CBT, and when delivered well, this therapy — often used alongside medication — is really effective.”
Pharmacists can also approach Pharmacist Support for guidance. “We can refer an individual to a counsellor for advice, and can also talk to them about any issues they may have at work,” said Leicester-Hallam. “This could be in relation to, for example, workload, relationships, targets and staffing levels. Depending on the circumstances we can refer enquirers for employment advice.
“People sometimes want to talk about a job or career change and we can discuss possible provision of careers coaching. We can also offer them a Listening Friend with whom they can confidentially discuss their anxieties.”
Call advises anyone experiencing symptoms of OCD to seek help. “I struggled needlessly for 10 years of my life. Pharmacy is hard enough without having to deal with these thoughts all the time.”
Jane concurred. “Don’t wait to get help. I wish I’d known when I was 13 that it wouldn’t affect my registration. It doesn’t affect how I treat patients. It doesn’t impact on patient care.”
Call also emphasised the importance of talking about mental health. “I have talked to colleagues about having OCD. It helps reduce the stigma surrounding mental health. If only there had been someone who could have done that for me, when I first started experiencing symptoms at university.
“My colleagues have always been supportive and it has not hindered my career with my employers. I think you prove your ability in how well you do your job.”