Patient with overactive sex-drive

Talk about inappropriateness.

Today a middle aged man comes into the pharmacy to request Stud 100 - desensitization spray. He then proceeds me to ask for my advice. You see, he has a problem with an overactive sex-drive. As in he gets an erection easily. He tells me that a simple touch of the penis or even someone walking past him, can make him go 'hard'.

Trying to remain professional, I tell him to see his doctor as there are some hormone tablets he can use to control libido.

He asked me what they are called, and I just told him go see your family doctor, he will discuss with you the options.

Him: "Yeh well its a pretty specialised area so they might not know."
Me: "Well a male doctor would certainly be able to help you with your problem - it depends on if its hormonal or psychological. The doctor will have to find out what the cause may be.  I'm really not the best person to speak to."
Him: "Hmm yeh your right."  and leaves


Seriously, I wonder if he did get an erection whilst talking to me?!?!?!? Not sure, I didn't look. Its kind of rude to look you know.

Why do so many call their toes, fingers?

A lot of people call their toes their fingers.

This lady came into the pharmacy the other day and confused me. She said her fingers are itchy. I asked her if they are red and between the fingers. She looks down at her feet and says 'yeh a bit red.'

Then I ask her: "So is it on your feet or you hands?"

Her: "Its on my feet."

Me: "Oh so you mean its itchy in between your toes?"

Her: "No not toes. Fingers."

Me: "Feet or hand?"

Her: "Feet" points to her feet. 

Me: "Yeh those are called toes."

LOL. I've seen this more than once. Quite a number of people don't know they're called toes. They think they're fingers. 

Doctor won't write repeats for Crestor

I dispensed a Crestor script for a regular customer today. His been on the same dose for over a year. But the doctor doesn't seem to write repeats for him. I asked the patient today.

Me: His your Crestor Mr XX. The doctor hasn't written any repeats for you.
Him: Yeh I know. I don't know why she doesn't write repeats for me, I have to go every month to see her.
Me: I was going to say. You can get up to 5 repeats. I've noticed you've been on the same dose for a long time so your cholesterol would have been stabilised on this dose. I don't see why you can't repeats.
Him: Yeh so annoying. I asked her and she said she can't write repeats for me.
Me: I don't see why not. Other doctors do it for their patients. Do you get a blood test every month?
Him: No! I only get a blood test every 6 months.

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You see, this is when I suspect fraud by doctors occur far so frequently in our community that no one questions them. They do it for blood pressure, fine I guess the justification would be to 'check their blood pressure' at least once per month. But for cholesterol?!?!?! You know the only way to check cholesterol levels is to get a blood test. So unless the doctor actually does a blood test EVERY MONTH for this patient, I don't see any justification as to why a patient needs to see the doctor every month, coz there is no monitoring that can be done in a consultation. Blood test every month is pretty silly if all you have if cholesterol and blood pressure. Patient was not on warfarin either so I dunno. Doctor probably wants to swipe an extra Medicare so they get paid $60 just to merely press the print button on the computer.

Medicare Australia is not doing enough audits to track these kind of doctors down. So many dodgy doctors out there who does dodgy things, wasting our taxpayers money. Too lenient Australia!!!! Your generosity will ruin this health care system. Too many loopholes!

Time to dispense prescriptions and medicines

Busy day. Had to dispense 6 medicines for a customer. She stood there and saw one after one customer get their medications before her, and she started to get frustrated....

She: WHY SO LONG!!!?!?!?! Everyone's getting their medicine before me.

And then her buzzer starts beeping, coz I just finished dispensing her medications. I look at her and ignore her antics and proceeded to act normal.

She looks at me to find other reasons to complain: "Where are all my medicines!!??!"

I calmly said: "They're right here. I just need you to sign these papers."

Calm down and stop whinging. People need to realise when they get their prescriptions dispensed at a pharmacy, 6 medicines does not take the same amount of time to be dispensed as 1 medicine. They also need to realise there is not just one pharmacist working, there are several pharmacists and we go by a queue system. So if you are the unlucky one and you get a slow pharmacist, their your script will take longer. But there are some pharmacists who can touch type and do it within 5 seconds, and you'll get your script within seconds. Depends on luck I guess.

Clomid can only be prescribed by a specialist

Ok this has been happening way too often recently that I'm starting to doubt if the doctors actually know the state pharmaceutical laws when it comes in prescribing.

I've been seeing about 5 prescriptions of Roaccutane and Clomid being prescribed by general practitioners recently.

Patients won't know this but Roaccutane and Clomid are specialised medicines that can ONLY be prescribed by specialists. Roaccutane by a DERMATOLOGIST and Clomid by a Gynaecologist or a doctor from a infertility clinic.

I've been seeing these scripts come in written by our local GPs.

Please brush up on the laws by referring to the Department of NSW Health Poisons Schedule!!!! The laws have been around for over 10 years, I find it amused why doctors are clueless about this.

Let me tell you a story about a patient yesterday.

This lady who is not a regular customer comes in with a script for Clomid written by her normal GP. So I checked AHPRA to double check his qualifications before calling him. So I call the doctor and informed him of the schedules and that he needs to refer this patient to the specialist. The doctor was clueless!!

Dr: Oh really? I didn't know that. Is that a new law?
Me: Errr no it's been around for a very long time. There's a list of medicines that's restricted to being prescribed by specialist and that list can be found through the Department of NSW Health Poisons Schedule.
Dr: Oh ok. No I didn't know. Ok just let the patient know that she needs to contact her specialist for the prescription then.
Me: Sure. I'll let her know.

So after hanging up with the dr, I let the patient know the problem with her prescription.

Me: Sorry I just got off the phone with your dr. There is a problem with your prescription, it can only be prescribed by a specialist so your family dr is not authorised to prescribed this.
She: Excuse me? So I can't get it?
Me: No you can't because your dr is not authorised to prescribed it. I've already called him and told him the problem. He wants you to see your specialist to get the prescription from him instead.
She: Look you listen to me. I need to start this today because my period is today. So I must get this medicine today.
Me: I understand but this script is not valid. Your family gp wants you to see the specialist.
She: I can't! My specialist is on holidays!
Me: Well then you'll have to go back to your family doctor to get a referral to see a different specialist if its an emergency.
She: I don't have time to do that!! I don't understand you, I got this before from other chemists, so I don't know why I'm having a problem here.
Me: As I've said already, your doctor is not a specialist, he is not authorised to prescribe this medicine. There are restrictions and laws that doctors need to abide by. I have already called the doctor and those are your options he has given you.
She: So I can't get this? What am I gonna do now? I need to start today.
Me: I've already told you 2 options: a) Go get the script from the specialist......
She: She's on holidays.
Me: Ok well then option b) is to go back to your family gp, get a new referral to see another specialist. That's the next option.
She: I got no time!
Me: I can't help you then. I already spoke to the doctor about this problem and those are your two options.

HUFF IN A PUFF she got so angry that I wouldn't give it to her, she snatched the script out of my hand and chucked a fit and walked out.

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The public needs to realise that a doctor, a person with a medical degree, does not override any law in the country. Doctors still has to been requirements and have restrictions in their profession. They also have a Board they have answer to. I really don't like it when people always use the doctor as their excuse: "the doctor said this, the doctor said that, the doctor said it'll be this price so why are you overcharging me, the doctor said all pharmacists are a gp why are you not, the doctor said I can get this without a prescription but you are saying its a prescription only medicine, the doctr said this and that...."

Geez, gimme a break. The lady's excuse "I got no time." which she said for several times, I was thinking in my head: "Well, if you got no time, you would MAKE time to go see the doctor if its an emergency."

Since you are not willing to see the doctor, I guess its not an emergency then. If you want to make babies, so desperately, be a bit more prepared and try again next month.

And doctors, a tip: please read the prescribing laws associated with this profession, because you are making it very inconvenient for both the patient and the pharmacist who's taking the blame for your mistakes.

Your responsibility is not just to diagnose and prescribe, you need to learn about ethics and legal requirements as well.

Guild President steps down. Problems with the Pharmaceutical Industry in Australia

http://www.contactmagazine.com.au/news/latest-news/guild-president-to-step-down

Kos Sclavos, Pharmacy Guild of Australia national president resigns

My thoughts: good. The Pharmacy Guild hasn't done much to help the industry and all of us pharmacists. The industry is at its lowest point EVER and all the Guild does is negotiate useless things with the Government and it doesn't really benefit the industry.

Problems with the pharmaceutical industry at the moment:

a) Too many graduates and pharmacy schools: UTS Pharmacy in 
Sydney just opened this year. Don't know why the government even approved to that when there's already a few Masters of Pharmacy courses and Bachelor of Pharmacy courses available.

b) Too many graduates means less available jobs: I've seen interns still looking for an internship position 6 months post-graduation because there are no open internship positions available. How can those ppl undertake clinical and become registered pharmacists if they don't have an internship?

c) Newly registered pharmacists can't find full time jobs: I've also seen newly registered pharmacists being let go by their internship employer because they can't afford to take on another pharmacist.

d) Pharmacists being paid minimal wages: Pharmacists from a certain discount chemist gets paid a mere $20 per hour because they just can't a job anywhere. Even a Cityrail ticket attendant gets paid more than that! Here you go, attend uni for 4 years, attend 1 year clinical placement, and all you get in the end is some pity wage that's less than a retail shop assistant.

e) Closures of pharmacies: pharmacies going bankrupt coz they can't compete with prices of the big discount pharmacies and because Medicare's price reductions mean pharmacy owners earn less than they used to.

f) New pharmacy services that don't seem to last very long: Pharmacists were undertaking courses to become accredited and do HMRs but that seems to be going very well because its time consuming and Medicare doesn't seem to want to pay us any more due to some fraudulent claims made by a minority of pharmacists. Clinical interventions used to be a few dollars, now we're only getting 10 cents per CI because the pool of money has been exhausted. MedsCheck has just started and getting paid $60-$90 per check which is good, but lets see how long that will last before they stop paying us the incentives.

g) Supermarkets still eyeing on the pharmaceutical industry: They were stopped from opening pharmacies within supermarkets but they never stopped. In the next few years, the government will probably give in, why - so they can get more money that way. Like Americans, pharmacies will be within supermarkets and you can buy antibiotics from Woolies

h) Government puts Pharmacists onto the shortage skills workers list: that means due to stats, they say there is a shortage of pharmacists in Australia, so they open the doors for pharmacists overseas to come to Australia on a work visa and work here. Seriously, a shortage? Local students are having trouble finding a job, why are you inviting overseas pharmacists to work in an already saturated market. So stupid. Someone didn't do market research or something.

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Time to change industries and careers kiddos.

Lady in tears because we gave her a generic brand

A lady who is not a regular, comes into the pharmacy with a half used box of Alphamox 500mg capsules. She asked us why we gave her the generic brand when she didn't ask for it. She wants to swap it over to the Amoxil brand because she's been taking for 2-3 days and still not better. She says when she usually takes Amoxil, one tablet would usually fix her up. But with this Alphamox brand, 2-3 days still can't sleep.

I know I know its only $2, I could've swapped it over to minimise any trouble, but its the principle you know? She comes in saying that we were being unprofessional and gave her a generic brand. Well, I question that because she had so many chances to ask us and request for the original brand. She saw the box when it was first dispensed, she saw the box when she paid for it at the counter, she saw the box 7 other times that she opened the blister pack to the take the tablet. If she was really concerned about us giving a generic brand, why didn't she bring it up at the time of purchase and why didn't she bring it up before she took the first tablet? Why bring it up AFTER you've taken 7 capsules from the box?

I know why. Its not because we didn't ask her. This is what I think. We did inform her that we had given her the generic brand instead of the original. She accepted it at the time of purchase. Got home, took her capsules for a few days, didn't get better, so decided to come back to the pharmacy and complain that we did a dodgy and didn't ask her.

I explained to her that its the same thing, and we've informed her about the brand change. The reason why its not working may be due to:
- antibiotic being a bit weak to infection.
- bacterial resistance
- she hasn't finished the whole course yet.
- another course might be required
- placebo effect


She wouldn't listen and started to tear up that she's really sick and that we are a dodgy pharmacy who lie to people...... blahhhhhh

Give me a break. And then after that, the manager has a talk with us pharmacists about customer service and to always swap the brands over whenever customers are not happy with the generics. Ok, I guess I didn't handle it that great this time, I mean its only worth $2 - I didn't have to make the whole situation so hostile. But will too much leniency cause even more trouble? So for every patient who comes back with a used box of generics, they can swap it over for the original. What happens if they have half a box left? Do I give them just half a box? Then we'll have so many non-full boxes. I don't know how this can be cost effective. Of course, if its a regular customer, with a big account with us, I know I would change it over. But for a random customer who buys antibiotics once or twice a year from us, seriously? do we have to give THAT kind of service to THOSE people as well? That's the question. Depends on the reason. So ppl come up with unreasonable excuses - do we need to accept them as well?

Good luck. Hope no patient comes in with 5 tablets left from a Kalma bottle and want Xanax instead. Not sure if that still applies. That's gonna create so many problems with our stock. Gives people too much flexibility and exchange/refund power with medicines. they should think carefully first before buying. If you accepted the generic brand at the time of purchase then you shouldn't be coming back for a refund. There is not such thing as a 'faulty' medicine just because it hasn't worked for you. Moreover, it could be due to the doctor under-prescribing you a medicine that is too weak for your problem.

Inderal lady who does not remember our conversation

An old lady comes into the pharmacy and asks me if I have Inderal 40mg. I said yes and she gave me the prescription to get it dispensed. She's about to pay and then realises its $9.25 (concessional price) and comes back to the dispensary and asked me why she's charged that price coz she's a pensioner. 

Me: "This brand is more expensive. On pension card, you have to pay this price."

She: "But I always get it for $5.90."

Me: "You have always paid $9 for this brand before. $5.90 is another brand."

She: "Ok can you change it for me? I want the other one for $5.90."

Sure so I have to find her script and amend the script on the system to Deralin 40mg. I give it to her and then she freaks out: "Why you give me this brand? I don't use this. I want the Inderal!" 

Does she have dementia?!??!?! No idea.

Me: "Ummm I did give you Inderal remember? You didn't like the price so you wanted the $5.90 brand and you told me to change it for you.?!?!?!?!

She: "Nah I always take the Inderal brand. I don't want this."

Me: "The Inderal is $9 - you said you didn't like the price."

She: "I don't mind the price. But I don't want this brand. Just cancel it for me please."

Me: "Ok do you want me to change it back to the Inderal brand then?"

She: "No don't worry. I got some at home so I can get it later. Just cancel it for me."

**FACE PALM**

Why did you come into the pharmacy in the first place to get the prescription filled if you have plenty at home?

Why did you tell me to change from Inderal to Deralin if you know you only want Inderal?

Why did you complain about the price when you're happy to pay the $9?

Why did you waste my time to a) first do the script and b) amend the script and c) to cancel the script? 

Why did the doctor not diagnose you with dementia yet? 

Grrrrrrr 

Nurse complains about me being rude

A lady brings in a script for Voltaren Rapid 50mg and Bactroban Ointment. Now before I dispense it, I let the lady know the price because its not covered on Medicare/PBS. I show her the boxes coz she wanted to have a look at it first. 

She looks at the Voltaren Rapid box and says: "I'll be very angry if I have this at home and I buy another one." 

I'm thinking in my head.... "geez ANGRY is a very strong word to use" but oh well... i didn't think much about it. She's still looking at it. 

Me: "So did you just want to get the ointment today?"

She: "Yeh I don't know because I know i'll be very angry if I find that I have this at home and I buy another one...."

The word ANGRY again..... okies lady....

Me: "I'll just process the ointment for you today then. You can always come back to get the tablets."

She: "Yeh I'll just get the ointment then."

So I start dispensing the ointment prescription, and then she goes: "Nah I'll have the tablets as well."

Me: "Ok - just be aware that there is no exchange or refund with medicines."

She scrunches up her face. 

She: "I want to ask you, what do you use for pain?"

Me: "Voltaren is for pain. Bactroban is for infected skin."

She: "No that's for the my feet. The swelling of my feet. I'm asking you for pain."

Me: "Yeh Voltaren is the one that you use for swelling as well as pain. It can be used for both as its an anti-inflammatory."

She shakes her head. WTH

Anyway, I continue with dispensing. She's all quiet and then all of a sudden she asks me: "Are you the pharmacist?"

Me: "Yes I am."

Then I look at her and wait for her to elaborate on her question. She stares straight without saying anything. WTH what's the point of that? Such a random question. So I turn to my colleague and give her a "WTH is wrong with her" look because of her random question and because she didn't elaborate. 

She probably saw me give my colleague that look so as my colleague was serving another customer, she goes to my colleague: "Why is she laughing at me?" ... my colleague gives her a 'i don't know what you're talking about" look. 

Later the lady confronts me. "You know I'm a nurse."

Me: "Ok.....that's good" (and in my head.... yeh so and your point is? I find it very surprising you don't know what Voltaren is????!!!)

She: "I'm a nurse and you're the pharmacist. But you didn't answer my question. And I find you being very rude."

Me: "Umm I think there's a misunderstanding. I've answered all your questions that you've asked me. I don't understand why you are saying that."

She: "No you didn't."

Me: "I've answered all your questions. I'm sure my colleague here and this other customer next to you have heard our conversations and that I've answered your questions."

She: "Don't drag other people into this! Its not nice!"

Me: "I'm not dragging other people in. I'm just letting you know that it may be just a misunderstanding or you misheard because there are witnesses here who would have heard everything.

She: "You should calm down you know."

Me: "I am calm. I'm just explaining to you that what you think she heard is not what you heard."

She: "No you should calm down."

Me: "Ok no I think you should be the person to calm down."

She: "Calm down."

Me: "Ok fine maybe both of us should calm down."

She: "See so you agree."

Me: "I agree that you should also calm down."

By this time I've finished dispensing her medicines. 

She: "I hope you have a nice day."

Me: "I certainly will. I hope you do too. Here's your medicines and you can pay at the front. Thank you and good bye." 

I give her the meds and walk away before she can say anything. She's about to say something but stopped and sighed a bit then walked to the counter. 

Ok so after that me and my colleagues were talking about it ...... WTH just happened. After she paid, she asks to speak to the boss to complain about me. My boss was in the dispensary at the same time that we were 'arguing' so I don't understand why she didn't complain to him when she saw him then.... People only turn back to complain when they're angry and I think I got her pretty pissed off and angry so she had to turn back to complain LOL....

She speaks to my boss and then my boss asked me what happened, told him the story, his like "no idea what she's pissed off about, arghhh forget about it." Yeh can someone tell me what happened? I don't know what she's pissed off about. About the Voltaren bit or about the Pharmacist bit? LOL 

Nurse...... who doesn't know what Voltaren is. Great.  

Obsessive lady requesting contraceptives

Today a lady came in requesting a packet of the Morning After Pill. Upon questioning I find out 2 things:

a) she took the MAP just last week.
b) she already has Implanon in her and is taking oral combined oral contraceptives on a daily basis to regulate her period.

Which came to the question of, she's already taking more than enough contraception, she doesn't need to take the Morning After Pill.

Turns out she had a "dream" last night and that she was pregnant. She's paranoid and even though Implanon and oral COCs are not 100% effective, she thinks if she takes the Morning After Pill, it will add up to 100%.

Err no, because the MAP is not 100% effective.

I told her she doesn't need it. She's got all basis covered with the Implanon and oral COCs. Explained to her the side effects of taking those tablets long term. So I refused the sale.

Then she says: "So you punish me because I told you the truth?" all upset.

Me: "No I'm not punishing you. I'm helping you and giving you the safest advice. You seem worried and in doubt about these other contraception your using. Have you spoken to your doctor about the option of getting your tubes tied? That's a more permanent solution...."

She: "No i want to have kids maybe 4 years down the track...."

Me: "Yeh well you can't keep on taking these MAP. You'll have long term side effects and puts you at risk of getting cancer etc so if you are concerned, you should speak to your doctor...."

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She left not happy I didn't give her the MAP. She sounds like she has OCD and paranoid and hallucinations. As they always say, the most effective contraception that is 100% is ... abstinence. =)