Alphamox NON-PBS

A man comes in the pharmacy to fill a repeat for Alphamox 500mg capsules. 

Him: "These are for my wife. Her health care card is on the system."

The repeat is for Alphamox 500mg 8 repeats. It says non-pbs on the repeat. I checked our system, they got the Alphamox non-pbs at $8. 

Me: "Yeh this prescription is not covered on health care card, so it'll be $8 which is the same price you paid last week."

He has this shocked look on his face like I'm ripping him off or something. 

Him: "WHY NOT? She's on health care card. Its always been covered!"

Me: "Yeh because the doctor wrote a big quantity. the government Medicare has a limit on how much is covered. If its more than the limit, then they don't cover it."

Him: "That doesn't make sense. If the doctor writes a big quantity, then you must give the big quantity." 

Me: "Yes I know. If the doctor writes a big quantity, there are steps he needs to go through to get that approved in order to be covered. Your doctor hasn't, he just wrote it like that so its not covered."

Him: "Whatever. Just hurry up and give me the tablets. Forget it. Forget about this bullsh*t you are saying. I don't care."

Me: "You seemed a bit confused so I was only trying to explain to you its not covered. Whether or not you want it, its really not my problem. All I'm telling you is, its not covered."

Him: "No im not confused. I can go to the doctor and get a script right now and it'll be covered. "

Me: "Yep that's exactly right. But only for one box. Not 10 boxes. You'll have to keep on coming to see the doctor." 

Him: "So they can swipe the medicare more. I can't put up with this bullsh*t you are telling me. Its the most stupidiest thing I heard."

Me: "Unfortunately that's the way it is. 

Him: "Well I can't accept your explanation. It doesn't make sense."

Me: "I don't make the rules, Medicare does. Well if you can't accept the truth, then I can't help you then." 

WTH, I don't make the rules! Take it or leave. You paid the same price last week you can in, I wonder if he complained then. 

$8 private VS $5.90 concession .... that's $2.10 extra.... that's just spare change for you. Stop complaining! 

Out-of-date medicines

Read this article published by the Pharmacy Council. 

The article talks about dispensing medicines that had a short-expiry date. The pharmacist had dispensed a medicine that was in-date but the patient comes back a few months later and complained that the medication had expired when they came to take it. 

I've actually encountered such a problem before and the patient wasn't really happy with my response. I think other parties such as the doctor, and the PBS-Medicare system should also take some responsibility of this. 

Let me give you an example. 

Moduretic. Maximum PBS quantity that the doctor can prescribe is 100 tablets. Now if the patient was only taking half a tablet once a day, that supply will last them 200 days aka 7 months. Bit silly for the doctor to prescribe 100 tablets don't you think? So they expect the patient to take those tablets for 7 months, no review or follow-up?

Megafol. PBS quantity 200 tablets. Patient takes 1 daily. Again, one supply will last them 7 months. 

Ventolin Syrup. 2x150ml = 300ml PBS quantity. Doctor prescribed it for a child who takes  0.5ml three times daily. Again, this is a 7 month supply. Do you think a newborn child needs to take Ventolin for 7 months? 

What are the consequences for these practice?

- wasting taxpayers money on prescribing excessive quantity

- doctors not thinking how many tablets or boxes the patient actually needs, instead just prints it out from the computer system without changing the quantity

- don't expect the pharmacy to throw out their stock 3 months in advance. 

Overall, I think the system is silly. And doctors should be the ones thinking of how much they SHOULD prescribe. Don't shift the blame and responsibility and financial repercussions to pharmacists and call them not diligent enough. 

Customer who ever has a prescription

There's this regular customers of ours that always come into the pharmacy never having a script. She takes all these medications, she never has a script, and she ends up asking us to give her an owing. Every time you see her walk in, I never expect her to have a script.

Why?

Because her doctor never writes repeats for her even though they are regular medications and coz she's unorganised!

And the customer is too spoilt by us so she never has to worry about seeing the doctor coz she knows we will give her owings.

But its frustrating coz we have to put through twice, once for the owing and second to clear the owing.

So I had a talk with her yesterday. The customer I mean. I asked her why she doesn't ask the doctor to write repeats, she keeps on coming without a script.

She: "Yes I know. She doesn't write me repeats I don't know why. Every time I go get a script, she doesn't see me anyway. She doesn't check my blood pressure. I need to go to the hospital to check my blood pressure every week."

Me: Yes but you've been on the same medications for a while now. It would be much convenient for you to get a repeat so you don't have to keep on going back and forth.

She: Yes but I don't want to trouble the doctor, she gets angry when I get upset over getting scripts so I try to not cause any trouble.

Me: Its not trouble at all. Its her job and responsibility to make it convenient for you. You shouldn't be too easy on her. You need to complain so she will write repeats for you. You have to come to the pharmacy twice to get your medications when you could've come once. Especially if she doesn't even see you each time you get a script, I don't see the point of her not writing you a repeat. 

She: Yes I know. The other doctor is nicer, he writes me repeats.

Me: Well see him more next time. Seems like this doctor isn't doing her job properly.

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Seriously. The patient is on Lipitor 40mg long term. Why would you write NIL REPEATS? Medicare Australia - you really need to do an audit on these doctors. Medicare card swipes with NIL consultation. You are (actually we taxpayers) are paying $60 for a dodgy doctor to simply print out a prescription without consultation. How do you feel now?

Stubborn Elderly don't listen to pharmacist

An elderly customer of ours took a box of Nurofen and asked for my advice "Is it ok if I take this?".

Now this question, I've already answered it for him 2 weeks ago. He has back pain. Regular medications: Clexane 100mg injections. He's also taking blood pressure and heart medications. He looks late 80s so probably have impaired renal function.

Last week I told him Nurofen would not be suitable for him as it can increase his blood pressure, and increase risk of bleeding as he is already taking a blood thinner. And not good for his kidneys either. He didn't take it last time but decides to come back into the pharmacy because he still has a sore back and paracetamol doesn't work.

Me: "Have you seen a doctor yet?"
Him: "No, but I think Nurofen will help me. My sister takes it sometimes and its helped her."
Me: "Yeh but Nurofen is not suitable for you. I told you last week. You can't take it."
Him: "Well what can you do? If I go, I go."
Me: "But why don't see a doctor first, there's other tablets that may help you?"
Him: "Nah nothing works. I'm going to take this. Do you think this will be alright?"
Me: "No. Its not alright. I've already told you. It's not good for you."
Him: "Oh I'll just take a little bit, won't do any harm. Panadol doesn't work, so I'm going to try Nurofen."
Me: "Up to you. But I still don't recommend it."
Him: "Ok. How much is this?"

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Arghhh, stubborn customers like this makes me so angry!!!! Why ask for my advice if you don't listen to me??? They like to self diagnose and self prescribe. They will end up in hospital and you just wonder why?!??!?! Complications like this can be avoided in the first place. I don't like their thinking: "If I go, I go." No this is suicide mission because you have been warned and you know there are risks, yet you don't listen and you still go ahead with it. then you end up in hospital and then your family's gonna cry and you're gonna be in more suffering....... all because you didn't listen to your pharmacist!