Pharmacy Guild of Australia & Medscheck Caps

A lot of colleagues and friends in the industry ain't very happy with the recent changes the government and The Pharmacy Guild of Australia has put through, again without consultation with their pharmacy members.

Read their article here:

http://www.pharmacynews.com.au/news/latest-news/guild-to-assume-responsibility-for-hmr-payments-as

Each year, pharmacy owners pay heaps of $$$ to The Guild who is the representative body for community pharmacies. But each year, they continue to disappoint. I don't see why we need to continue paying them if their stupid proposals do not benefit us.

The changes Feb 2014:

MedsCheck and Diabetes Medscheck has been capped at 10 per pharmacy per month. So that means for small pharmacy with one pharmacist a script volume of less than 100 per day VS a large pharmacy with 7 pharmacists per day with a script volume of 600 ---- do they really think 10 MedsCheck per month is reasonable? You develop this service to help the greater good of the community, but after one year, you take it away from us and impose a stupid cap so you can keep some of the money? So if we think a patient would benefit from a Medscheck, guess we'll have to say no sorry and turn them away coz we have reached our quota this month.


The Guild is sly. Pretending to represent us, but then taking over Medscheck and imposing a cap. Seems to be could be some secret dealing under the table.

Why do pharmacists have to suffer when it comes to cost-cutting Medicare expenses?


Why don't they focus on doctors who prescribe inappropriately and charge inappropriately from Medicare? Let me tell you how Medicare can save some money easily just by auditing doctors:

• Abbocillin VK 150mg/5ml syrup, Ventolin Syrup, Celestone Cream, Aristocort Cream, Adrenaline injection all come in packs of 2 under PBS. Most doctors prescribe maximum PBS quantity even though the patient only needs to use it for a few days. Technically, one bottle is more than enough, but doctors are too lazy to change the quantity. What happens to the second unused bottle of syrup or box of cream? Goes into the bin unused when it expires after sitting in the cupboard at home for a long time. 
• Doctors charging Medicare even though they just print off a repeat script for their regular customers. I know doctors who refuse to write repeats just so the customer can go back and see them again for a new script so another Medicare swipe is required. I know the doctor does nothing because no doctor requests a blood test every month when the patient is only taking cholesterol tablets and the dose has been the same for the past year. 
• Micro consultations that only take 5min as patient's condition is not bad. Eg. sore throat, patient comes out with script for Nurofen. Seriously, that's another $60 of Medicare wasted. 
• Doctors prescribing items on PBS when the patient doesn't meet the criteria. Eg. Normacol Plus is for disabled quadriplegics but I see normal grown people being prescribed that. or Klacid Syrup prescribed for children as part of a triple therapy with Amoxil and Losec when its only indicated for Pertussis.   
• Doctors writing PBS scripts for their regular patients who intend to send it overseas to their sick relative. (illegal btw) 

Medicare of Australia - my advice to you is audit those doctors in our country if Medicare requires cost-cutting. Do not focus everything on pharmacies and makes constant changes such as price disclosure, price dropping, clinical interventions value reduction, Medscheck caps, audit us ..... coz these will drive us out of business, unemployment rates with increase. Trust me, doctors require auditing as there has been a lot of illegal activity going on. and I'm surprised nothing has been done about it. Pretty unfair if you ask me. Why are we always targeted? Changes in the past few years have affected pharmacies.

Confused woman who doesn't know what one plus one is

I dispensed Voltaren EC 50mg tablets for a customer today. I explained to her its an anti-inflammatory for pain and inflammation; counselled her on how to use it:

Me: You need to take one tablet twice a day so one in the morning and one at night.

She looks at me blankly and frowns with a very confused look on her face.

Her: But the doctor told me I need to take two tablets a day?!?!?!?!?!?

Me looks at her very confused and I say: Errr yeh that's correct. One morning and one at night IS two tablets a day?

Her: Oh.....


Either slow or dumb... actually maybe both.

Doctor encourages patient to forge CTG (Closing The Gap) script

This dodgy customer of ours keep on coming into the pharmacy with a script from that particular doctor and it always says CTG on it. Lately, its been written as 'GST' and 'CGT'. I call the doctor to confirm and he says its correct. So then I dispense it.

Today the script looked unusual. The doctor's signature was in black and the words 'CGT' was written in blue. Weird because I just dispensed a CTG script from that doctor for another patient and it was CORRECTLY WRITTEN. So I call the doctor to confirm.

The receptionist picks up and says she'll check with the doctor. Comes back and tells me the doctor says its ok. I hang up the phone and the patient saw me calling the doctor so he tells me HE was the one that wrote CGT on it.

Me: Why did you do that?
Him: The doctor forgot to write it and he told me before I can write it in.
Me: No you can't. Only the doctor can write on the script. If he forgot, you have to go back to him and get him to write it in himself. I can't dispense this script.
Him: Ok ok i'll come back.

Now while his gone to the the doctor's, I was not happy I was lied to by the receptionist. So I called back the surgery and I told her off.

Me: Ok I found out what happened. The patient just told me he wrote it in himself because the doctor forgot to.
Receptionist: Oh ....
Me: So obviously the doctor did not write the code on it, why did you confirm that the doctor did?
R: Oh I thought the doctor wrote CTG so that was what was confirmed.
Me: I called you to confirm the script for a reason. If the doctor didn't write it, you should not confirm that. Now for a person other than the doctor to AMEND a prescription is a criminal offence and illegal. I have told the patient not to do that again. I am sending him back to get the doctor to fix it up properly. Please remind him not to do that again. The doctor is the only person to write it.
R: Ok ok ok  thanks for letting me know......

Patient comes back with the script, initiated by the doctor and stamped. I'm pissed.
Patient apologises.

Patient: Doctor sometimes forgets to write it in so he said i can write it in.
Me: No that's not true. Who told you that?
Patient: The receptionist - who's the doctor's wife.
Me: So what. She's not the doctor. You know what you just did was illegal. You could get in trouble, I can get in trouble and the doctor can get in trouble. If the doctor forgets to write it in, you remind him.
Patient: Yeh sometimes his busy or in a hurry.....
Me: No that's no an excuse. If he has time to see you and write a prescription, he should have time to write the code. You can't do this. If you do this again, I'm going to have to report you.
Patient: Ok I won't do it again.
Me: We do not do illegal things here and that receptionist knows nothing, she's wrong and don't listen to her. Let's do in the right way ok.

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I can't believe they encourage the patient to write it in himself!!!! Closing The Gap is such a flawed system though. All you have to do is write CTG on it and it'll be covered. Medicare wasting our taxpayers money on dodgy people like this. I have a feeling maybe the receptionist is in it with the patient - maybe the patient isn't eligible for CTG but they just write it in. Blah.... seriously if it happens again, and I catch them out. No more chances, will report them to Medicare Fraud. Sick of dodgies!

Patient only cares about time, doesn't care about the pharmacist helping her

This regular customer of ours keeps on whinging about the wait of her scripts every-time. Today I got so annoyed at her - I was THIS close to cancelling her script.

Complained about the wait while everyone in front of her was patiently waiting. Basically I think, if you are in such a rush then maybe you shouldn't come at this time so go to a more quieter pharmacy. We are not Maccas or any fast food chain and we do not guarantee you get your medicines in 2min. It was busy today and lunch-time, short-staffed and there her doctor wrote her the wrong strength of her medicine which means we had to call the dr to confirm.....


My colleague's on the phone with the doctor and she's like whinging and whinging then tells my assistant - as a sign of protest - that she doesn't want to wait anymore coz she's waited too long already.

My colleague just got off the phone with the doctor and clarifies the problem when my assistant tells her that the customer wants to cancel the script. Colleague says it will be ready now coz she spoke to the doctor. Assistant is about to tell the customer it will be ready soon but I jumped in....

Me: No, if the customer wants to cancel the script, I'll cancel the script. I don't care if we fixed the problem, since she doesn't want it, I'm happy to cancel the script even though its done now.

Assistant looks at me awkwardly and asked the patient, the patient wants it now since its done.


Well I'm annoyed and sick of her tantrums. She doesn't seem to appreciate what we do here, we called the doctor to fix your problem, and then you turn your back on us and complain that we're making you wait too long. Stuff you. You wasted my time, and if I had it my way, I would push for cancelling the script despite it being ready because you're just asking for trouble.

The patient did talk to me since I was the one in-charge and I asked her: "Did you want me to cancel it? Its ready now but if you want me to cancel it, I'll cancel it for you."

She: Well if its ready, I take it.

Me: No if you don't want it, I will cancel it for you. You want it or not?

She: Yes I'll take it. I don't know, all this problem...

Me: Well it was a problem with the doctor and we fixed it for you.

She just shut up. and then later told my assistant to apologise to me.

You know what I said to assistant: An apology? Yeh I accept her apology. Good to see she's finally admitting she's wrong coz that apology ain't coming from me.

Do not guess when I ask you an important question

As pharmacists, there's a protocol to go through when you are giving advice to someone. 

Who is it for?

What are the symptoms?

How long have they had it for? 

Are they taking any other medications?

Do they have any other medical conditions? 

Now today a man walks into the pharmacy and he wanted something to increase his dad's appetite. 

Do they have any other medical conditions? No, but he had a stroke 8 months ago. 

Are they taking any other medications? Just Asasantin.

I questioned him if there are any medications and he kept on saying no more. I pointed out that if he had a stroke 8 months ago, he should be on more medications not just Asasantin. 

He was firm with his answer: "He doesn't have a heart problem, no diabetes, no cholesterol." but I still suspicious there should be more. Missing therapy - so wanted to do an HMMR right there. 

Then he gets his mother who's sitting on the chair and she pulls out a BUNCH of new scripts from the doctor for her husband. 

And what do I find amongst those prescriptions? Asasantin was one of them. As well as Minax 50mg and Lyrica 25mg..... 

I questioned the man: Ok well I can see from these scripts, he has a pain problem and a heart problem and a stomach problem. But when I asked you before, you said there was nothing else. What are these then?

Man: I don't know about these. I am not aware of it. 

*Dude! How can I provide the correct advice if you don't provide enough information. And when I question it, he didn't attempt to find out. You don't know doesn't mean its no. 

Me: Ok. I'm going to assume that these are the only medicines his on and provide you with a product suitable based on that. I won't know what other medications his on if you don't tell me ok? That's why I ask you. If you don't provide me the full information, then I might not be able to provide you with the appropriate medicine.

Man: Yeh i didn't know ......

Me: Next time, you ask the person who knows best - namely maybe your mother or get a list from the doctor of the most updated medicines his on. Do not guess. This time was ok, but if he was on other important medicines and you didn't tell me, and I give you another medicine - it can be dangerous.

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Sorry but I just had to tell him off because he was being ignorant after I asked him so many times. These people need to learn!  

 

Special sunscreen for special skin

This Indian man walks up the counter and asked me if the SunSense sunscreen is 'transparent'.

Me: Well the sunscreen is white. When you put on a thin layer and rub into the skin thoroughly then yes it will be transparent.
Him: Ok thank you.

He comes back 5min later and complains. Now you'd think its just sunscreen - what is there to complain about?

He shows me his hairy arm. There's white residue all over. It was the sunscreen he applied.

Him: You said this was transparent. But when I put it on, its white!
Me: That's because you haven't rubbed it in properly. And look at your hands, they're so greasy. You must have put too much on.
Him: No i didn't. Its white. You gave me the wrong advice.
Me: Excuse me? Ok let me try.

So I squeeze some sunscreen and applied it to my arm like normal and guess what - it was transparent. I showed him my arm.

Him: Well I don't know. It doesn't work for me.

Me: Maybe because your skin is dark? Let me get my colleague who has dark skin to try.

So I get my male colleague who's got really dark skin and applied it on. Transparent.

Me: Well as you can see, all of us have applied the same sunscreen on and its all transparent. There is nothing wrong with this sunscreen. You just applied too much and not spreading it out.

Him: No you are wrong. I came here thinking the pharmacist can give me professional advice, but obviously this is not what I want.

Me: Are you saying I lied or gave you wrong advice? Because clearly, it is transparent when everyone else puts it on.
Him: Well I don't want a product that's transparent on other people. I want a product that's transparent on ME.
Me: Well sorry but there's no such thing as a custom made sunscreen for each individual. All these sunscreens are basic and standard. There is no special one for different colored skins. I gave you advice based on what the 99.9% people would get but I think you've put too much on and you are just refusing to accept that.
Him: This is ridiculous.
Me: Its not ridiculous. Can you explain to me why its transparent on me and my colleagues arm then? We applied it in front of you. My colleague is dark skin and his a male, why would it be different?
Him: I don't know why.
Me: You don't know why. Can I just ask you a question? Is this the first time you've used sunscreen before. Because you seem a bit adamant about it.
Him: Yes its my first time.
Me: Errr ok so its your first time. Well I guess you came in with a very high expectation of sunscreens. I'm telling you, sunscreen is something very simple and basic. But you make it sound so complex. There is no sunscreen tailor-made for anyone. You have to understand that.
Him: I came in with an expectation that I would be given professional advice but I guess I was wrong. You've give me the wrong advice.
Me: Fair enough. If that's what you think, fine. Well there's nothing I can do for you then. All I'm going to say is - I'm sorry there is no special sunscreen for your special skin. You will have to try all those different sunscreens on the shelf then, since I can't fulfill your requests just by looking at it, you'll have to try it in order to know.

And I ended it at that.

WTH. Its just sunscreen!!! He clearly put layers and layers on to the point where his whole hand is greasy and wet. How dare he come in and say I gave him wrong advice! What did he expect man? Special custom made sunscreen for his special skin? Come on!

Rude Duromine lady wants me to call doctor before everyone else

This regular customer of ours probably had an episode of PMS or something coz she gave me a bit of attitude when she came in today.

She had a repeat for Duromine 15mg. She said she wanted 30mg. People need to realise you can't just 'swap' different strengths around just coz you have a repeat of the same medicine. She tells me to look in her record and she's taken both the 30mg and 15mg before. For the Duromine 30mg, she should have 2 more repeats left. She says she's lost it. 

I tell her if she's lost her prescription, she will have to see the doctor, let him know she's lost the repeat so he can write her a new one. She urges me to call the doctor for her coz she 'can't be bothered' or 'have no time' to see the doctor. 

Lazy sh*t. Anyway, because she's a regular customer, I said I'll call the doctor for her and see if he can fax a script over. Now mind you, I was in the middle of doing a prescription, and there were 2 other prescriptions waiting to be filled before hers. So i put her order in line. 

She walks to the other counter and stands there watching me. I'm in the middle of dispensing someone else's script. 

She stands there for a few minutes then she says: "Umm excuse me, have you called the doctor yet?"

Me: "No not yet. There are 3 people ahead of you in the line, I will call the doctor when I get to your prescription." 

She rolls her eyes and sighs and snaps: "Wellllll I'm going to go the bank now, by the time I come back, you should have better have called by then."

Now that was extremely rude. So I snapped back: "Well that depends on if I get to your script by the time you come back. Like I said, I'll call when I get to your script."

Then she asks for my boss. I said my boss wasn't here. Then she asked for my name..... and I proudly showed my name tag and said this is my name. I am certainly NOT afraid of giving my name. 

I later call the doctor while she's gone and the doctor says: "my surgery's just across the road, just tell her to come over and see me." Good. That's all I need. Confirmation from the doctor that he is refusing to fax over a script and rather see the patient in person. HOW it should be done. Can't wait to tell her the bad news hahahaha... wanna see her reaction when she comes back.

She comes back and speaks to my assistant: "Has she called the doctor yet? Coz if she hasn't, I find that quite rude."

Excuse meeeeeee... I find you quite rude in fact. 

Me walks over: "I've called the doctor. His won't fax over the script, instead he wants to see you in person first." 

She looked disappointed: " Can't you just give it to me?"

Me: "No coz the doctor said no. I've tried to help you but the doctor wants to see you first. Ok. that's his answer."

She: "Fine." and walks away.....

Teeehhheeeee... I felt so good telling her that. Suckers! Lazy people - stop making excuses. You have time to walk to the bank which is next to the doctor's surgery, I don't know why you don't have time to see the doctor. If you need it so desperately then surely it's worth the wait.