Squiggles on paper – hey a prescription!

If I have made a mistake, I don’t mind apologising. I own up to it and would take responsibility towards it.

This script came in, on a generic pad with no doctor’s name and no practice address. There was a registration number, signature and date of prescribing. I think this is not the first time I’ve seen this type of script and I have a strong feeling it was from the same patient as well – he gave me an explanation, “We are friends.”

Look, before anyone launches fire on me, let me explain. I don’t judge you for writing prescriptions for your friends. What I do (legally) require is that you do your part and provide ALL details necessary for a piece of paper to be a legal prescription. You can squiggle bits and pieces on the back of a name card (that’s what I’ve gotten before) but as long as ALL the details we need are there, it is possible for me to dispense off it. When the VITAL information is not on a prescription and we do NOT deal with you that often (or at all!), PLEASE do not pass the blame on me.

I suppose the way DrFren responded to my query didn’t rub me the right way. His first sentence was, “The prescription is from me and it’s genuine, so WHY DIDN’T YOU give it to him?”

The Rx was for Buproprion + BD (yes, not dot slash dot but +) x 3/12 and Codeine linctus 100mL.
It didn’t help that the writing on the Rx was liKe tHis. I kid you not.

DrFren proceeded to tell me that he was trying to get his friend to stop smoking and BECAUSE I refused to dispense of the incomplete Rx, his friend is not going to stop smoking. Uh huh. He has left the country for good apparently. Yup – day before he flies out, he comes in to get a Rx for an item that is non-stat.

I’m quite sure you spent some time in med school being taught how to write a prescription and what needs to be on it. It doesn’t matter that previously you’ve had no problem with your said prescription pads when you did your house visits – maybe the staff at the pharmacy where they got dispensed worked with you before and could recognise your signature but we don’t. Since it was handwritten (the medical centre you work at generates electronic scripts), I couldn’t even ask the nurse to check on the patient’s record/history (best thing? The friend has never been to the medical centre before so they had NO information at all)
We don’t deal with your medical centre and when we rang, the receptionist said you were OFF DUTY! We tried contacting your mobile but it went to voice mail and no one answered the phone at home. ALL measures were done to ensure we COULD dispense it. Even the receptionist didn’t think it sounded right. Of course your friend offered to call you but we were taught to contact the place of practice to obtain numbers.

At the end of it, you said with an irritated tone, “I guess I will stamp all my prescriptions now.”
WHY did you not think of/do it in the first place? It’s a REQUIREMENT. You don’t even have to write it down, just a stamp! How hard can that be? It’s just not right that I’m the blame for your friend not stopping smoking because I “refuse” to give him the medication. C’mon, pick up the slack. If you choose to write from a private pad, at least write it properly.

It’s not enough that we get nonsense from patients, we get them from doctors (okay, maybe just this one in my job so far!), too – and for what? For getting our jobs done.
Ugh!

Miss Community

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Should have stayed home

Now, the boss is away for 10 days and my preceptor is also going away for a long break to visit his family in Canada. Thus came the roster nightmare for Keather and I thought I’d help out by volunteering to go to work when it’s my day off.

What a nightmare! I should’ve stayed home. It would’ve been quite nice since the sun was out.

First thing that greeted me was a “complaint” from a patient about her blister pack – apparently she received the pack with several doses punctured out and she was very unhappy about how it looked like (honestly, it did look like crap but NO WAY on earth the pack would’ve gone out that way). I looked at it and remembered that the pack was left out last week, so we delivered it on Monday instead (with Friday, Saturday and Sunday’s dose cut off) – I personally charged it and Jules bagged it. It went out pristine!

You know what the q-tech (qualified tech – that’s another story for another day on how she demanded for a pay rise because she was the only qualified tech) said to me?

“Oh, I thought maybe it was the newish-tech or new-tech who did that instead of cutting the days off.”

WHO DOES THAT?! Even if they are new as in just-started-work-today-new, I am confident NO SANE PERSON would have sent the pack out looking that way. Did she really think that the other two are idiots? The driver (we took the time to ring him to find out if he left the pack in the mailbox or handed the pack over in person) confirmed that he left it in the hands of a lady on Monday (patient claims that she only got the pack yesterday and it arrived in that sad state). I have a feeling it has been tampered with but not by any of us – maybe the kids got into it (the driver said there were two children with her when he delivered the pack) because who would want to dig into a pack for metformin and gliclazide tablets? The note from q-tech wasn’t very clear but I assumed she wanted to find out who did it and for that person to call the patient to explain/apologise. Jules said ignore it and don’t bother ringing. I suspect patient is a little delusional – may need a little more than just anti-hyperglycaemic medication.

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Pharmacists know all the pills in this world.

As the title says it all, I was asked to identify a pill during my on-call last weekend. When the phone rang at 11:44pm, I was jolted awake and answered in my best professional voice. It was an ED consultant “I have got a patient who came in with an overdose on what she claimed to be sleeping pills. Should I get the nurse to bring the capsules to you for identification?” And I went “Ermm, I am sorry but I am not based in the pharmacy after hours. We have to do this over the phone.” To which there was a pause of dissatisfaction and a reluctant description was given in the line of “It’s a red/brown capsule”. No numbers or letters or words on it. Now, if anyone can identify that I salute them. But at least I can tell the doctor that I do not think any sleeping pills in this country is in capsule form (I was quite positive at that time….if anyone wants to contradict me, please do not as it is too late now). And I am very sorry that I can’t help her. She grunted and put down the phone. Excuse me!!
This is not the first time of me being asked to identify a pill in the middle of the night during my on-call. The last time was to identfiy an orange, round tablet. Again, no numbers, letters or words on it. My first immediate thought was Vitamin C. But somehow I do not think the ICU Registrar will appreciate that. So, again, I have to tell her no, I do not know what it was. But at least we laughed about the impossibility of the task.
Anyway, I felt bad as if I have let the ED consultant down. I proceeded to open up my formulary and start going through the sleeping pills and antidepressants to see if I could find something. Lo and behold, I did manage to find a TCA that bears the description red/brown capsule!! Rang the consultant to tell her of my find and suggested she asked the patient if she takes any anitidepressant. But of course I emphasised that it’s just a guess. Well, this time the call ended abit friendlier.
Now, I welcome any suggestion on good references for pills identification. But I guess the difficulty is different country will have different generic medications.
1 more day of being on-call, I can’t wait for it to end.

Miss Hospital

There’s always a first time

I think I was phone-sex-ed today. It’s really annoying that it is so painfully obvious now but not so when I was on the phone earlier. I suppose you could say I was too polite and idiotically “naive” to think that it was a genuine phone call asking about Viagra.

Even when I think of the conversation now (which REALLY annoys me as my idiocy is glaringly obvious at this point of time!), my skin crawls! UGH!

The phone call came when I was in the midst of trying to complete our daily stock order and it was right smack before my home time. It started innocently enough (although looking back, he sounded like he was whispering or was very breathless – I took it as a sign of pain/discomfort at that time somehow) when he asked if he could speak to a pharmacist. When I replied in the positive that I was one, he proceeded to ask, “Is it okay for me to talk to you about the medicine Viagra?”

Being in our profession, you wouldn’t think too much about such questions because hey! It’s about a drug. It’s what we do – provide advice about patients’ medications.

Let me emphasize again on how STUPID I feel now because even as I try to recall the conversation, I don’t know why I hung on for THAT long – so don’t judge me when you read the rest of my story. I know that I should have been more aware of the conversation’s direction but I was honestly confused/torn between wanting to provide good sound advice (this also through listening to the patient’s problem) and slamming the phone down (I should have trusted my instincts to do that!).

He continued with another question, “I wanted to know, how long does this medicine work?”

It should be effective for about 4 hours – is that what you wanted to know?

So out came the whole jumble. As in the WHOLE JUMBLE.
From time of taking a 50mg tablet (1 hour 45 minutes ago) to “it came up after a few minutes of taking it” to unnecessary information about how he and his partner indulged in foreplay to how his penis did not turn flaccid until 10 minutes after ejaculation.

Yes.
I don’t know what came over me but I just thought he was being painstakingly thorough in explaining his problem.

Then my instincts kicked in when he started going on about how “it is now up again although my partner did not stimulate me and I’m not aroused” to how his partner said she wasn’t satisfied so he had to go down on her (WHAT ON EARTH? DO I NEED TO KNOW????) and too much explicit information about how it was done. Then more information about how she was on top and did I think that having another ejaculation would help his “pennies” come down.

When this was happening, I was trying to cut in to ask, “Sir, so what exactly is your question or your problem now? It’s advised that if you have an erection for 4 hours or more, you must go get help. Call your doctor or go to the hospital – perhaps the dose is too strong for you but you have to talk to your doctor.”

Then there was the “my family physician (yes, not doctor but physician) is also a lady…are you from India?”

WHAT?!!!
I’m not being racist but he had an accent and he did indeed ask that question.

He also told me that he thought masturbation (he apparently thought I didn’t know what masturbation was because he started explaining that he uses his hand to touch his “pennies” up and down…WHY WAS I SO TOLERANT?) was a better way to relieve his erection. The funny thing was, he also threw in a, “I hope I’m not making you uncomfortable, I’m not doing phone sex with you but just wanted to ask what to do.”

I think my “too polite” came across as “ooo, tell me more, I am enjoying myself and I think I will participate, too” that’s why he kept going on with all the explicit details (and that in turn probably turn him on or something) – I really hate myself for not thinking faster or asking him to piss off. Honestly. I’m ashamed that I let a bloody pervert drag myself through this whole ordeal.
If he really had a partner with him, piss off to her – why bother calling a pharmacy? I should’ve passed the call to David but hey, I’m a pharmacist. I didn’t know it would turn out this way – I know better now but I’m still peeved!

In the end I said, “Sir, this conversation is going no where and I can’t help you. You should go get some help from your doctor or go to the hospital.”

There was a disgusting, breathless, “Uhhh thank you so much for talking to me.”

Can you say EWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWW???

Miss Community