Let's Count More Tablets

A lot of people think that all we do is count tablets. Well, that misconception is about to become even more real with the advent of even bulkier packaging.



Pharmac's way of saying thank you: Out with the old (RHS) and in with the new (LHS)


Your patient needs 360tabs? Psh, don't be lazy and count out only 140 from a full bottle of 500. Let's actually count 360! Lazy pharmacists.

Condom-Stealing Phantom Strikes Again

This is a sequel to the case of the walking condoms. $3 for 144 condoms is apparently not enough a deterrent to condoms being stolen.

Do you see the empty space next to the durex extra safe? Yep, that used to be occupied by durex pleasuremax. No sale history on that either so where did it go? Judging by the amount of Avigra scripts we do, I guess I shouldn't be surprised. At least they are practising safe sex right?!

Cee Lo Green spotted!

I see you pumping heaps of blood round the body I love and I am like Beta Block you.

Iridology! Because western medicine is too mainstream

A typical Iridology eye chart for the left eye

Not so long ago I saw news about pharmacies offering Iridology services. Whilst I can understand the need to diversify and make your pharmacy *unique* to the public eye (ha!), offering what is tantamount to a palm reading service is contentious at best.

The most recent case underscores the importance of seeking a second opinion (and no, not from a homeopath).

Top 3 things you need to know about the new Blood Glucose Meters starting 1st Sept 2012

Courtesy of  http://www.caresens.co.nz/page/caresens-meters.aspx 

Oh Pharmac how we love you changing the funding list like we change our undies.

This change, starting 1st of Sept 2012 however, is not at all minor. Based on the fax notification from Pharmac, there will be three new listings for the meters. Here are 3 things you need to know about this change.

(1) LCD back light for testing at night (CareSens N POP, see picture above)

(2) Manual and automatic coding. You know how when you use the Accu-Chek meter you have to insert a new chip into the meter every time you start a new box of test strips? (you should know!) Well, the CareSens II requires you to manually enter in the code every time you open a new box of strips whilst the other two better looking meters do that automatically.

(3) Patients who are already on Accu-Chek meters will continue to be able to receive strips fully funded until 1st March 2013 although it makes sense to start newly diagnosed patients on these new meters.

Wouldn't it be helpful if there was a side by side comparison of those meters? Well, click away!

Bear in mind though that the last meter in that chart (CareSens POP) didn't appear in Pharmac's fax notification as a new listing so I am not sure if that will be one of the options.

UPDATE: Pharmacists can switch people who are on old meters without a prescription. Every pharmacy should've received a prescription look-alike pad named "Pharmacist Claiming of Blood Glucose Diagnostic Test Meters". Process that as you would a prescription and Toniq has assured me that it will adjust it automatically so that no co-payment will come up.

Disclaimer: While every care has been taken to ensure this post is free from error, I do not warrant its accuracy as I am not an omnipotent and omniscient make-believe. Oh, and also Pharmac changes its mind faster than I can count to 90 tabs.

The Endless Phone Loop

How many operators does it take to put someone through to the right number? Two, apparently.

I had to call Novartis today as I discovered a colleague had left out, not one, but *two* Sandostatin LAR 20mg injections on the shelf, in room temperature, for what looks like a full 48 hours. The two fridge item injections have a total cost of about NZD $5600 excluding GST.

Not knowing its stability, I called (datasheet had nothing). Initially I followed the telephone prompt (press 1 for blah blah) and reached Medicine Information. I was straight away met by a voice mail (with an Australian accent) that kindly informed me that no one is at the desk so I should leave a message.

The patient is waiting at the counter so leaving a message is a no go. I called again to go to the operator.

"Hi, I need some urgent info about one of your pharmaceuticals and I have already tried Med Info without much success"

"sure, I'll put you through to someone in NZ so they can help"

ring ring

"Hi, is this fire or emergency?"

"err, I think I was put through to you by mistake."

"no fire or emergency?"

"no"

"good"  #click

Called back again and behold mother jesus I am talking to the same operator.

"Hi, I think you put me through to 111 or some sort of emergency line" (hey, Screw.You.)

"oh really? sorry, let me try again." (Am I going to get "fire or emergency" again? Lets hope not.)

"Hi there Carolyn speaking, how can I help?" (That's more like it)

"Hi I just need to know how long can Sandostatin LAR stay out of the fridge?"

"Umm is this a human product?" (say what?)

"yes"

"Sorry, you've actually come through to the animal division"

"That's great, please put me back to the operator"

"Hi there, Sauvignon Blanc speaking" A different operator. Not her real name but at this point I no longer care.

"Hi there, one of your colleagues put me through to the animal division for information regarding to a human product, can I please just speak to someone that can look up some info for me."

"Sorry about that, I am gonna take a short cut and put you through" (does that mean I get to talk to the big dog now?"

#and finally had a civilised discussion about pharmaceutical stability# For those of you who are interested, it is stable for 2 weeks out of the fridge at a temperature of less than 30ºC, at which point it has an expiry of 6 months

Moral of the story? Keep fridge items #gasp# in the fridge. Cause if you don't, a cute kitten is killed, by me, to eat, just to teach you a lesson.

3 things to take away from these amazing 3D Olympic visualisations

An Olympic Special today as it has nothing to do with drugs.

The New York Times has constructed the following eye-opening visualisations by comparing all 116 years of Olympic athletes in 100m Sprint, 100m Freestyle and Long Jump.

Just some of the facts to take home:

(1) The fastest 16yo sprinter in America today can win a Bronze in 1980.

(2) 100m Freestyle was held in open waters in 1896 and 1906.

(3) Long jump results is still relatively the same (unlike the other two sports that gained improvement over time) with Bob Beamon's 1968 record still holding strong even against today's athletes.

The New Zealand Formulary

If you are a health professional in NZ and are still using MIMS as your drug reference then you should probably be sodomised. Ok, a bit over the top but all jokes aside, NZ finally has its own version of BNF.

Not only does it have clinical information, it also provides PHARMAC and Medsafe info as well. For all the relevant links, see the New Zealand Formulary tab near the top of this page.

When you are using it on your computer (ie PDF version), don't be a chump and scroll through the pages when you are only trying to find information about one particular drug. Press Ctrl + F and type in the drug name and cycle through the relevant bits quickly. Unfortunately I don't think e-readers have that option.

LTC Assessment Tools - Education Evenings

For all the New Zealand Pharmacists that wants to know more about the LTC assessment tool and its application in a community pharmacy, you'll want to attend these education evenings. There's one in Lower Hutt tomorrow, make sure you don't miss out.

You'll find that I have added a tab above which provide links to extra LTC resources as well as PSA information. It pays to know the details of the PSA (dispensing ratios etc.) even if you are not a pharmacy owner (the new government paying method will indirectly influence an employee's pay/benefits. To think otherwise would be naive.)

Regardless of your views on the new Pharmacy Services Agreement, it pays to jump in the deep end and start swimming. The sooner you do, the sooner you can get across to the other side.

Indian Water laced with Quinine

Being not much of a drinker, I found this little gem particularly amusing whilst shopping in Big Carrot Town.

Want some fresh water from the Manawatu River? Not strong enough for you? How about some dysentery-causing indian tonic water (fresh from the Ganges) with a touch of Quinine.

At least you know you will be cramp-free whilst enjoying a bout of diarrhoea.

Top 5 Traits of a Beneficiary

Following on from the similar theme of identifying some typical patient characteristics, I will devote the whole post to people who are on "couch-sitting grants". No, I am not talking about people who just happened to be made redundant or the ones that came down with a debilitating illness in need of financial assistance. I am talking about the ones that seems to be getting the dole in perpetuity.

• They are always in a hurry. They come into the pharmacy sometimes up to 2 to 3 times a day, they got no job, yet they always need to be somewhere like the road runner. Solution? They just have to wait in line like everybody else.

• Sense of entitlement. "I am a human being, I deserve to be looked after by the government (whilst making no effort to look after myself), I deserve good (and free!) things and if I can't afford my cable tv then I will go on a current affair show and make a soundbite about how my eight children are not getting looked after"

• Asking to pay later. "Cool, I'll pick up 3 months worth of bread* and come back and pay the $3 tomorrow." What's that? You don't do that at the supermarkets? Alrighty then, I'll have your drugs on my shelf until you can pay for them. It's nostalgic to think that it wasn't so long a go that I would readily let them "pay later" because I know how important the medicines are... until I got sandbagged enough times for the reality to hit me like a moving train.

• They complain. Although not an exclusive trait, the complaints they come up with is baffling at the best of times. "Hi, can you please complain to PHARMAC that the Allopurinol tablets dissolve too fast in my mouth hence too bitter and even though it's quarter the size of a 10c coin, I am unable to toughen up as an adult and just take it so I can prevent the searing, unbearable pain in my toes."

• Finally but not least, dirty biohazardous prescriptions. Even though it might've just been written today, it looks like they have gone home, used it to clean their pet hippo's butt after performing a satanic blood sacrifice over it. Makes for a lovely mental image doesn't it?

A disclaimer before I finish: I do appreciate that a pool of unemployed labour is inevitable in any variations of capitalism. So no, this is not beneficiary bashing and me telling people to "just get a job"; this is a mere observation of what I have encountered (and still encountering) on a daily basis.

*Most medicines in NZ are fully funded at $3 charge per 3 months lot, hence the analogy here.

A Young Girl's Dream

A young girl "dreams of going to Tokyo to sample the food."

Nothing wrong with that right? Not really, considering the girl we are talking about is Britain's fattest teenager.

"How has it come to this?" was the question she asked herself when the local council built a special ramp just to rescue her out of her house in a 100,000 pound operation.

Hate to be the Captain Obvious here but nobody ever just *suddenly* got fat. Devouring crisps, chocolates and 2L of coke daily is not a 24 months cellphone contract, you have heaps of time to back out.

Oh, and she likes reading Fifty Shades of Grey.

This picture correctly summarises my feeling on this issue, without reservation

The Case of the Walking Condoms

Apparently businessmen are more horny than university students

I work in a CBD pharmacy and my clients are mainly suits and corporate people. Yesterday, I received an MPSO* from the medical centre next door for "variety of condoms." Feeling generous, I gave them a mixture of Durex Confidence and Durex Select (oh yes, NZ government fully funds flavoured condoms!).

It turns out, they just put them in the toilet and let patients help themselves. End result? Some wishful-thinking businessman took the whole 144 condoms before midday today. Seriously, I've seen free condoms last longer at student health when I was in varsity.

*Medical Practitioner Supply Order is essentially a prescription from a GP clinic that allows the pharmacy to provide the clinic with some basic essential drugs, flavoured condoms included.

Finishing your Antibiotics

Instead of *all* white pills, perhaps majority white + some blue pills is the way to go?

Most people are aware of the dangers of not finishing their course of antibiotics. These dangers, however, are not at all immediately felt nor does it pose any direct threat to the actual individual (in most cases). The lack of incentive is overwhelming and I know even I, did not finish my 5 day course of Amoxycillin (tsk tsk).

This issue popped into my head today as I inadvertently came across Rory Sutherland's video on human perspective. If you are on a quick lunch break and just want a gist of it then skip to 10:55 of the video although I highly recommend you to view the whole thing as it delivers a much more powerful message when viewed within context.

He basically proposed that instead of giving 24 white tablets, provide patients with 18 white tablets and 6 blue tablets instead. You then tell the patients to take the white tablets first and then the blue ones. His theory being that if there is a perceived "milestone" then people are more likely to reach the end.

I am quite fond of this suggestion, and had I been an authoritarian ruler, I'd make this happen tomorrow. Alas, we live in a democracy (some would argue quasi-democracy), where things grind along at the same pace as Lonesome George (the rare Galapagos tortoise). Perhaps, George's demise (which only just happened yesterday!) is a warning that we need to be approaching matters from a different perspective.

I am a Homeopath

The most amusing interactions in pharmacies are ironic ones:

Customer: Hi! Can I get some Phenergan 25mg tablets please

Me: Sure, it's a pharmacist-only medicine so I'll just need to ask you a few questions.

Customer: You don't need to do that, I am a homeopath*

Me: Oh that's excellent! Let me just go dilute that for you so it conforms with your pseudo-scientific hocus pocus.

Disclaimer: Not all of the above interaction took place, but that goes without saying.


*Homeopaths believe that by diluting a substance to the point of it being just water, it will enhance the substance's effect. For example, a standard 30C homeopathic dilution is tantamount to putting 1ml (around 12 drops) of active substance in a sphere of water that has a diameter of about 131.1 light years in length.

Soliloquy of a Pill Counter

You came in on a busy Friday afternoon to hand in a prescription for Cialis. The way you handed over the prescription to the nice shop girl is akin to you chucking ten cents to the local beggar on Courtenay Place.

The first words out of your mouth weren't "Hi, how are you?" or "Is it possible to fill this script?". It was "I expect to only pay $25* a tablet and that's what I am paying". And with that, you have established that you are very good at blowing smoke up your own behind.

You reminded me of the middle-aged white man that went into a Chinese restaurant (coincidentally also on Courtenay Place) to order a heavily marinated meat dish. Like those annoying people who order quarter strength soy milk decafe at your local barista, he proceeded with the belligerent "don't you dare add any MSG." When the clerk tried to tell him that the meat are all pre-marinated (hinting that he should perhaps order another dish), the subtlety flew pass him like a fat guy bypassing the fruit & vege section in the supermarket. So he said "did you get my order? Yes? Then why are you still talking?"

We took in your prescription, and finished it in ten minutes. Interestingly, you managed to substitute "Thank you, here's my money" with "What took so long?". It took every ounce of me not to say "I do apologise for our droopy performances, I am sure you can understand". But that double entendre would fly past you just like the fact that there were already two people waiting in the shop before you came in hence explaining the non-instant service that you were accustomed to.


After you left, the little boy in the shop asked his dad: "Why didn't the pharmacist say anything back to that asshole?"

Dad: "Because he can't, he's a professional"

Boy: "But he was so nice to him, why can't he just give that guy a taste of his own medicine?"

Dad: "Because he's the hero that the people deserves, but not the one they need right now. So he'll continue to be professional, because he can take it. Because he's not our hero. He's a silent guardian of our pills. A watchful protector. A Dark Knight."

*Equivalent of $20USD

I never had any problems with my blood pressure

This guys comes in asking whether the meds he's taking is compatible with what he wants to take over the counter. I kid you not, this is the following exchange:

Me: "### might interfere with your blood pressure but given the fact......"

Him: "I never had any problems with my blood pressure. I am on Metoprolol and Cilazapril and had a stent in but I never had any problems with my blood pressure."

Me:

Medication Noncompliance

Doctors quoting medicine prices to patients?

This is what I want to do to myself when
Doctors quote medicine prices to patients
(Courtesy of Erik Johansson)

This is a sincere plea. Please do not quote non-funded medicine prices from MIMS drug reference to patients. It will be like me telling the patients (who ask me how much the Dr visits cost) that they will only need to pay $10 for a 45min consultation. I will put on my captain obvious hat and construct the directional flow of a drug below:
                         
                     Markup + GST                           Markup + GST                           Markup + GST
Manufacturer        ==>        Wholesaler       ==>          Retailer            ==>           Patients
(Pfizer, GSK etc.)                                                         (ME!)

                             (1)                                 (2)                                    (3)

If you quote from MIMS, you are quoting (1), which as you can see is no where near (3). Surprisingly, I come off as the douche-bag to the patients because I am perceived as the big pharma trying to rip them off (which I find really hard to do seeing as the Dr's quote is less than my cost price!)

So please, give the pharmacy down the road a quick call, hell, I'll even give you my personal number if you email me here.

FML

No date for Valentines? Hate life? Generally pessimistic? Think 2012 will be the end of the world?

Use some FML eye drops!!

"I Want Something Chemical-Free"

If I had a dollar every time I hear the above, I'd be typing this post over breakfast in a Munich cafe.

A women came in today and tried to obtain a refund on a tube of cream by claiming that it caused these not visible bumps on her forehead. Did I mention the tube is empty? She looked up these horrible looking chemicals on the back and *gasp* there are preservatives inside!! Because of that, she is dead convinced its "that preservative" that's caused these reactions - despite the fact that she's been using it "for ages" and the reaction only started 10 days ago.

"But it's the only thing I am using, the only thing!!!!" (Translation: I'm not using anything else that *I think* is causing this reaction) I later found out she also uses Elizabeth Arden make up.

Did it matter that I was patient and explained that without the preservatives she'd probably be slapping on multi-dipped serving of unsanitary goo on her head? Or the fact I tried to explain just because it has a chemical name doesn't mean it's bad? It was like playing a harp before a cow

Yes, it's horrible how these companies are "getting away" with putting nasty-sounding chemicals in facial products but last I checked, you didn't mouth off to god in your prayers for including isoamyl acetate or 2-heptyl acetate in the banana.

Don't get too excited, that was in no way an admission of validity for creationism on my part.

The Chronicles of the Expired Exemption Card

January is almost over and to all NZ pill counters this only means one thing: explaining to the regulars why they have to start paying $3 per item*

The OFDs don't like change, they like their routines. Remember when Coronation Street's time slot on TV was changed because they wanted to slot in Master Chef? The grand total of 5 people were devastated (yet it made headlines in NZ, which just goes to show that really little happens here in the deep southern hemisphere, other than that one time when I was piloting this helicopter and made a mess). It doesn't help that those who qualifies for an exemption card are usually polypharmacy and reaches the twenty item threshold* within the first 3-6months. For the latter part of that year they then proceed to forget they ever paid the $3/item and accuse you for working for the big pharma corporations to rip off the common layman.

This is what I propose:

Child Resistant Cap

Preventing elderly Parkinson patients from getting their meds since 2011 NZ.

Pharmacist's Translation for the Common Folks - Part 2

This is a continuation from the first "Pharmacist's Translation for the Common Folks":

On the dispensing label the pharmacist types: "Insert ONE unwrapped pessary/suppository......"

Working in a retail pharmacy you sometimes do fear for the state of humanity. That's right folks, people do insert pessaries/suppositories with the plastic wrapping still intact. Another pharmacist told me they actually had a patient saying to him "Oh, you didn't tell me to unwrap the thing before inserting". Seriously guys, fast food restaurants don't tell you to unwrap your bloody burger before you eat so I think it's more than reasonable to assume that such a knowledge of unwrapping goes without saying. Every time I type the word "unwrap" it reminds me of the MacDonald Hot Coffee lawsuit and a little bit of me dies inside. Why do I still do it? Cause I am nice like that*.

How often do you use this? (said to an obvious anorexic buying a stimulant laxative)

With summer upon us**, the sale of laxatives unexpectedly unsurprisingly soars. Short of straight up refusing sale, I find it hard to probe the "abuse" issue other than just reinforcing that one should focus more on lifestyle choices before using laxative. I get one of these people at least once a day now.

The Pill Counter remains silent after a patient asks for a repeat, without saying their name (edit:on the phone).

It's a forgivable mistake often made by the patients but I do this mainly cause it's kinda funny (I try to keep myself entertained in a small pharmacy) and perhaps make an impression upon them that they are not the only people I serve.

When a patient asks to pick up three months worth of meds in one go, I ask "Are you travelling?"

I want to see if you have a legit reason to take it all stat. I know it might seem a hassle to pick up your prescriptions every month but seriously, if you only pay $3 for your Tambocor, I don't think you have any right to complain. Let us earn the 2 extra little dispensing fees instead of robbing us of them just because "you can't be bothered to come back in" even though you live one block away and pass the pharmacy everyday.


*No, I don't do it cause I am scared of getting sued. Health professionals in New Zealand are not liable to civil law suits due to the Accident Compensation Corporation scheme.

** Being in the southern hemisphere, it is summer now in New Zealand and yes we do have Christmas in summer with BBQs outside and surf and all that.

2012 - End of New Years Resolutions

I am sure I am not the only one that hold such notion, but having new years resolutions are about as useful as drug addicts adding zeros at the end of "mitte: 30" on a script for Diazepam (or Valium for those more familiar with brand names).

Be honest, how many of you have tried to makes these resolutions (be it related to business, personal or social) only to have it shoved in the bin like all those Viagra generic* fliers that you were inundated with last year.

If your goals were really important then why wait till the new years to start taking action? If they weren't that important for you to take action during the year then why put it in as a NYR?

Perhaps the resolution "Don't wait till the beginning of the year to take action" will suffice for the rest of our lives?

Just some food for thought.

*Pfizer's patent on Viagra expired last year in New Zealand.

24/7 Pharmacy

Took a picture of this while I was overseas a couple of months back. Perhaps this is the future of Auckland Pharmacies? So competitive to the point that perhaps one has to open 24/7?

Medication Wastage - The Cost of Irresponsibility

The other day this lady came in to dispose some of her husband's medication. It was about 4 boxes worth of Lipitor 10mg literally untouched like a baby's bottom. So I inquired as to the reason of the return. She revealed that her husband has been put on to another medication "or something".

Being the curious guy that I am, I pulled up the guy's file to see what he was swapped to, thinking maybe he got put on the fancy Crestor that the Astra rep (these reps almost always needing a set of pronounced curvaceous glory) have been raving about.

Behold, he was put on to Lipitor 20mg just a few days before.

Connecting the dots together (the returned lipitor had a dispensing label dated 3 months ago), one realises that he has not been taking *any* of the Lipitor for at least 3-4 months. The Dr, being none the wiser, understandably increased the dose due to unchanged/worsening cholesterol profile.

This whole exercise have just put $80 of the tax payer's money down the drain plus the $90 worth of 20mg that he most likely is not going to take. But does he give a shit? Not really seeing as he only pays $3 per script.

This is small money in the grand scheme of things but I hope he doesn't end up being one of those guys that gets on Campbell Live and complain that he has to wait for 6 months to get a CABG.