Because You Are Wasting My Time!

Patient is receiving funds from National Kidney Foundation (NKF) for his medication. The thing about NKF funding is the pharmacy cannot process more than a month's medicine under a single receipt at any one time. This means, if the patient wants to claim 3 months medicine, we have to process it 3 times, all for 1 month's duration of medicine, and charge them under 3 different receipts. Yah, I know this sounds really stupid, but unfortunately, NKF staff cannot do simple mathematics, so they cannot calculate how much the patient is claiming for each month when you lump all the charges under one receipt.

Anyway, I'm not ranting about NKF today. It's the patient's mother that I want to strangle. This is not the first time the patient was collecting his medicine using the NKF fund. Problem comes when he just dropped his Rx at the counter without even letting us photocopy his NKF card (this is another stupid thing, our finance department needs us to submit a copy of the NKF card every time the patient wants to make a claim, and the pharmacy processing program is not able to capture the card's details). Without the card, my tech processed the Rx under a single receipt. The patient only passed me the card when I called his number. Blood pressure started rising. Told the patient he is still underage and I needed his mother to be around before the medicine can be given to him. Also told him to drop his card off with the Rx THE NEXT TIME. My tech was pissed off because it meant she had to reprocess the whole Rx, and it was really busy today.

The poor boy was left to sit forlornly on the sofa for more than an hour while the mother went gallivanting somewhere. Before I started counseling her, I reminded her again that she has to drop off the NKF card with the Rx the next time. She then started to question the patient asking him if he did not show us the card yada yada. Was really pissed off by then. I do not have the time to wait for her to question her son seeing I still have other patients who had to give up their queue for her because she did not turn up when her son's number was called. So, I told her straight off in her face that her son did not show us the card when he dropped off the Rx, and we had to reprocess the Rx. The apology she gave was dripping with sarcasm, and to be frank I really wanted to tell her she was wasting everybody's time.

When I turn away to file the Rx, she actually had the gall to ask why I was angry. Since you are such an inconsiderate retard, let me explain. Because this is not the first time I am reminding you to drop the d*** NKF card with the Rx; the same thing happened the last time. By not doing as you are told, you not only waste the pharmacy staff's time, you also waste other patients' time because while reprocessing your Rx, we cannot process another patient's Rx. Other patients had to wait longer due to your stupidity!

Queue Number Revisited

This time I'll talk about the patients who DO take their queue numbers. Here is a list of things they do that make me roll my eyeballs until I get a migraine.

1. Stupid patient takes the queue number and walks off with both the prescription (Rx) and queue number. Turns up 15 mins later demanding why it takes so long to process the Rx when it is only one item. Duh, but of course. If you had been smart enough to leave your Rx for us to process in the first place you probably do not have to wait that long. This is not Minority Report where we install machines all over the place to scan the retina to retrieve all information about you from a super mainframe. Without any information as to who the heck you are, how am I suppose to know what medicine was prescribed for you?

2. Stupid patient takes the queue tickets*, leaves the Rx in the tray and walks off with both the queue tickets.

3. Stupid patient takes the queue tickets, staples both queue tickets to the Rx and leaves Rx in the tray.

4. Stupid patient takes one of the queue ticket, leaves the Rx in the tray, and leaves the other ticket hanging from the queue machine.

5. Stupid patient staples one queue ticket to the Rx and leaves the other hanging from the queue machine.

6. Stupid patient presses the queue machine once, staples both the queue tickets to the Rx and presses the queue machine again to take another number.

* Our queue machine issues 2 tickets, one for the patient and one for them to staple onto the Rx.

Common sense tells you when you see 2 tickets of the same number you need to start looking for instructions telling you what to do with them. Not pretend you cannot read the sign then take it out on us, nor pretend this is some bug with the machine.

Medisave Claim

To all Singaporeans out there who happens to be reading this, pls stop asking your "friendly" pharmacist this stupid question: why can't I claim my medicine under Medisave?

You cannot claim your medicine under Medisave because MOH says so. It is not up to me, nor the hospital to decide what medicine can or cannot be claimed under Medisave. We are not the policy makers. If you want a reason, try writing to the minister of health and ask for a reason. The worse that can happen is that your mail gets lost in the tons of mail the minister receives everyday; at the very least you do not get the "are you a retard" look from me.

If I were to be the policy maker, I could not care less what medicine you are going to purchase using your Medisave. As far as I am concern, if you wipe out your Medisave prematurely then that is YOUR problem. Making sure you have enough dough in your Medisave account to last till you draw your last breath is entirely your responsibility. Not the government's, not the hospital's, and most definitely not my responsibility.

If you haven't any money to pay for the medicine, then kindly go get some before you even come to the pharmacy. Hospitals need money for daily operations and we are not about to do charity work just because you come with some sob story on how you mismanaged your Medisave fund and now has naught from the Medisave or personal savings to pay for the medicine.

Welcome to the real world.

Queue Number

This is something that annoys me EVERY SINGLE DAY that I am working. Mine is a small outpatient satellite pharmacy serving only the pediatrics and the adult orthopedics. Without fail, everyday, 5-6 out of 10 patients who came to the 2 dispensing counters would stand in front of our queue ticket machines and ask, "Do I have to take a queue number?"

No, you don't have to take a queue number. Let's see... maybe the queue machines are there for show? Or they are there to hog scarce space on my dispensing counters? Or maybe they are there for your kids to play with because they are so amused by the "beep" sound the machines produce and the slips of paper that appear whenever the buttons are pressed? Or maybe they are there to prove what an i**** you are?

Oh, and by the way you can also ignore the sign that is next to the machine telling you to:
1. Press the green button for queue number. (The green button, not the red triangle!)
2. Tear off the queue tickets from the machine. (Tear off the tix, not rip my machine apart!)
3. Staple one of the queue tickets to the prescription.
4. Leave the prescription in the tray. (Just leave your d*** Rx in the tray & stop shoving it under my nose or placing all over my dispensing counter!)

For your information, the sign is attached to the tray so sign and tray are both just next to the queue tix machine. One tray, one sign for each machine. No excuse for not seeing the sign and tray. It's not as if I asked Dr Wayne Szalinski to shrink the signs and trays.

You Chicken Shit of an SAF Man

I don't usually like to use crude words such as those referring a fowl's faeces in my blog, but this patient really pissed me off and I just had to let off some steam else I'd become even more dysfunctional than I am now. So here goes the story.

It started with this chicken shit of an SAF (Singapore Armed Forces) man, henceforth referred as CSSAFM, who came to the pharmacy to collect medicine last year. He was holding an Identity Memo for Determination of Fitness (IMDF) letter which he passed to the pharmacist when he collected his medicine. No where in the IMDF letter was it stated that it does not cover medicine, therefore the medicine was dispensed to him without upfront payment.

However, when we submitted a copy of the letter to Mindef (Minstry of Defence of Singapore), the hospital was told, much later, that Mindef would only pay for the consultation, and all the tests done in the course of the consultation. Mindef is absolutely not going to cover the medicine. Okay, that is fine. We can always bill the patient. Things get nasty when CSSAFM received the bill, and he called up to complain and declare that he is not going to pay up for the medicine that he had already consumed and poo-ed out.

His claim was, he checked with the pharmacist if the medicine was covered under the IMDF letter, and was told the medicine is covered under the IMDF. Come on, the stupid letter does not state whether it covers or does not cover medicine, how is the hospital staff expected to know? In fact, when we called up and emailed Mindef to clarify the issue recently, we were told that ALL SAF men should know exactly what is covered and what is not covered under their IMDF letters. That means CSSAFM knew all along that medicine is not covered and he delibrately cashed in on the ignorance of the pharmacist who dispensed to him and then hoped he can get away without paying for the medicine.

When I called him up to inform him that he needs to pay for his medicine, he started blah blah-ing about how it is not fair to expect him to pay up for the medicine since he was told by the pharmacist that it can be claimed under the IMDF. Now, pray tell me, just exactly how fair it is that he quietly cashed in on our ignorance instead of being honest and coming clean with us that he knew that the medicine is not covered under the IMDF. Are we suppose to know the Mindef policies better than him?

See, Mindef's reply to us was if CSSAFM is not satisfied as to why medication is not covered, then he needs to contact the IMDF unit which issued the IMDF letter to him and clarify with them why medication is not covered. When I told him to contact his IMDF unit for clarification, his answer was, "You want me to make all the way down to IMDF and then go around asking why they do not cover the medicine!" Well, if you do not want to, there is always the contact number of the Mindef personnel whom we spoke to and she is most willing to "counsel" you on why you need to make your payment. But of course CSSAFM is too chicken to call. His answer to calling the personnel was, "Why should I be making any calls? You know what? I will think about it and maybe I will talk to the press about this."

Go ahead, and be my guest. Everybody knows you are a CSSAFM. If you ever dare to let the whole nation know that an SAF personnel owes the hospital money, and the reason why you got away with not paying the medicine in the first place was due to your lack of honesty, everyone of us in pharmacy will applaud you.

When I told my brother of this incident, he laughed and say CSSAFM is just too scared to contact his superiors to check why the medicine is not covered. Reason being, he'd be a dead piece of meat before any reasons would be given him. In fact, no reasons would probably be given; dead meat needs no reasons.

Know what? I think I will really make him a dead piece of chicken meat. I believe I have grounds to lodge a complain about him. After all, he did threaten me by saying he will talk to the press. Time to slit the chicken neck and drain the blood.

You Stupid Lousy C.H.E.A.T!!

An Indian lady came by during our peak hours to complain about the glucosamine capsules she obtained from us. In the first place, this was not my first encounter with her and I was seriously pissed off that she came bothering me at the busiest hour. She is the typical rude patient who thinks she is the world and all of us should be groveling at her feet.

First of all, from my previous encounter, I already knew she is a cheat. The previous time she had the same problem with the glucosamine capsules. She claimed that her glucosamine was contaminated with loose silica gel, and that the silica gel was all over the place. You should have listened to the way she hysterically described the silica gel.

"It is all over the place, on the table, on the chair, on the floor and there's a lot of the silica gel on me too!! What to do?! I have already consumed a few capsules. Are they contaminated too? Will anything happen to me?" The way she went about it, you'd think somebody actually sabotaged her glucosamine with anthrax spores rather than silica gel. Anyway, the last time I exchanged a new bottle of glucosamine for her. When I finally had the time to examine the "silica gel" which she had dutifully collected for me in a serviette, I realise it was actually glucosamine powder. How do I know? I opened up a glucosamine capsule, and I opened up the packet of silica gel that came with the "defective" bottle of glucosamine to compare.

So when she came back today, I was ready for her. I promptly opened up a capsule and showed it to her, pointing out that the powder looks the same so it is just glucosamine powder not silica gel. She tried to argue with me that the powder consistency is not the same yada yada. While she was ranting I cut open the packet of silica gel and poured out the silica gel for her to see. Stumped her for a while, then she said the powder I poured out from the capsule is not as yellow as the one she brought over. Of course it is whiter. Any idiot knows there is such a process called oxidation, and if it took her more than a month to bring the exposed glucosamine powder to us, naturally it would appear yellow compared to the one that I just poured out from the capsule!

She argued with me that the powder was not exposed to air and kept repeating the same stupid thing about how after she had spoken to us over the phone she immediately wrapped the powder in the serviette and stuffed the serviette back into the bottle. I really felt like slapping her on her stupid head and telling her to cover her nose with the serviette and see if she can continue breathing through the serviette. Not exposed to air indeed! Try a little harder next time.

Foreign Workers

My pharmacy serves the orthopedic clinics and we get quite a number of foreign workers, usually Bangladeshi, coming in for consultation after industrial accidents and the likes. What I cannot understand is how they had managed to come into Singapore not knowing how to speak proper English. Okay, to be fair not all Singaporeans speak English anyway, but you have to at least speak one of the 4 major languages in Singapore. Even if I do not understand a single work of Tamil or Berhasa Melayu, at least I know who to get help from. If you only speak Bangla then things get really tough.

It becomes a frustration just trying to get past the routine steps of checking for identification and then checking for drug allergies. I came to realise that less than 50% know what is an "appointment card", but more than 99% know what is a "work permit", so I gave up on asking them for their appointment cards for identification purpose. I'd rather wait a few more seconds for them to dig out their work permit then to mime and think of a synonym for "appointment card" in simpler English, if there is one to begin with.

Checking for drug allergies is like going through some torture routine, for both me and the patient. They do not understand the question, "Do you have any drug allergies?" Most will give me a puzzled look, and I will raise a phantom eyebrow meaning "great, it's time to practise those rusty paraphrasing skills I learned years back when I did general paper at A-levels". So I attempted again. "Any medicine you cannot take?" More puzzled looks; I guess it is just one too many words for them to process. By then, I would given up on those who gave me puzzled looks twice in a row. I would check the computer system in hope that the sometimes not reliable doctors have updated the patient drug allergies info. Then there will be those who attempt to tell me they have "a little allergy" or "allergy have" and then start scratching their skins. When you probe further to find out which drug they are allergic to, they give you the puzzled look again. *roll my eyes*

After getting past the identification and drug allergies checks, the next set of problem comes. For some reasons I do not understand, the orthopedic doctors like to give multiple painkillers for their patients regardless of their capability to understand when they need to use the medicine. Of course, it is my job to educate the patients on when to use which painkiller, but it is hard when the other party is not capable of processing the information due to language barrier. For ages I had problems telling them that paracetamol is only used for mild pain and the NSAIDs or tramadol are used in moderate or severe pain respectively. Well, that was until one of my techs introduced me to the phrase "many many pain". So paracetamol is for pain, and NSAIDs or tramadol are for "many many pain". I cringe whenever I hear myself say that, but the weirdest thing is the foreign workers actually do understand what I mean when I use that phrase. So much for my effort in trying to speak proper English.

What comes after that is something that really annoys me. 6 out of 10 times when I ask for payment, the foreign workers will tell me the company will pay. When you ask for the letter of guarantee (LOG)/ company letter (after paraphrasing) as proof, they will tell you there is no LOG. Then I start giving them the long lecture, which I know they do not understand half its content, on the need for the LOG else I cannot bill the company etc etc. It always end up with me telling them, with a super black face to emphasize the point, I am not giving them any more medicine the next time if they do not present the LOG. And don't even think about cheating. I will always leave a pop-up message in the dispensing program that states the day when I informed the patient to obtain the LOG from their company and not to supply any more medicine if the patient only comes with a song on his company's willingness to pay the medicine bill.

Senna

Senna or sennoside: laxative.

Wanted to strangle the parent when I was dispensing this medicine to her. This was what I told her, "Take one tablet daily when necessary to relieve constipation. If diarrhea occurs, stop." You would think this instruction is simple enough to follow for any adult who can understand the 3 languages that I speak: English, Chinese and Hokkien, but no. This was how the conversation went.

Me: Take one tablet daily when necessary to relieve constipation. If diarrhea occurs, stop. Total would be $1.50.

Parent paid up and left. Less than 2 mins later...

Parent: Sorry Miss, can I ask you something?

Me: Yes?

Parent: Let's say if my daughter has passed motion, do I still need to give it to her?

Me: No, the medicine is taken only when necessary.

Parent: No, what I mean is if she just passed motion, do I still need to give her the medicine?

Me: No, she only takes the medicine if she is constipated. If her bowel movements are smooth, there is no need for her to take the medicine.

Parent left the pharmacy, and came back in less than a minute's time.

Parent: So you are saying I do not need to give her the medicine if she can pass motion?

Me: (In irritated tone) Yes, she only needs to take WHEN NECESSARY.

Just exactly what is so hard to understand about "take when necessary"?!

Time to Work Those Fingers

Yah, I know I have not been updating anything on this blog and even considered it defunct, but with a new year, I guess it is time to start working those fingers. One year older now with less angst, but I am sure I can still continue to amaze people with the stupidity of the patients and people I've met.