Defunct

Yes, this blog is officially defuncted. I'd not been working front line for 3 years, so there are no more stories to tell. But I thank the people who came and left comments especially fellow pharmacists around the world, and apologies to those who were following my blog.

The posts here are probably hard for non-healthcare people to relate to, and some may find my words abrasive. I can only say, you are not in my shoes. You are not the one who was working in a non-conducive environment of having to deal with more than a 100 prescriptions a day on top of dealing with nonsense behaviour from patients and colleagues, and still making sure no medication errors reach the patients. And I probably forget to mention, the hospital slaps a >90% prescriptions processed and dispensed within 30mins performance indicator on us. The amount of focus required on the job is tremendous. Try doing this for more than 40hrs every week, and sometimes with no weekends off, and you might understand why I need to have this avenue to vent my work frustrations. If you don't understand, nevermind. Nuff said.

Parents... the Dumb Ones

When you work in a paediatric setting long enough you sometimes wonder if Adolf Huxley's Brave New World (sans Soma and orgy) isn't such a bad one to begin with. We allow the bright ones to be sexually productive, and brain-wash the stupid ones into sexually unproductive individuals. Oops... I made an elitist remark, but I am not apologetic about it.

The following conversation happened a few days back when I dispensed a prescription. See if you don't agree with me some parents are really stupid to the extend you wonder if it is such a good thing to let them raise the next generation.

Me: Medicine for XYZ?

Mom: Yes.

Me: Is the address at Blk XXX etc etc?

Mom: No, that's not the correct address?

Me: Was it your old address? This is a common problem, people moved house and they assumed everybody knows they have moved

Mom: No, we've never lived there before.

Me: ?? But your child's name is XYZ?

Mom: Yes.

Me: Then why is the address wrong?

Mom: Er... (at this point the Dad came).

Dad: Oh that's not my child's name. I saw the doctor key under the wrong name just now.

Me: Huh?! Then what's your child's name? And why didn't you tell the doctor on the spot that it is the wrong name?

Dad: (passes me his child's appointment card) Oh I thought it was the doctor's name. in case you think this is an acceptable reason, the wrong patient name clearly belongs to a female (if you disagree, show me a male named Claire), and the doctor is male.

Attitude Problem?

Okay, I'm officially back to slamming the stupid patients.

I really got to give a hand to the dumb asses of humanity, they really think once they're out of school nobody's going to think they're dumb, or they can get away for being dumb.

Story goes that a stupid husband came to the pharmacy to pick up some medicine for the pregnant wife. I picked up the basket and started dispensing the medicine to the dumb husband. The doctor prescribed lactulose syrup, bisacodyl suppositories, Proctosedyl suppositories, and Flagystatin pessaries. For the sake of the general masses who are not familiar with these medicines, lactulose and bisacodyl are laxatives, Proctosedyl is for piles, and Flagystatin has got an antibiotic and an anti-fungal used for treating vaginal infection.

Lactulose was easy enough, but my torture started when I began counseling the suppositories. The stupid excuse of a human being, kept saying the bisacodyl suppository was for oral taking when I repeated and corrected him multiple times that the suppository is for insertion into the rectum. I even wrote the instructions for him in Chinese together with the phrase "not for oral taking" on the drug label.

When I got to Proctosedyl suppositories, I think his brain has no more memory space left. Wrote out for him in Chinese what the medicine is for and how to use it, and he still asked if it was for oral taking. And he even asked if Proctosedyl and the bisacodyl suppositories are the same. I nearly fainted, but I definitely lost all patience with him. How difficult is it to comprehend that bisacodyl is for constipation and Proctosedyl is for piles?! Even if he cannot remember which is which, surely any normal human being can tell they are not the same!

When he started saying I've got attitude problem, I really felt like telling him I'll give him real attitude problem. Just pretend I didn't hear anything he said and let him tell his wife the pessaries and suppositories are to be taken orally. If I have a attitude problem I would not have bothered correcting his mistakes. After all I've done my job translating (verbally and in writing), counseling, and explaining how to take/ use the medicine.

H1N1

H1N1, previously known as swine flu, is all the rave now. It's become an international problem and here on the little red dot, things are beginning to spice up with the total counts of people infected rising to 315.

With all this talk of cluster spreading, schools are extending the current school holidays by another week. I thought this is the proper thing to do. However, a significant number of parents apparently seem to think otherwise. Their main concern is their children are missing school and will end up lagging behind in school work. A totally brainless way of thinking. If the school closes, all the students start their lessons one week late. How then, can their children lag behind in school work? Besides, the decision to extend the school holidays by another week is made with the intention of protecting the students' and teachers' health. I wonder if our society's perverse obsession with results and accolades has reached another new height; now a child's education is paramount to his/her health and safety. Are we still treating our children as children, or are we treating them as pets to be groomed then shown-off at some pedigree show?

Anyways, under social pressure (I believe), some schools have decided to start online lessons such that students do not "lag behind" in their studies.
In this whole charade of starting online lessons, we have conveniently forgotten there are families out there who are too poor to even afford new school books, much less computers with internet connections. Now, this is really going to cause some students to lag behind in their studies, and so much for a "democratic society, based on justice and equality"**.

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**The phrase "democratic society, based on justice and equality" is taken from Singapore's national pledge.

CPE Points

After a long haitus I have decided to stop complaining about patients for a bit. Not that I've seen the light, but the current hospital I'm working in does not have a load high enough to make me angsty. Yes I've moved again. Lol!!

Anyways, there is something that I am compelled to bring to light. In case you're wondering, CPE means "continuing professional education". The doctors have it, the nurses have it, and the pharmacy profession (in Singapore) has just joined the bandwagon a couple of years back. Basically, we are expected to accumulate a certain number of points to qualify for renewal of our practising license.

In all frankness, I do not doubt the good intentions of "forcing" us (pharmacists) to get CPE points. Sometimes we need a little push to keep updated with current drug knowledge, else it is in human nature to slack off. However, I have come to realise good intentions are sometimes just not good enough.

Singapore, like all other developed countries, needs more pharmacists to run the pharmaceutical side of the healthcare system. With regards to this, our health minister Mr Khaw Boon Wan already said the ministry will look into hiring more foreign pharmacists to fill the positions. In the last couple of years, retired pharmacists are even encouraged to return to the workforce to help ease the shortage.

Somehow, asking the retirees to return to the workforce does not seem to be such a good idea. There are 3-4 ex-retired pharmacists in the current hospital that I'm in and most of them are just not competent, knowledge-wise. Common reason being they have never practised as a dispensing/ clinical pharmacist prior to this. Heck, there was one who is incompetent even though he worked in my current hospital before retirement.

Perhaps I should elaborate on how incompetent they can get at times. Let's name them TL and TS. TL never practised as a pharmacist prior to this. Always believed he will hate the job, sounds kinda like me, so he joined the drug companies straight out from university. When he continuously "latched" himself to me during dispensing sessions, I found out he was totally incompetent in knowledge. He had (I hope it's past tense now) no idea that aspirin, mefenemic acid, naproxen all belong to the class of painkillers affectionately known as NSAIDs (non-steroidal anti-inflammatory drugs). Heck, he had never even heard of the term NSAIDs. Had no idea Seretide inhaler is used to treat asthma; he claimed the only form of treatment for asthma was oral steroids during his time. He also had no idea that loratadine and ceterizine are anti-histamines, cousins to our all fave yellow pill, chlorpheniramine aka Piriton. What really peeved me during the times he observed me for dispensing was he never picked up any drug knowledge. It's like going for some class and not pay attention such that at the end of the day you have no idea what's been taught by the lecturer.

TS was the one who had worked as a pharmacist in the hospital and remained incompetent. Slowness aside, he has to refer to the pediatric dosing guide given to our technicians who are helping out with dispensing very frequently. There's nothing wrong with referring if you really cannot recall the dosing range, but I most certainly think it will be helpful to commit the dose of commonly used medicines ie painkillers, cough and cold medicines, and anti-biotics to memory. And he frequently uses MIMs as a reference. Any self-respecting pharmacists knows MIMs gives minimal knowledge, heck it doesn't even list all the drugs available in Singapore. He also has no idea what is a Ventolin evohaler although our pharmacy has it.

These are just a few examples. If you sit down and think about it, these are people who are approved by the Singapore Pharmacy Council for renewal of the pharmacy license at 2008. Obviously they met the 50 CPE points requirement. That means they must have accumulated their points through attending talks, conferences, and reading medical journals or articles. How then is it possible they are still so deficient in basic knowledge? I'm perturbed. We really should not be allowing people like them to continue to hold the practising license even if they fulfill the license renewal requirement. Else we can consider "forcing" pharmacists who have not been practising for more than 3-5 years to take a basic competency test before they are given the green light to start practising again.

Different Hosptial, Same Stupid Patients

Yes, I am currently working in a different hospital. Better working conditions, but still the same stupid patients. Guess if I want to stay in this line I really got to close one eye on human stupidity. Not.

Stupid Incident No. 1

When your doctor tells you to proceed to pharmacy to collect medicine but forgets to send the electronic prescription down, we are trying to be helpful by helping you call up the doctor instead of sending you all the way back to the clinic to get the doctor. Therefore, the least you can do is to let me know which consultation room you went to so I know which doctor to contact. No need to tell me which clinic you went to as your appointment card already tells me that. I need to know which consultation room. It is better if you can remember the doctor's name, but that is just a good-to-have information. Unless you cannot remember which room you went to, then I must know who you saw how else am I suppose to know who to contact to get your prescription.

However, you are most certainly not being helpful by repeatedly telling me which clinic you went to instead of telling me the consultation room number. Also not very helpful when I asked if you recall the name of your doctor instead and you tell me you saw a Chinese male doctor. For your information, majority of the doctors in Singapore are male and Chinese. Since you cannot provide me with the necessary information I have no choice but to send you back to the clinic. So do not whine, make a big fuss, or threaten to complain.

Stupid Incident No. 2
When you come to the receiving counters to get your queue number you asked for the fast queue number. Reason: your dad is an elderly patient. Have you ever used your brain to think about it or for that matter use your eyes to take a look at the crowd in the waiting area and tell me how many of them are elderly patients? This is a semi-geriatric hospital. If I give the expedited queue number to all elderly patients, then how expedited can that be?!

Stupid Incident No. 3
You come to collect your regular medicine, tell me you want the expedited queue number because you are sick. Use your commonsense. Would any person be in the hospital, much less in the pharmacy collecting medicine if they are healthy? Anyone of those in the waiting area would have the same right as you to request for the expedited queue number because they are all sick.

Stupid Incident No. 4
You come to the pharmacy to collect medicine, then tell me the doctor told you there is no medicine prescibed. Nuff said.

A Tiny Flame

Somebody, obviously too scared to name him/herself, recently left an anonymous comment on my blog saying I am stupid not to help a patient's son. Link to that post is here.

Quoting his/her comment:
i think you are stupid and the customer is right. singaporeans in general cannot think independently and are basically slaves to procedures and have lost the ability to think creatively. i'm wondering why one cannot call the doctor, get him to write a new prescription and fax it if possible? surely it is on his records...furthermore, if it is on his records, then that is all you need to satisfy your records...give the medicine to the patient and pharmacist and doctor can work it out while the patient receives meds. regardless, there is something that collectively can be figured it. so yeah, it is stupid...only stupid on your part. but then again, after living in singapore for a number of years i would expect no more and no less then a scared or uncaring attitude instead of a helpful one...uniquely singapore :)

All this just proves you are as stupid as the patient's son. Good job. Your vocabulary is obviously lacking if you do not even understand the word legal. You also obviously have no aptitude when it comes to comprehension.

Go to this link to understand what it means by legal.

Let's dissect your comment.

"Why one cannot call the doctor, get him to write a new prescription and fax it if possible?" One, you do not call the doctor regarding a patient he saw a few months back. A hospital doctor sees many patients in one day, you do not expect the doctors to remember patients they saw a few months back when they cannot even remember who they saw a couple of days back. Besides, I would not know who wrote the prescription for the patient, we happen to have more than one doctor working in the hospital. Two, a faxed prescription is not legal for obvious reasons such as a high likelihood of forgery etc. But of course you, though not a Singaporean, obviously cannot think creatively as well and I do not expect you to arrive at the above reasonings.

"Surely it is on his records...furthermore, if it is on his records, then that is all you need to satisfy your records...give the medicine to the patient and pharmacist and doctor can work it out while the patient receives meds." I have already mentioned those records are to facilitate work processes. The law does not require us to keep a record of the patient's medicine history, but it does say a copy of the dispensed prescription must be kept in the possession of the pharmacy for 2 years before destruction. The prescription is required to satisfy the law, NOT the records.

"After living in Singapore for a number of years I would expect no more and no less then a scared or uncaring attitude instead of a helpful one." Scared? Nay, you are sorely mistaken. Any pharmacist, in Singapore or overseas, would protect their license, because we need to go through 4 years of grueling university coursework, pass our forensic (law) exam, go through another year of internship before we can qualify to apply for a pharmacist license. After all the time, sweat, and money spent do you think I would do something that blatantly flouts the law, then get my license revoked? I am not the stupid one here. You are. As for "uncaring" and "unhelpful", did I mention earlier you are lacking in your comprehension faculty? It was in my post that I arranged for the clinic to get another doctor to write the prescription. One thing I did not mention was that I offered to arrange for the medicine to be delivered as the patient's son said he did not have the time to wait for the doctor to write the prescription then pick up the medicine. So much for being "uncaring" and "unhelpful".

"Uniquely Singapore." Ain't got anything to do with being uniquely Singapore. More like you and the patient's son are "uniquely stupid". :)