Announcing a new pharmacy blog that I found in the i-bulletin of Malaysian Pharmaceutical Society (MPS): Malaysian Pharmacist.
Finally, a pharmacy blog by local pharmacists!
Oh, there’s in fact another: Dispensing with Sanity. I like the name of this one.
It’s funny how people associate the prescription/dispensing counter with the cashier counter in a retail pharmacy. Why do they always want to pay at the prescription/dispensing counter when there are 4 cashier counters (for this particular chain pharmacy) at the entrance? 1 may not be visible, but aren’t 4 counters obvious? Why do people pay at the pharmacy counter? Why?
Sitting at the prescription/dispensing counter of the retail pharmacy allows me to see the interaction of the pharmacist and the customers. After asking for a medicine, and when the pharmacist hands it over, the customer will take his/her purse out, ready to pay for it. This process does not happen once or twice. I was behind the counter from 10am to 6pm and after much observation, I noticed that 6 out of 10 customers will pay at the pharmacy counter. They do not seem to know (from their expression when told to pay up-front) that the pharmacy counter is only a counter to dispense medication, and not for $$$ transaction. A typical “customer-paying-at-the-pharmacy-counter” process goes like this:
Customer: Hello, do you have (brand name of drug)?
Pharmacist: (hands over the medicine) Here you go.
Customer: How much is it?
Pharmacist: (checks shelf tag and informs customer)
Customer: (takes out purse, reaching into it for cash, ready to pay)
Pharmacist: Please pay at the cashier counter at the entrance.
Customer: (looks sceptically at pharmacist) Oh, OK.
And yes, I forgot to mention that almost all customers ask for the price of the medicine (a sign they want to pay at the pharmacy counter right away!). Probably they assume that the pharmacy counter is a pharmacy-cum-cashier counter. But don’t they know that a pharmacist isn’t a cashier? And that a pharmacy counter IS a pharmacy counter, not a place for transaction of $$$?
In the end, the pharmacist got fed up repeating the “please pay up front” line, and you know what she did? She took out a signboard and put it on the pharmacy counter, which states “This is not a cashier counter. Please proceed to the cashier counter”. My friend and I (we were having our attachment at the pharmacy) burst out laughing.
Those 2 days of attachment at the retail pharmacy made me realise that people still do not view pharmacists as professionals. My opinion is that they probably they do not associate a retail setting as a professional place for patient counselling (even though there is a counselling booth), unlike a doctor’s clinic where they will be in a room with the doctor. A retail pharmacy is somehow still viewed as a business setting (pharmacists need to apply for type A license in order to dispense medications at a pharmacy, and type A license is premise specific), whereas doctors are not bound to this requirement.
Some people do not treat pharmacists with the same respect as they do doctors. I remember an incident where this elderly man came in to ask for a medication, and when he was told by the pharmacist that they do not have this particular brand and dosage form, he responded in an angry tone, “I know, I know, I’m just looking,” and kept looking at the cabinet behind the pharmacist, still searching for the medication. In another incident, a girl came up to the pharmacy counter and requested that an electrical equipment that she bought be tested. The pharmacist just signalled to one of the workers to assist her. Since there were many customers in the pharmacy at that time, the girl was told to wait for a while. She eyed the pharmacist angrily and said, “Could you be fast? I’m in a rush.” I was like hello, what the heck! That isn’t even a pharmacist’s job!
However, despite the unpleasant incidents, there are people who are really nice, who really appreciates the work of the pharmacist. A lady came in to have her blood pressure checked, and she related to us that her doctor doesn’t provide as much information as the pharmacist does about her condition, although she wishes to know better about her condition. She kept saying that she was very pleased with the pharmacist’s service and said she would come back if she had any questions.
I believe that community pharmacists play a very important role in the healthcare system of Malaysia. The value of pharmacists in healthcare, be it in a retail or hospital setting, will bring benefits to the general public. {below: obtained from the I-Bulletin of Malaysian Pharmaceutical Society (MPS).}
Some of the studies that conclude that pharmacists patient care services can significantly reduce overall health care costs.
- Health problems resulting from improperly taken prescription medications cost more than $177 billion each year – more than the cost of the drugs themselves. {Ernst FR, Grizzle, AJ. Drug-Related Morbidity and Mortality: Updating the Cost-of-Illness Model: Journal of the American Pharmaceutical Association. 2001. Mar-Apr; 41 (2): 192-199.}
- Pharmacists’ services in an intensive care unit decreased adverse events by 66%, saving $270,000. {Leape LL. Cullen DJ, Dempsey Clapp M, et al. Pharmacist participation on physician rounds and adverse drug events in intensive care unit. JAMA 1999 July21; 282(3): 267-70.}
- Pharmacists’ services at a Veterans Administration outpatient clinic reduced the number of medications taken by an average of 2.4 prescriptions per person. {Galt KA. Cost avoidance acceptance, and outcomes associated with pharmacotherapy consult clinic in a Veterans Affairs medical center. Pharmacotherapy 1998 Sept.-Oct.; 18(5): 1103-11}
- Pharmacists in long-term care facilities save an estimated $3.7 billion by improving patient care services. {The Fleetwood Project, American Society of Consultant Pharmacists}
Services provided in community pharmacies saved approximately $3.47 per prescription. {Dobie RL, Rascati KL. Documenting the value of pharmacists interventions. American Pharmacy. 1994; May; NS34(5): 50-4}
The studies may be conducted some time ago and it goes to show that the value of pharmacists have long been established but for whatever reasons their services are still not recognised here.
Sad, isn’t it? I hope and wish that the public’s perception of the role of pharmacists in healthcare will change for the better.
What is your answer to that if you have portfolios to do, with questions like this one here:
Ms. GSS, 26, driving her new car to Sri Petaling, is waiting at the traffic lights near Bukit Jalil stadium. The lights change to green. She releases the brake and starts to move forward. Suddenly she hears sirens behind her and in the rearview mirror sees a police motorcycle-led cavalcade making its way through the traffic queue. She reluctantly changes direction, moving to the kerbside to make way for the convoy.
1. Draw diagrams of the neural pathways involved in GSS’s sensory perceptions and actions in the scenario.
2. What are the consequences to GSS’s vision and hearing if she suffers-
a) a spinal injury in the lumbar vertebrae?
b) an injury which affects the auditory cortex?
I nearly died answering that question. It was a 2000-word portfolio, mind you. Of course it wasn’t that bad, but I thought we would benefit more if it was more of a pharmacological-based question. Well, isn’t that what we are supposed to be specialised in? Sometimes I feel that we are learning too much of anatomy and physiology, and thus, neglecting the pharmacologic aspects.
Now that portfolio days are over (for this semester), I can breathe a sigh of relief. However, I cannot relax just yet. There’re still millions of things to do. Management for the Pharmacist project is one, class test is another, and of course, not forgetting the few remaining PBLs. And yes, talking about PBLs, we now have a new system called the e-PBL. Seems like everything has to have something to do with the internet eh? Even our PBLs and portfolios aren’t spared?
I’ve always thought that the main purpose of PBL is to train us how to speak, how to interact with people, how to carry out a discussion professionally, and how to put forward our ideas in a way that isn’t offensive. Well, as mentioned in the educational objectives of the PBL: “…to develop communication skills (ie able to listen, explain, answer, respond, discuss, defend effectively in professional manner” , isn’t that supposed to be the main basis of having a PBL? So, why e-PBL now?
Maybe I’m just being pessimistic. After all, everything’s going global now, with everything having an “e-” prefix. But what can one do when one gets a PBL trigger like this??? This trigger is nothing like the usual trigger we get.
A ‘fridge’ for the staff
As the Drug Information Pharmacist you are also the Secretary to the hospital Drug & Therapeutics Committee. The remit of this Committee includes assessing medicinal products for possible inclusion in the Hospital Formulary; and also, to contain the size of the annual drugs budget. Your colleague, the Purchasing & Stores Pharmacist, is the other member of the Pharmacy Department on the Committee.
Recently you put forward a proposal for the inclusion of a generic version of gliclazide tablets 40mg. You supported this proposal using data from the manufacturer, GenEquiv, showing comparable bioequivalence with the market leader, Diamicron®. At last week’s meeting the Committee accepted your proposal, and directed that the next Drug & therapeutics Bulletin (published monthly by Drug Information, and distributed to all doctors and pharmacists in the hospital) should recommend the use of this much cheaper generic equivalent instead of Diamicron.
Yesterday the Marketing Manager of GenEquiv rang your Chief Pharmacist to express his satisfaction that a major product in the GenEquiv portfolio had “made it” into the Hospital Formulary. The Manager said that GenEquiv wished to express its thanks by underwriting the expenses for you and your colleague in Purchasing to attend a forthcoming major pharmacy conference in Sydney. He would also like to present the Pharmacy Department with a microwave oven and a ‘fridge, for use in the staff room. Finally he wanted to make an appointment to discuss other GenEquiv generics for consideration for the Formulary.
Today your Chief Pharmacist has called you and the Purchasing Pharmacist in to his office to discuss formulating departmental policy on handling “inducements from pharmaceutical companies”.
To be honest, I do not know where to start. I NEED HELP!!! And worse, the PBL session is going to be carried out online. I wonder how it’s going to be like then. I really wonder.
I received an email a few days ago from my mom. That email was originally from my aunt, who sent it to my mom, who then sent it to me. (Ever since I started pharmacy school, family members and relatives have been targeting me for information about medicines they are taking, or herbs in the market that they aren’t sure about. Oh my. I don’t really know much either.) It was an enquiry about the following:
“Fairy Remedy” for Joint Pain
Four ingredients are all in the same amount:
Ganthoda powder
Tumeric powder
Fenugreek powder
Flax seed powder
A teaspoon in 1/4 C of warm water, twice a day.
I have no idea what the first three herbs are, only that they sound like spices. I am familiar with flax seed though, as I did a presentation on it last semester. However, I remembered that flax seed oil is beneficial for its anti-inflammatory properties, while flax seed mainly contains fibre, and is used as a laxative for constipation. So I’m wondering why flax seed powder is one of the ingredients in the above formulation for joint pain.
I managed to find some information online regarding tumeric and fenugreek from the National Center for Complementary and Alternative Medicine (NCCAM). Unfortunately, I couldn’t find any information for Ganthoda powder, except that it is a spice.
Does anyone have any idea what the above herbs are (especially the first three)? Also, is the formulation above a good remedy for joint pain/osteoarthritis?
I just had a class test on the Central Nervous System this morning, and here I am reading an article about the brain again. The brain…AGAIN?! Oh my, I must be crazy. No doubt this module is interesting, but having to memorise all the pathways in the brain and the neurotransmitters involved is an information overload, really.
Well, the title of this article caught my eye, so I decided to click on it (that’s free will), and no, I didn’t change my mind at the last minute knowing that it is something about the brain again (it will be “free won’t”, if i decide otherwise). Oh my God, what the crap am I talking about now.
The article, titled Second Thoughts Are Real, can be found on WebMD, while the research article can be obtained from The Journal of Neuroscience Online. Basically, the article discusses about the “little voice that says ‘stop’ in the brain”. I found the results of the study quite interesting, and that little voice in your head is actually a function of a specific part of the brain! Below is the full article obtained from WebMD:
Aug. 21, 2007 – The a little voice in your head that warns you not to do something you were just about to do is real, brain researchers say.
Well, maybe not the voice. But researchers now say last-minute second thoughts come from a specific part of the brain.
A different area of the brain allows us to act voluntarily. That’s free will. This is “free won’t,” suggest Marcel Brass, PhD of Germany’s Max Planck Institute and Patrick Haggard, PhD, of England’s University College London.
“Many people recognize the ‘little voice inside the head’ that stops you from doing something, like pressing the ’send’ button on an angry email,” Haggard says in a news release. “Our study identifies the brain processes involved in that last-minute rethink about what we are doing.”
Brass and Haggard find that a brain region just above and between your eyes — the dorsal fronto-median cortex or dFMC — is specifically designed to let you pull back from doing something you were just about to do.
University of Pennsylvania researcher Martha Farah, PhD, says the findings have major implications. Farah was not involved in the study.
“It is very important to identify the circuits that enable ‘free won’t’ because of the many psychiatric disorders for which self-control problems figure prominently — from attention deficit disorder to substance dependence and various personality disorders,” Farah says in a news release.
In their study, Brass and Haggard hooked up 15 healthy young adults to functional MRI machines that did real-time scans of their brain activity. The participants were asked to decide to push a button at times of their own choosing. Some of the time the participants were asked to decide at the last minute not to push the button.
Brain scans taken when the participants actually pushed the button were different from those taken when the subjects restrained themselves from pushing the button.
This self-control came at a cost. The subjects reported feeling frustrated when they did not push the button as they had intended to do. That fit with their brain scans; a part of the brain linked to feelings of frustration (the anterior ventral insula) lit up along with the dFMC “free-won’t” brain region.
Interestingly, some of the study participants were less likely to refrain from pushing the button than others. These subjects had relatively weak dFMC activity, while those with better self-control had stronger dFMC activity.
“This could be a factor in why some individuals are impulsive, while others are reluctant to act,” Haggard says.
How about indecisive individuals like me? Should I or should I not push the button? To go or not to go? And for today’s multiple choice question (MCQ) class test: B or C? True or False? Ahhh…at times like these, decision making is something I dread.
It was like a dream, a fantasy. It seemed as if I was reborn again, only that my senses are still numb and my thoughts blurry, my heartbeat faint. The only edible sound is the growling of my overactive gut.
It was over in exactly one hour. One hour to answer 2 short answer questions (SAQs) out of 3 SAQs. There was little time to think, much less maintain my writing as legible as possible. Like a robot, we vomited out everything that we know, everything that we think relevant to the question. There was barely time to even write an outline, or a draft.
It was a battle, a battle for survival. Time constraint is the worst enemy at this moment. My usually very neat handwriting has turned into scribbles. Accumulation of lactic acid in my arm is causing my muscles to ache. Yet, I had to keep going. To stay alive.
Come to think of it, it wasn’t much of a SAQ. It was more of an essay question! Bloody hell. Each question was allocated 15 marks, and each question were subdivided to 2 questions with 10 marks and 5 marks each. However, the scope of the answer is just too wide, and to make sure you have all the answers written down, you just have to write like a mad man. Still, there wasn’t sufficient time to put down all the facts. An SAQ should be an SAQ, not an essay question!
What’s worse is that my brain has limited memory space. What has been read and fully understood could not be recalled. But still, the hippocampus must be squeezed dry until sufficient information is obtained to answer the questions. Ahhh!
Eating is a good way to put things behind my mind, which is what I’m doing now (anyway, it’s close to lunch time), but that’s only a temporary remedy. What I really need is: (1) more memory space, (2) more time, (3) more intelligence, and (4) …a break. But you know what? I am not even entitled to the last one! There’s just no spare time at all.
The test is over, but life has to go on. I have thousand other things to do! Problem based learning (PBL) on insomnia is one, the Management for the Pharmacist project is another, and of course, not forgetting uncountable portfolios and the upcoming class test on Central Nervous System.
I think I’m going to die. From exhaustion, that is.
I can’t even finish my lunch.
God help me.
Everytime I choose to sleep early (read: EVERY TIME), I get tonnes of calls and messages on my mobile phone. I kid you not. It wouldn’t be just one call, or just one message, it would be a flood of them. Some people even have to call/message twice. Can’t I get some peaceful sleep just for once?
I didn’t sleep well last night. Some time in the middle of the night, I heard the phone ring a few times. Being too tired, I just couldn’t get up to answer the calls. Nevertheless, my sleep was disturbed. I did not (and cannot) switch my mobile phone to silent mode simply because I need the alarm to wake me up! Instead, phone calls and messages took over the task last night.
When I checked my phone this morning, I had 3 missed calls and 6 messages, all from different people. The worse thing was 2 people had to contact me exactly 1 hour after I went to bed. I thought I could sleep early and wake up the next morning with a fresh mind, but I wasn’t even given the chance to rejuvenate! Having a class test to study for, the Management for the Pharmacist project to prepare for, and a PBL session to get ready for certainly do not help in this situation.
I just don’t understand. Why only when I choose to sleep early? Why???
Well, maybe because the topic of today’s PBL session is insomnia, and having a personal experience of awakening in the middle of the night will give me a better understanding about the sleeping disorder, so I could priovide a good explanation about it during the discussion.
How very nice indeed.
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