Monthly Archives: October 2012

Considering Academia? Guest Post by a PhD student

Considering Academia?

So you’ve worked in community or hospital pharmacy (or both) and fancy a bit of a change. How about a PhD to add to your list of achievements? Why not? Hmm, maybe consider the pros and cons below…

Pro:        You set your own working hours             

Great! You’ve worked 9-6 five days a week in a job where you can’t even leave your place of work during your shift. It doesn’t leave much time for the practicalities like doctor/dentist appointments. Or a lunch break where you get to sit down uninterrupted for more than 10 minutes. With a PhD if you can pop out when you like, turn up when you like and go home when you like. Awesome!

Con:       You set your own working hours

The onus is entirely on you to manage your time. Which means if you spend too much time during the day on Daily Mail/BBC News/Guardian/Facebook/Twitter/Mr Dispenser’s blog/*insert procrastination website of choice* you will go home feeling incredibly guilty so you feel you have to compensate for time lost by doing work in your supposed ‘free’ time. And then feel guilty if you don’t. Which turns into a continuous cycle of guilt that you can’t get out of. Which will eventually drive you mad.

 

Pro:        Your PhD may make a difference

You could discover that gene that is responsible for a type of cancer. Or you could implement an intervention that improves patient adherence to their medication.  Or find that pharmacoepidemiological link between a common drug and a common condition or side effect. Something you work on during your PhD could potentially save lives or change pharmacy practice in the future. Plus you get the pleasure of calling yourself Dr.

Con:       Your PhD may make a difference…but you couldn’t care less

Your thesis instead can just become a means to an end to get the PhD out of your life. It’s very easy to become disillusioned with your research when you suffer setback after setback, whether it be lab equipment on the blink, agonizingly slow recruitment of patients or the long, ridiculous process of ethical approval just to be allowed to have a chat with some pharmacists. Because when you reach the end of three funded years without having submitted you don’t care about your results and just want the thing out of your life so you can get a proper job and start earning actual money.

 

Pro:        You get to work closely with lecturers you admired (or were scared of) during your undergrad

I returned to my alma mater to do my PhD in the same department that I did my undergrad pharmacy degree. My supervisors are well respected in their field so I know the skills and knowledge that are rubbing off on me will be invaluable to me. And they really aren’t that scary. Plus you get to call them by their first names.

Con:       You get to work a bit too closely with former lecturers

When both your supervisors are pharmacists they can be a bit matter of fact about health issues. Being quizzed by one of them about my bowel movements when I was ill last year was quite possibly the most cringeworthy meeting I’ve ever had to sit through. Maybe this is too much information in itself. Aaanyway…

 

Pro:        You get paid quite generously for demonstrating the modules you hated

Taking undergraduate tutorials in the dispensing and OTC practice modules for the past 3 years makes me forever grateful that I have that stage of my pharmacy education long behind me.  You’d almost feel sorry for the poor wee lambs. And breathe a sigh of relief that it’s not you in their place.

Con:       You may get paid generously but the marking is mind numbing…zzzzz

Whether it’s marking the same extemp product 20-30 times for nearly four hours straight or the 35+ tutorials and homeworks every week, being a demonstrator can try the patience of a saint. And I’m no saint.

 

Pro:        Your PhD can open the door to alternative career paths

Industry, teaching, further research, back to community or hospital. The world is your oyster!

Con:       Your PhD can open the door but might not be enough to let you in

Like any area, academia is a competitive, fickle and slightly ruthless place. You must be prepared to dedicate a large proportion of your life to your job in order to make progress up the ranks. I did this in first year and by the end of second year I was burnt out with a very negative view of everything academia is about. Don’t make the same mistake. Work life balance is something that must not be taken for granted.

 

Pro:        You get student discount again

Speaks for itself!

Con:       You are a student again in your mid to late twenties

While the friends you went to school with are growing up, getting married, buying houses and being sensible and settling down in general, you’re static or going backwards. Still renting, still single, still living in a student area, stuck in a general rut. (This is just me being bitter though, several of my PhD friends are married and/or own their own home).

 

So have a good long think before you jump feet first into academia. Might be worth dipping a toe in with a diploma or masters first to get a taste of things to come.

 

Disclaimer: This was written by a very disillusioned PhD student who really doesn’t like their PhD. It is not intended in any way to be representative of all PhDs. Other (far more positive) PhD views are available. I think.

 

J

 

Awkward Pharmacy Moments

 

@mrdispenser: When you locum on the weekend and you don’t want your company to find out and you spot your area manager!

 

@mrdispenser: When you dispense a script for someone that you went to school with and you wait to see whether they acknowledge you or not.

 

@JoMyatt: I had that on Thursday. I told him he was the year above me and he knew me! Clearly, I’ve not changed in 20 years.

 

Arlene Caldwell: Even better when it’s a teacher who taught you at school!

 

@MrHunnybun: Very true, I can never tell if they genuinely don’t remember me or are pretending not to because they have a prescription for 1g of Azithromycin.

 

@Raman2089: I had a prescription for an old teacher once. I was so tempted to ask him but decided against it!

 

@alkemist1912: Particularly when their prescription for something like Methadone or maybe for an STD. I’ve had to deal with both situations.

 

@Alkemist1912: Or that awkward EHC for someone’s wife/partner – and you know that they’re supposed to be home alone!!!

 

@Andychristo: Ooooh. Been there! Awkward moment, especially as it was for a stat dose of Azithromycin…

 

@Checkedshoes: EHC with friend of daughter

 

@Kevfrost: Even more awkward when you present an FP10 and see it’s someone you trained in pharmacy.

 

@gemmieangel: Or when old geography teacher wants advice about the failure of his ‘privates’ when he has important lady friend to impress!

 

What are your awkward pharmacy moments?

Thoughts of a diabetic patient: Guest post by @ninjabetic1

One of the things that worries me about my diabetes is that people don’t need to help me, they don’t need to look after me. I have to do it for myself to survive, but others do it because it’s their job.

 

Putting my diabetes in the hands of others and learning to trust them has always been tough for me. I’ve had a lot of bad experiences when it comes to my health due to my own choices, but now I’m turning a corner and I need others to help me do that.

 

Over the last few months I haven’t had good experiences when it comes to getting the diabetes supplies that I need. Since March this year on 9 occasions I’ve popped into my pharmacy to pick up insulin, test strips and needles to find that my prescriptions either haven’t been brought over from my doctors surgery, haven’t been signed for by my GP or have been queried by my GP.

 

This means that on 9 occasions I’ve had a plummeting feeling in my stomach as I’m told that my life lines aren’t available to me like they should be. On 9 occasions the pharmacy staff have taken charge and gone out of their way to help me get those supplies which I depend on every day.

 

I cannot fault the service that I receive from the pharmacy, and I really feel for the staff when I ask for my prescription only to be told that there has been another error made from the surgeries end. They see my face fall and panic set in as I’m told that the medication which keeps me alive is being withheld. They saw me burst into tears when I was told yet again that my insulin wasn’t there and had to ask if I had enough to keep me going me over the weekend. They’ve given me emergency supplies, made phone calls, given me advice and support whenever these errors have been made.

 

I’ve started to dread going to pick up my treatment because I never know if it will be there for me or not. I’ve complained to my surgery every time that it has happened and these mistakes are still being repeated again and again. I’ve been left feeling that having diabetes is too much work for others, that the reason there are errors with my prescriptions is because others simply don’t need to help me. I feel that I’m trying so hard to turn a corner but I’m constantly hitting a brick wall and being let down. I’m starting to lose any trust that I’ve built up in those people who are paid to help me. The only suggestion that I can think to make is that more communication is needed between the pharmacy and the doctors surgery, however the pharmacy staff have made this clear to them on a number of occasions.

 

I know that I’m very lucky to have great support from the pharmacy staff… if I didn’t have them then I hate to think where I would be. I’m grateful that they don’t just see their work as a job, and that they truly want to help me turn the corner

 

 

Dirty Harry Dispenser

 

I know what you’re thinking. “Did he count five tablets or only four?” Well, to tell you the truth, in all this excitementI kind of lost track myself. But being as this is a treatment for Bacterial Vaginosis, the most powerful disease down below in the world, and would blow your area clean off, you’ve got to ask yourself one question: Do I feel lucky? Well, do ya, miss?

Dont you want me, doc?

 

You were workin’ as a registrar in a surgery

When I met you

I picked you out, I shook you up and turned you around

Turned you into someone new

 

Now five years later on you’ve got the world at your feet

Success has been so easy for you

But don’t forget, it’s me who put you where you are now

And I can put you back down too

 

Don’t, don’t you want me?

You know I can’t believe it

When I hear that you won’t see me

 

Don’t, don’t you want me?

You know I don’t believe you

When you say that you don’t need me

 

It’s much too late to find

You think you’ve changed your mind

You’d better change it back or we will both be sorry

 

Don’t you want me, doc?

Don’t you want me, ohh?

Don’t you want me, doc?

Don’t you want me, ohh?

 

I was working as a registrar in a surgery

That much is true

But even then I knew I’d find a much better place

Either with or without you

 

The five years we have had have been such good times

I still rely on you

But now I think it’s time I live my life on my own

I guess it’s just what I must do

 

Don’t, don’t you want me?

You know I can’t believe it

When I hear that you won’t see me

 

Don’t, don’t you want me?

You know I don’t believe you

When you say that you don’t need me

 

It’s much too late to find

When you think you’ve changed your mind

You’d better change it back or we will both be sorry

 

Don’t you want me, doc?

Don’t you want me, ohh?

Don’t you want me, doc?

Don’t you want me, ohh?

 

Don’t you want me, doc?

Don’t you want me, ohh?

Don’t you want me, doc?

Don’t you want me, ohh?

 

Don’t you want me, doc?

Don’t you want me, ohh?

Don’t you want me, doc?

Don’t you want me, ohh?

 

Don’t you want me, doc?

Don’t you want me, ohh?

Don’t you want me, doc?

Don’t you want me, ohh?

A Change of Heart: Guest Post by @aptaim

 

I’m taking advantage of being a guest blogger to do something that doesn’t always come naturally, and that’s to admit that I’m wrong. Actually more than that, I’m confessing that I’ve been exactly wrong for more than the last year.

 

A couple of weeks back I was at an intimate strokey-beard meeting on commissioning with various representatives from the DH, NHS Commissioning Board and such, and it was there I realised just how wrong I’ve been.  The meeting was tabled as a discussion on the place in the new NHS of Local Professional Networks – designed in principle to be pools of subject experts that could be pulled upon by the NHS CB for input into the commissioning process – but it transpired that for various reasons they no longer exist in the new NHS framework:  a three-in-the-morning decision if ever there was one.  This, and the recent news that pharmacy commissioning representation in the Local Area Teams of the same Board is absent, made me realise my folly.

 

Because right now, who will commissioners go to for pharmaceutical advice?  More importantly, who will champion the role of pharmacists so that commissioners even know that they are a viable option?  Some may seek support from their emerging CSU, others will house some expertise in their CCG. But how many of them fully understand the breadth of pharmacist’s potential and the services that can be offered by pharmacists, and more so in the easily accessible sites that are retail pharmacies?

Perhaps some of you will suggest our governing body the GPhC. Well personally I’m not so sure, after they responded to my P-medicine self-selection query.  So what about Pharmacy Voice? The PSNC perhaps? The AIMp? The legendary Chemist and Druggist Senate? The NPA then? The CCA? The PDA? The UKPCA? No? OK, surely the PCPA? The GHP?  The PPRT?

And herein lays my concern: there are too many organisations that ‘represent’ parts of pharmacy, and too few that represent ‘pharmacists’.

 

In 2010 I decided that the Royal Pharmaceutical Society wasn’t worth my money, mainly after hearing a local (then) RPSGB branch member say that the cleaving of professional and regulatory functions wouldn’t actually change anything other than their logo.  But now in late 2012 I know that was the wrong decision based on someone else’s flawed attitude.

From my experience so far the RPS has changed. It is not always the speediest or responsive of organisations (their statement on 3-for-2 offers was praise-worthy, but I think we’re still waiting to hear their position on salbutamol by PGD?) and their coverage doesn’t extend fully to all sectors including my own speciality in community services, but that’s down to individual members, and the pharmacy ‘representatives’ above, to influence.  But what they do deliver on is media engagement, and this is important for three reasons.

 

Firstly, it cements pharmacists into the mid of the general public as a healthcare professional. I know that more people visit a pharmacy than any other healthcare setting, but this weekend I watched a couple agonise over which two pharmacy-only medicines to buy so they could get a third free, only to suffer their backlash when I intervened to say three boxes of Nurofen Plus – whilst not illegal – was not something I was prepared to let out of the front door.  Retail pharmacy is our most often visited sector, but it is most often seen as a shop not a centre for healthcare.

 

Secondly, increasing general public opinion of pharmacists as a healthcare professional increases the support the profession gets from patients. In the NHS, old or new, patients aren’t the same as the public, but certainly in the new NHS patients have a greater voice, if not a greater influence on decision making.  The more patients regard us as professionals, and talk about us as such, then the more this message will drip-feed, or directly feed, into commissioning intentions.

 

Thirdly, being an expert pharmacist is good for business: predominantly retail, but this will extend further as more roles and opportunities in primary care emerge.

 

Throw into the mix their extended joint-working initiatives over the old RPSGB such as the RCGP Joint Statement,  Transfer of Care initiative and the standards for in-patient prescription charts, and the RPS is emerging as a strong leadership body for pharmacists.   Things are currently moving rapidly and uncertainly in English healthcare, and I envisage the ‘pharmacist trilema’ becoming more relevant to our every working practice: you can deliver any balance of quality, time or return on investment, but if you want more of one, at least one of the others must be sacrificed.  I sacrificed return on investment for my employer (and my own ear-drum) on Sunday when I put quality first and denied the Nurofen Plus sale, but this individual action can only go so far.

 

It appears the current government remains committed to reviewing the principles of remote supervision, and the only certain outcome of this passing will be a squeezing of posts or remuneration for retail pharmacists.  The GPhC seems not to worry unduly about the requirements of the individual pharmacists they regulate, so it will be organisations like the RPS who must – and I now think can – deliver the right message to policy makers and healthcare commissioners that pharmacists are, and must remain, the universally accessible frontline clinical provider of all aspects of pharmaceutical care.

 

So my change of heart? Well the first thing I’ll do with next month’s wages is join the RPS.

 

I can only hope that other non-members will do the same.

 

Is it just me? Guest Post by @helenroot

 

I have a confession – I think I’m a Pharmacy geek. There is something that has been bugging me for a while, but I have been trying to ignore it. I’ve been in denial, but I can hide my secret no longer.

 

This week on my Twitter feed was news of a new app that can identify drugs. It was only a matter of time I guess, and it didn’t make me question my career choice. No, that was just the trigger for my secret to rear its ugly head again. That evening a Twitter conversation began with “guess the tablet?” and equivalent Pharmacy related paraphernalia as the topic. The enthusiasm for this was immense, and whilst I missed the event (It was the Great British Bake Off Semi-final!), that conversation was the trigger for my imminent confession.

 

I’ll set the scene. You’re watching your favourite soap opera and Janice, the new blonde young interest, has been having a run of bad luck, you know the kind of thing. Broken hair straighteners, chipped nail varnish, burnt toast….. life is tough. So, she books an appointment with Dr.Dish who tells her she’s depressed. Cut to scene with Janice in the pub, opening her prescription and telling the lippy barmaid all about her tough life. Well, this is my gripe. Janice always produces a brown (often unlabelled) tablet bottle, and tips out some pink tablets, “these are the antidepressants he gave me”. Cut back to me shouting at the TV, “that’s Ibuprofen! When did you last see an SSRI out of a calendar pack……” and here is my point.

 

It drives me insane when so much time is spent on continuity in TV and films and yet there is a total disregard for continuity of medicines. I’ve seen it in Hollywood blockbusters. A scene of crime search, diazepam, they must have used this to sedate the victim, cut to shot of random white tablets the size of horse pills, and quite obviously to our trained eye, not diazepam.

 

Also, in movies, the hero or the villain gets shot and then breaks into a pharmacy or house. Then they grab some aspirin or opioid painkillers and take the whole bottle. No GI bleeds or respiratory depression ensues.

 

My secret goes further though. Does anyone else get annoyed by the pathetic pictures used in glossy celebrity magazines (that’s a whole other confessional) or pictures used to illustrate online medical stories? It that just me too?

 

“New research shows the contraceptive pill can make your hair curly” – Headline picture of either an ancient HRT products (I’d spot Trisequins anywhere) or a worried looking woman about to take a tablet from a non cyclical calendar pack, you just know that isn’t a contraceptive.

 

“Flu Jab linked with hiccups” time to dig out that picture of a man sneezing and a glass hypodermic syringe circa 1970/1980 that is now sitting in some museum for Pharmacy.

 

Well, I could no longer live with not knowing whether or not I am alone in my annoyance. I have just a sneaky suspicion I am not alone. Now I have planted the seed you won’t be able to escape it. You’ll find yourself looking for this everywhere. Or, is it just me?

Taken 3: The Pen

 

Mr Dispenser: I don’t know who you are. I don’t know what you want. If you are looking for ransom, I can tell you I don’t have money due to the global recession and category M. But what I do have are a very particular set of skills; skills I have acquired over summer vacation placements, 4 years of university and one year’s training. Skills that make me a nightmare for doctors. If you let my pen go now, that’ll be the end of it. I will not look for you, I will not pursue you. But if you don’t, I will look for you, I will find you, and I will kill you.

 

Patient: Woah, woah, woah. Have your pen back. I’m off to Boots…

 

Taken video

A View From The Other Side of The Counter: Guest Post by @OptforOptimism

Thanks for Sophie for this guest post.

 

I try my very hardest to avoid going to the GPs’ surgery for three reasons;

 

 

1) I hate waiting 40 minutes after my appointment to “get in”.

 

 

2) I like to think that I don’t abuse the service, and therefore try not to go.

 

 

3) I hate The Pharmacy afterwards.

 

 

The last time I visited the GP was about a year ago.  I was almost 8 months pregnant and had a horrific chest infection.  Every time I coughed I would pee. Sexy, I know.  However the GP was more concerned about me triggering early labour, so he kindly prescribed me an inhaler.

 

 

My local surgery is a new build, with flat screens and comfy chairs; it also has a Pharmacy attached to it.  Rather than move my car, I tend to wander into it straight from the surgery.  My visit to The Pharmacy went like this;

 

 

Enter pharmacy.  Join the queue and wait for ten years while the Busy Body Counter Lady finishes her conversation about Jim from Bush Street and his bad foot.  Further discusses patient information.  Asks after grandchildren.  Falters to find any new topic to discuss, and beckons me over.

 

 

I hand her my prescription (which are free in Wales).  I attempt to tear the back off.  Very difficult when you have other “waitees” literally sat on the counter between the rack of throat sweets and lip balms and you can’t raise your elbows without smacking them in the jaw. I presume they think their prescription will arrive quicker if they invade innocent peoples’ personal space.

 

 

I hold my breath, not wanting to catch the flu or other disease.  Now it’s The Wait.  You know, the ridiculous amount of time it takes to get a simple prescription filled.  I wander about, trying not to stare at badly behaved feral children and their screeching parents.  Look at the make up display.  Read a few leaflets on diabetes and heart disease.  Avoid the automatic door, if it opens, you see, everyone turns around and glares at you.  I play a game of “guess the ailment” but can never truly win, unless Busy Body Counter Lady feels the need to discuss said ailment with patient of my choice.

 

 

Stare at a few people going in and out of the Consultancy Room, wondering if they’re after the morning after pill or weight loss tablets.  Lose the will to live.

 

 

Pick up a packet of Berocca and decided RIGHT THERE AND THEN to start living healthier and taking vitamins for the rest of my life.

 

 

Join the queue and wait for ten years while the Busy Body Counter Lady finishes her conversation about Jane from Meyrick Street and her husband’s gimpy leg.

 

 

I, almost triumphantly, hand over the Berocca and pay by debit card.  Decline a bag as they’re 5 pence in Wales and I have no change.  Wait for a moment longer than I should in case Busy Body Counter lady turns around with a winning smile and says;

 

 

“Sophie? Here you are” and hands me a green bag.

 

 

She doesn’t.  I turn and back away, there’s no waiting space near the queue or the counter, as the other “waitees” are still lounging on the displays trying to peer into the back.  I wander over the knee supports, and before I decide to make the fatal decision to start up running, I stand back in the queue.

 

 

And wait for ten years while Busy Body Counter Lady insists on sticking reduced stickers on every single hair dye in the box on the counter.  I couldn’t count them all but I’d say there was at least fifty thousand.

 

 

It’s finally my turn and the conversation goes a little something like this;

 

 

Me: Shall I just come back another time?

 

 

BBCL: What is it you’re waiting for?

 

 

Me: Well my prescription (?!)

 

 

BBCL: Well what was it for?

 

 

Me: Erm, well *CUE Waitees to prick their ears up* nothing exciting…just an inhaler.

 

 

BBCL: Well The Pharmacist is going as fast as he can, isn’t he Sandra?

 

 

*Sandra stocking the knee supports nods her head in agreement*

 

 

Me: Right well, yes, but that isn’t what I asked…shall I just come back?

 

 

*The Pharmacist enters The Pharmacy through the automatic doors, and in true form to the waitees I turn around and glare.  His mouth is full of sandwich, with crumbs on his tie and clutching his car keys.*

 

 

Busy Body Counter Lady has moved on to the next customer.

 

 

I have a violent coughing fit and pee myself a little bit.

 

 

Lose the will to live and go home.

 

 

Isaiah was born a week early.

 

 

Now I LOVE the fact that the NHS is free and accessible.  I have private cover and wish I could see a GP on that to avoid taking up space in an undervalued commodity.  That said, if I had to see a Pharmacist I’d rather just get ill.  And die.  Ok, that last bit was a bit extreme.  Pharmacists have their place and do an excellent job;

 

 

Me: What is this? (opens mouth and allows stranger to peer in)

 

 

Pharmacist: Ulcer, go and buy XYZ.

 

 

Excellent, what’s not to like?  But when you are waiting for a script it’s like waiting to DIE.  Long and unnecessary.  EVEN for the stuff they don’t have to count.  Like an inhaler, for a random, unassociated example.

 

 

Next time I have to go, I shall take my baby and my toddler.  And feed them Skittles in the waiting room.  Let’s see how long I’ll have to wait THEN.

 

 

Disclaimer:Sophie love Pharmacists.  This, while a TRUE account, was written tongue in cheek.  Before you come after me with flamed torches, and I end up having to go and get burn relief from erm The Pharmacy

The problem with dispensing GPs: Guest Post by Anon

 

The problem with dispensing GPs For a long while I have jocularly berated my fiancée over the fact she gets her medication from her dispensing GP surgery thus betraying my profession. Granted, for her, it is the convenience factor and I would do the same in her position were I not a Pharmacy student. The GP surgery is across the road from her home, the rural location would otherwise mean a drive into town to the Pharmacy, and she doesn’t drive. However, this week this came to a head. After much deliberation, she was put on a PRN antipsychotic by her consultant, arguably a high risk medication, and the prescription request was dutifully sent through to the GP surgery. This was where the problems started. You see, although the surgery is across the road, they insist on seeing her at their other surgery which is a drive away in the next village. This was where the request was sent and issued, so she had the initial hassle of having said prescription sent back to the surgery across the road to collect. As you will see, this is the least of our worries.

 

So, she duly went across the road, collected her medication, but on her return home was rather alarmed to find no patient information leaflet in the box. The prescription was of course for less than a full box, so the dispenser had not bothered with the leaflet. I know for a fact that the dispenser knew it was new medication because she personally dealt with the issuing and transfer of the prescription from start to finish, so through either ignorance or laziness she knowingly broke the law and compromised patient safety. Now my fiancée is pretty astute (the cynics may insert a joke here about an astute person needing antipsychotics!), knows from me that this is not ok, and was able to look it up in the BNF or download the leaflet from eMC, but this really does not excuse the fact that the surgery issued the new medication with no advice or information whatsoever.

So our conundrum is what to do about this now?

Furthermore, I am deeply concerned about what else the surgery is dispensing willy nilly without counselling. My fiancée has never had antipsychotics before and it was all but left to us to do our own research into whether this medication was a good idea or not. The surgery have no idea I am a Pharmacy student, the dispenser probably has no idea as to my fiancée’s mental capacity, so I fear for what might have happened if someone else had been given this medication, or any other high risk medication. This really illustrates for me the major issues with dispensing surgeries, and why the Pharmacist is so vital in the dispensing process. What else goes under the radar in GPs dispensaries?