Monthly Archives: June 2013

Which?

Guest Post

These are the personal opinions of an anonymous pharmacist and do not mean much – apart from them having a rant!

So maths then. Maths that great subject where you can add and subtract, multiply and divide. Where numbers can be manipulated into percentages and fractions. Manipulations that can bring forth great tools such as statistics…and tables and graphs.

Maths is a great tool which informs people as to whats going on within areas of interest.

And – maths can be abused.

In maths the very tools that can be used to express larger numbers as percentages can then also be used to show the effects of smaller numbers and the changes and differences that these smaller numbers can mean as percentages and can be confusing! And (far worse) damaging.

Within the world of pharmacy maths is a great tool. It is used extensively when checking to see if medicine X is better then medicine Y and/or placebo. It can help people check to see if people are prescribing effectively, in audits to find out if SOP’s are being used correctly.

And then maths can be used to make something look shocking.

Recently the Which? consumer people went round a “selection” of pharmacies around the UK and used 1 of 3 scenarios to check on the advice etc given and then compiled a report. I have now read articles in a few magazines which was saying how bad we were in response to the Which? consumer report, well that’s how it felt to me.

The results in the Which? article weren’t good!

In fact, the results showed that whilst multiples had improved, for independants there had either been no change or a worsening in advice given since the previous Which? report a few years earlier.

This doesn’t look good for any profession.

HOWEVER. Which? only visited 122 pharmacies. Out of (in the region of) 13,500.

There are approximately 92 counties in the UK.

So….

122 out of 13,500 = 0.9% of the toal number of pharmacies
122 in 92 counties = Which? visited just over 1 pharmacy per county on average. (1.33 to be exact – assuming 92 counties)

From their 122, they visited multiples, small chains and single independents. They must (surely) have visited some inner city pharmacies and some in the countryside within the 122.

It’s at this point that you have to stop and ask yourself..how relevant a sample size was this. To me the numbers don’t stack up. How can you visit 122 pharmacies and then compile a report that basically says “Pharmacy isn’t doing its job”

I have also heard that academics may have viewed this sample size as “good”..

Which propaganda machine do they work for? The “Ministry of Truth”

What size were the error bars again….

Or am I missing the point?

A less then 1% sample size is enough to tarnish a profession and seek much hand wringing from within the profession. If the sample size was 50% then fair enough. We would have to sit up and take notice. but 1%…

I also note that one of the situations has been challenged by a group of people regarding warfarin interacting with pantoprazole…

If a drugs manufacturer used data from 1% of the available “population” to get a new medicine to market – they would be laughed out of town. Application denied.

This report does highlight one big problem. We are being asked to provide more and more healthy living advice to members of the public, yet regardless of this we are still stuck to the dispensing bench.

More then anything, I am somewhat annoyed by the tone of the magazine’s columns which i believe should have chosen to look at the report more objectively and reported as such with much less bias and more balance – rather then decry against the profession! We are taught (as any good scientist is) to evalute data and then dissect and check to make sure the data and the conclusions are valid.

Any new scientific paper published is open for checking by peer review – quite honestly it feels like no one has done this and taken the Which? report at face value.

The Which? report is nothing more then a tiny snapshot of pharmacy life on a single visit. Pharmacy does a fantastic job at providing excellent healthcare to the general public and this should not be lost in the maelstrom.

Mystery shopping is a very useful tool to provide some information as to what happens. Maybe in future mystery shopping in Pharmacy needs to have a different approach. By all means have your “test the knowledge” questions, but maybe allow the shopper to rate the approach of the staff of how they deal with all their customers – before and after them. ie an all round approach rather then just “narrow focused”.

One off situations do not give the full picture of how all pharmacy works. But if this approach is the only way forward and the sample findings of future reports are deemed to be the same.. what then.. more outcry and more beating and berating.

It’s funny, we have a book in our pharmacy – in fact ALL pharmacies have one – it’s called the “complaints book”. This is indicative of how i feel things are stacked against us. We always focus on the negative – why cant we have a “congratulations book”… The more negative we have, the more feelings of doubt we instill, the more the profession feels apathy.

It’s hard to walk upstream wading through treacle when you feel that the people connected to your profession are diverting more treacle into the mix.

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Dispensersize

DO YOU WORK IN PHARMACY?

DO YOU LIKE CAKES?

Then this work out video is for YOU

I guarantee that you will lose pounds! 39.99 to be exact!

1] Encourage people to not pay for their prescription. Give them a 30 second head start and then run after them. Great for cardio.

2] Stretch for those items on the top shelf

3] Keep making near-misses when dispensing so you have to walk back and forth to the pharmacist. A great way to increase your steps

4] If short, stand on your tiptoes so you can see over the counter. Great for your calves

5] Engage in NMS: No More Sugar

6] Do more MURS: Motivate Urself Really Severely

7] Step aerobics using the kick stool

8] Popping tablets makes your fingers stronger

Was Shakespeare a pharmacist?

@pharm112: “You are a tedious fool” = To want your 24 item script with stupid quantities done in 10 minutes.

@pharm112: “You are strangely troublesome” = Reading a handwritten script…is that four times a day or three??

@alilvshk : “Better three hours too soon than a minute too late.” If only addicts felt this way

‏@alilvshk: Hell is empty and all the devils are here. = Saturday mornings in the pharmacy

@weeneldo: Had it pleas’d heaven to try me with prescriptions… I should have found in some place of my soul a lot of patients.

@MrDispenser: For I can raise no money by vile means. = I refuse to sell homeopathic products

@MrDispenser: I dote on his very absence = I like it when my pharmacist is off

@pharm112: “For my part, it was Greek to me” = parallel imports

@pharm112: There’s not a note of mine that’s worth the noting = Dispensers near miss log.

@pharm112: There’s many a man has more hair than wit = #finasteride

@pharm112: The golden age is before us, not behind us = With regards to Nexphase…

@pharm112: The lady doth protest too much, methinks = My ACT. ‘Okay, there’s two S’s in ‘Spoonful’ so what??

@SegundemArtem : “what’s in a name? That which we call a rose…..” Try selling that after a propriety-generic switch!

@pharm112: Suspicion always haunts the guilty mind = ‘No, there’s no interactions’

@googlybear84: “All that glitters is not gold” Pointing out how ‘tacky’ that one staff member looks in her ‘Bling’

@googlybear84: “Deny thy father and refuse thy name” That rebel who refuses to be part of the system and goes rogue

@googlybear84: “My best beloved and approved friend” Sweet-talking THAT one GP who never amends their scripts

@googlybear84:”It is the green-eyed monster which doth mock” when that rival pharmacy has a sweet-as makeover
‏‏
@KevPharmacist: “Not poppy nor mandragora Nor all the drowsy syrups of the world, Shall ever medicine thee to that sweet sleep”

@googlybear84: @MrDispenser “For I ne’er saw true beauty till this night” When you have your first staff night out

@googlybear84: “Out, damned spot! out, I say!” when trying to clean that damned Methadone stain which refuses to go

@googlybear84: “I love you now; but not, till now, so much” That one patient who always, without fail, brings goodies

@MrDispenser: Listen to many, speak to a few. = follow a lot of pharmacy people on twitter but only speak to a few of them

@googlybear84: “Once more unto the breach my friends, Once more” Boss to staff upon bringing shutter up on Monday morning

@MrDispenser: Nothing can come of nothing = If you have no methadone left but your CD register disagrees

@SiobhanAbrahams: ‘Out out damn spot!’ =roaccutane

@SegundemArtem :”the course of true love never did run smooth, now azithromycin should be taken an hour before food”

@SiobhanAbrahams: ‘Tomorrow & tomorrow &tomorrow, creeps in this petty place from day to day’=we’ll collect ur repeats

@MrDispenser: Neither a borrower nor a lender be = I don’t go to your house to borrow sugar so please don’t ask to borrow tablets

@KevPharmacist: “Be not afraid of being manager. Some are born management, some achieve management, & others: management thrust upon them”

@josh6h: “He’ll is empty, and all the devils are here” = were being audited

@KevPharmacist:: “prick us do we not bleed? And wrong us shall we not be avenged?” Shylock complaining over warfarin error

@josh6h: “Expectation is the root of all heartache.” =There are no jobs left

@MrDispenser: “I’ll not budge an inch” = It’s my pen. I found it. Finders keepers.

@Pharmusician: “Neither a borrower nor a lender be” – always get a prescription first

@MrDispenser: “So wise so young, they say, do never live long” = that summer student better stop being cheeky to the staff or else

@googlybear84: “We few, we happy few, we Band Of Brothers” said the boss during Mondays inspirational speech

@SiobhanAbrahams: ‘Hubble, bubble, toil and trouble’ – making up antibiotics

@MrDispenser:’Now is the winter of our discontent’ = will you shut that door? It’s December! It’s freezing!

@a_lethal_dose: ‘it is the green eye’d monster which doth mock the meat it feeds on’ = methadone

@MrDispenser: ‘The lady doth protest too much, methinks’ = My technician is not doing as I ask

@MrDispenser: ‘What’s done cannot be done’ = Making a mistake in the CD register

@weeneldo: What’s in a name? That which we call lactulose, by any other name would smell as sweet.

@Xrayser didn’t The Bard also say “Get thee to a pharmacy”?

@Hobbesma: “to sleep perchance to dream” – got any Nytol?

@pharm112: “More of your conversation would infect my brain” = I just asked you to confirm your address, I don’t want your life story

How to annoy the rival 100 hour pharmacy

1] Ring them and ask if they have done a prescription for Hugh Jass

 

2] @dodgychemist: Tell all the local tramps that there’s somewhere warm with chairs where they can spend most of the week.

 

3] Ring every hour to see if they are open

 

4] @dodgychemist: Tell them clocks have gone back so they need to open for 101 hours this week

 

5] Send in your mum with her 15 item script at 10.59pm

 

6] @dodgychemist:  Phone and ask if they do enough items to cover their electric bills

 

7] Send your horrible patients to them

 

8] @dodgychemist:  Stick a “2 hour waiting time” notice in their window

 

9] Let pharmacy students know on Twitter and FB that if they ever need any help with coursework or any pharmacy questions then to ring the 100 hour pharmacy

 

10] @dodgychemist: When I’m bored I sometimes phone the 100 hour pharmacy and get them to order high value goods for me and promise to bring in a Rx.