Why do patients seem to hate being asked questions when buying OTC products, when you're only asking them as a precaution to protect their own health?

I’ve mentioned the importance of gauging OTC requests in a previous rant - sorry, I mean blog - but it can sometimes actually be the patient's fault if an unsuitable recommendation is made. Only today did a lady come in and ask the counter assistant for some One-A-Night Nytol. The counter assistant asked the relevant questions (or, more correctly, tried to ask the relevant questions) but was cut off mid-sentence each time, with "Oh, I always use it!", "Yes, yes it's fine", "I've used it for years and years", etc... 

I interrupted the conversation with my recommendation for her to maybe speak to her GP about her sleeplessness since she has the tablets “all the time". She then claimed she had only meant to express that she has used them before and did not want to be quizzed further and did not use them often...Hmmm.

I appreciate that if you do something regularly it may be irritating to hear precautionary questions each time, but we do it for other things with no qualms, so why not when buying medicine? For example, when checking in to a flight you could have had your Gran pack your bag as far as they're concerned but you still make a conscious effort to fully listen to and understand the importance of the questions being asked. Nobody likes to hear the same old questions but you comply and answer them correctly, understanding it is for your own safety.

Could you imagine if the next time you took a flight your questions and answers with the check-in assistant followed the same lines as some OTC sales?
“And have you packed your bags yourself?”
“Yeah, yeah, yeah"
“And are you carrying any dangero...”
“Yeah, yeah, yeah, I regularly travel thanks”
“Has anybody given you anything to hol...”
“No need to ask, I know what I'm doing thanks” etc.
It just wouldn’t wash! You’d probably end up in a hidden room with a cavity search!

But anyway, back to pharmacy, my point is that questions asked to the public when buying P medicines are probably some of the most important questions they'll face, yet a significant number really do not want to hear them or they lie, and that may prevent us from correctly gauging any possible interactions or dangers.

Having just got back from a stag weekend in Valencia, I realised just how easy it can be to purchase POM medicines in other countries.

I have come across quite a few people while working in pharmacies who have bought medication abroad on holiday after feeling ill or suffering pain and wanted to buy more upon returning to the UK, only to have me tell them they're only available on prescription.

My friend who suffers from pretty bad hayfever usually has Telfast (fexofenadine) prescribed in the UK. Having left it here (obviously prioritising his sunglasses and Resolve over his prescribed medication), his allergies flared up when we got there. I went with him to the local pharmacy to see what 'emergency supply' they could help with, but instead, with no hesitation whatsoever (almost as if buying a box of tissues), they let him have the Telfast.

I put it partly down to luck that he didn't have much trouble in obtaining it. After a night out, however, he lost that box! We had to then go to another pharmacy the following day and it seemed we were 'lucky' again - the pharmacist just asked what strength, then fetched it from the dispensary and handed it over.

I'm not sure whether it was pot luck twice or whether it really was that easy to obtain POM medicines abroad? Thinking back, maybe I should've bought some Tamiflu out there!

A lady came in to the pharmacy today and asked the counter assistant whether she could talk to me about swine flu. She looked deeply concerned but not, as I later found out, for herself but for her dog. Yes, her dog.

She explained to me that she was very worried that her dog may contract the infectious disease and wanted to give it something to boost its immune system. It’s the kind of thing someone says when pulling your leg, but she was serious.

I was speechless. Swine flu has caused enough commotion, but could you imagine if there was a sudden emergence of ‘dog flu’ too! Anyway, explaining that it was very unlikely (bordering on impossible) for her dog to contract swine flu any time soon, I eased her concerns.

Here in the UK, as I type we have 68 confirmed cases of the infamous swine flu out of a 61,000,000 population. I know on a global scale it is a pretty serious infection, but here in the UK, nobody has died from it and many have recovered without any need for medication.

In fact, given the current stats, you’re more likely to die from being struck by a meteorite than you are from swine flu, yet I am constantly asked if the pharmacy has any face masks or Tamiflu for sale. Every pharmacy I have recently worked in seemed to have sold out of these masks but I’m yet to see anybody wearing one on the street…who is hoarding them??

Personally I feel the new Department of Health’s message for the public should : catch it, bin it, kill it and calm down.

Every month seems to bring with it another restriction on selling products to children. Products that have been on the market for years but are then suddenly restricted because of 'safety issues'.

I have found that explaining the reasons to a concerned and/or angry mother is not an easy task. No matter which pharmacy I am in, I'm sure to find a parent wanting to buy something for their child that has now been restricted, whether it’s Medised, CalCold, Tixylix or Benylin for Children.

The reason I bring this up is because only last week we had the largest age restriction increase – for Bonjela! One mother had come in to buy some Bonjela for her 11-month-old baby daughter after the restriction alert. She claimed that she had used it on her son two years ago when he was only 6 months old (which was OK, since its licence up until last week was for anybody above the age of 4 months).

I had to inform her that the minimum age restriction had now been moved up from 4 months to 16 years because of safety concerns. "16!!" she exclaimed in disbelief. How can you truly justify this decision (which appears to be an afterthought) to a parent who has been using the product on their 6-month-old baby up until now?

Last year, during my pre-reg year, I remember a bulletin that came out restricting Medised (originally for babies of 3 months plus, being increased to only use in children over 2 years old). A mother had come in and asked for Medised for her baby, whom she'd being giving it to for cold symptoms since it was 3 months old.

We then had to inform her that we could no longer sell it to her for that baby nor should she give it until they were at least two years old. She was quite angry that these 'tests' and 'safety risks' had not been concluded beforehand, and was deeply concerned for her baby's health.

My tutor tried to explain but the mother (understandably) wasn’t willing to accept or forgive the fact that these safety concerns were not sorted out prior to marketing the product. She also felt the manufacturers had not given sufficient reassurances after the changes had been made and left very irate.

I wouldn't want to have been the person that told her this year that she can no longer use it for that same child until they are now 6 years old!

I received a prescription last week for amoxicillin 500mg (Take ONE capsule FOUR times a day, an hour BEFORE food). It was for a middle-aged male patient who had a typical chesty cough and was on no other medication.

As, I am sure, other pharmacists out there would, I recognised this as a common flucloxacillin/phenoxymethylpenicillin dose as opposed to one for amoxicillin, especially since it does not need to be taken on an empty stomach and has a licensed maximum dose of ‘500mg x three times daily’.

Although I knew this dose would probably not cause harm to the patient but, because it is unlicensed, I thought to call the doctor for confirmation. I thought I was merely being helpful just in case the dose was not intended for amoxicillin, therefore giving the prescriber a chance to alter the dose if need be, before being dispensed.

Upon calling the surgery, the receptionist filled the doctor in on my query and transferred me through. I explained to the doctor that I just wanted to check he was happy with the dose prescribed to which he replied: “Well that’s what it says on the prescription doesn’t it…?”

I explained that the dosage interval and direction ‘before food’ seemed like a clue that it may not have been intended for amoxicillin, to which I was told: “All antibiotics work better on an empty stomach; why don’t pharmacists just dispense what is being asked?”

Of course I was a little taken back but it was only after the conversation had ended that I got irate thinking about my intentions and the responses I was given - a little cooperation and a little less arrogance would not have gone astray!

It just seems that in community pharmacy this hierarchy difference between doctors and pharmacists is more apparent. When I temporarily worked within the hospital sector, there seemed more of a sense that doctors were acknowledged as being experts in diagnosis/prognosis and pharmacists as experts in medicines. They worked together to give the best patient treatment. The doctors asked the pharmacists what medicine to prescribe for that certain diagnosis.

However, in community it seems like the doctors are the best in both fields and perhaps the pharmacist is best used simply as the safety net if an overdose/erroneous dose slips through?

Good luck to all those who entered this year's C+D awards! I am judging the Pre-Reg of the Year entries this week, so if you're in that category, you still have time to send me your cash before I make any decisions. I accept BACS, CHAPS or cheque...

Shame I won't be holding this 'Pre-Reg of the Year' title for much longer!

A small observation I've made while working in various pharmacies (which makes me laugh more than anything) is the universal waiting time for all prescriptions as quoted by counter staff.

Whether it's a pharmacy in Southampton or London, a small independent or multiple, the phrase "oh, that will be 5 to 10 minutes" is ubiquitous. Without knowing pack sizes, which drugs are in special containers and so forth, you’d expect them to ask how long it will take, before informing the patient that "it will take 5 to 10 minutes".

You’d really be surprised as to how many times I’ve experienced this in different pharmacies - whether it is a single item or a whole page, it seems that it will still take 5 to 10minutes.

However, in their defence, I believe that it is because giving a processing time of anything longer would upset the patient, and this leads me on to what really bothers me, which is when patients tell ME how long it will take!

I’m not talking about the "oh, it’s just an inhaler so it won’t take you a minute" (regardless of how many prescriptions may be ahead of them) patients, but the ones who give you a time limit. They patiently wait in the surgery to see the doctor, patiently wait for their repeat slip to turn into a prescription and then patiently wait to collect their prescription in the surgery queue, but as soon as they enter the pharmacy it turns into the Crystal Maze! Waiting more than 5 minutes in a pharmacy will surely lead them to be locked in!

This story is God’s honest truth and if the staff at this particular pharmacy are reading this, they’ll no doubt remember. One middle-aged lady brought in a prescription for a few items, nothing major, the usual fast-movers. However, it was 4:30pm and extremely busy and herds of people were waiting for their prescriptions. The pharmacy looked like an auction hall. I informed her that it would take around 25 to 30 minutes before being able to process her prescription and recommended that she come back. She refused to believe me and told me that I was wrong and that it would not take that long. With a smile I assured her it would definitely take more than 20 minutes judging by the queue, but she still refused believe me (as if she’d be coming into the dispensary to dispense it herself).

Ultimately, it did take 25 minutes :) Aaah the joys of being right.

Why can't prepared and bagged up prescriptions be given out when the pharmacist is on lunch??

It seems a pharmacist can work a 12-hour shift and not have a proper break, while other staff that work fewer hours are entitled to two half-hour breaks. Even when you're eating, managers can still insist that you come out to check prescriptions or answer to patient queries, which can mean you don't even sit down for more than two minutes before getting up again to work.

Obviously, I understand that it is our duty to be available to assist with queries and prescriptions during opening hours and that PCTs specify the hours for which full pharmacy services should be operating from a pharmacy, but don't pharmacists need a sufficient break? After all, the patients who moan that they shouldn't have to wait for a pharmacist to finish a break would be the first to complain if a mistake was caused due to a lack of one.

I remember a day last year, when I was still a pre-reg, my tutor had popped out to grab some lunch when a patient returned to collect their prescription. They had been in the day before at the same time (between 1-2pm) and was again given the answer that a pharmacist needed to be on the premises for the prescription to be given out, even though it was waiting on the shelf. The patient replied: "but the pharmacist had lunch yesterday"!

The reply obviously annoyed me, as pharmacists also deserve breaks, but it was also slightly irritating that even if my tutor was on the premises, the prescription would have been handed out by counter-staff with no extra re-checks by the pharmacist anyway.

I know I've blended two rants here, but both the lunch break and handing out of prescriptions are closely tied issues. Does anyone else share my thoughts or am I just being cranky after not having a sufficient lunch?

I don't know about anyone else, but did last week seem busier than ever?! Usually during half term things quieten down slightly. My theory is that the recession has prevented people going away on short breaks and holidays this year...

I managed to infuriate a difficult patient today. She had handed in a three page prescription (which she insisted on waiting for) and was told the waiting time would be approximately 10-15 minutes by the counter-staff - the norm I’d say for such a large waiting script.

Anyway, stock was taken out, correct quantities made up and labelled. But this takes time and meanwhile another patient had come in with a one item prescription for 100 x paracetamol tablets. The dispenser picked it off the shelf, labelled the box and gave it to me to check, which took no time, especially since I knew it was a repeat item. This was obviously given out fairly quickly, but the first waiting patient seemed to think this was utterly unfair!

I wonder if, when she’s standing in McDonalds, she would complain if her massive family-feast order was given out later than a second customer’s one cheeseburger order?? Who else agrees with what I chose to do? Who believes the dispensed prescription for the paracetamol should have been kept waiting on the side, already checked, just to be given out after the first had been completed, no matter how long it took...?

As I sipped my first cup of tea of the day, preparing for the usual work ahead, little did I know this day was going to be anything other than average!

It turns out the police had called the pharmacy minutes beforehand, explaining that they were trying to locate one of our regular patients in connection with a serious crime. They requested that we try and keep the patient busy in the pharmacy so they could hurry down and make an arrest.

We waited and waited and finally at around 4pm, the suspect arrived. I asked the patient to wait in the consultation room while I prepared their meds. The dispenser began the mission and called the police. After exhausting all possible excuses for further delay, I entered the consultation room and supervised the patient’s consumption. Further procrastination killed a few more minutes, but that was all that was needed, as I saw two police cars pull up outside, through the blinds, and one officer rush out. Unfortunately, so did the suspect.

The patient bolted like a greyhound! Like something out of the A-Team, the scene was chaotic! After treading on my foot (which I wasn’t impressed with), the suspect ran out into the dispensary knocking over ALL the stock that had arrived in the afternoon order (and which had been neatly piled on the side) and made for the back door, amid shouts off: “I ain’t done nothing.” It was hard not to acknowledge the amusing double-negative, but I don’t think the police shared the same view.

Anyway, after a frantic police chase around the car park, they finally got their suspect. Who would want to resume checking dosette boxes after that?!

Did anybody see C+D’s previous opinion poll on making the contraceptive pill available as a P medicine? Around half the votes opposed the proposal and I just wanted to know why so many people were against it?

After all, making ‘The Pill’ a P medicine would not mean it would be available OTC just as easily as purchasing a pack of Nurofen - it would be through the pharmacist, just as Levonelle is currently.

Since the C+D site is probably accessed primarily by pharmacists, pharmacy staff and other members of the pharmacy profession, it was surprising to see so many people against it. Surely it is a good idea to reduce GP appointments of women simply wanting to obtain a prescription for contraception when pharmacists today are in just as good a position to advise on appropriate contraception and ‘pills’, especially when enhanced with any further training. This would create further accessibility to GPs for patients with other medical conditions or concerns.

I had expected the poll to conclude with around 75% in favour and 25% against, but this was not the case. In fact for many days those against the proposal were in the majority. What aspect of this pharmacy service is being perceived negatively?

Rumour has it pharmacy multiples are feeling panicked over Saturday 27th December. The date sits nicely between two national holidays and a restful Sunday 28th December. I think the thought of how many people will call in 'sick', on top of those who may actually still be hungover after a very merry Christmas, is making the big companies feel a little nauseous themselves. So locums, be ready for your phone calls!

This obviously links in with government’s plan to change the current system from needing to obtain a doctor's note to confirm you are unfit to work, in a case of illness, with a proposal for having to get a doctor's note to show that you are fit enough to continue to go to work, or indeed work from home in some instances. Anyone got any ideas how this will affect pharmacy?

I am increasingly beginning to realise that sometimes being a ‘bad’ pharmacist can indirectly be a factor in whether support staff regard you as a good locum.

My statement can be explained through examples I've heard about in talking to other locums. Apparently, there have been occasions where staff were happier if the locum DIDN'T ask for certain things. For example: requesting child-resistant caps for all antibiotic bottles; labels with directions placed onto tubes of cream rather than boxes; and even verifying ID and asking for a request letter when a methadone patient wishes to collect their partner's methadone installment along with theirs.

In my own experience, there have definitely been times when I felt pressured to ignore proper procedures in order to maintain rapport with staff and, ultimately, feel more confident of being hired again!

Do any other pharmacists have any thoughts on this, or do any support staff want to share their views?

Things seem to be going from bad to worse. Today, a gentleman came in the pharmacy to buy something for his cold. He requested Day & Night nurse. I was luckily listening to the counter staff’s conversation, where she asked whether he had taken it before, and he replied "yes, once", so she was happy. She then began tilling up one packet of Day Nurse, one packet of Night Nurse and a capsule pack of Day & Night Nurse. I stepped in explaining to the gentleman that he was not allowed to buy them all in one go, and routinely questioned what medication he was on. I discovered he was taking 5 different blood-pressure lowering tablets!

Now this sort of thing is undoubtedly occurring across the country in various pharmacies, where counter staff may need extra instructions on sales of P medicines and further training on interactions. The Which? report that was published on this topic and a centre-page spread I read in a newspaper two weeks ago - 'Can you trust your Pharmacist?' - is sending the wrong message to the public. A more understandable title could have been: 'Can you trust your Pharmacy?'. The point I’m making here is that more research needs to be done on WHO was asked when these random studies were being carried out. If the pharmacist was actually asked personally, would the results have been the same? If these inspectors went into surgeries and began giving medical queries to the receptionists, would they go back and write an account from the answers with reports titled 'Can you trust your Doctor?'

A few days ago I went to an unfamiliar pharmacy near Portsmouth. After sitting in almost endless Monday morning traffic, I finally arrived. I parked the car and made my way to the pharmacy only to be welcomed by a seagull or some other kind of massive bird (possibly genetically modified), which decided to lay its excrement on my head!

Introducing myself with faeces on my ear, I swiftly headed for the sink to clean it off. 9:10am – only 10 minutes in and I could tell things were not going to end well for me – probably just what Chelsea must’ve felt a couple of Sundays ago. Anyway, the dispenser welcomed me to the most amount of methadone scripts I have ever seen. Though weekly-dispensing, they were all coming in to collect today.

The first supervised patient arrived, I dispensed the methadone and took it into the consultation room where I asked the patient to confirm his address. He stared blankly for a good 15 seconds before remembering it. Dubious, I asked for extra ID, which checked out. Half way through drinking the methadone he started laughing uncontrollably, spewing a green mist onto my face, white shirt and tie!! He claimed he found it funny that he’d initially forgotten his address. I didn’t say a word. I opened the door for him, wiped it out off my forehead and headed back to the sink to clean myself up...again. I’m glad the staff managed to see a funny side to this saga...

A lot of my pharmacist friends who live outside London are always asking me about locum rates in the City. The truth is, unlike most other industries, the hourly rate for a locum pharmacist seems to be much less within Greater London due to large supply of pharmacists living within the M25.

I know the C+D have done a survey on locum salaries, but they forgot to mention a key factor influencing rates - locum agencies! Most, if not all, locums sign up to a variety of agencies to ensure they get as many available offers as possible across a wider area. However, what they may not realise is the financial motives for some locum agencies compared with others.

It can be in the best interest for some agencies to provide the locum with the lowest possible rate they would accept. This allows the agency to take the difference between the locum’s minimum acceptable rate and what is actually offered by the pharmacy contractor as their agency commission. This makes it free for the contractors to use the agency to book locums, and therefore more favourable.

Other agencies work by charging a fixed amount to the contractor for placing a booking, and therefore work to get the locum the best possible rate, as it would not cut into their commission scheme.

I use different agencies. My personal favourite have demonstrated that they work to get me the best rate offered, as my rate does not affect their commission. I know this because I had two offers for working in the same pharmacy for the next day as emergency cover and one agency, which I will not name, informed me that the best possible rate the contractor was offering was £23/hour, whereas my preferred agency informed me at the same time that the contractor was actually offering £27/hour.

So it is prudent to recognise the fact that differences between agency commission schemes exist; one may provide you with more offers with lower rates, as it favours contractors, whereas others may provide fewer offers but with higher rates.

I've now been qualified for just under two months. I've been locuming for various pharmacies, ranging from small independent village ones to the Harrods Pharmacy, Knightsbridge. My advice to those awaiting their results, after sitting the September Pre-reg exam, is not to be scared from doing the same due to lack of experience; the training year prepares us well. The different computer systems aren't hard to grasp either, and can be picked up pretty quickly. I've loved seeing various pharmacies and meeting new people daily!

It may look like I'm glorifying locuming, but if you are newly qualified, have an outgoing personality and relish no day being the same, then I think you should go for it before settling down as a permanent pharmacist. This was the advice a newly qualified locum pharmacist named Shelina gave me whilst I was a pre-reg at Biggin Hill and I thank her for it, as I was very reluctant to believe anyone who was newly qualified could be "thrown in the deep end". Oh, and the money's not too bad either! But there are always two sides to a coin, so please feel free to reply and share your own views.

p.s. Just a quick thank you to Fernando Torres for a 3-2 victory over the weekend.

Let me start by introducing myself. Five years ago I decided to study Pharmacy at the University of Manchester, partly for the diverse modules it offered but more so to fly the Liverpool FC flag high in the heart of the City.

After four years and recently finishing my pre-registration year with Day Lewis, I am now a fully qualified pharmacist. I was awarded the ‘Pre-Registration Pharmacist of the Year 2008’ by C+D this year, which some say had to have been the result of a few bribes, but I still refuse to comment!

Anyway, as a result, the editors have asked whether I would be interested in writing this new blog. So, what is it about? Well, C+D has introduced the blog to ideally be aimed at younger, new-age pharmacists and pre-registration pharmacists - those of us who don't just poke at the keyboard with our index fingers to type.

As the website continually expands and online readers are steadily increasing, it will be a good way to get new pharmacists involved and to contribute their opinions, which you cannot do so easily through the magazine.

I will be sharing my personal thoughts, views and experiences with you as I progress as a pharmacist, with the aim of encouraging readers to get involved and offer their own views. I am still looking for a good sign off, so all suggestions welcome!

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