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Xrayser: One in the eye for difficult customers

Fussy patients may pay the price for doubting my advice, says Xrayser

Funny things, eyes. The windows to the soul are particularly sensitive at this time of year, and many patients walk in looking like a vengeful red-eyed daemon after a particularly heavy drinking session in hell the previous night.

Ah, conjunctivitis. That rare thing – a “medical” term that most people can pronounce, and is used to mean “eye infection”. “Do you think it's hay fever or conjunctivitis?” asks a worried mum, as I try to look at her son’s eyes. Just for a moment, a little bit inside me gets excited at the chance to play doctor and make a diagnosis.

I start by taking a history from the patient – duration and severity of symptoms, any pustulant discharge or simple watering – before a spot of over-the-counter prescribing of drops and the patient is on their way.

Of course, this is also the one area where we can sell an antibiotic. Well, a bacteriostatic, but let's not get picky. Chloramphenicol was one of the most important POM-to-P moves in recent times, and one of the very few where we can actually treat a disease – albeit one that is self-limiting – that has the potential to rob someone of their sight. So for that reason, I insist on having all cases of conjunctivitis referred to me, in order that we get the right diagnosis of the underlying cause of the condition, infection or allergy.

For part of my CPD once, I tried to find pictures that showed the difference between bacterial and viral conditions. My presumption was that the discharge would define it but, like a classic CPPE multiple choice assessment, the differences were very hard to identify.

Yet still we are supposed to restrict the antibiotic drops, being the good little antibiotic guardians that we are, and this makes it all the more frustrating when people walk in asking for some chloramphenicol drops for their friend. When I decline, we get the usual, “Well the other pharmacist/pharmacy always sell it to me” – an expression only superseded in frustration by the, “I had a telephone consultation with the doctor, who told me to buy it”.

If I'm honest though, I'd rather have a stye any day. They look dramatic and are quite uncomfortable, but are a great opportunity to play the game of “upset me and it will cost you” because, after all, there’s nothing more self-limiting than a stye.

So if I get a cheery smile and a simple explanation, I'm happy to send you on your way with some free advice about a hot compress. But if you upset me, or make a fuss about such a simple condition, I will sell you every oculentum occulent I can lay my hands on, and probably try to link-sell you one of those really expensive eye sprays too – see if I don't.


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