Friday, September 26, 2008

What is the different between doc and pharm?

John Updike (a patient himself) once wrote, " I am silvery, scaly. Puddles of flakes form wherever I rest my flesh. Lusty, though we are loathsome to love. Keen-sighted, though we hate to look upon ourselves. The name of the disease, spiritually speaking, is Humiliation". (Fitzpatrick)
My patient was very upset today, so did I. He had a severe flare of his skin condition.

My heart sank because at the beginning of the consultation, he just threw all his anger toward me. But, why me? What was my fault?

I was upset because, I had already tried my best to help him, but there were lot of things beyond my control.

He is a young man, just began to have his business expanding, opening second branch of his shop. He has a lot of commitment at home and in his business, in addition to his whole live burden having to have an incurable skin disease.

Sometimes, I tried too to understand the reason when he could not keep up to his appointment.
His disease was well controlled on regular topical treatment.

However, one of the reasons he had worsening of his skin condition because he did not get enough topical cream that he was supposed to get.

The pharmacy had run short of that cream for the past 1 month and I was still wondering what took them 1 month that long, yet the supply problem was not sorted out.

To make matter worse, he could not source those cream from the private pharmacies as none of them in this region had it.

This man was so emotional today. He expressed how embarrassed he felt till he dared not meet his customers for the past one week.

Judging from his skin condition I could not dare imaging how his social life has been, with all those red and angry lesions and flakes all over the house and the bed.

So, basically I spent most of the time trying to explain the reason why the pharmacy could not provide the exact amount as I wanted him to get.

There were lot of things really beyond my control.

So my job was to prescribe and it was the pharmacist's job to dispense.

What can a doctor do when he has the gun but he has no bullets? The bullets are with the pharmacists.

Sometimes, how I felt the patient should strip in front of the pharmacists and beg them to see how extensive his skin lesions were and at least, they were more compassionate to consider giving him enough supply as prescribed.

So, you see, the difference between the doc and the pharm is, whenever a patient is angry or frustrated due to matters not of the doc's will, the doc has to basically "swallow the dead cat".

This is because pharmacies don't see patients as the way doctors see them as.

P/S: Sorry, this post is not intentionally meant to 'step' on pharmacists, but if you feel offended, then, sorry.


Anonymous said...

The difference is some Dr is lame and they blame others (pharmacist) when they can't treat their patient. Pharmacist can't produce cream out of nowhere without the supply (which you like to call as bullets) from the manufacturer

Cytusm said...

Dear anonymous,

Isn't the pharmacist's job to ensure that the bullets are well stocked? If one can't find from one manufacturer, go find another. Also, isn't the duty of the pharmacist to dispense according to what was written in the prescription, including the correct dosage and amount? So what are pharmacists been trained for? Storekeeper or even not?

Anonymous said...

This is called inefficiency on the part of the pharmacists. They are professionals and should understand the need and take the initiative to ensure that the stocks are enough. But as they do not deal direct with the patients, they do not understand their predicament, sufferings or the urgency of the treatment needed.

If the patient is one of their loved ones, see how quickly they will go over the hills to get the medicines.

Anonymous said...

To see that all medicines are well stocked up, yes , that is the responsibility of the pharmacists. But sometimes, even suppliers of those medicines have no stock and to order those same med from others need approval from orang atas, which of course takes time.
Some patients do not follow the direction of use of the med , esp if it is a cream. Let me give you an example of my patient who was prescribed a certain steroid cream and was instructed to apply it thinly over the affected area once daily. He was given 1 oz, which if used correctly, should be able to cover the whole body. In his case, he finished the cream in less than a week, and the cream was supposed to last him a month. So he came back complaining that he was not given enough of the med.My MO that time, straight away blamed the pharmacist, saying the pt was not given the correct amount.
What I am saying is, we are all human. And we make mistakes. If only there is a better communications between docs and pharmacists, a lot of misunderstandings can be straighten out.
Oh sorry , have I gone out of topic here? :)

Mark said...

Dear cytusm,

First of all, I regret that your patient had to go through such difficulties. No one should have to go through that kind of problem.

But on to the topic. Assuming the problem is due to the fact that there are no more supplies and NOT because a pharmacist refused to dispense the medication, then it is unfair to immediately blame the pharmacy. In many hospitals, creams like that are obtained from the central supplier as they are not made via compounding by ourselves. With the government procurement policy essentially being a monopoly by a certain company, there can often be problems if that particular supplier has had a problem with their manufacturing or logistic capabilities. As an end result, the government hospitals suffer. In situations like that, many pharmacists actually use their own departmental petty cash to procure the drug privately for the sake of the patient. Unfortunately for your patient, the drug wasn't available anywhere else.

This is an unfortunate combination of circumstances. I would like to believe that the pharmacists in your hospital did everything in their power to procure it, but the sad fact is that in many cases our hands are tied. However, I'd like to point out that occasionally shortages in medicines are also caused by irresponsible prescribing by doctors. While doctors prescribe the drugs according to their will, it is often a headache for pharmacists to figure out how to balance budgeting, storage space as well as current and future supplies.

I would like to emphasize this once again, as our professionalism was questioned by an earlier commenter: If the healthcare system is that you can only buy from ONE supplier and that supplier has a problem with supplying you with that drug and try as you might, you cannot procure that drug anywhere else...frankly speaking there is nothing much to be done except to apologize profusely to the patient.

Fat4 said...

I cannot believe you are still harping on the pharmacist issue? You have left my last discussion with you hanging. God knows if you have the balls to be so "holy superior", you would at least defend yourself. Your discussion against pharmacists are getting more and more absurb with you having ZERO, yes a BIG ZERO knowledge of how pharmaceutical industry in Malaysia works. It sucks. Because the essential issue of dispensing separation is not given, there will never be a "good" pharmacy.

Come on, you India-trained doctor, the more you post on this topic, the more I will react against India-trained doctor. My take to you is to shut your bloody mouth so that you do not hurt the integrity of doctors. I hate it when people like you spoil the good names of doctors. SHUT THE ***** UP!

Cytusm said...

Dear Mark,

Thanks for the comments. I think many pharmacists (or even some pseudopharmacist) are very angry with me now, judging from the comments over here.

Anyway, this is just a piece of personal ranting, especially my disappointment about how the dispensing system is happening in the government hospitals.

As far as I am concern, I am already seeing so many patients in the clinic, and the last thing I want to get involved, is the dispensing problems.

When the dispensing job is with the pharmacists, it is their duties to make sure the adequacy of the supply, in whatever way they can source. It is not the physician's problem.

Communication is very important. When the physician prescribe, the dispensing pharmacist has to respect the prescription.

If there is disagreement, the first thing is to communicate and clarify.

When I said, 'pharmacists don't see patients the way doctors seen them as', I meant, pharmacists sometimes don't understand how severe the patients' condition can be, because they don't examine patients.

Sometimes, there should be exemption. When I personally called and spoke directly to the pharmacist in-charge regarding the severity of my patient, and he be exempted, my plea was ignored.

I am not insulting any profession in particular, but I am just highlighting some problems we are facing sometimes, and try to solve things through discussions.

Cytusm said...

Dear Fat4,

Thanks for putting comments here. I feel no compel to answer you.

Nevertheless, ....

This is still an open public blog (at the moment), and there is only a small circle of readers.

I am not trying to gain popularity over here, and I certainly do not need the publicity in your blog.

I am just sharing my experience about some unfortunate encounters I faced in the daily practice.

I may be right, I may be wrong, and I hope to find solution through discussion.

You may disagree with me in many things, and I would appreciate your constructive comments or criticisms.

By shouting profanity over here, and in your blog, will not make thing better.

I will continue to write about what I feel I want to write.

Mark said...

Dear Cystum,

Thanks for the reply.

Looking at the big picture, I think we generally agree that the entire system is screwed up and really, our two professions need to meet in the middle and start to talk.

Here's to a better working relationship.


Fat4 said...

I really sense that you are totally lost at this discussion. Now that you have upgraded me from "pharmacist" to "pseudopharmacist", I don't know if i should be happy or not? You cannot imagine one of the docs would screw you so badly? But with your massive egoistic attitude, I find that I will continue writing against you should you continue writing against the profession of pharmacists since you have point out I have vested interest in them.

For starters, I only did not shout any profanity here. Once again, you must have been blinded by god knows what. I write how I like on my own blog, but I do reserve some common courtesy elsewhere. Here you are, DEFAMING me. Last I heard, people can claim defamation if wrongly accused.

The biggest problem of the whole issue is your refusal to even acknowledge your alma mater. How bad can that be? Are you ashame of it? Or what? Just like how you like to tag pharmacists to be some form of second class citizen in the medical fraternity, I will tag all Indian grads doctors far worst than pharmacists. Why? At least pharmacists dare to admit where they graduate from. But not you. Why?

So unless you decided on this blog to stop bad mouthing pharmacists, continue to receive the wrath of my posts every now and then. And for the medical aggregator that continues to publish links to your posts (that idiot doesn't publish links to my posts against you), I will also give it its fair share of tongue lashing.

So what will i be next now that I am a pseudopharmacist?

Anonymous said...

Why the doctors always think they are the only one who cares for the patients?No matter is a pharmacist, nurse or doctor, we all are healthcare providers. Our aim is the same that is to optimize patients health. Why do you think the pharmacist unable to give sufficient medication to the patients and require the patients to come back so frequent?Because the pharmacists are too free?. It is because budget problem. We are lack of money. Thanks to the doctors. Many MO and HO are prescribing medication which only can be given by the specialist!!Please be clear that some of the medication are beyond your power to prescribe!!!Do you all understand?With limited budget, pharmacists have to supply medication for 1500 patient per day.This is a government hospital. Please be clear of the situation before you give comments. tq

Anonymous said...

First of all i'm very sorry about your patient. But i CANT BELIEVE you are just so naive and entertain your patient without thinking properly!!! Please read something about government medicine procurement system before you explain to patient. Don't mislead your patient and follow their feelings.
I want to emphasize that Pharmacy is not a supermarket! We cant simply top up our stock by just order from anywhere.... It's always come in a system. You know what is system?