Ward fun

While in the ward, we approached an old lady and had the following conversation:

Us: Good afternoon. We’re from the pharmacy department and we’re here to check your medicines.

Old lady: huh? Sandwich department???

______________________________________________________

Drug chart showed that doctor has prescribed a drug for OD (meaning once a day) but he circled 4 different times.

Pharmacist: Dr. Why did you do this?

Dr: I don’t know….

Me: –_-|||

______________________________________________________

Me talking to a old patient.

Me: Hi Mr X. Good afternoon. I’m from pharmacy and wondering if I could ask you a few questions.

Pt: Sorry!! You need to speak up!! I came here in a rush last night and forgot to bring my hearing aid and my teeth! (laughs)

So, not knowing how to react I nervously laugh with him as well.

Pt: Don’t laugh!! I can’t eat without my teeth.

Me (slightly louder): I’m sorry…… (oops)

______________________________________________________

And then you get sad cases such as this:

Old lady: Do i walk this way then?

Me: No Mrs Y. You need to sit by your bed.

Old lady: It’s getting dark soon and I want to be home before it gets dark.

Me: If you wait by your bed, a nurse will come and let you know when you will go home.

Old lady: My parents must be really worried about me. They probably don’t know where I am.

Me (after a pause): I’m sure they know where you are and won’t worry too much.

And then you think back and wonder whether you should’ve said what you said. And feel sad for the little old lady with dementia.

Pharmacy pre-registration troubles

During the 3^rd year in pharmacy, we are bombarded with the fact that we need to prepare to apply to various pharmacies at the end of the year for a pre-registration placement. If we have an eye on certain pharmacies, we might have to think about it even earlier as they require you to do a 3^rd year placement in order to qualify for a pre-reg. And if a place couldn't be secured before the start of 4^th year, we would need to worry about it when term starts as well.

I, for one, did not have much trouble with securing a placement, and I am thankful that I did and do not need to go through what my friends are going through. Take a friend of mine for example (let’s call her R), who has gone through a bit of tough times just to get the placement that she is finally happy with.

R did a 3^rd year placement with X pharmacy, which was a pre-requisite for a pre-reg. When she applied for her 3^rd year placement location, she did not realize that the pharmacies in the northern region actually bonded a pre-registration student for 2 years – meaning the pre-reg year plus one year as a qualified pharmacist. If you were going to break that bond, you had to pay a huge sum of money. She had her own reasons for not wanting to be bonded, so started searching for alternate arrangements by asking for advice from the university tutors, who were happy to help her in trying to find a new location.

About a month ago, she had an offer from Z pharmacy, which she had gone for an interview for during the summer (yea, long time ago), and thinking that she could not get a better location with X pharmacy, she verbally accepted the offer, not knowing what will happen next.

R heard back from X pharmacy, offering her a location that she was happy with. Whilst comparing X and Z pharmacy, she found that X was more attractive and rejected Z though email, and thought nothing more about it.

She got a call from Z pharmacy early in the morning, asking her why was she rejecting their offer. Being too honest, she told them that she had another offer from another company, with better conditions than Z. The caller from Z (let’s call her T) then said that they can still negotiate for better conditions, but R stressed that she really was rejecting their offer.

As it is too long to repeat what was being said in their conversation, I’ve decided to extract and edit what R had wrote in her blog (I feel that it’s better than she remain anonymous so excuse me if I do not put her blog address in). Below in blue is what was being discussed and in red is R’s explanation of what really happened. (“She” in the extract is T, and “I” is R)

She said I had been unprofessional because they actually sent me two offer letters since September but I took long time to reply their offer.

This isn't true because Z Pharmacy had only made an offer to me recently. I was on hold since August .

She said there were actually two offer letters but first offer letter was lost on its way. After a second check, she found out the offer was made on 10/10/2008.

T then changed topics and she said since an offer had been made on 10/10/2008, why did I take so long time to reply?

I said I had only received offer letter from them after two weeks, which was on 28/10/2008. I received offer from another company (X) after I had received offer letter from them. I took about two weeks to reply them because I needed time to make my decision. (She later found out that she only had the letter for 8 days.)

SHE SAID TWO WEEKS WAS TOO LONG TO MAKE A DECISION.

I replied her saying that I think I have the right to make decision in two weeks. Even for first round candidates, RPSGB also mentioned that they must given enough time to decide, how come I can't have that TWO WEEKS?

Fact: There wasn’t a reply-by date stated on the offer letter.

She said because of me they had to turn down other candidates.

I explain to her that I was told by her manager that the place I was offered to already have enough students and my offer was by special arrangement. So, I had taken it for granted that no other candidates are waiting for my post.

That phone conversation ruined her whole day. Imagine waking up to a call like that. She was also told that she was being unprofessional and a complaint would be submitted to the university about her. She again went for advice from her tutor and staff in the school and was told that they would support her and that Z pharmacy had no grounds to do anything to her, but to email them regarding what had happen so a response could be given if and when a complaint letter was submitted.

I would not say that my friend was totally blame-free. She was being a tad unprofessional by verbally accepting and then rejecting Z pharmacy but I would say this is due to naivety about how the world is. How can it be that they expect students who are in their last year of pharmacy, to know all about the working environment? This just discourages students when they think about having to work soon.

The caller from Z, was being unprofessional herself when she made groundless accusations. She should’ve gotten all her fact right before accusing someone else of being unprofessional.

I would like to commend the School of Pharmacy for standing by their own students first and in helping R a lot in her decisions.

Several things to take from this situation:

1. Do not give a verbal agreement if you are not sure. Tell them, “Thank you very much for the offer, but I would like several days to consider this offer.” I, for one, was very lucky as my future employer told me to go back and think about it first.
2. Be sure that you are happy with any decision you are going to make.
3. Be sure that you are able to back up your decision with valid reasons and that you can stand firm in your decision even when faced with accusations (especially when those accusations are false). This is something you would have to do when you are working.

I wish everyone the best in their applications for a pre-registration placement and may what I have told you help you in what not to do when applying. It is good to keep options open but do not respond in the affirmative when you are not sure about it.

Not fair

Our final year project titles have been allocated and I did not get what I had chosen. We each had 6 choices and I did not even get allocated to any of them. It's not fair that other people get their choices but I did not get it. Why then did they even ask us to rank our preference? It makes no sense to do that if we are going to get something that we didn't choose in the end.

Well, an upside to this is that the title I got (novel gasotransmitters) has 11 students assigned to it and half of them are friends. So I suppose doing this project won't be that boring after all if there's friends doing the same research. We can discuss about our research instead of having to do it alone.

But it is still not fair.

Success!

I finally got an offer for my pre-registration placement! It's a very early offer as placement only starts in August next year. Well, at least I do not have to worry about it while I continue on with my final year.

So, during the interview (by two different hospitals), they asked me about the recent happenings in the pharmacy world. Sad to say, the things that I have been reading about in the Pharmaceutical Journal did not get asked (well, maybe a small part) and they asked me about NICE which I did not even think to read about as preparation. So I had to be honest and said, "I'm sorry but I have not recently read NICE guidelines so I cannot tell you anything about their recent reviews." I couldn't very well talk about something that I haven't even read.

Anyway, after the very brief interview (it only went on for around 15-20 minutes), I was asked if I would accept if either of them offered me a placement, and to sign a document saying I will consider any other offers from hospitals in the West Midlands. I said yes to everything. In my mind, I found myself a desperate person who does not mind wherever I will work at in the future. I didn't think I did very well during the interview but it was a very big improvement from the first one.

But I was glad to hear from one of hospitals the next morning offering me a place. She asked me whether I would like to accept and with a bit of hmmm... I just said yes. She did say she's not going to pressure me into accepting but I did anyway. So all that's left to do is to email them formally saying I accept.

Well, it's a relief to be able to say that I have a job when I graduate. That I do not have to worry about finding one when I finish with my studies. But the thing is, where has the time gone? How is it that 3 years has flown pass so quickly that I have a glimpse of it and now I am about to start my 4th and final year tomorrow?

Hospital Pre-registration Interviews

I attended an interview on Tuesday and I can't help feeling that I did really badly at it. Considering it's the first interview I have ever attended, I guess it cannot be blamed. I just hope that the second interview which is coming up this Tuesday will be better.

Throughout the interview, I had to keep thinking about how to explain it perfectly and express myself in an appropriate way. I found myself forgetting the word that was needed in that context and then kicking myself mentally when I remember it a moment too late. I was always better at expressing myself in writing rather that verbally. Wonder if I can do an interview through messenger?

One thing about all this is that you come back thinking that you should have said this instead of that or should have elaborated more instead of just stopping where you did.

Still anxiously wondering if I can actually get a pre-registration placement in a hospital pharmacy which is what I really want. I just have to take whatever I have undergone in the last interview and improve on that for the next.

Now... all I have to do if to keep myself calm for the next interview and stop hemming and hawing when answering. I just feel that if there were clinical questions I would've been able to answer those better than the questions that were asked of me.

Quality in medicines design and usage

It's 9.15am now.. and it feels like I've been awake for ages. Trying to study for the abovementioned module which will be examined on later on. Just to test my memory, decided to test my memory on how drug development is..

Normal drug development is done in a few stages. First comes drug discovery by various methods, such as natural product sources, targeted drug design, random synthesis and high throughput screening.

Then, the chemical process development. Here, bulk quantities of the drug is produced and the most cost effective synthetic pathway is to be discovered. Then, the absorption, distribution, metabolism and excretion (ADME) or collectively the pharmacodynamics are studied. Toxicology is also being done on that chemical compound. In vitro testing on cell culture or Ames test (which tests for bacterial mutagenicity), acute toxicity, chronic toxicity, carcinogenicity, and reproductive toxicity are being done.

Then comes pharmaceutics. The form of the drug has to be determined, taking into account the physicochemical properties of the drug and aiming for an oral formulation.

Next comes the clinical trials. This is in 3 parts (or 4 including post marketing surveillance).

Phase 1: Clinical pharmacology and toxicology

This is being done in health volunteers (males age 18-45) to find out the smallest effective and highest tolerated dose. The metabolism and pharmacokinetics of the drug is being observed. Any side-effects are also recorded.

Phase 2: Clinical investigation of therapeutic effect

Assesses the bioavailability of the pilot formulations and also the therapeutic effect of the drug.

Phase 3: Full-scale therapeutic evaluation in patients

Determine the dosage form and also the regimen. The efficacy, benefit, long term tolerance, adverse side effects, contraindications and interactions with other medicines are investigated in this phase. If everything is up to par, the documents can then be sent to the appropriate regulatory agency for approval and registration (MHRA in UK).

Phase 4: Post-marketing surveillance

The drug is already sold.... more research will be done to find out - long term side effects, efficacy, toxicity, and maybe find another indication for the drug. The dosage regimen can also be optimised for better effect.

So.. will I get 100 marks for all that? Cross my fingers that this question will come out and that I can actually remember everything that I have read through.

Sorry to bore you all with all this... It just seems more fun to study this way. (I hope all my details are correct though, I kinda took all these from my notes and paraphrased them..)

Update @ 1546: it was a lousy paper... I was just writing anything and everything that came to my head and I realise that my english is getting worse.

Exam Exam Exam

2 more days! Then I'll have to tackle Pharmacy Law and Ethics...

It's so hot these days... up to 25 degrees each day! Good thing I got my mini-fan... my window is open throughout the whole day regardless of the bee that seems to like to visit my room each morning and evening to say good morning and good night.

Ok, good luck everybody with the exams. It's only 4 papers anyway, no worries... (yea, right)

The dreaded time has come....

The time of our lives has come again... exams.. We can never run away from them. They will haunt us forever and ever!!! LOL.. ok... they won't.. but it sure feels like it..

Anyway.. this time I have to tackle: Disease and the Goals of Treatment (DGT), Toxicology, Law relating to Pharmacy, Quality in Medicines Design and Usage... not forgetting Dispensing exams which I have my last session on Friday.

DGT is fine (to me anyway, others may disagree and we shall agree to disagree).. Most of the answers can be found in the BNF anyway and it's an interesting module where we learn how to apply our knowledge in a clinical setting. We get case studies and we get to solve them like puzzles.

Next there's tox.. can too much revision on toxicology be toxic to my brain? It's an ok subject, not as fun as DGT but still applicable in pharmacy like how to treat an overdose. But there is a lot of information to remember/memorize and I hate memorizing. I need a way to understand all of this.

Law is just annoying. It's an open book test, thankfully. But since there are no past papers on this, we have no idea how the questions are going to be given. why do we need to study law???? I'll just employ a lawyer...

Quality in Medicines Design and Usage is one of those modules that are not very useful unless you plan to go into the pharmaceutical industry. Teaches you all about the process of how a drug is formulated and brought into the market. And get this.... It's a one hour paper... and you need to choose one question out of three and that will give you the total of 100%!!! How and what are we supposed to write for that????? I don't see a good outcome for this for me as this is memory work. And I do not have the best memory!

Anyway.. timetable for exams:

12 May: Law relating to Pharmacy

14 May: DGT

16 May: Quality in Medicines Design and Usage

19 May: Toxicology

30 May: Home

Good luck to me! and ok ok, to all you others as well (but don't take all my luck, k? hehe... jk..)..

Dispensing

Dispensing exam today! I've been practicing really hard these few days and got it down to doing 2 sets (that's 16 prescriptions) in 2 hours...

So, today's exam had 7 prescriptions and I did all in an hour and a half... I tried doing it slower but it just seems natural to do it fast... I think it's in my nature to do things fast. Which isn't a good thing sometimes as I might miss something important..

Oh well.. one session down.. and two more to go!

More news on dispensing rights

I just read two doctors' blog on their view on the dispensing rights:

one is here and here (two posts) and to summarise it, he has given 10 reasons why pharmacist should not have exclusive dispensing rights, but from what I have read it sounds like why are pharmacist trying to act smart. Among the 10 reasons are, pharmacist want to make money, there are no 24-hour pharmacy and pharmacist keep trying to be better than doctors. Can't they give a new reason cuz this is getting old? (BTW, I noticed something in his post. He said that he wrote a prescription for his sister to buy something. Correct me if I'm wrong but, I thought you shouldn't treat your own family? If I'm wrong, I'm sorry)

Another is here, here and here ( a three-part series) in retaliation to the above person.

Mind this, both are doctors. I do not know where the first one was educated in but the second graduated and worked in a developed country before.. see how different their views are?

Ok, so far I've read doctors comments and doctors blogs... Anybody know any Malaysian pharmacist blogging about this topic?