This week

Verli busy and tired, got a few headaches here and there. Photophobia, need ice pack on cheek for sinusitis.

Got another clinic round with our HRT clinical prof together with a dermatologist. One patient got bonus pharmacist-in-training and dermatologist with her HRT visit.

Never knew women can put on weight once they are off HRT. Saw some bone benefits with early intervention in women in perimenopause. Also saw some cases where patients trust the newspaper reports more than the doctor.

Next monday will be sitting for a UG clinic with the "Just let it come out and give it a name" doctor. Hope it would fun - was told that he rather frank with patients and enjoys potong potong.

Perhaps if possible, I can also pop in for the a round of pediatric endocrinology - now dunno which doc yet - may be the MP (lidat must seal my political thoughts).

After this week can wake up a little later as I start my emergency pharmacy rounds for one week hengz.

Yyyy I still having so many patients during 7th month?! My throat wanna die liaoz. Then one PT tell me that the latter half of 7th month more suay so they come first.

Got a few polypharmacy cases picked out last week - even within the hospital (patient seeing a couple of docs at one shot). Another one with very high BP wan go for AHM w/o telling doctor - nearly went on my knees to tell her to rest first. Got a few cases of underdose with MDI picked out as well. But then hor, it takes a long time to get patients to reveal these nonsense in order for me to dose them and counsel them correctly. My TKN will kill me for waiting time soon. So how now? Fast brief service or slightly more time consuming but more complete service?

Sometimes dun like docs interupting my counselling with another patient and telling me "I know how to take my medicine, just give it to me" machiam I bang open your door and say "I know what's wrong with me, just give me my prescription."

Went out with my Maple khakis to Ichiban Sushi @PS for makan on Friday night - realised the standard now dropping - very fast. Perhaps it's time to switch to another restaurant. Soo many people going NIE to find job - the market seems baaaad.

I really hope the other ministers could be like our CJ - increase the pay of the professionals to make them stay and practise correctly. Everytime my pharmacy admin see the falling numbers of pharmacists, she shakes her head and sigh.

<3 doc who listens to pharmacist for drug therapy. I think all the docs should concentrate on diagnosis - get the diagnosis right rather than rack brain to think of appropriate drug therapy for wrong diagnosis - let me handle the pharmacotherapy.

This month the AJOS people have a bumper crop of flowers -http://www.orchid.or.jp/orchid/people/walke/AJOS2007-08.html - verli swee.

My bathiorum

Verli led led

What the Missies got for Missy's Day

Now the wards and the SOC counters semi-plagued with AVs

Cattleya intermedia

Another couple of JO's plants

var. aquinii



Then the blue blue var coerulea (how come colour neber come out one har?)

Cynoches barthiorum

Wah liao ehz! 35 flowers. JO's bat crap fertiliser should be a banned steroid.





Mine from Jumbo oni got 5 flowers but I cheated by placing the plant in my office to allow the flower size and colour develop fully. Today open red red - need to bring camera on Monday to snap. And no CT, the plant is mine!!! Grow your herrenhausum sui sui first hor.

Or Horrrrr tell donor wrong thing!

I've donated my 33rd time today in a very crowded HSA. Got some special event were the Burd Bank was celebrating it's birthday. The lunch time horde was fed by the Vegetarian Society of Singapore. Neber asked them if they are paeso, lacto, ovo or vegan. I'm a meatarian - eating there was against my religion. Also neber met ah kwan there also.

Anywayz, my eyes opened big big when one missy tell patients to take iron before food. Then I check what was printed on the iron tablet packet was really take before food. I neber took their iron supplements before (for the obvious reasons - male and a weekly diet of BCM), so neber realised until today. The Staff told me the advice from the Doc was take between meals and with juice - orange juice best.

Patients when they see take before food: to them means to take on empty stomach. Neber eat food after that neber mind. Lidat, I confirm you doing Taiji Quan on the royal throne for a nong nong time. Imagine euu do this 3x a year or more - self penetration (trans into Mandarin plox) will confirm happen one and when happen, will be happening.

Donors' compliance most important if not all medicine in times of need become poison when taken the wrong way w/o pharmacist advice.

Anyway here's OJ's advice for Fe Fumarate:

- Take with or after food. If got stomach irritation, do the latter
- Take with vitamin C or vitamin C rich foods to increase absorption
- Drink more water
- The key is that the more Fe you absorb, the less constipation you have
- If you on an empty stomach, the chances is the Fe2+ becomes Fe3+ and ur body won't be able to absorb and you get your constipation resulting.
- Your crap come out brack coror neber mind but should return to normal coror once you finished the course
- Come back for your next donation when you are ready and have a nice day.

"I'm a doctor"/"I'm a nurse"

Well, it doesn't tell me that you can do a grab and go. It tells me that I can use jargon during my drug counselling.

It's my responsibility to do drug counselling and I appreciate that the other medical professions accept that. Unless you are doing some abusive bulk buy to lug overseas, I'll find it pointless to do drug counselling as how much can you remember from a list of 10+ drugs?

A lot of pharmacists are doing a "so since you are a nurse/doctor, so you know how to take your medicine hor?" Lidat, aren't they relieving themselves of the duties of a pharmacist? We educate patients - if we allow grab and go-es, won't patients want that too? It really brings the locally accepted point that we are shopkeepers and not drug therapists. In this way, more doctors will give drugs without our intervention and drug counselling and the same goes for the nurses who may do not feel a need for us as pharmacotherapists.

Even if they filled in blank cheque for their medicine, I make it a point to clarify their medications, serious A/E, potential hazards and right way of taking. Don't be surprised that some doctors and nurses will have their eyes opened wide wide during such counselling sessions. Same applies for pharmacists who are not familiar with the medication dispensed.

So, even though you are a doctor or nurse, do me a favour by not merely saying that "I'm a doctor/nurse. I know how to take my medicine." Let me do my job and give you a thorough and full drug counselling - unless it's a repeat prescription or you have been taking it for a nong nong nong time then would I stop short of a fullblown counselling session.

As pharmacists, we ought not to be pushed over by such statements but exercise our right to professional judgement and professional execution of tasks that are specific to our profession. In this way, take full responsibility in hope that it will become our right.

Ang Gu Kueh

Solli no pic of the AGK from my favourite stall near the car workshops in AV. Zoomed over there after buying a pair of pair of NB shoes from QW. Didn't know NB got workshoes - very comfy. Got another pair of trekking shoes for standby. Slurged a bit on the shoes but I don't really mind as NB shoes are super long lasting - not like R or N - the tongues start to come out in 6months.

By the time We went to the AGK stall, oreadi queue nong nong - not like our student dayz where there's nobody around - now I know why some people reminisence the student dayz. In the end got 2 of each of the 4 flavours left let my M and P try try. I really like the melt in your mouth skin. Then the rest of my classmates came but everything sold out =p

I got lucky yesterday when I saw someone I missed a lot. Neber seen in 6 years. Every time I take MRT past the station, I really hoped that person would just hop on it. But anyway got the name card already, anytime can fix a date =).

We had a beeching session amongst the cliche after the talk at AH - makes me feel so fortunate about where I am now. Although the distance is far, the staff really makes the difference and I feel very grateful for that. Everyone has his or her own short comings but these are minor if tolerable.

Testing

Kena audit the other day - people compren I no smile enuff.

I look serious if I need to treat you stat.

What's creepy is that I was audited by 3 people at one go. Verli suay kia. But the review was OK just that I felt the reviewer should have done some homework before she decided to kena me - she decided to call it quits after i asked 3 questions. Dun @#$ with OJ.

I wonder if there 's a recent change in MOs or HOs or not? There seems to be a tonne of intervention to do until the patient had to wait wait wait. Then the poor dispensing pharmacist had to kena big time some time.

Had to correct doses, sometime they any how shoot one drug onto the script. Some time they forgot to sign or chop or follow some part of the legal requirements for the script. Some times they never ask the patient enough about their current state of health - only when the patient comes to the dispensing bench then we had to correct and the patient wait some one.

May be this is the value for pharmacist - we are the guardians of the medicine cupboard. But we need patients to be their namesake - patient.

Pre-reg is a very testing time:
- your speed
- your alertness
- your pharmacology
- your pharmacotherapeutics
- your communication skills
- your Hokkien
- your Teochew
- your Malay
- your Sign Language (I had a couple of audio-impaired patients and I oni know a little bit of American sign - so ended up very grateful to some drug company for its very nice gift of scribble pads)
- your Mandarin
- your Canto
- your charm
- your negotiation skills
- your luck

blah blah blah

Happening

Despite being a specialised practice, the hospital is a rather happening place as the most unusual people concentrates there.

Missy Day is today but the day before and yesterday, my best pre-reg pal and I went out to pass all the Missies their gift from our department. Must remind meself to send a thank you e-mail to the plant wholeseller. Now pots of African violets are spewed thru' out the hospital. The one thing that the misses found verli amusing was the Plant Info Leaflet. Apparently my best friend found pollen rather allergenic to him and he had to do a sing out for Missy's day. He's so going to be the singing DI Pharmacist of the hospital.

Didn't get to eat any of the spread for Missy's Day. By the time I finish off at OP - can only jiak hong nia. The servers already packing up halfway - fulfillment of my PP's prophecy.

Nearly forgot to gif the homecare nurse a pot for missy day - so had to buy over from one of my PT's who made a personal order. Luckily she allowed it or else hor, I'm at loss. Home care nurser verli important - verli few people know about palliative care. If not for these people, many will stay in the emotionally sterile midst of a hospital for a nong nong time.

I had a run in with a few patients who treat the pharmacy like shopping centre - this includes a few healthcare professionals who remain very much naïve about the roles and origins of a pharmacist.

I had to smile and inject sarcasm into a counselling for a nurse when she came in for some long term medications on a limited budget. I had to request that she stop treating us as a supermarket and bear in mind that we are there to help them manage her disease. She rudely reach over to the dispensing bench and starts fingering with the medicine packets tossing them about like a shopper tossing fish around at a fish monger's stall saying which she wants and do not want. It was not courteous and it undermined the profession. So I had to nicely remind her where she stands and I went through the medication wrt their use instead by their names.

A patient's husband helping her pick her long list partial supply of long term medication told me to make it quick as "(he) knows everything already" as she had been taking the medication for a long time. Well, the patient wants to be the pharmacist and wants to relieve me of my duties so be it - he's not allowing me to discharge responsibilities. May be I should pull the trigger and refuse to dispense without proper drug counselling. Or may be he thinks I'm MacDonald's waiter or a cashier at a supermarket. Before he left he gave a passing remark that may colleague was talking too much with a patient. For goodness sake lah! You not a pharmacist what do you know?! The patient is on a new drug for a very odd indication of course the counselling will take time. If anything happens don't you dare say "the pharmacist never tell me" because you dun wan to listen what.

Got also another patient who requested a couple of ear medication from the doctor which she wants to self medicate for her daughter's eyes. I had to call the ENT doctor check and he clarified that the medication is only meant for the ears which he examine. Had to tell the patient that if she wants to use for the eyes, it's at her own risk and we are not held responsible. She looked annoyed and ask for the dose of the eyes - I can only tell her I usually see one to two drops but reminded her it's at her own risk.

Today is neurology day and a hell day indeed. I actually sweated like mad in the aircon pharmacy. Scripts poured in like the rain outside. And my 2 TKNs are not in!!! Got my first psychiatric patients at normal queue and I just wonder how my IMH classmates are doing when I already felt a bit queasy with the few depressed patients I saw. I can't really judge whether they understood what I was saying or not. The understaffed staff were so whacked out that a couple of them started laughing for no reason.

Going thru and fro to work can be BORING

So I've to listen to some good music

Currently in my play list:

Madazulu by Deep Forest



marta's song by Deep forest



Boheme by Deep Forest

http://youtube.com/watch?v=OLhjpThXG2g

Pacific by deep forest

NUS Pharmacy Class of 2007 video

Nice hor? TY to YSW, DTCT, TYZ, EY, etc for all the hardwork.

Safe handling of cytotoxics (ASHP)

Interesting pharmacy video

Dispensing errors

A lot of patients here want to do a grab and go - they want to be the drug therapists themselves. They will yell at you as they believe that we must dispense no matter what (we have a right not to).

And nurses thought drug counselling is trauma counselling by a psychologist (it happened to me when I told the staff nurse it would better for us to do a group counselling for their prophylatic drug - they thought it was something eyes =/)





But then hor, waiting time rules everything. It's hard to balance things out.

NOG guiding

Drizzling a bit today but all is fine. Guided 3 Italianos and 2 trainee guides (not the volunteer kind but those going for licensing exams one - very easy to recognise since they copy like no one's business).

Went a bit earlier to recce but then the blooming season is at all time low. Enjoyed the kaya toast from the Kopitiam there though.

Met a CH tourist who was commenting that the cicadas in SG are louder than those in CH - must be kiasuism even in the entomological world.

Managed to catch hold of a nice presentation of Dillenia suffructicosa flower and fruits


Then walked past the Bandstand post-rain


Today sooo yellow


More yellow


All freshly planted.

A couple of Chinese cymbids in flower. Too bad the weather here is too hot for scent production

All claimed to be Cymbidium ensifolium




Then you got Cymbidium finlaysonianum from SEA


Dendrobium farmeri's in bloom at the Orchidarium




So's the Sobralia sp.


Newly planted hybrids at the THSMH





Jasmine-scented Vanda Mimi Palmer



Like this yellow one:


Ornithochilus fuscatus in bloom in the Cool House

Went to watch Harry potter yesterday

Have not read the book (boh eng), so the plot changes did not affect me much. The special FX sucked in certain parts -e.e. when Sirius Black was speaking via a fireplace - the FX of the similar scene in Globlet of Fire was much better.

Miss Umbridge is unsurpassed in her role -e xcept by Rong Momo in Huanzhugege. Very well controlled acting where most people will burst out in laughter when trying out that role.

When Fudge discovered that the Dark Lord has return, someone in the audience went "Duh!"

My inaugural yell-out

or rather yelled at.

My infection is still being cleared - all the thick thick yellow muscus slowly extruded out. But then today the ears still feel a bit stuck. It's like the entire muscosal area being sloughed off.

Already started dispensing since Monday. Starting to familiarise with most of the regular medication. For some reason (may be I was seen doing triage so often), some of the patients like to come to me. Very unfortunate that none are pretty and available.

Check medicine halfway, will disturb me - had to point them to triage counter.

I had to move over to get a PIL for that script just in case and when I checked finish the script and called the patient - the volcano erupted. She started losing her head. She yelled at me saying that I should be serving her first since I already got hold of her medication, saying that she saw me serve the other patients first, then went on to scream that for the past 10 times she was here, the same thing happened.

I've no intention of serving those who walked up just like that - I tried to divert them to the triage counter, my primary intent is to check and dispense.

Whatever the case, one should remain calm and empathise with the patient - the pharmacy is the last stop and they had already been in the hospital for the whole day: bottle up then BOOM. Do drug counselling first with a straight face then after that if tak boleh tahan, just go into packing area to weep. You are so going to cause a scene if both sides fight.

May be I'm approachable that's why all the patients start to move to me - I think have to start a 1900 chatline - $5/min - confirm can earn my current monthly salary in 5 hours.

I wonder if it was the pertussis season - got so many whooping cough scripts coming up.

This week in OJ's life

Verli happening

First had to deal with a family on pertussis prophylaxis, went to the wards to get their details then on hindsight decided to get the missy to send the details down via fax. Now my sp and me kena secondary exposure. But then clarithromycin 500 bd 5 days is for primary exposure. Now coughing up yellow phlegm, coughing with wheezing sound, congested chest and it all started off with a flaming irritating sore throat. Luckily I had the right mind to pop by polyclinic to get clarithromycin. Usually I go see doc if thymol doesn't help.

I have met one of the super grateful patients this week. There was a foul up with the script which I caught during triage.Patient had to wait. Tried to contact doc, missy gave wrong number, so kena scolded by hp owner. But so had to check directory myself and had to go get the script myself....Boh pian had to mail the script to the patient since partial supply.

Next week do dispensing loh. Got all the farnie stories about dispensing pessaries to patients. I hope the women dun give me blank stares when I counsel them on drug use. So far, had only done P items and KLKK (kia lai kia ke) but then I more used to GLGK (gia lai gia ke).

IRB submissions this week!!!! chong ahhh. Nid to do all the online tests (about 2 hrs each), did the wrong tests then had to redo another set.... Jin tian bu huay jia. Filed up the whole thing then realised medical collaborator's cert expired!!! But luckily, we can submit the cert next week.

Yesternight went for pharmacy DnD - i think my class has talent! The food sux but the entertainment rocks!!! <3 the Emcees. They rock! I felt as if I stood out as a sore thumb as I came stright from work - stayed back to do some personal administration. I'm a workaholic, a slow workaholic - verli scary. I had being photographed as I'm not photogenic. Look like road kill on photos, so I stood around to find people to chat with. PHZ's erhu skills verli good, until my classmate also give standing ovation. Too bad no encore. Interesting ensemble - zhong ran, keyboard, pipa, clarinets, harmonica and guitar.

Went home late - tong panged the PLO's car to Clementi then shared cab with the MBLO home. It was fun. I think next time must follow the medical people - each hospital book one table but then can they do it as well as the class of 2007?

Week before was ASM. Doc WHHC really hilarious even though his script writing sux and is prone to dispensing errors. Showed all manner of prolapses after lunch and when he came to the uterus "now u can do a shelf administered PAP smear" =.= "Just let it come out then u give it a name."

I think it would be nice if next year a pharmacist presents during the ASM.

All the Dendro carroniis are in flower now. Same thing, dun bother to photgraph.

Every night come home late late

This song keeps be company for the 2km walk from MRT. Easy to sing with simple lyrics

So sorry to those who nid to endure =p

Sianz got simi CITI to complete, IRB, project write up until brain going wrong liaoz.

Today one patient gave me an evil eye when I was trying to clear the triage queue alone when I failed to entertain him.

Seriously, not many people want to come to this poorly paid profession even though we are subtly important and the things we do are not drama material like the docs. The hospitals are understaffed because no one wants to pay us enough. At this rate, I will end up a well-informed and clever pauper - and parents wonder why we sometimes work harder than HOs but with lousier pay outs. or may be it's just the workaholic me?