I spared a mother further sleepless nights

One mother came in to see specialist. Her child also took medicine from a GP. Came to my bench and I went thru her child's current meds and asked if the child is taking any other meds.

She was wise enough to draw a list. I went through with her the drugs and which not to take together. Saw triprolidine plus pseudoephedrine (Actifed). Pointed to her that when child takes this, child may not go to sleep easily.

She looked at me, then look at the child then gave a face and said ,"Doctor never told me."

Then told her to give it to child 3-4 hours before bed time.

Adventures in Coamoxiclavunate and Amoxicillin

Scene 1:
Doctor came in to fill own prescription due to an Infection. MO currently in paed round.

Dosed self with a very high (1250mg BD x 7/7) regime for Augmentin. My PT recommended to go down to the regular adult 625mg BD

Script sent in for typing and packing. I got to dispense it. Then the doc pulled out Frank Shann then point to dosing .... That's the problem with paed MOs trying to dose themselves - they forgot that they are adults and there's a different dosing regime. If doc gets 1250mg BD, I congratulate doc for making doc's potty doc's second home for at least 7/7

Scene 2:
Patient came in with prescription.
Can't see the weight clearly and called the patient. Thought 7.3 kg, turned out to be 73kg (for a 9 yo!!!)
Doc wrote Augmentin 500 mg TDS 14/14. Thought he must have confused with amoxi and augmentin. So called up and ask whether want to change to adult dosing for augmentin - 625mg BD. He gives ok.
Patient called. "Hi, got any drug allergy?" "Amoxicillin" @@
Called doctor, "Hi did the patient tell you he's allergic to amoxicillin?" "He neber tell. So what's the matter? "He's allergic to amoxicillin and you prescribed augmentin." "Augmentin corect loh" @@
Later changed to clarithromycin 500mg BD

Scene 3:
Doc wrote script for self. I got to dispense. I saw Amoxicillin 500mg TDS 10/7. Got worried because of compliance issues and doc doesn't look so bad. I asked doc whether wan to continue with such a long course - doc shoots back "I will keep the rest of the meds when I feel better. I AM A DOCTOR!!!" But I think this doc doesn't behave like one - problems with sitting in clouds tsk tsk. But then got meet one super nice doc, only thing is that doc not ready *sad sad*

First day with PS

The paperwork siao4 one?! No wonder the people at purchasing so stressed up at times

I already missed dispensing to patients face to face

Tried to make microwave cake today - semi sucessful. If not made properly, may turn out to be chocolate kueh

1 cup chocolate unsweetened 70%
1 cup milk
1/2 cup sugar
3 eggs
vanilla
1/2 cup cooking oil
1 cup SR flour

Today last day to burn paper - tomorrow surely CEP flooded with chewren who kena nebbed.

head tilted down

Just feel so down down down

I know got a few peeps comprening I neber update this space for some time already. Was disappointed with myself, very disappointed with myself these past weeks for a bug boo boo that I made.

Unlike some other place of practice, even the OP setting is like intensive care - things can go wrong due to teeny weeny mistakes. It's life and death situations like they call it. One mistake and you wished that you were strangled at birth and do not wish to see the light of day. It can be that bad. I want to be the best there can be and any spot I trip over really is a very painful fall. But then like our chief pharmacist of Singapore had said, "Competence before confidence"

Reminder to self and to everyone else:

Chewren onco and prevalence of diseases are very different from the adult meds that we were taught in skool:

Dexamethasone + ranitidine used as lymphocyticide in ALL c.f. most adult onco use for N/V purposes.

Very disappointed in self.

Saw one person whom I liked, even though saw oni twice. Check if attached, the person was set to go, but then for some reason, dinner was turned down. Boh pianz, at this timing, I also cannot commit - but then I find that person ideal for me, but can I reciprocate?

Lidat, got more excuse to squat in DDMS to go thru' case notes - never knew a 40 DAY old kid can have 7 volumes to go thru'.... YYY pharmacist dun have time allocated like the loooh goons to do research one - the irony of having better research backgrounds but not being able to practice it.

Last day at OP today. Next week start at PS, then CIP with the viva in between. Can believe my OP ic soooo evil - give one tablet/ capsule and have to ID. @@

I think recently got a lot of changes in MOs ? HOs as I had to call new numbers to do interventions. Some got confuse over chewren and adult doses until they wan to dose themselves like big chewren @@ overdose liaoz. Should I call one or 2 of the time to hang out ? May be not. WE are all too busy.

I like peds because of the challenge of handling the chewren of today but then hor, the auntiez easy to talk to. Poly pharmacy can be prevalent in our setting as our patients visit use as the last resort after seeing a chain of private GPs or other centres such as NHC before having their gyane problems inspected her. Verli the scary. I really appreciate the patients who lug the drugs to my bench to let me go through to check for duplicates.

sia suay

Today sat in Endocrine clinic. Studiously prepared for it the night before. Thyroidal disorders, growth disorders, glucose metabolism, blah blah blah

First patient = one rare but increasingly common case of ricketts. Neber studied (last studied in yr 2 Physiology), knowledge in vit D metabolism all SK2. So dunno how to answer about the various forms of vit D - got at least 4....

*shakes head*

I am pathetic

I am hopeless at personal relationships but more firm with my work. I have courage when dealing with adversity in work - difficult patients, drug orders and faulty scripts- but I dun even dare to ask a lady whether she's attached or not.

The concession is that I've only met her twice. Not bad in appearance and vocal presentation. Personality mroe to dig into. I've been asking about her with a classmate who distantly knows her but apparently my dear doctor friends in my hospitals dun quite like to reply SMS or phone calls. Skarly, one of them whom I called is her stead @@ - that's why dun wan reply.

Just got a reply from one of my pharmacy lecturers stationed abroad. Apparently, pharmacists have a very active role in specialty practices - they sit in with consultants. The other lecturer (the bak chor mee lurvin' one) boh reply.... skarly in junkmail @@

Over here, those sitting with consultants are usu those on attachments @@ - not powerful enough. I did enjoy my sit in - I feel that we have an active role to play. Most of the doctors just tell the patients that medications will be given and prescription given and just lidat. Occasional brief med usage instructions given. Patients may appear blur blur with such abrupt stuff.

Pharmacists are there to ensure compliance and rational drug usage. We have to ensure that medications are used appropriately and when required together with doctor's monitoring. And there's no point giving patients something that does not work or some drug that is rendered harmful or useless by the patients own cocktail of daily chronic drugs.

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