The Doctor and the Pharmacist with an Attitude

I have been rather tensed lately. No, it's not due to too many patients, in fact I enjoy seeing patients, talking to them and gently cajoling those with chronic conditions to take their medications regularly. What I was unhappy about was the unilateral action of a pharmacist who took it upon herself to determine what prescriptions she would delete. I have never realized this till out of concern for my patients I have asked them to return to me once they received their prescriptions from the pharmacy so that I could advise them which tablets/syrup I was referring to during the consultation.

And so one mother came back to complain that the Pharmacist did not want to give her the syrup I prescribed for her three-year old. I called Miss X  the Pharmacist and she told me that the syrup was not supposed to be given to a child less than five. I am quite conversant with drugs and I know that cough suppressant and sedative drugs are no longer recommended for children but the one I prescribed was not in this category.

I asked Miss X to bring over the list of drugs in this not-recommended group. True enough there were 23 drugs on the list and the one I prescribed was not on it! So Miss X was quite surprised herself as all this while she had been deleting other doctors' prescriptions as well and none of them ever complained!

Yes, none of the doctors ever complained because their patients follow the flowchart in the clinic religiously. Patient comes to see a doctor and then goes to the pharmacy and finally goes home. In my selected patients the flowchart is modified such that after the pharmacy they come back to see me!

On another occasion an asthmatic who, after several trips, sometimes in the wee hours of the morning, to the hospital emergency department, had finally decided to come to the clinic. From the history I could discern that this young man had been having  bad bouts of asthmatic attacks for which no structured and regular treatment had ever been prescribed to him. Having examined him physically especially listening to his chest, I decided not only to give him the medication which relieves his acute attacks but also one which when used everyday would help reduce the number of attacks.

What did our clever Miss X do? She deleted the daily inhaler because she told the patient usually only one inhaler is prescribed for a first time-diagnosed patient. She did not have the courtesy to contact the doctor. She was acting like one. Again I engaged Miss X by focusing on the clinical condition of the patient, his inflamed, swollen bronchiolar smooth muscle cells that trigger incessant attacks require cellular stabilization through the daily inhaler. Granted that a mild asthmatic would only require the rescue inhaler only but not in this particular patient. And by the way since when the B.Pharm can do the work of an M,B;B,S?

In Malaysia due to the present healthcare arrangement, it is common that you see Pharmacists prescribing antibiotics and even anthypertensives and blood sugar-lowering drugs! In developed countries like the UK and US , they absolutely and legally  cannot do that. The practice in Malaysia  is very disconcerting and can affect patients negatively. Like the patient who was given painkillers NSAID for a long time by a Pharmacist for her arthritis ended up having erosive gastritis and a bleeding peptic ulcer.

Coming back to Miss X,  I told her to liaise with me in future in case she feels like being a doctor. By the way, UK-trained Miss X  is our new Pharmacist with an attitude. We had no problems with our old one who had resigned to open her own Pharmacy.

Really , remaining professional can sometimes be rather challenging..