[AMA] I Am a Community Pharmacist, Ask Me Anything

I have been working in community pharmacies for almost 5 years now. I have probably seen enough of everything.

Ps. I am not allowed to give out any specific health advice.

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    • Anaecdotally the GPs can also sometimes get lazy and just write the preset directions on the script (on a printed script) but tell you different directions in person.

    • +1

      A lot of time doctor make mistakes on the scripts. Pharmacist can change the direction after discussing with the prescriber. However, pharmacists are not allowed to change by themselves.

      • Interesting. The most recent one I remember was the doctor gave me antibiotics and told me to stop after X days. The pharmacist told me to finish the whole course which was a few days more than X days (sorry I forgot the exact days). Even when I told them what the GP said, they still said to finish the whole course.

        • Hi there, dr and pharmacist may give you different timeline because maybe they follow different guidline reference. In that situation, just check which reference the pharmacist use and if they know what type of infection you are treating for.

  • Do you have any insight into when Aimovig might be added to the PBS? I’m a chronic migraine sufferer have averaged 3 to 4 a week for last 25 years since early teens. Have developed overuse headache from painkillers so can only take triptans but limit to 2 a week so don’t get MOH from those also. Currently into week 6 of a ketogenic diet which has reduced frequency but keen to see if Aimovig would reduce further, but cld only afford if on PBS

    Thanks for answering all the questions, very informative

    • Pretty hard to say actually,

      https://pbac.pbs.gov.au/ - The Pharmaceutical Benefits Advisory Committee ultimately make the decision on what items become available on the PBS. They also decide what conditions are approved for certain medications and this is ultimately a dynamic process as data becomes available e.g. a drug originally is available on the PBS for epilepsy however the drug company can hand over more data as time goes on to show it works well for migraine prevention and this is ultimately "added to" the treatable conditions allowed by that drug on the PBS.

      Drug companies are required to submit all available data (e.g. clinical trial data as well as post-marketing data if available) for drugs to be considered. It's a process of negotiation between PBAC and the drug company themselves and requires extensive cost-benefit analysis. It may be a slow process unfortunately and pharmacists usually aren't made aware until the drug finally becomes available.

      Additions happen on a quarterly basis during the year.

      Community harmacist as well…pharamcist. =)

    • I hope soon. I have seen 1 patient get really good result.

  • How often do you get people on some unknown alternative therapy come in and ask you about the GABA fluoxymethobutylaldewhatever pathway and then look at you like you're stupid because you don't know?

    • Not that often, but yeah I don't know alot of this weird treatments :(

  • What's your go to remedy for the common cold/flu?

    • Anything with pseudo haha. Not that I am making meth with it

  • +1

    Why do you guys sell that useless Phenylephrine? It doesn't work!

    • Because the bikies wanted to do a little breaking bad.
      Just ask for Pseudo from the pharmacist directly with your license.
      The amounts in each box are tiny though :(
      Just enough for one cold.

  • Would you recommend that a newly registered pharmacist pursue med/dent as an alternative to staying in pharm?

    • I am happy for them. As you have prob seen, theres not much money in pharmacist career. Also people realize the do not enjoy pharmacy career as much but still want to help people. Hence, the switch to med and dentist

    • If you no longer enjoy pharmacy go for it, pursue your dream. I am actually studying online something completely different atm

    • Be a dentist

      • How come you'd say dent over med?

        • Med is harder to get into, harder to get out of (getting into a specialist college) and you earn less when you graduate and won't come anywhere close to what a dentist makes for years.

          End earning potential may be more but may be less than a dentist, depending on what you end up doing.

          In med, as part of gettin onto one of these programs, you usually end up pulling 60 - 100 hour weeks for about 10 - 15 years where you may or may not be paid for the overtime. Don't know if dentists do this.

          Wouldn't recommed med if your only reason is pharmacy is too hard to ear high salaries in.

  • OP can you help me setup a meth lab?

    • You need a chemist for that. Pharmacists can't cook anything.
      Talk about recrystallization, filtration, reflux and product separation. I can cook it for you if you buy me the ingredients ;)

  • +1

    could you make LSD if you wanted to

    • Not really haha. I googled it before out of curosity but not much luck. I am sure my chemistry lecturer can tho

  • +3

    Congrats OP made it to AJP!
    https://ajp.com.au/news/ask-me-anything/

    • Shit my first article. Am I going viral now :p

  • What exactly are you doing for the 10 mins after I give you my prescription?

    You come back with a box that you picked up off the shelf.

    • +1

      Haha, this is the question I get most of the time.
      There are many reasons to it and keep that in mind not all of them apply to every pharmacies.
      1. Some pharmacies purposely do it so you can shop around (mainly discounter because they need to increase basket size due to low profit margin)
      2. They can be reallllllly busy. Sometimes you walk into the store and it seems empty. It does not mean that there are not 10 scripts baskets waiting to be dispensed.
      3. Dispensing is not just about putting label on a box. Next time you visit a pharmacy, politely ask a pharmacist if you can visit the dispensary or see the dispensing procedure. It is actually not as easy as it seems. If you are healthy, not on any medication and present with a single script of antibiotic for example. It should not take too long. However, each medications have a lot of precautions, contraindications, side effects, interaction with other medications. Pharmacists spend most of their time checking for all of that. Sometimes, prescribers make mistakes on the script and pharmacists have to contact them to get it fixed. At the end of they day, we are just trying to keep you healthy.

      • To just elaborate on the more common situation:

        It takes 10 minutes because:
        1. There are probably anywhere from 2-20 people waiting before you who are inside the pharmacy or are coming back later. Scripts are normally processed in the order that they come unless there are a large number of scripts for one customer.
        2. The pharmacist doesn't want you in the store waiting so you can constantly glare at them ^__^

    • +1

      trying to finish my game of solitaire /s

  • our local chemist have that HUGE drug sorting machines - you just dump newly ordered medication and it will sort and put them into the order and records stocks.

    what do you think about these machine? less work for you?

    • Love that robot lol. We have one at my work and love it. However I feel like I grab the stock faster than the robot. However, if the store is busy the robot save lots of time and energy

    • That's the ROWA… Wait until the machine is down and see how many minutes it takes to do your script…

      • yeah it happened a few times. Struggle town

        • Yup, primarily the reason I wont use a robot. Reliability is king

  • Any tips for buying EpiPens with the longest expiry? Maybe a case of just checking before handing over the cash or ringing ahead?

    I need to buy some for the first time and heard that one should try to ensure they are getting the freshest batch (for obvious reasons).

    Cheers

    • +1

      Am a pharmacist myself, you'll be lucky to get EpiPens with expiry dates longer than 12 months. One way is to get the pharmacist to order in the stock for you before hand and get them to dispense the "fresh ones".

    • Go to a busy pharmacy

    • +1

      14 months is the longest expiry date you can get as they are mostly imported from Germany. The batches will vary after distribution from the supplier. As a consumer you will be lucky to get one with 14 months expiry. You can always ring ahead.

      • Thanks all for clarification. I just rang my local and they said their batch expires March 2020 which is over 15 months. 👍

  • What's your take on the stigma on the morning after pill?
    Did you go through a workshop or anything where you learn how to give special sort of consideration/care to women asking for them esp younger women whp show up by themselves or whatever

    • I'd like to just interject on this before another reply is given as it is often a touchy subject. Pharmacist, experienced 12 years no longer work in the field.

      There is no stigma apart from on the consumers part or a perception stemmed from pharmacists that are inexperienced and lack tact. For a pharmacist it is a daily request.

      Though universities teach the procedure the final encounter depends on the empathy skills and counseling experience of the chemist in question, just in any profession. That said as testing on the pill has only been conducted on girls 16 and above (or thereabouts) minors may get referred back to the doctor - it is a grey area.

      There has been numerous media coverage (albeit covered for the purpose of just having news) on incidences where customers have been refused as they are not present. Without opening a can of worms, the question is, how well does someone listen to you when they are actually present, vs talking to them over the phone? When was the last time your doctor agreed to treat you over the phone? Some food for thought.

      The above is not medical or professional advice.

      • Empathy training eh
        Would it be possible to fail an empathy training module at uni?

        • I said the universities teach the procedure, not the empathy part.

          I know what you mean, though. The situation will get worse as the caliber of graduates has significantly decreased over the last few years as the clued in would be pharmacist would be reading posts of whirlpool and be well informed of poor pay and poor treatment of pharmacists. Most good ones I know have left the field, to go do medicine, dentistry, IT.

          In one of the businesses we consult on, forklift drivers who did a 2 day training course get paid better than a pharmacist.

          You would have to be extremely ill informed or lack basic research skills to choose the profession nowadays.

          Unfortunately the strongest union is the Guild that is primarily for owners of pharmacies, not employees.

          The fact that the professions only real general publication the AJP chooses to post an article on this thread in OzBargain speaks for itself.

      • Being a time lord, would you have gone back in time and not studied pharmacy in the first place? How come you changed out of pharmacy just to be curious? (I know it's not your AMA but I'm curious hehe)

        • Not who you asked but thought I'd give my 2c.

          Bad pay. Bad career prospects. No chance to open your own pharmacy. Basically working a retail job. Constantly need to study and keep up to date. Have to pay yearly registration fees. A bad mistake can end your career instantly. Can be dangerous in some areas (get robbed by druggies etc). People also don't think much of pharmacists. A small percentage of people value your advice but most people still just see you as a drug dispenser and will defer to a doctor for every little thing.

          In hindsight, I probably would have studied something else just because of how much time I wasted before I realized I really didn't want to pursue this. But having said that, having drug knowledge and knowing how pharmacies work behind the scenes is pretty useful in general for life.

          • +1

            @Astrohawke: Don't forget compulsory cpd, 20points which should be face to face usually means paid events, indemnity insurance, expectations to work unpaid overtime e.g closing up shop, reaching your kpis to companion sell to make ends meet although it's against your ethics.

            Yes there is a chance to open your own pharmacy as shown in the other thread, however your mind set changes from pharmacist to business owner. Your worries are no longer about Ms Jones and Mr Smith and their medications/ailments or researching a topic to present to the rest of the staff for training.
            It all changes to remembering to meet 6cpa claiming deadlines, making sure the workers are stacking the shelves and dispensary, pushing for companion selling, worrying about indexing of rent (no need to worry about employee wages trololol), getting post PBS cut priced meds a month early and trying to get Mrs Jones to fill out all their repeats before it's in effect, (not applicable to all pharmacies but recent news shows pharmacies have been doing this), pillaging through RUM bins to reuse into patient medication packs, claiming scripts fraudently..list goes on.

            As pointed out in the other thread the better 'future' of employee pharmacists are to go into ownership. Ethically I personally feel it's better to be a business owner of something else if you're in it to make money if you're going to start compromising your integrity as a pharmacist as well as the trust of the public.

            • +1

              @charzy: Buying a pharmacy just isn't realistic for the majority of people. Since you can't open any new ones, you have to buy an existing one and rarely do these go on sale in the open market. And even if you could find one for sale that isn't a sinking ship, who's gonna be able to just pull out a couple mil on shitty pharmacist wages.

              And personally, I was never interested in taking on the risks and stress of becoming a business owner. If I wanted to do that, I wouldn't have studied pharmacy, I would have just gone and opened a business. And I'm sure many people feel the same way. So with that out of the picture, there really isn't much of a "future" for pharmacists as I see it.

          • @Astrohawke: Maybeamacy - refer astrohawke lol.

            Bad pay. Serving end users in a retail environment. That said, the perspective you have to understand is, you are serving end users who are often on the lower end of being able to take care of themselves and often come in with a victim attitude. Most customers who came in are not like those going on a holiday, they are sick, in a bad mood and may suffer from a large degree of ailments of which anything that goes wrong they will blame on you. You are generally not serving the affluent or open minded person who would generally have a better ability to be in a better mindset, have a better attitude and have a better grasp of how the world works - in summary it is better to be around inspiring people than those who are more often than not unable to take care of themselves in one manner or another. Man is the cause of his own ailments.

            It is a high risk job, one mistake and you could easily kill someone. Renumeration would overcome this if the pay was not pathetic.

            I left because I chose to do more with my life (aka make more money) than have a victim mentality. Pharmacy did open my mind as to how people work - but the wasted years does not balance that out. You could have easily attained a better experience in another field. I also disliked the thinking and mentality of actual pharmacists so do not blame anything other than the people in the profession for the way it has gone. Professions that are adverse to risk often train up the mindset of the people to be as such. The ability to scope the bigger picture, get the job done, make change where change was needed was virtually non-existent. It is a very passive group of people who rarely speak out unlike the nurses union or the ama. Unfortunately you cannot change people, generally.

            I would have gone back and majored in commerce + IT.

            Currently I do enjoy what I do, a mix of business/consulting - which is what I had been doing part time all throughout my career as a pharmacist. Sometimes you just reach that age where you gotta go.

            The main argument in community pharmacy has been they offer professional services blah blah - but the underpinning fact is they were employees working for an independent business of which the ultimate goal is to make money for the owner and keep the rent and wages low. As an employee you would never win. Even as an owner in the discount chain environment there are many other businesses than give a better ROI in a shorter period of time. Even the junior partners in the discounts chains are often very naive about the return they are really getting. It is not black and white like a properly document career progression at large finance firms like EY, Accenture, KPMG. For many young pharmacists, including myself, you really don't become aware of this till at least 4-6 years in.

            Moral of the story is, if you are in pharmacy, leave. If you like a poor standard of comfort, want to live in extreme mediocrity, then stay.

    • No stigma at all.
      We didnt have any specific workshop but I had some training online for that kinda thing. We are taught to be empathetic at uni.
      Pharmacists should not have any stigma on morning after pill anw.

  • Hi Farmacist, is it worth shopping around for prices on prescription medication or are they controlled?

    • +3

      For prescription medicine, just use PBS search function.
      For example, Celestone, a cream commonly prescribed for skin conditions like eczema.

      See below
      https://www.pbs.gov.au/pbs/search?term=CELESTONE

      On the bottom, it tells you the forms it comes in and the sizes.

      BETAMETHASONE VALERATE
      betamethasone (as valerate) 0.02% cream, 100 g
      betamethasone (as valerate) 0.1% ointment, 30 g
      betamethasone (as valerate) 0.1% cream, 30 g
      betamethasone (as valerate) 0.05% cream, 15 g

      It will list the generics available as well as the original brand, and what PBS has listed as General Patient Charge.
      Additional charge for this brand is $x.xx

      Then just search priceline website's PDF list (kind of like MSY!)
      chemistwarehouse online for the brandnames.
      You can even call some pharmacies up and ask for their script price, and ask them to pricematch/beat another place.

      Since we're on Ozbargain, that is what you do for the cheapest price, if you require absolutely no service (i.e. your regular medication, you know it's the cheapest price).
      However please do not forget that pharmacists provide other services to patients as well.

      • Thanks very much cwongtech, that looks very helpful! Often there are various pressures going on when you need to buy prescription medication and you don't have many options. Only afterwards I look at the price and think to myself, could I have found this cheaper somewhere else?

    • +3

      It depends on your situation.

      Fixed price for consumer:
      * It is PBS-listed: You have a concession card and it is more expensive than $6.40.
      * It is PBS-listed: You are a general patient and it is more expensive than $39.50.
      * You have hit the safety net for the year after spending a certain amount on PBS medication and it is more expensive than $0 or $6.40. (Concession or general)

      Not fixed price, pharmacy-set:
      * It is not PBS-listed. You may be able to get a receipt from the pharmacy and claim from your health fund, depending on what your cover offers.

      cwongtech lists an excellent resource for PBS medication, and good advice/disclaimer. However, be aware that sometimes doctors are influenced by reps (heh) and they may not always know what the cheapest option is, if that is what you are after. It's not very common but the exact same medication and formulation (but different box size in the case I'm thinking about) can be listed on as PBS or non-PBS, depending on the brand. Do your own research using the generic name of the drug to see what is available. Unfortunately, I don't know of any consumer resources that can easily find all available formulations on the market, but I do know you can search CWH using the drug name (e.g. metformin, atorvastatin) and it will give results, though they're sometimes somewhat unpredictable. I would still recommend this over the Priceline list, which has no drug names. :(

      Also, sometimes the higher dose of a medication is not necessarily more expensive, especially if the lower dose is a newer formulation. As an aside, if you are really trying to save, you are not on a very dose-sensitive medication, don't mind the extra hassle, and can find a formulation with tablets that can be split, that might be something you can discuss with your doctor.

      • Thanks also jennkei, another good perspective :-)

  • Is there an alternative boner boost or over the counter substitute?

    • Nop unfortunately. All are prescriptions only meds

  • Is it true you can get a medical certificate from a pharmacy these days instead of a GP? (apparently you have to pay for it though)….

    • Yeah you can but only for 1-2 days. If you need longer cover for any health reason, visit your gp.

  • I use Coaguchek XS PT test strips for my INR. But I accidentally threw out the micochip before I finished using all the strips in my last pack. Is there anyway I can get a new microchip to match the strip batch? I have about 15 strips left in the pack, hence why I'm not keen to throw them out. Thanks

    • I belive you cannot really do that. The chemical/enzyme in the test strip and the microchip are made in batch and coded respectively.

  • If I came in and requested a 500ml bottle of Ethanol (for a project of mine) would you sell it to me?

    • Dont think I can cos we dont stock them

      • Surely you have Ethanol out the back that you use for other 'compounding' purposes, that you could dispense some out for a specific request!?

        Or, is it strictly retail trading nowadays?

  • My pet hate is the wall to wall vitamin products in virtually every chemist outlet which are a total waste of money imho
    But probably a nice little earner

  • I know this will sound stupid, but here goes, so my hay fever tablets went past Expiry date (2 months past) and I was desperate for relief, so I popped it in and hope I wouldn’t die.

    Am I ok? Lol whats likely happening to the hay fever pill when it ticks over the date and effect on silly people like me

    • No question is stupid. You will be fine. The expiry date is just means when medication efficacy is lower than a specific number.

      • So it's ok to keep consuming :)

  • Sorry, I was replying to a thread and think it got lost.

    Is there a particular probiotic/brand you would recommend? And is it desirable to change probiotics over time? Thanks

    • I normally take 1 month worth of SB floactive then 1-2 months of life space probiotic. You do not really need to change it over time.

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