Friday, 12 December 2008

ENT - Ear, Nose and Tools

ENT is the bane of my already dismal existence. Every time I go over there I feel like I'm entering another world...the world of the tools. Let me explain.

My first encounter with an ENT tool happened a couple of weeks ago. It was late afternoon, and D (the bitter locum pharmacist) called me over whilst I was half-way dispensing something. He handed me a prescription that was covered in red-inked scribbles and explained to me that I needed to go over to the ENT clinic and find the prescribing doctor. There were mistakes with the script including: a date that was both illegible and looked like it had been fraudulently altered ten times; co-trimoxazole had been prescribed with no strength to indicate if it was meant to be regular or double strength; and the fact that co-trimoxazole had been chosen for acute otitis media (definitely not usual). D couldn't reach the doctor on the phone (this tends to be a trend with ENT - apparently they don't know how to pick up a phone and answer it...I blame their apparent lack of opposable thumbs due to some malfunction in their evolutionary chain) so I had to physically go over there and find this doctor. Only of course, this isn't a regular doctor but a consultant. Wooooo..

Anyway, me (being the naive, innocent pharmacy technician), happily take up this task just so I can get out of the dispensary. I walk across the airy foyer and enter the ENT clinic. It seems nice enough - a large, carpeted room with white walls and plastic waiting room chairs and a television showing day-time TV. I explain to the receptionist/nurse lady that I need to see Dr Prick*. She’s friendly enough and takes me to his room. I greet Dr Prick with a warm smile and explain to him my concerns with the prescription. However, before I can say anything, he removes his glasses carefully and looks me in the eyes. “What is it with the pharmacy department at Royal South Hants?” he asks me in a supercilious and semi-rhetorical manner. He caught me off guard. I was like…WTH is he on about? He then continues, “Whenever I work here I always have trouble with pharmacy. Nowhere else, only here.” I give him a confused look.
“I don’t know,” I murmur, “I’m just the middle man.” He raises his idiotic eyebrows just to highlight his arrogance. He then finally takes a look at the script.

When I tell him about the date and whether he meant today’s date, he says, “That’s what I wrote.” I look at the mess in the “date” section of the script – a “2” that looks like it’s been made into a “4” but then changed to a “5” as an afterthought so that the end result is a cross between a “3” and a “9”. I tell him that it isn’t very clear and if he could rewrite it. So instead of neatly crossing out the mess and rewriting the date in the space above, he deliberately makes the mess even worse by rewriting on top of the jumble of figures. Fine. I don’t care.
I then tell him about the lack of a strength for the co-trimoxazole. “I wasn’t aware it came in different strengths,” he says in a voice that makes it sound like he was the inventor of co-trimoxazole and that he only invented the one strength. “It does (you stupid moron consultant),” I say and explain to him the choices. So he scribbles “regular” all over the script just to make it clear. Thanks.

Then I tell him about the choice of drug. Wasn’t that a big mistake. He gives me the biggest, most contemptuous smile that’d make you wanna sock him in the face. “Yes I’m sure I want that drug,” he grins menacingly, “I’m aware that it’s not a common choice, but I’m a consultant.” And there we have it. He pulled out the big Italicguns. He’s a consultant. Oh Hallalujah! We have a consultant! You truly are the Messiah Mr Consultant Sir. And what’s that? You’ve got more to say to me? Oh hush everyone and let’s hear what Mr Consultant Sir has to say now:

“I’ve been a consultant for twenty years

Did I just hear that right? He’s been a consultant for twenty years??? *Gasp!* OMG…how could I ever question someone with that many years of being an utter prick? Oh, let me bow down before you oh great consultant. Let me bathe your feet and scatter rose petals before you so that you may never have to contact the lowly carpet on which us regular folk walk. What a prick.
But instead of just giving a polite smile and an apology, I say in a really sarcastic I-don’t-give-a-toss voice “Oh, that’s great! Bye!” and I leave. Go me! Lol.

My second encounter with an ENT tool was today. D managed to find another problem script for me and sent me over to the clinic. I was more cautious this time. Basically, the script was written up for “Betamethasone scalp lotion”. Now, there’s no such product. We have a Betacap scalp application (which is alcohol based) and a Betamethasone lotion (which is aqueous based). So D was right in questioning it. I was advised by the receptionist to take a seat and wait for Mr Doctor (whoa..he’s a mister!). Whilst I was waiting (and enjoying a British version of Jerry Springer) a nurse comes up to me and asks me what the problem is. I explain to her that it isn’t clear on the prescription which product the doctor has prescribed. “It’s the Betacap,” she says. I look at her and wonder who she is.
“I’ll need to confirm it with the doctor as there are two possible products,” I say.
She gives me this exasperated look and says, “What’s the confusion? It’s the Betacap. I’ll show you it in the BNF.” Ok. Let me explain how this is extremely degrading to a pharmacist.
The BNF (British National Formulary) is the same as the Australian AMH (Australian Medicines Handbook) ie. the pharmacist’s bible. Now what the nurse said to me is kinda like if an aethiest went up to a Christian and said, “Don’t you know who Jesus is? I’ll show you in the bible.” So that pissed me off.
But then I pulled out the pharmacy big guns. I explain to them (she had a taciturn accomplice) the compositions of each of the different products and how they vary in formulation. Ha! Take that nurse woman! I studied four years of pharmaceutics just for that moment.

Anyway, I’m finally allowed to go in and see Mr Doctor. He seems nice enough (by nice I mean he didn’t throw a hissy fit and tell me he was a surgeon with twenty years experience and also the sole inventor of betamethasone related products) and I explain to him the problem with the script. “I want the lotion – the aqueous based product – NOT the Betacap as the alcohol stings the ears.” Ha! Take that nurse cow! You were wrong! I was grinning from ear to ear. Then the nurse woman tries to sound intelligent, “Oh I suppose the alcohol dries up the ear.” The doctor looks at her and goes “No, it irritates the ear canal.” Haha. That was funny. I mean it would dry up the ear and sting it but the doctor totally shut her down. Haha. Go pharmacy!

Oh, but the fun didn’t stop there. A few hours later one of the other pharmacists found an ENT script with two months of itraconazole written up. The pharmacist needed me to find out if it was a prophylactic course or an ongoing course as it would alter how much we could supply (a cost issue). So I headed back to good old ENT clinic and as I entered, good old nurse cow was there. She was aiding some elderly patient and she saw me and started being all sarcastic like, “Oh it’s you again, back to cause more problems.” Whatever, you stupid cow. You’re the one causing the problems! And she kept going on trying to be funny and stuff so that the patient would laugh. Give me a break. Anyway, she asks me what the problem is and I reluctantly explain to her the issue. First of all she asks me what itraconazole is. OMG…if you don’t even know what the drug is how do you think you can help me? Why don’t you look it up in your BNF, you cow. I explain to her it’s an antifungal. And then all of a sudden she reckons she knows the answer. “It’s prophylactic,” she says. Whatever. How the hell do you know? Like seriously?

Anyway, her taciturn accomplice takes the script from me and goes into Mr Doctor’s room to ask him. She returns, hands me the script and tells me it’s an ongoing course. Ha! Stupid nurse cow! It’s ongoing! NOT prophylactic! What the hell is wrong with these bunch of stupid reckon-they-know-it-alls?

I leave ENT clinic with a mixture of anger, pride and exasperation. But mainly regret for ever stepping foot in that place.

*Not his real name. His real name has been altered to protect his identity and suit his prick-like personality.

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