Antibiotics are prescription drugs

Antibiotics are prescriptions drugs.

What?

Surprise surprise surprise. *sigh*

In the Philippines, confusion on which drugs are RX or OTC is prevalent. It is an eternal epidemic here *sigh*

The top drug categories that cause confusion and hot debate between pharmacist and person with NO MEDICAL BACKGROUND are maintenance drugs and antibiotics, of whether these are OTC or RX. I'll be focusing on the latter.

Now here are some myths about antibiotics that you might have heard from your neighbor/relative/stranger who ALL HAVE NO MEDICAL BACKGROUND WHATSOEVER:

1)    Antibiotics are treatment of choice for the common cold

2)    Antibiotics are vitamins that strengthen your immune system

3)    Antibiotics do not require prescription

4)    Antibiotics pose no risk or threat whatsoever

5)    One does not need to consult a doctor in order to take antibiotics. One can choose for himself.

6)    There is no wrong way of taking antibiotics. Just take as you want.

7)    It requires mefenamic acid on the side

8)    It is an over-the-counter drug

9)    When you tell the Pharma staff that you need an antibiotic, they know exactly what antibiotic, brand, dosage form, dosage strength you have in mind.

Now, I'm here to tell all of you that THESE ARE NOT TRUE!!! Quit playing doctor!!!

Scenario 1:

Lady: I have UTI. I need Ciprofloxacin.

RPh: Do have a prescription, Mam?

Lady: Whenever I have UTI, I always take one of this drug and it works. Just give me one piece.

RPh: We need a prescription for this medication, Mam. The reason why your UTI is recurrent may be due to your wrong use of this antibiotic. A physician might have to prescribe you a more potent antibiotic because clearly you have already abused this one and it will not work anymore.

Lady: I'll just buy somewhere else.

Scenario 2

Guy: Hi, I want to buy some Azithromycin.

RPh: Do you have a prescription, Sir?

Guy: This is for sore throat, right? I just need this because my throat is sore.

RPh: When did your throat start to hurt?

Guy: Just this morning.

RPh: -___-+

RPh: We need a prescription for this, Sir. Only a physician would know the right type of antibiotic for your condition. We're not even sure if you need an antibiotic, as your infection may just be a mild viral infection. I recommend some gargle, or perhaps lukewarm water mixed with salt first, and if the symptoms don't subside, consult a physician.

Guy: How about Amoxicillin?

RPh: It's still an antibiotic, and therefore still requires a prescription.

Guy: Even just the 500mg

RPh: Yes, Sir.

Guy: (walks away)

Now this 3^rd one is the best:

Old man: I want to buy some amoxicillin.

RPh: May I see the prescription, please?

Old man: Prescription? We don't need a prescription for that!

RPh: Yes, we do. We need a physician's recommendation because only they have the expertise the diagnose your condition and have the authorization to prescribe the right medication for you.

(Oh, this next line is the best! You will hear this everytime if you work for the “other” drugstores. This line NEVER gets old. I mean never. It's the ultimate punch line. It just kills a part of me everytime.)

Old man: BAKIT SA MERCURY DI NAMAN KELANGAN NG RESETA?

RPh: They may be lenient, Sir, but it does not mean that it's right. It's still wrong to dispense an antibiotic without a prescription.

Then a friend of the old man passes by. The old man calls the attention of his friend and makes fun of me to his friend.

Old man: Hey, look at this Pharmacist! He/She says that I need a prescription for amoxicillin! Hahahahahaha!!!!

PAKSHET!! PAKSYET TALAGA!!!!

Friend of old man: It's because it's an antibiotic (he replied rather quietly).

I'm just thankful his friend had some sense in him.

Okay, before some mercurians gather up and rally against me, let me show you this scenario to enlighten you of why we are now in this predicament. I watched this scene while I was shopping in one of your stores.

Customer: 5 pcs. Amoxicillin.

PA: Do you have a prescription?

Customer: No.

PA: Okay, next time please bring your prescription. (and then goes on to process the transaction)

Where was the pharmacist?! Is this the right practice? PA's can now prescribe antibiotics?? Sorry, I may not be updated.

Aren't PA's trained to ask the Pharmacist first before dispensing an antibiotic without a prescription?? The PA didn't even interrogate the patient! He just processed the order without so much as a care for the risks to the patient and the license of the pharmacist. If the patient said that he left his medication at home and needed to take one now for his condition, sure, this case may be given consideration, but it's not up to the PA! I mean, what are the pharmacists for? Props so you can hang their board ceritificate up your drugstore's wall?

Although it's my first time to have witnessed this kind of leniency myself, it isn't the first time I've heard of it. I've heard doctors complain about it, too. Sorry if Mercury yung na-mention ko, pero nagkataon kasi na Mercury rin ang minemention palagi ng mga customer, and it is given dahil kayo ang nangungunang drugstore at kayo ang unang pumapasok sa utak ni customer.

Solution to the problem: Train your PA's to ALWAYS ask the PHARMACIST. I don't care if they have been PA's for 500 years!! Bakit, may BS degree in Pharmacy ba sila??? If they dispense antibiotics so easily without a prescription, it just goes to show that they actually DON'T KNOW BETTER!

And just so Mercury wouldn't feel so lonely, this goes to all drugstores! I'm not exactly sure about the other drugstores, though, as I've never visited them, but if they THINK before dispensing, instead of just blindly selling, then I commend you for being able to do what a big chain drugstore couldn't do.

And sa mga branches na natamaan dito (Of course, I'm not going to assume that all branches practice this way. I have Mercurian friends, after all), please stop giving your company a bad reputation.

I just hope not all Mercury drugstores are as lenient as the one I visited and the others the doctors that have complained to me visited.

You know how I've said before that Pharmacists are not to blame entirely for the predicament we are all in now? In this case, I blame the administration for not training their PA's to ALWAYS depend on the judgment of the Pharmacists (I know your PAs have quotas to reach, kaya benta ang nangunguna imbis na yung alaga sa pasyente at yung tamang practice) and your PAs na mga nagmamarunong. Kung may mga pabayang pharmacist sa inyu, yeah, you're also to blame. Your ignorance have caused these myths to spread as factual knowledge to unknowing consumers and now we pay the price. It is what encourages patients to self medicate, making them believe that they can prescribe RX drugs for themselves. Ngayon, ako pa ang tanga na pinagtawanan dahil hiningian ko ng reseta yung customer na gusto ng amoxicillin.

Reality bites. Bah.

Bitter Truth #7: You only use 10% of what you learned

You know how they say that we only use 10% of our brain? Philippine Pharmacy education is pretty much the same way: You only get to use 10% of what you studied in Pharmacy school. Why? Because that's all you'll get to remember :D (I'm only referring to the average students, of course. Forget the smart asses that constitue only 5% of the whole pharmacist population!)

And another sad thing about it is that they didn't teach us the more practical stuff. Here are some classes that I wished we had before they threw us into the real practice:

Lie Detection 101

Minimum wage at 6 days a week 9 hours a day (1 hr break included) with no OT pay contentment class

The art of multitasking

The art of dodging (or maybe this is more applicable to a PE class?)

Basics of Mindreading

The types of customers and how to deal with them (example: the angry lolo, the budul budol lola, the know-it-all, the madam dona, etc.)

Dealing with crime (scams, modus operandi, addicts)

Profit vs. Ethics vs. Regulation

and much much more!

So where did all those four years of learning go?

If 85% of students who graduated pharmacy, passed the boards and entered work share the same experience as mine (on your first day of work, you feel as if you've learned almost nothing from college), I can assume that the cause for this problem is our extremely flawed curriculum. Some adjustments clearly have to be made for it to do its purpose.

And I thought pharmacognosy was important! o_O

Reality bites.

Bitter Truth #6: If salary=value of job, then pharmacist=almost worthless

While I was browsing online for other career job opportunities, this ad showed up and caught my attention:

Online Gamers
PHP 20000 - 26000
National Capital Reg

Hooked to online gaming??

Want to work while playing at the same time??

Then this is the job that you're looking for!

Apply online or walk-in for immediate processing.

Pioneer account*

Package:

20K-22K + 2K + night diff

And I was like WHAT THE F***?!?!?!?!

And here are the requirements that you need to be eligible for the position:

• Candidate must possess at least a Vocational Diploma / Short Course Certificate, Bachelor's/College Degree , Professional License (Passed Board/Bar/Professional License Exam), any field.
  
• Fresh graduates/Entry level applicants are encouraged to apply.
  
• 255 Full-Time positions available.
  
• Applicants must be 18 years old and above.
  
• Bring three copies of CV and a proper ID.

Seriously?! What the f***?!?!

So like, uh, I could just quit my job right now, be an online gamer with play as my work and have almost twice the salary of an average pharmacist? Sweet!

I should've known. All those years and money spent, all the blood (literally, the blood), tears and sweat and sacrifices I have given up for this profession that would provide me only half the salary of a position that requires no license, no particular college degree??!? Heck, I don't even need a college degree! This is just sad, I tell you.

I feel so broken-hearted right now.

So basically, if the salary is the reflection of the significance of our job, then compared to online gaming, our job is not so important, after all. You hear that pharmacists? Online gaming is more important than telling the patient that they can't take a Tetracycline with an antacid!

Why do we even exist? We're just a waste of tuition fees. Why don't they just replace us with robots? Oh wait, I know why – because we're much cheaper!

Reality does bite hard sometimes.

Bitter Truth #5: Pharmacists are not to blame

Remember those years in college when our profs told us how pharmacists were not doing their jobs properly and that their negligence is to blame for the sad predicament of our profession today?


Pharmacists in the cashier's chair? Oh my! Yes, it's the pharmacist's fault for sitting on that chair and doing cashiering duties!


Pharmacist not counseling the customer? Oh my, how can that be? No wonder people see us as medicine sellers! We're not doing our job properly! Mystery solved, right?


If it's so easy to do the the ideal job of a pharmacist, then why is it still not happening?


Easy - Ideal is not equal to actual.


You see, when our profs were feeding us with the statements that pharmacists are to blame, and that when we graduate, we should initialize the change, I actually believed it. Yes, I will be the best pharmacist ever! Watch me world, I will change the face of the profession by doing my job properly regardless that others are not practicing it.


Or so I thought... Naive, that I was.


Let me enlighten you further with another example of how it is implemented that pharmacists are to blame through the words of our beloved PPA President, Ma'am Leonila Ocampo found in this article by Theresa S. Samaniego entitled "Pharmacists crucial in effective healthcare": (You can read the whole article here: http://business.inquirer.net/5116/pharmacists-crucial-in-effective-healthcare)


“It is a fact that there is a lot of medication errors occurring which the public may not know. The sad thing is, this error is very much preventable if only our pharmacists would really do their job,” Ocampo noted.

“We challenge the pharmacists to really do their job, meaning from educating an individual regarding a particular drug down to the selection, procurement, storage and dispensing of the drug,” Ocampo said.


I have  to admit that as a Community Pharmacist, yes, on a whole, pharmacists are really not doing their jobs. But I think, if given the opportunity, we would be MORE THAN happy to provide patient counseling and promote correct usage of medications. Sinu bang pharmacist ang gusto na tindera ng gamot lang ang tingin sa min ng mga kababayan natin, di ba?


Those are the keywords: if given the opportunity. The question is, is the ideal job of a pharmacist applicable to the actual setting?


Let me give a true-to-life scenario:

In a large drug store...

The people upstairs can't give you enough staff because of whatever, so the pharmacy section of your store is one person short.

Fact: Pinagtitipid ang pharmacists. Kaya maliit ang sweldo mu kahit todo multitasking at OTY ka.

Your PA has to take a break, leaving you the only staff of the pharmacy present.

Even with two of you, it isn't enough, but with you by yourself, you can already predict the chaos that is coming.

You're the cashier, the pharmacy assistant and pharmacist all rolled into one multitasking overworked underpaid worker.

You cannot impart even a single word of patient counseling to a customer because some of the people at the back of the line are already yelling at you, and you do all you can to remain composed and calm inspite of this for fear that in your haste, you might just dispense the wrong drug.

Good thing, hindi naman ako namura sa instance na ito. Sinigawan lang ni lolo yung back office kung bakit ako lang ang nag iisang tao sa buong store dahil hindi na gumagalaw ang pila (lolo was shouting while I was transacting a senior citizen purchase with the customer asking me to compute what would fit with their budget with the senior citizen discount. If I remember correctly, there were less than 30 customers on that line. Men, it was like a battlefield to me. And again, this was a large store)

And this is just one day.

Could I have made the people in line wait so I could impart 1-3 minutes of patient counseling to each customer rergardless na mumurahin na ako ng mga tao? Thereby making the people wait for at least 30 minutes in line for their order to be taken? There aren't any chairs. Take note that they're all just standing there in line, and I don't think that they'll like waiting at least half an hour just to get a paracetamol, for example.

I would accept those accusations from a fellow community pharmacist of a 'large chain retail drugstore' for at least 2 years, because if that was the case - Ah, community pharmacist ka pala dati sa Mercury at nagawa mung magpatient counseling sa BAWAT customer na bumili sa branch mu? Whoa, astig ka! You have to teach us how you were able to do that! (interested rin ako kung nanggaling ka sa Watsons or The Generics Pharmacy at nagwork ka dun ng at least 2 years at nakapagpatient counseling sa BAWAT customer na bumili sa store mo)


Hospital pharmacist ka? Do you counsel EVERY outpatient patient that purchases from your pharmacy?


Manuf experience? Not even close.


Academe? As in, no experience working in a drugstore whatsoever? Sorry, if that was the case, those accusations would be unacceptable.


*Ocampo is also appealing to hospitals and drugstore owners and operators to support pharmacists in espousing this type of practice, adding further that this is all for the good of the patient.

That was one thing I agree with. Yeah, appeal to the companies to actually LET us pharmacists do our jobs!

Andyan ang intensyon, pero asan yung oportunidad?

I hope I was able to make clear to you the mystery of why the ideal practice of our profession is almost never practiced here in the Philippines. It was a mystery to us back when we were college students, but now, I hope I have cleared up any doubts that you might have. Yes, college students, and people of the academe who have no experience in the field (other than internship) whatsoever but feel that they can rightly blame us - it is no mystery at all!

It's not us. It's the whole fucked up system.


Reality bites.

Bitter Truth #4: Dealing with people's lack of knowledge

There's a lot most Filipinos don't know about drugs. For example, they think drugs are just like food – they can take whatever they want whenever they feel like it for how long they want. They don't know that there are consequences.

Example scenario:

Patient: May azithromycin kayo?

Rph: Meron po Sir. Pwede po makita yung reseta?

Patient: Kailangan pa ba ng reseta yun? Para lang naman sa sakit ng lalamunan.

Rph: Opo Sir. Kailangan po kasi nating masigurado na nirekomenda ng doktor ang gamot para sa 'yo. (Attempts to assess the patient's condition by interrogation). Kailan po ba Sir nagsimula yung sakit ng lalamunan nyu?

Patient: Kaninang umaga.

Rph: -_____-+

Patient: Amoxicillin na lang, yung 500mg.

Rph: Kailangan pa rin po Sir ng reseta kasi antibiotic rin po yung Amoxicillin. Kailangan po ng rekomendayon ng doktor para safe tayo.

Patient: Yung 500mg lang naman e. Bakit sa ____ di naman kailangan ng reseta?

Rph: Baka po hindi nyu naman kailangan ng antibiotic since kanina lang naman po nagsimula yung nararamdaman nyu. Marerecommend ko po yung panggargle muna para sa kondisyon nyu. Maraming komplikasyon kasi ang antibiotic kung hindi tama ang pag inom.

Patient: Sige, sa iba na lang ako bibili.

What is wrong with the Patient?

Una, dahil kaya mung bigkasin ang Azithromycin, hindi ibig sabihin doktor ka na at kaya mu nang resetahan sarili mu. Okay lang na limitado lang ang kaalaman mu, pero yung pagmamarunong mo, pwede mung ikapahamak. Makinig na lang kayo sana at wag na kaming awayin. (ok, so hindi naman ako inaway, hehe)

Pangalawa,

E di dun kayo bumili!

I'm also at a loss of how some customers know so many drugs, but have no idea on its implications.

In the communty pharmacy practice, pharmacists deal with blind pride and stupidity of some people everyday. They also sometimes get mistreated. Ikaw pa ang mali at masama. Ayun nanaman, mumurahin ka pa ng nagwawalang customer dahil sa sarili nyang katangahan at dangal na walang katuturan.

And it's the pharmacists who pay for these people's stupidity.

Reality bites.

Bitter Truth #3: Bayani Ka

I remember this class quite vaguely when a professor of ours was discussing something I can no longer recall... Anyways, while he was discussing this topic and was asking something from the class, he mentioned as a side comment that “Okay, given naman na bayani ang mga pharmacist, anu pa....”. This statement was never emphasized in class ever after, but in my opinion, it was the closest to the truth of what the actual scenario of our profession is here in the Philippines.

And I didn't realize the significance of this mere side comment until I entered the real world of Pharmacy.

Yes, pharmacist, you have invested a lot of money, sweat and blood to earn your degree and license. Think of the summers you had to work for free (960 hours internship) while your friends enjoyed their vacation. Think of the money you parents invested for your tuition (in one University, Pharmacy had the most expensive tuition fee). Think of the all those aching units you had to pass (223 units in total), kung panu ka nahirapang makahabol sa barkada mu dahil 15 to 17 units lang per semester nila at ikaw hingalong hingalo at parang bugbog sarado ka sa sched mu dala ng 28 to 32 units per semester. Also, remember the money you spent on your thesis just to be able to graduate, the money your parents spent so that you could enter a good review school and pass your Licensure Exam as well as all the effort you put into it.

And you think it would all pay off? I had thought so too.

Kahit sa pagtatrabaho, ikaw pa rin, pharmacist, ang bugbog sarado at hingalo sa sched mu na walang weekend at walang holiday at puro OTY (Overtime w/o pay). Malaki rin ang posibilidad na hindi mu na masaydo makakasabay ang pamilya mu sa paglabas o pagkain dahil iba ang restday mu sa knila at iba rin oras mo.

At may additional na hiya pang kasama ang mundo ng trabaho, dahil ang mga kabarkada mo, mas marami na ang kayang i-afford, pero ikaw, mahihiya ka dahil di mu kaya i-afford ang kaya nila kahit ikaw yung bugbog sarado sa trabaho mo (pwera na lang kung may kaya ang pamilya mu at nakakahingi ka sa mga magulang mu kahit may trabaho ka na). Mahihiya ka dahil mag aadjust sila sayo dahil maliit lang ang sweldo mo at di ka pa rin nakakahabol sa kanila in terms sa sched nilang maluwag at sa sahod nilang bongga kumpara sa sahod mong mababa (below minimum pa nga sa ibang kompanya).

So here are the facts when you are employed as a Community Pharmacist

Salary: low to below minimum

(If you're offered a slightly higher salary, expect that there's a catch. You'll still be overworked and underpaid)

Perks: Verbal abuse from customers, sometimes even physical abuse

Responsibility: Life of your customers

Risk: Your license, all the money, efforts and time you have invested for 4 to 5 years to earn your degree

Isn't it all worth it?

Reality bites.

Bitter Truth #2: Not a job for the fainthearted

Like what I wrote earlier, kaaway tayo ng mga pasaway at nagmamarunong na nagseself-medicate. Don't get me wrong – From what little experience I have had, I can say that people are generally nice. However, we have to accept that some people are just plain mean. May mga taong salbahe lang talaga.

Because of their limited understanding, these people will treat you as if you're beneath them. You are not a certified Community Pharmacist until you have been scolded and cursed at. Sisigawan ka, duduruhin ka at/o mumurahin ka. This can all be done simultaneuosly to you.

It can traumatize you (it did me). You see, nobody told me that the job of a Pharmacist is not for the fainthearted. Don't worry, as we have no choice but to grow stronger emotionally and not let some people's meanness and stupidity get the best of us.

It is through these experiences that you will appreciate further the nice customers – the ones who give the effort to smile or thank you, the ones who have been patient and did not complain aloud to you when they had waited a very long time for their turn, the ones who are understanding even when you aren't able to give them enough change because you just didn't have anymore centavo coins. GOD bless these people for making our work more tolerable.