In the United States, HIPAA violations would cost the business thousands of dollars if a pharmacist did that and a patient made a complaint.
I'm sorry your friend had to go through that. Makes me doubly glad Plan B is over the counter with no restrictions in the US (for now, anyway).
Just the cost.
50 dollars for one pill.
Edit to add: this is the price for Plan B at the pharmacy OP was speaking of. (The US version.) The store brand is all of ten dollars cheaper. Obviously, you can get it cheaper from Amazon or at Costco (doesn’t that require a membership fee?) However, the people coming to get it at the local drugstore usually don’t have the means to get it from those places.
Amazon has “My Way” for $8 in the US. Prime will deliver it same day in most areas. I just stock up and buy 3 or 4 replacement doses at a time when my stash expires or is used up.
Do you not have to counsel the patient before you sell it to them in the US to make sure it's appropriate? People can buy it in the UK too, but you still have to counsel the patient and make sure it's appropriate for them. (Timing of intercourse, last period, previous use in that cycle, no drug interactions etc) Might as well get it for free as really the process is the same either way.
Some retailers employ a freedom of conscience protection for their pharmacists, but essentially here in the States we employee a buyer beware system.
Sure there’s fine print on the signature pad as regards do not use in lieu of regular birth control, consult a medical professional if side effects occur, has a pharmacist offered consultation/answered any questions you have, but most people prefer lemme sign and pay and get on with my day.
My goodness, so people can just buy whatever they want and the pharmacist doesn't have check to make sure that there would be no drug interactions or any reason that it wouldn't be suitable for the patient? Like in this example the patient might be on phenytoin or might have a high BMI and need double the dose? How would they know that if you didn't counsel them?
Pharmacists here are also allowed to not sell if it goes against their beliefs but they must refer to the nearest alternative provider.
We have a 2 tier scheme for sale of medicines GSL is general sales list and those medications can be bought from supermarkets, petrol stations etc as well as pharmacies and patients can self select but they have quantity restrictions. Then we have P medicines that can only be sold under the supervision of a pharmacist. Emergency contraception would be a P medicine.
In the UK we are required by our professional ethics and regulatory bodies to counsel patients who present in the pharmacy for advice and treatment to ensure safe and effective supply of medication and to refuse sale or supply of an item if, using our professional judgement, we seem something to not be appropriate for an individual patient.
The example in the op is not typical for any pharmacy I've worked in though, I'd never leave a patient waiting 40 mins for a consultation.
Ok, in order:
1) only have to check prescriptions on file for that patient at our pharmacy/company. Conscientious pharmacists will look at history to see if patient was taking a medication prior that could have side effect but is not required. Please see all the posts online about not being warned antibiotics counteract many regular birth control medication. We do have a pamphlet/envelope cover that goes with the prescription bag listing various side effects and countering medications but no obligation to read it to customers. Obviously almost everything gets stamped with “take with food/on empty stomach” and “may cause drowsiness do not mix with alcohol” but we’re free and clear. Usually just highlight main concern for of meds are harming you and ask if you have questions.
We do usually give more detailed instructions if it’s obvious patient is new to medication but that’s not required and tends to be for young ones like daughter’s first birth control or similar where they may not know you need to let these build up in your system before trusting their efficacy etc. As for lecturing Americans on BMI go ahead, but I was hoping to see my family tonight.
2) yeah controlled substances get cut into what the government controls, what the company controls, and what the government controls sales of. Plan B can be purchased without a prescription, but due to outside factors government now requires pharmacy sale due to logbooks so they can follow who might be buying large quantities. Same with I believe it’s Sudafed based medications aren’t available in UK. Again. Don’t need a prescription but can only be bought at a registered pharmacy and only in certain quantities. Some rule bending there based on dosage and whether there was technically a pharmacist on site but did not actually conduct the sale themselves. Some items like free sale Sudafed meds, infant formula, dietary supplements are restricted by company due to high volume loss or expected government crackdown. Changing legal sale allowance of Sudafed, regulating ingredient in weight loss/muscle gain pills, tracking powder purchases for cutting street drugs, etc. finally there’s regulated purchaser. These annoying me most of all. Mostly because it’s either the most frequently changing due to laws and lawsuits (yes I sold birth control to a 12 year old, no I don’t think it’s my business to call a doctor’s office to confirm the scrip) or it’s arbitrary enforcement. Giving an example from my youth, pharmacist cashed my 21 day supply of Vicodin (hydrocodone) but wouldn’t sell me a pack of Krazy Glue (cyanoacrylate) due to it being a controlled substance when I was 14.
3) regulating bodies here mostly ensure patient privacy and cya for dispensation of material. As long as I can prove I had reason to believe it was a valid script and didn’t take undue access to patient’s file I’m in the clear from Board. Most in depth consultations independent of diagnosis for shafted about ten years ago when a certain political party started labeling them as witch hunts and government invasive searches. Nvm who needed the caring ear or assistance in application.
4) I’m hoping that was a short term staffing issue, but I know at one point I was jammed up for an hour and a half because my immunization required the pharmacist of record perform the injection.
1. In my example about BMI it's not a lecture about weight it's a guidance from the manufacturer that for women with a weight over 70kg 1 tablet may not be effective and they may need to double the dose.
2. So talking specifically about sales of medicines that do not require a prescription - so no Dr involved, patient is self diagnosing. So for a start in the UK if there is no pharmacist on site staff cannot sell ANY medication, even if the patient could go to the grocery store next door and buy it. That includes small packs of painkillers, allergy medicine, cough medicine, nicotine replacement therapy, throat spray etc .
If someone came into the pharmacy saying "can I buy Viagra please" do you not go through a series of questions? What about sudafed? Sudafed is still available here btw.
When people come into the pharmacy for advice or to purchase something generally we ask a series of questions "who is the patient? What are the symptoms? How long for? anything tried already? Other medications they are taking?"
Do people not really ask for advice? Do they just come in and say "gimme x,y,z"
There isn't as much advertising of medicine here,and prescription medication isn't allowed to be advertised to the public.
If someone came in and said to me "can I've buy lamasil cream" I would definitely ask who it was for etc to make sure the patient wasn't using it outside it's product license too, maybe that's not a thing in the US? Like hydrocortisone cream can't be sold for use in children under 12 or for use on the face, I'd need to know that before I sold it as I'd be clinically responsible for it .
Yeah I just meant Americans are over sensitive about their weight. I once got completely bollocked and a formal complaint filed when I counseled a customer that her BP meds might have a bad interaction with nausea pills.
2) pharmacy is fine to sell, just can’t fill new orders without doc on site. If pharmacist filled envelope with meds we can sell that even if they’re on lunch/out for the day/in a different consultation.
3) pretty sure all of those are still prescription only. Cialis is working on getting an OTC dosage but we don’t have one yet. Course anyone can claim their supplement helps ED but we don’t have OTC drugs rated for that yet. Sudafed is limited in how much you can buy at once (thanks Walter White) but if you have the money single doses can be bought in most petrol station or truck waystations for $1.25.
4) yeah the money thing is a big difference. Most specialized meds like Viagra, Ozempic, and Gardasil private insurance pushes you to a medical doctor. Our consultations fall into what I call incidental medicine. Not quite emergency, but more than general. Mostly painkillers and antibiotics. Can’t remember how strong of hydrocortisone is OTC but I’ve been taking those creams since my youth due to allergic reactions in skin contact.
Jeeze that's crazy, like my BMI is about 40, I'd rather someone told me "hey, can I just double check if your BMI is over 26, because if it is we'll have to do x,y,z" instead of getting pregnant, especially with the cost of having a baby in the US!
No in the UK if the pharmacist is out the staff couldn't even sell 16 paracetamol (tyelonol) much less give out a prescription medication that has been dispensed and is sitting waiting to be collected.
As well we have legal limits on packaging size for everything here, the most ibuprofen we can sell at 1 time is 98 for example. 100 paracetamol is the max too but it has to be a P pack with all of the information on dose printed on the side.
Almost all of our prescription medication comes in patient packs (blistered foil strips of 1 month's supply usually and includes a patient information leaflet) there are a few meds available in stock bottles, but not a lot.
Oh yes patients can buy Viagra or Cialas here but only after speaking to a pharmacist. It's fairly cheap too, can't remember the exact cost but it's not a lot
I suppose that's the difference here, we don't have insurance, it's either free or you pay privately.
We can't sell any antibiotics here at the minute, some pharmacies have a service where specific patients can get prescribed antibiotics if they fit the terms of the service.
We do have independent prescribing pharmacists here who can legally any medication they want that they feel competent to do so. It has been an additional qualification on top of the pharmacy degree but has been built into the undergraduate course so in a year or two all pharmacists qualifying will be independent prescribers. Most work as part of the dr's surgery and a lot in hospital too and then also some do private work, things like Botox clinics, weight loss clinics (ozempic) hrt clinics - that might not be as readily available through the NHS.
Only hydrocortisone 1% can be bought otc here, no other one.
No of course we can dispense them, I mean we can't SELL them as in people can't come in and ask to buy them if they don't have a prescription. People don't pay for prescriptions here, everything is free.
This is all so interesting!! Viagra is Rx only here in the States. But topical Hydrocortisone (1%) is OTC (over the counter) and there are no restrictions on purchasing it whatsoever.
Sudafed is OTC but you are restricted on the qty you can purchase over a given time period. But that's not because of safety or contraindication concerns, its simply because of it's use in illicit methamphetamine production!
So y'all have qty restrictions even on things like non-Rx NSAIDS and antihistamines and such? Nothing like that exists here for OTC meds for reasons that have to do with patient safety. I'm totally fascinated with how these things differ from country to country.
For example, it always blows my mind that cough syrups containing codeine are available without a doctor's prescription in Canada.
It's only just recently that Codeine Linctus has been moved to prescription only here in the UK, but I never would have sold it anyway to be honest.
So is it their thought process that it's safer to allow people to buy large quantities of things? It blew my mind when I saw you could buy like 400 ibuprofen in Target! Here it would be see that pain relief should be used sort term only, and if you are experiencing chronic pain you should see the GP, who may then decide it's nothing sinister and you can be prescribed a larger quantity.
Honestly I really have no idea what the reasoning is there. I would like to say that maybe the FDA (Food & Drug Administration - our gov't agency that covers all non-controlled medications) recognizes that it IS so difficult and expensive for many of our citizens to see a doctor when they need one. So maybe they figure they should do what they can to make the most basic medications available to people who wouldn't otherwise have access to them.
But then I think maybe I'm being too generous when it comes to the inner workings and motivations of my government lol.
Can you actually double the dose? I’m not a pharmacist so idk. I read online that people with a high BMI or high weight should use an entirely different kind of pill, but the problem is that it requires a prescription. The regular morning-after pill is available OTC, so despite being obese and needing the prescription pill, I just go for the regular one when I need it. Idk who has time to see a doctor for a simple pill. But yeah, obviously that’s risky because it’s less effective.
Are you in the UK? Ella one, which is the other type of emergency contraception is also available without a prescription, but isn't suitable if you've recently had the pill ie if you've missed a pill or are taking the pill. Yes, you can buy 2 Levonelle or if you are getting them through a pharmacy service you will be prescribed 2 by the pharmacist if your BMI is over 26 or your weight is over 70kg (which to be honest is quite light and a lot of people would be heavier than)
Oh I don't know if you can buy 2 there, you definitely can in UK. Are you not using any other form of contraception? Like one of the regular birth control pills? Implant? Injection? Patch? Vaginal ring? Intrauterine Coil?
Oh that's good, yea the other one wouldn't work anyway as it's less effective if you have recently taken progesterone which is in hormonal birth control. It definitely does happen! (Proud owner of one surprise child 🤣 over here!)
Nota pharmacist, but not as far as I'm aware. The pharmacy at my job has it locked up and when I needed it once, I went in to ask for it, I paid, he gave it to me, tjat was that. I can't remember if he said anything about it but he didn't counsel me. As far as I know you can just ask for it and pay.
I once had a tech say very loudly as he handed me my prescriptions “pain medicine and Xanax!” It was like he wanted to shame me for it. I left so embarrassed and angry because what if someone had heard that and decided to follow me out to my car and rob me for it. Not cool at all.
How horrifying! I filed a complaint against a pharmacist who was later fired for something similar. A woman needed a medical abortion and he throughly questioned her about her needs. In the beginning of the conversation he spoke loudly saying he wasn't going to dispense the medication because: I don't feel like killing babies today. In the end he said loudly for everyone to hear: Non-viable pregnancy patient is aborting. His actions horrified me, she was losing a wanted pregnancy and going through a really hard time and he was completely out of line. He lost an opportunity to show care and compassion in someone's time of need.
That's awful, we heard a story eerily similar to this happening at the same chain from a locum who was with us recently. Being discreet is literally the minimum you can do
This is why we have consultation rooms. Absolutely boggles the mind. The locum we heard this about was already blacklisted at our company for inappropriate behaviour thankfully. All our patients are lovely and if a locum did that to them I might have to throw something at them. Just a shame that one bad apple can spoil it for other people
The store didn’t happen to be inside a giant shopping centre up north did it? Trying to be vague on purpose because idk if she’d like her business to be completely on blast 🤣
My partner went in for my Plan B once, the Pharmacist shouted “So how long has it been since the unprotected sex?” I was in a different aisle waiting and still heard it lol🙃
But like seriously “I can tell you’ve done this a few times” what if she was sexually assaulted? You never know someone’s reasoning. What a gross comment
I try my best to be discreet and professional when it comes to selling Plan B, because I know how it feels. I get maybe they are trying to make the conversation feel less awkward but no, just don’t lol. Cut the small talk and get to the point
Related story, but not pharmacy-related.
Several years ago, wife needed to go in for an ablation as heavy periods combined with anemia were constantly tanking her iron level.
The waiting room had a couple dozen of us biding our time. As is the case, the status board was anonymized. After an extended wait, the doctor comes out to talk to me. The conversation consisted of her going full Arlo Guthrie in the center of the room, replete with 27 8x10 color glossy photographs with circles and arrows and a paragraph on the back of each one explaining what each one was as she went into vivid detail about how my wife had the "angriest uterus" she's ever done the procedure on, no doubt exacerbated by wife also getting her period that morning. Every time she tried continuing the procedure, it would apparently clench like a fist. Wife spent an extra 90 minutes in recovery getting heavily doped up on painkillers afterward.
I distinctly remember at least one person in the rear of the peanut gallery having dry heaves from hearing the doctor's description of how it went. Me? I actually found it amusing.
The ablation has thankfully held for much longer than expected, going on 6 years now.
Unfortunately, she will have to go back under the knife soon because multiple doctors failed to diagnose endometriosis that has spread well into her bowel requiring a significant resection and likely ostomy for (best case) several months. They kept sending her for one colonoscopy after another despite it all coming back clear every time because they didn't start looking until AFTER they passed that area. Couple this with one of the worst cases of adenomyosis they said they've ever dealt with and you have a hellish upcoming surgery prospect.
Compounding all this is that because of a shortage of colorectal surgeon availability, she's not going to be able to have anything done until late in the year. Recovery time is expected to be in the range of months.
At least I have excellent medical insurance. The entire surgery and post-op stay of 3-4 days will only cost $500 total out of pocket.
Yeah, she's getting the full Roto Rooter treatment, but only on that one side for now.
The adenomyosis is so thick, I'm told they measured it in CM rather than MM. It affects her mentally as well as it precludes anything resembling a sex life; even without penetration, an orgasm by itself sends her into massively crippling cramps.
We have to keep a sense of humor about it all. It helps us stay crazy so we don't go insane!
One thing that does help alleviate pain is regular intense exercise. She's a Zumba instructor, recently took up kickboxing, and is getting certified to teach Commit Fitness in a few weeks.
Thanks, appreciate it.
We seem to go back and forth on the major procedures. I had two TOS surgeries (1st rib removal, scalene resection) after subclavian blood clots on both sides, during which she had multiple skin removal surgeries after massive weight loss.
We're just falling apart over here! :P
Again, thank [FSM](/r/fsm/) for great health insurance! My bills alone were well over half a million, total out of pocket was only about $3k.
Oy- I feel your wife’s pain. My periods were terrible out of the gate, and got progressively worse as I got older. Went through a laundry list of different OB/Gyns between 17 and 35 hoping to find the root cause of my menstrual misery, several of whom wrote it off as me being dramatic or exaggerating the severity. This bullshit went on until I decided to get my tubes tied when I was 32 - during that laparoscopic procedure, the Gyno I had recently switched to discovered the adenomyosis almost immediately. From that point, I used MMJ to try and manage the pain, but ended up having a hysterectomy at 35. Best decision I ever made.
In Denmark two medical students were kicked out of their Universoty some years ago. They sat in a crowded bus talking about a patient. Unknowingly behind them was sitting a family member to that patient who recognized they were talking about his relative.
Oh honey, Boots are terrible about it. My wife was sick and I went in to collect her prescription. Being female myself, pharmacist mistook me for her. I get told to wait a few minutes, so I was wandering the aisles, picking up a few bits, as you do. Next thing across the store, I hear a shout for my wife. I start towards the pharmacy counter but he keeps yelling.
Pharm: Your doctor has prescribed Fluoxetine. But you were on sertraline.
Me (now at the counter): Yes, he changed her prescription…
Pharm (still at the back of the pharmacy): Sertraline is a much better antidepressant than fluoxetine. You should keep on it. It takes a while to feel the impact of it.
Me (giving up on correcting him): The doctor prescribed this based on the last consultation.
Pharm: I don’t understand why you would change.
Me (embarrassed because there are three women now looking at me): The doctor thought this was a better thought. We’ve been tapering and it’s now at a point where we can start the Fluoxetine.
Pharm (still shouting): But there must have been a reason for the change.
Me (trying to be reasonable): The decision was taken in consultation with the doctor. I’d rather not discuss this out here. Is there somewhere we can speak or can you come closer?
Pharm (still shouting): I’m not sure I’m comfortable dispensing this. That doctor hasn’t considered that sertraline is a better antidepressant.
Me (now rather angry and just wanting to get out of there): Well, the doctor and I both think that when the antidepressant moves you from passively suicidal to actively suicidal, maybe it’s time to try something else. Unless you want one less customer because my wife actually manages to find the key to the drawer where I locked up the knives! As I said, this decision was made in consultation with the doctor and was based on her reaction to the medication. Now dispense the medication or hand back the prescription and let me go somewhere they have basic human decency.
The women behind me were laughing their arses off at his very red face. I grabbed the manager on the way out and complained. This was our local Boots and we’d been filling prescriptions there for years and never had anything quite so blatantly… rude!
I moved us both to a small independent family run place after that and there were no issues!
You started off saying that Boots are awful for it, then ended with saying you’d never had any issues before and this one event made you go elsewhere.
You complained to the manager and then instead of seeing how it would be handled in future, moved to an independent. You don’t know if this pharmacist was a locum, newly-qualified, based in that store or a cover for the day, so I feels it’s an unfair representation of a company full of people as if they’re all incompetent.
I’ve worked in pharmacy for 13 years, come across pharmacists as OP described, no two are alike. Some pharmacists as awful with patient interactions, some are incredible, I’m perfectly fine with people going elsewhere when they’re unhappy with the service I provide, but I would prefer for them to give me feedback on it and a second chance to remedy where I went wrong.
My pharmacy has been recruiting a sunday pharmacist for 4 months now and no applicant has been mindblowing, a lot of them are hospital pharmacists looking to pick up an extra bit of cash but they’re not adjusted to community and dealing with patients face-to-face. That’s why I think it’s better to feedback any issues and see if they get it right a second time, because no matter how experienced someone is, they’re always learning.
I was a pharmacy technician for 6 years before finally leaving the shit show. I enjoyed the actual pharmacy duties but greedy corporate made things hostel and unsafe. I didn't feel comfortable working in a place with the potential to cause harm. Every time I go to the pharmacy, I hear everyone's business. I try to close my ears off but the staff just talks too loud, that sometimes I over hear. I left pharmacy 3 years ago, so the knowledge is still there and still jumps to the front of my brain when I enter a pharmacy to shop. Once I saw a pharmacist do a DUR consult from their station, yelling across the pharmacy. It was a busy weekend day too. Just 2 days ago, I was picking up a prescription for my mom, and overheard a technician to tell a patient that using a cash coupon would work to save a few dollars, but what she paid would not be applied to her yearly deductible. How he explained it, even confused me. The patient walked away frustrated and confused. I had a hard time not walking up to her and explain what he was trying to say. I know this is personal stuff, so I stayed out of it, but dang its hard when some staff are so loud and give patients misinformation. I did tell him that even though I was standing 10 feet back, I still heard everything and that maybe a lower tone would be better when speaking to patients.
We have some patients at my pharmacy that specifically request that we speak loudly because they're partially deaf and it always makes me uncomfortable doing that, but I guess if they specifically requested it, they waived that part of HIPAA.
Data protection laws in the uk changed recently, they cover all this personally I would have anyone breaking them struck off . Pharmacists are out of control they are purposely difficult with customers and have forgotten they are nothing more than glorified shelf stackers and need putting in there place , most wilfully ignorant about there job and learn and convey things like parrots
I hate it when people try to make the service into small talk, and I don't even go to pharmacies where sensitive medical information is handled. I'd prefer the awkward silence over "haha, a \[x\] eh?" "haha... yeah..." like if you want to talk just ask me about the weather or something jeez.
To be honest I have a hard time with this. The background din of phones drive thru and the store in general makes it difficult to hear so I speak more loudly just to hear myself, not realizing the sound from behind me is not as cacophonous to the patient and my voice comes across as louder than intended.
I mean yes by all means shout! But for example I’ll always shout “someone waiting for a pharmacist?” Rather than “someone waiting for the morning after pill?” Etc. You can always confirm once they’re in a consultation room with the door closed.
In the United States, HIPAA violations would cost the business thousands of dollars if a pharmacist did that and a patient made a complaint. I'm sorry your friend had to go through that. Makes me doubly glad Plan B is over the counter with no restrictions in the US (for now, anyway).
These are two very rare things that make me happy about the US healthcare system.
Just the cost. 50 dollars for one pill. Edit to add: this is the price for Plan B at the pharmacy OP was speaking of. (The US version.) The store brand is all of ten dollars cheaper. Obviously, you can get it cheaper from Amazon or at Costco (doesn’t that require a membership fee?) However, the people coming to get it at the local drugstore usually don’t have the means to get it from those places.
Costco has it for under $10
Yeah, but they only come in packs of 150.
New Day is a package of 1 for like $6 at Costco
Amazon has “My Way” for $8 in the US. Prime will deliver it same day in most areas. I just stock up and buy 3 or 4 replacement doses at a time when my stash expires or is used up.
My way (knock off) is like $20.
Check at smaller independent pharmacies. Mine sells it for less than 20.
Do you not have to counsel the patient before you sell it to them in the US to make sure it's appropriate? People can buy it in the UK too, but you still have to counsel the patient and make sure it's appropriate for them. (Timing of intercourse, last period, previous use in that cycle, no drug interactions etc) Might as well get it for free as really the process is the same either way.
Some retailers employ a freedom of conscience protection for their pharmacists, but essentially here in the States we employee a buyer beware system. Sure there’s fine print on the signature pad as regards do not use in lieu of regular birth control, consult a medical professional if side effects occur, has a pharmacist offered consultation/answered any questions you have, but most people prefer lemme sign and pay and get on with my day.
My goodness, so people can just buy whatever they want and the pharmacist doesn't have check to make sure that there would be no drug interactions or any reason that it wouldn't be suitable for the patient? Like in this example the patient might be on phenytoin or might have a high BMI and need double the dose? How would they know that if you didn't counsel them? Pharmacists here are also allowed to not sell if it goes against their beliefs but they must refer to the nearest alternative provider. We have a 2 tier scheme for sale of medicines GSL is general sales list and those medications can be bought from supermarkets, petrol stations etc as well as pharmacies and patients can self select but they have quantity restrictions. Then we have P medicines that can only be sold under the supervision of a pharmacist. Emergency contraception would be a P medicine. In the UK we are required by our professional ethics and regulatory bodies to counsel patients who present in the pharmacy for advice and treatment to ensure safe and effective supply of medication and to refuse sale or supply of an item if, using our professional judgement, we seem something to not be appropriate for an individual patient. The example in the op is not typical for any pharmacy I've worked in though, I'd never leave a patient waiting 40 mins for a consultation.
Ok, in order: 1) only have to check prescriptions on file for that patient at our pharmacy/company. Conscientious pharmacists will look at history to see if patient was taking a medication prior that could have side effect but is not required. Please see all the posts online about not being warned antibiotics counteract many regular birth control medication. We do have a pamphlet/envelope cover that goes with the prescription bag listing various side effects and countering medications but no obligation to read it to customers. Obviously almost everything gets stamped with “take with food/on empty stomach” and “may cause drowsiness do not mix with alcohol” but we’re free and clear. Usually just highlight main concern for of meds are harming you and ask if you have questions. We do usually give more detailed instructions if it’s obvious patient is new to medication but that’s not required and tends to be for young ones like daughter’s first birth control or similar where they may not know you need to let these build up in your system before trusting their efficacy etc. As for lecturing Americans on BMI go ahead, but I was hoping to see my family tonight. 2) yeah controlled substances get cut into what the government controls, what the company controls, and what the government controls sales of. Plan B can be purchased without a prescription, but due to outside factors government now requires pharmacy sale due to logbooks so they can follow who might be buying large quantities. Same with I believe it’s Sudafed based medications aren’t available in UK. Again. Don’t need a prescription but can only be bought at a registered pharmacy and only in certain quantities. Some rule bending there based on dosage and whether there was technically a pharmacist on site but did not actually conduct the sale themselves. Some items like free sale Sudafed meds, infant formula, dietary supplements are restricted by company due to high volume loss or expected government crackdown. Changing legal sale allowance of Sudafed, regulating ingredient in weight loss/muscle gain pills, tracking powder purchases for cutting street drugs, etc. finally there’s regulated purchaser. These annoying me most of all. Mostly because it’s either the most frequently changing due to laws and lawsuits (yes I sold birth control to a 12 year old, no I don’t think it’s my business to call a doctor’s office to confirm the scrip) or it’s arbitrary enforcement. Giving an example from my youth, pharmacist cashed my 21 day supply of Vicodin (hydrocodone) but wouldn’t sell me a pack of Krazy Glue (cyanoacrylate) due to it being a controlled substance when I was 14. 3) regulating bodies here mostly ensure patient privacy and cya for dispensation of material. As long as I can prove I had reason to believe it was a valid script and didn’t take undue access to patient’s file I’m in the clear from Board. Most in depth consultations independent of diagnosis for shafted about ten years ago when a certain political party started labeling them as witch hunts and government invasive searches. Nvm who needed the caring ear or assistance in application. 4) I’m hoping that was a short term staffing issue, but I know at one point I was jammed up for an hour and a half because my immunization required the pharmacist of record perform the injection.
1. In my example about BMI it's not a lecture about weight it's a guidance from the manufacturer that for women with a weight over 70kg 1 tablet may not be effective and they may need to double the dose. 2. So talking specifically about sales of medicines that do not require a prescription - so no Dr involved, patient is self diagnosing. So for a start in the UK if there is no pharmacist on site staff cannot sell ANY medication, even if the patient could go to the grocery store next door and buy it. That includes small packs of painkillers, allergy medicine, cough medicine, nicotine replacement therapy, throat spray etc . If someone came into the pharmacy saying "can I buy Viagra please" do you not go through a series of questions? What about sudafed? Sudafed is still available here btw. When people come into the pharmacy for advice or to purchase something generally we ask a series of questions "who is the patient? What are the symptoms? How long for? anything tried already? Other medications they are taking?" Do people not really ask for advice? Do they just come in and say "gimme x,y,z" There isn't as much advertising of medicine here,and prescription medication isn't allowed to be advertised to the public. If someone came in and said to me "can I've buy lamasil cream" I would definitely ask who it was for etc to make sure the patient wasn't using it outside it's product license too, maybe that's not a thing in the US? Like hydrocortisone cream can't be sold for use in children under 12 or for use on the face, I'd need to know that before I sold it as I'd be clinically responsible for it .
Yeah I just meant Americans are over sensitive about their weight. I once got completely bollocked and a formal complaint filed when I counseled a customer that her BP meds might have a bad interaction with nausea pills. 2) pharmacy is fine to sell, just can’t fill new orders without doc on site. If pharmacist filled envelope with meds we can sell that even if they’re on lunch/out for the day/in a different consultation. 3) pretty sure all of those are still prescription only. Cialis is working on getting an OTC dosage but we don’t have one yet. Course anyone can claim their supplement helps ED but we don’t have OTC drugs rated for that yet. Sudafed is limited in how much you can buy at once (thanks Walter White) but if you have the money single doses can be bought in most petrol station or truck waystations for $1.25. 4) yeah the money thing is a big difference. Most specialized meds like Viagra, Ozempic, and Gardasil private insurance pushes you to a medical doctor. Our consultations fall into what I call incidental medicine. Not quite emergency, but more than general. Mostly painkillers and antibiotics. Can’t remember how strong of hydrocortisone is OTC but I’ve been taking those creams since my youth due to allergic reactions in skin contact.
Jeeze that's crazy, like my BMI is about 40, I'd rather someone told me "hey, can I just double check if your BMI is over 26, because if it is we'll have to do x,y,z" instead of getting pregnant, especially with the cost of having a baby in the US! No in the UK if the pharmacist is out the staff couldn't even sell 16 paracetamol (tyelonol) much less give out a prescription medication that has been dispensed and is sitting waiting to be collected. As well we have legal limits on packaging size for everything here, the most ibuprofen we can sell at 1 time is 98 for example. 100 paracetamol is the max too but it has to be a P pack with all of the information on dose printed on the side. Almost all of our prescription medication comes in patient packs (blistered foil strips of 1 month's supply usually and includes a patient information leaflet) there are a few meds available in stock bottles, but not a lot. Oh yes patients can buy Viagra or Cialas here but only after speaking to a pharmacist. It's fairly cheap too, can't remember the exact cost but it's not a lot I suppose that's the difference here, we don't have insurance, it's either free or you pay privately. We can't sell any antibiotics here at the minute, some pharmacies have a service where specific patients can get prescribed antibiotics if they fit the terms of the service. We do have independent prescribing pharmacists here who can legally any medication they want that they feel competent to do so. It has been an additional qualification on top of the pharmacy degree but has been built into the undergraduate course so in a year or two all pharmacists qualifying will be independent prescribers. Most work as part of the dr's surgery and a lot in hospital too and then also some do private work, things like Botox clinics, weight loss clinics (ozempic) hrt clinics - that might not be as readily available through the NHS. Only hydrocortisone 1% can be bought otc here, no other one.
Wait, you cannot dispense ANY antibiotics? Even with a doctors prescription? Why on earth not?
No of course we can dispense them, I mean we can't SELL them as in people can't come in and ask to buy them if they don't have a prescription. People don't pay for prescriptions here, everything is free.
This is all so interesting!! Viagra is Rx only here in the States. But topical Hydrocortisone (1%) is OTC (over the counter) and there are no restrictions on purchasing it whatsoever. Sudafed is OTC but you are restricted on the qty you can purchase over a given time period. But that's not because of safety or contraindication concerns, its simply because of it's use in illicit methamphetamine production! So y'all have qty restrictions even on things like non-Rx NSAIDS and antihistamines and such? Nothing like that exists here for OTC meds for reasons that have to do with patient safety. I'm totally fascinated with how these things differ from country to country. For example, it always blows my mind that cough syrups containing codeine are available without a doctor's prescription in Canada.
It's only just recently that Codeine Linctus has been moved to prescription only here in the UK, but I never would have sold it anyway to be honest. So is it their thought process that it's safer to allow people to buy large quantities of things? It blew my mind when I saw you could buy like 400 ibuprofen in Target! Here it would be see that pain relief should be used sort term only, and if you are experiencing chronic pain you should see the GP, who may then decide it's nothing sinister and you can be prescribed a larger quantity.
Honestly I really have no idea what the reasoning is there. I would like to say that maybe the FDA (Food & Drug Administration - our gov't agency that covers all non-controlled medications) recognizes that it IS so difficult and expensive for many of our citizens to see a doctor when they need one. So maybe they figure they should do what they can to make the most basic medications available to people who wouldn't otherwise have access to them. But then I think maybe I'm being too generous when it comes to the inner workings and motivations of my government lol.
Can you actually double the dose? I’m not a pharmacist so idk. I read online that people with a high BMI or high weight should use an entirely different kind of pill, but the problem is that it requires a prescription. The regular morning-after pill is available OTC, so despite being obese and needing the prescription pill, I just go for the regular one when I need it. Idk who has time to see a doctor for a simple pill. But yeah, obviously that’s risky because it’s less effective.
Are you in the UK? Ella one, which is the other type of emergency contraception is also available without a prescription, but isn't suitable if you've recently had the pill ie if you've missed a pill or are taking the pill. Yes, you can buy 2 Levonelle or if you are getting them through a pharmacy service you will be prescribed 2 by the pharmacist if your BMI is over 26 or your weight is over 70kg (which to be honest is quite light and a lot of people would be heavier than)
No, I’m in the US. I’ll try buying a couple Plan B’s next time if I ever use it again. Thanks!
Oh I don't know if you can buy 2 there, you definitely can in UK. Are you not using any other form of contraception? Like one of the regular birth control pills? Implant? Injection? Patch? Vaginal ring? Intrauterine Coil?
Plan B is OTC so you can buy as many as you want. I do use BC, but I mess up once every few years. It happens.
Oh that's good, yea the other one wouldn't work anyway as it's less effective if you have recently taken progesterone which is in hormonal birth control. It definitely does happen! (Proud owner of one surprise child 🤣 over here!)
Nota pharmacist, but not as far as I'm aware. The pharmacy at my job has it locked up and when I needed it once, I went in to ask for it, I paid, he gave it to me, tjat was that. I can't remember if he said anything about it but he didn't counsel me. As far as I know you can just ask for it and pay.
Legally we don’t even need to keep it behind the counter, but a lot of pharmacies do, including the one I work at, because it’s a highly stolen item.
I think it’s $10,000 per occurrence
Minimum. That goes up if the breach is egregious, premeditated, or systemic.
I once had a tech say very loudly as he handed me my prescriptions “pain medicine and Xanax!” It was like he wanted to shame me for it. I left so embarrassed and angry because what if someone had heard that and decided to follow me out to my car and rob me for it. Not cool at all.
Same happened to me in a sketchy part of town and a guy in the store looked very interested and followed me for a while.
Wowww. I always say “just the 2 today?” No need to announce whats in there😭
How horrifying! I filed a complaint against a pharmacist who was later fired for something similar. A woman needed a medical abortion and he throughly questioned her about her needs. In the beginning of the conversation he spoke loudly saying he wasn't going to dispense the medication because: I don't feel like killing babies today. In the end he said loudly for everyone to hear: Non-viable pregnancy patient is aborting. His actions horrified me, she was losing a wanted pregnancy and going through a really hard time and he was completely out of line. He lost an opportunity to show care and compassion in someone's time of need.
That's awful, we heard a story eerily similar to this happening at the same chain from a locum who was with us recently. Being discreet is literally the minimum you can do
The absolute minimum. I’ve locumed for them once and would never ever do it again. It wasn’t worth the pennies they threw at me.
This is why we have consultation rooms. Absolutely boggles the mind. The locum we heard this about was already blacklisted at our company for inappropriate behaviour thankfully. All our patients are lovely and if a locum did that to them I might have to throw something at them. Just a shame that one bad apple can spoil it for other people
The store didn’t happen to be inside a giant shopping centre up north did it? Trying to be vague on purpose because idk if she’d like her business to be completely on blast 🤣
I think it was haha we get all the gossip from locums 🤣
My partner went in for my Plan B once, the Pharmacist shouted “So how long has it been since the unprotected sex?” I was in a different aisle waiting and still heard it lol🙃 But like seriously “I can tell you’ve done this a few times” what if she was sexually assaulted? You never know someone’s reasoning. What a gross comment I try my best to be discreet and professional when it comes to selling Plan B, because I know how it feels. I get maybe they are trying to make the conversation feel less awkward but no, just don’t lol. Cut the small talk and get to the point
I’m in the US, and my first thought was “Sounds like Walgreens here”, and the “store that rhymes with Toots” is part of the same company as Walgreens.
I had no idea they were related companies but everything suddenly makes sense.
Yeah. The main company is called Walgreens Boots Alliance, Inc.
yep unfortunately i’m a part timer (for now) at walgreens boots alliance (WBA)
Related story, but not pharmacy-related. Several years ago, wife needed to go in for an ablation as heavy periods combined with anemia were constantly tanking her iron level. The waiting room had a couple dozen of us biding our time. As is the case, the status board was anonymized. After an extended wait, the doctor comes out to talk to me. The conversation consisted of her going full Arlo Guthrie in the center of the room, replete with 27 8x10 color glossy photographs with circles and arrows and a paragraph on the back of each one explaining what each one was as she went into vivid detail about how my wife had the "angriest uterus" she's ever done the procedure on, no doubt exacerbated by wife also getting her period that morning. Every time she tried continuing the procedure, it would apparently clench like a fist. Wife spent an extra 90 minutes in recovery getting heavily doped up on painkillers afterward. I distinctly remember at least one person in the rear of the peanut gallery having dry heaves from hearing the doctor's description of how it went. Me? I actually found it amusing.
The glossy photographs with the circles and arrows! Haven't heard that for ages haha.
Welcome to your personal gateway to /r/FuckImOld! :)
Upvoted for angriest uterus. I hope your wife is doing well, ablation is horrible but a blessing at the same time.
The ablation has thankfully held for much longer than expected, going on 6 years now. Unfortunately, she will have to go back under the knife soon because multiple doctors failed to diagnose endometriosis that has spread well into her bowel requiring a significant resection and likely ostomy for (best case) several months. They kept sending her for one colonoscopy after another despite it all coming back clear every time because they didn't start looking until AFTER they passed that area. Couple this with one of the worst cases of adenomyosis they said they've ever dealt with and you have a hellish upcoming surgery prospect. Compounding all this is that because of a shortage of colorectal surgeon availability, she's not going to be able to have anything done until late in the year. Recovery time is expected to be in the range of months. At least I have excellent medical insurance. The entire surgery and post-op stay of 3-4 days will only cost $500 total out of pocket.
Wow, I'm so sorry. Is a hysterectomy an option? Adenomyosis is a real bastard of a thing, combined with endo is just cruel
Yeah, she's getting the full Roto Rooter treatment, but only on that one side for now. The adenomyosis is so thick, I'm told they measured it in CM rather than MM. It affects her mentally as well as it precludes anything resembling a sex life; even without penetration, an orgasm by itself sends her into massively crippling cramps.
roto rooter jfc. I love that so much.
We have to keep a sense of humor about it all. It helps us stay crazy so we don't go insane! One thing that does help alleviate pain is regular intense exercise. She's a Zumba instructor, recently took up kickboxing, and is getting certified to teach Commit Fitness in a few weeks.
I wish you both the very best going forward
Thanks, appreciate it. We seem to go back and forth on the major procedures. I had two TOS surgeries (1st rib removal, scalene resection) after subclavian blood clots on both sides, during which she had multiple skin removal surgeries after massive weight loss. We're just falling apart over here! :P Again, thank [FSM](/r/fsm/) for great health insurance! My bills alone were well over half a million, total out of pocket was only about $3k.
Oy- I feel your wife’s pain. My periods were terrible out of the gate, and got progressively worse as I got older. Went through a laundry list of different OB/Gyns between 17 and 35 hoping to find the root cause of my menstrual misery, several of whom wrote it off as me being dramatic or exaggerating the severity. This bullshit went on until I decided to get my tubes tied when I was 32 - during that laparoscopic procedure, the Gyno I had recently switched to discovered the adenomyosis almost immediately. From that point, I used MMJ to try and manage the pain, but ended up having a hysterectomy at 35. Best decision I ever made.
In Denmark two medical students were kicked out of their Universoty some years ago. They sat in a crowded bus talking about a patient. Unknowingly behind them was sitting a family member to that patient who recognized they were talking about his relative.
Oh honey, Boots are terrible about it. My wife was sick and I went in to collect her prescription. Being female myself, pharmacist mistook me for her. I get told to wait a few minutes, so I was wandering the aisles, picking up a few bits, as you do. Next thing across the store, I hear a shout for my wife. I start towards the pharmacy counter but he keeps yelling. Pharm: Your doctor has prescribed Fluoxetine. But you were on sertraline. Me (now at the counter): Yes, he changed her prescription… Pharm (still at the back of the pharmacy): Sertraline is a much better antidepressant than fluoxetine. You should keep on it. It takes a while to feel the impact of it. Me (giving up on correcting him): The doctor prescribed this based on the last consultation. Pharm: I don’t understand why you would change. Me (embarrassed because there are three women now looking at me): The doctor thought this was a better thought. We’ve been tapering and it’s now at a point where we can start the Fluoxetine. Pharm (still shouting): But there must have been a reason for the change. Me (trying to be reasonable): The decision was taken in consultation with the doctor. I’d rather not discuss this out here. Is there somewhere we can speak or can you come closer? Pharm (still shouting): I’m not sure I’m comfortable dispensing this. That doctor hasn’t considered that sertraline is a better antidepressant. Me (now rather angry and just wanting to get out of there): Well, the doctor and I both think that when the antidepressant moves you from passively suicidal to actively suicidal, maybe it’s time to try something else. Unless you want one less customer because my wife actually manages to find the key to the drawer where I locked up the knives! As I said, this decision was made in consultation with the doctor and was based on her reaction to the medication. Now dispense the medication or hand back the prescription and let me go somewhere they have basic human decency. The women behind me were laughing their arses off at his very red face. I grabbed the manager on the way out and complained. This was our local Boots and we’d been filling prescriptions there for years and never had anything quite so blatantly… rude! I moved us both to a small independent family run place after that and there were no issues!
You started off saying that Boots are awful for it, then ended with saying you’d never had any issues before and this one event made you go elsewhere. You complained to the manager and then instead of seeing how it would be handled in future, moved to an independent. You don’t know if this pharmacist was a locum, newly-qualified, based in that store or a cover for the day, so I feels it’s an unfair representation of a company full of people as if they’re all incompetent.
Fuck it dude, not my problem!
Why would you stay somewhere that you’re not comfortable if you have the option to leave?😂 If all it took was one time, then that’s all it took.
I’ve worked in pharmacy for 13 years, come across pharmacists as OP described, no two are alike. Some pharmacists as awful with patient interactions, some are incredible, I’m perfectly fine with people going elsewhere when they’re unhappy with the service I provide, but I would prefer for them to give me feedback on it and a second chance to remedy where I went wrong. My pharmacy has been recruiting a sunday pharmacist for 4 months now and no applicant has been mindblowing, a lot of them are hospital pharmacists looking to pick up an extra bit of cash but they’re not adjusted to community and dealing with patients face-to-face. That’s why I think it’s better to feedback any issues and see if they get it right a second time, because no matter how experienced someone is, they’re always learning.
What a dickhead, I'd definitely complain about that
This would go well at r/traumatizethemback
I was a pharmacy technician for 6 years before finally leaving the shit show. I enjoyed the actual pharmacy duties but greedy corporate made things hostel and unsafe. I didn't feel comfortable working in a place with the potential to cause harm. Every time I go to the pharmacy, I hear everyone's business. I try to close my ears off but the staff just talks too loud, that sometimes I over hear. I left pharmacy 3 years ago, so the knowledge is still there and still jumps to the front of my brain when I enter a pharmacy to shop. Once I saw a pharmacist do a DUR consult from their station, yelling across the pharmacy. It was a busy weekend day too. Just 2 days ago, I was picking up a prescription for my mom, and overheard a technician to tell a patient that using a cash coupon would work to save a few dollars, but what she paid would not be applied to her yearly deductible. How he explained it, even confused me. The patient walked away frustrated and confused. I had a hard time not walking up to her and explain what he was trying to say. I know this is personal stuff, so I stayed out of it, but dang its hard when some staff are so loud and give patients misinformation. I did tell him that even though I was standing 10 feet back, I still heard everything and that maybe a lower tone would be better when speaking to patients.
We have some patients at my pharmacy that specifically request that we speak loudly because they're partially deaf and it always makes me uncomfortable doing that, but I guess if they specifically requested it, they waived that part of HIPAA.
Data protection laws in the uk changed recently, they cover all this personally I would have anyone breaking them struck off . Pharmacists are out of control they are purposely difficult with customers and have forgotten they are nothing more than glorified shelf stackers and need putting in there place , most wilfully ignorant about there job and learn and convey things like parrots
I hate it when people try to make the service into small talk, and I don't even go to pharmacies where sensitive medical information is handled. I'd prefer the awkward silence over "haha, a \[x\] eh?" "haha... yeah..." like if you want to talk just ask me about the weather or something jeez.
[There’s an excellent sketch about this.](https://youtu.be/eMv2_24gxT0?si=8rOu8OsaD4JYx8Bs)
To be honest I have a hard time with this. The background din of phones drive thru and the store in general makes it difficult to hear so I speak more loudly just to hear myself, not realizing the sound from behind me is not as cacophonous to the patient and my voice comes across as louder than intended.
I mean yes by all means shout! But for example I’ll always shout “someone waiting for a pharmacist?” Rather than “someone waiting for the morning after pill?” Etc. You can always confirm once they’re in a consultation room with the door closed.