This truck nearly ploughed into me and AGR whilst goofing in the servo; still looks slick though.

Sunrise over the Mackay coast @ 115kph, windows down.

My feet aren't sore, and this gladdens me greatly. In fact, despite all the walking I managed to get a single blister. It hasn't popped, and is unlikely to, unless I try to wear some sort of new-fangled winklepickers in the next day or so. I love my new shoes and trail socks.

The Airlie trip was a success; the Medical Misadventures had a blast, covered plenty of kilometers and morale is high. We also managed some walking under the cover of darkness, which was an essential experience given the timing of the challenge itself. Four weeks to go!

This post is about the beauty of the long distance counsel, and whilst it's actually been six days since I cranked out a long-distance counsel (LDC), (it's that long since I've worked), they are quite possibly the greatest mass-communication tool in pharmacy. Possibly.

The long distance counsel is not for the faint-hearted or self-conscious. (Or possibly those without other hyphenated personality traits). It is not for those whom know not of which they speak.

Here's how it rolls; a patient rolls up to the register and loudly asks a question. There's often a good story provided, and the person's clearly not shy about what their problem is. The shop assistant looks a little confused and glances my way; I have a line of 'scripts longer than the distance from Marathon to Athens.

The essence of the LDC is distance. The person needs a counsel, but as they've waived their 'here and now' confidentiality rights by talking at the shop-girl loud enough for you to hear from 10 meters away (and the issue isn't particularly sensitive), you counsel them from said distance. Usually, this will occur across at least two dispensary benches and/or 10+ meters. It's like a public service announcement. With style.

The patient's complaint or question is rare enough that not every moron who watches TV had cottoned on to what it is, but it will still have a bit of practical application to the rest of the punters. A good example here is worms;

Pt: My kid's got worms. They got them off the dog, and now they've got an itchy head.

Clearly, this patient is an idiot.

Cue the long distance counsel; "Okay, we need to work out if you kid's got one of three things: fleas, worms or lice. Here's how you tell them apart: the worms that you get in Australia aren't from dogs. And they'll have an itchy bum and that's where you'll see them. Lice are mites that are running around the head. They lay eggs, and both the lice and eggs are small, like a fullstop. Unless you see them running around, the treatment's pretty easy. Fleas are common in dogs, and may be transmissible. They're bigger, say the size of a hyphen, and there'll be truck loads."

So, eight sentences that clarify three common infestations. What the shop girls hear is; "The kid's got fleas, worms or lice. Worms are unlikely. The customer will now tell you which one their kid has; ask me if you can't remember the treatment."

I reckon that one of the other strong points of the LDC is that they're frequently incidental, and the customers feel good that the pharmacist is actually listening to whatever else is going on in the store. The rest of the young mums and dads, waiting on their Efexor and Ventolin, listen in and everyone's more informed by the experience.

I guess that's the thing about most pharmacies; the patients don't ask, the pharmacists don't ask. More questions people.

Right now, I'm in Airlie Beach. It's a good 10+ hr drive from Brisbane, but that won't be happening for a few more days.

Meantime, me and the rest of the lads from Medical Misadventures are thrashing out a couple of training hikes; the plan is to do two 60km hikes in three days. Significantly, the second one will be exactly a month out from Kokoda Challenge day. This is the main training week, and a lot of confidence is riding on how we got over the next few days.


The Pharmacy-related issue that's been on my mind this week involved nurses.

Nurses do a wonderful job. I expect to spend much time in the next few years kissing up to nurses and thanking them for saving my bacon, much like JD in the first season of Scrubs.

Meantime, when it comes to pharmacy, Nurses are a pain in the arse. Why? Because they know everything. Everything about everything.

Typically, a woman in her early-forties will front up with an amoxycillin 'script for her 8 year old. The 'script was written about 8 months ago, and is hence legally valid. Before I even think about filling, I stroll out for a chat;

"I'm a nurse, and...", invariably their opening gambit, "Katie's just come down with a tummy bug
, so I want this one to get through the weekend."

After extracting substantial information (it's quite forthcoming), any pharmacist worth their salt has established that antibiotics are completely unnecessary. I gently explain this to the nurse, but she's insistent; "anytime at work someone gets a tummy bug, this is what they give them."

She then proceeds to lecture me on the dangers of pediatric diarrhoea. I just love being lectured at my place of work. Especially in front of shop assistants. It really brings out the best of my knowledge of medicine to the fullest. It also means that I get to speak much louder than usual , from behind the dispensing computer. This is known as the 7 meter counsel, and is possibly one of the more enjoyable parts of the job. More on this next time.

For those of you playing at home with your XYZ handbook of medicine; Common bacterial GIT infections are caused by Gram -ve, and Amoxycillin covers predominantly Gram +ve bacteria. Chances are, though, that this will be either diet related, viral or just 'functional'.

Less gently now, I explain the difference between multiple antibiotics, the fact that it was probably written for a chest infection and that amoxycillin for a gut ache is, well, bloody stupid, and flatly refuse to supply it. Risks > benefits. Deal with it.

BUT! Let's remember, I'm not an owner here; so I still need to have some iota of respect for the custo-patient. So, I decide that treating the actual tummy bug's a good idea; some rehydration and maybe some paracetamol for the pain. (There's no fever, of course).

I give advice about timing and ice-blocks and the whole works; I really do give a crap about the kid with diarrhoea. She makes a few selections and comes to the register, and just as the sale is about to go through she says;

"And the antibiotics, we'd better give her some of those too, right?"

Greetings,
As a society, we are obsessed with health. It has many manifestations across all levels of society. Three examples that I've experience in the last two days are thus;

"I don't want to be sick anymore; I don't like my finger nails having ridges."
"Last year, my mates just ate junk food leading into exams and they got some sort of food poisoning."
"I feel really well within myself, I'm so lucky."

Two of these statements were made by medical students, the other by a diabetic 75 year old lady with neuropathy that's led to having her leg amputated. My point is not to bitch about how clueless most people are about their own health. It's more to illustrate the perceptions of health and how they differ in groups....

Okay; so not really feeling a decent spiel about that. Yet.


Batman is currently watching Ugly Betty. I'm not a big fan, but apparently lots of people are. There are also lots of people in Med; like 400 in my year group. Anyway, where I'm heading with this is nicknames. Obviously it's impossible to instantly learn 400 names from the word go, and since I knew all of two people in the course prior, a few of the more notable figures have developed nicknames.

The nicknames aren't all my own doing (I'm not that original), but they're good identifiers when talking to others about intraclass gossip.

Back to the point; there's a girl in my class nicknamed Ugly Betty. She's lovely, and I'm more than familiar with her name... now. When I didn't she was the girl who dressed interestingly, alarmingly and, well, like Ugly Betty.

I'm gonna fly through a bunch of other nicknames:

Blotchy
Choo-choo-b'chutch
Orange Hair
Nerdo
Ano Girl
Irish
The Girl with the world's smallest bladder
Journo Guy
The guy with the Cerebellar gate
Really Old Guy
Motorcycle Chick
Army Guy
The Winemaker
Partyboy
The Path nerd
I wish I was British
Poor cleavage management
The handbag
The Redneck

I'm sure there are others in different groups; I've probably got one in there somewhere.

Tomorrow morning we'll all be the same; it's exam day.

I'm bashing this out early this week; it's nine days until exams, and this happened again on the weekend.

I'm not the bad guy. Currently, the group of customers/patients who are pissed are the parents of children under 2. I blame the TGA (Therapeutic Goods Administration) for turning me into the bad guy. Their marketing sucks. They're wimps.

Here's what happened; the TGA had acted on a recommendation from the US-FDA to advise that all combination cold & 'flu products in kids under two years old. The following classes of products are now not recommended in the wee ones:

Decongestants

Expectorants

So, under the new rules, if you dish this stuff out, and something goes wrong, your insurance is cactus. As of August, it'll be illegal. It's important to mention that previously these products, when used in under 2s, were pharmacist only medicines, which means if you want it, you've got to convince the pharmacist you need it and get them to chuck a label on it with your kid's name and the like. Now you need to get a prescription for it. As I work the all-day Sunday shift (and most Docs don't), my hands are genuinely tied. Here's how the transcript used to go:

Here's the new scenario:

Mum: I need some Dimetapp for my kid's cold/flu.
Capt. Atopic: How old's the wee tike?
Mum: 18months