I've spent almost a whole work week at the pharmacy now (if you count 4 hours a day a "work week," and so far I've learned quite a bit about pharmacy in Spain--although there is a lot I don't know. Since Elena is now at the IPSF congress in Serbia (or maybe she's doing an exchange?? I'm not exactly sure..), the pharmacy is the only place I hear a lot of Spanish. At times, its just too overwhelming. I generally understand everything the pharmacists tell me to do, but they are an extremely busy pharmacy right now; as they've explained it, they have a lot of pharmacists on vacation because its summer. So although I'd like to ask lots of questions to learn more and practice my Spanish, usually there's not enough time. Also, the pharmacy is connected to Dr. Goya's office, so there is a lot of business (patients done with their appointments walk right through the back of the pharmacy to the front door!! Thats one thing that would never happen in the States! HIPAA violations--although there is no real patient information to see, I'll tell you about it later) I only stay in the back--talking to patients is still overwhelming to me since madrileños speak soooo fast. Even when the pharmacists speak to each other, I don't understand most of it. After putting away the order, I pretty much just stand around until they have something for me to do. I'll get some medications for them or take out the trash---when I get really bored I just organize the generic meds and look at all the stuff they keep there. Its not exactly what I expected, but I'm still learning--and its only the first week, maybe things will get more exciting soon.
There are several big differences I've noticed so far. There is absolutely no counting of pills. Everything is prepackaged in counts of 10, 12, 20, 28, 30, 60 or 100, depending on the medications. There is also no real computer system--no patint profiles, no allergies listed, no patient information in general. Since they don't really have a private insurance business, computers are not as important I suppose (I guess medications are all just really cheap?? not sure, haven't figured out the details yet). The only way they know if they've given a medication to someone is by cutting off the barcode and taping it to the prescription. Which leads me to another point. There are no labels--so the patients literally just get a box saying what the medication is and (I suppose) the regular directions for adminstration. The directions written by the doctor are on the prescription, but the pharmacy keeps those. For me, it sends up a red flag. It seems like this system relies completely on patient compliance and the good ole' trust system. In the States the labels have everything--prescription number (I don't think they have such a thing as "refills" here), prescribing doctor, pharmacy, pharmacist initials, directions, date filled...everything. Also, what if there is a confusing dosing that is patient specific? I'm still trying to figure these things out. Something that seems weird to me is that male and female pharmacists have different uniforms. Males have lab coats like in the States, while women wear what looks more like scrubs--and I think nurses wear the exact same thing. Oh yeah---there are NO pharmacy technicians. Everyone in the pharmacy is a pharmacist, so there is no final check. You get the prescription, you go to drawer, get the box, take it to the register and check them out. Quite different.
I'm also not quite sure yet how the controlled medications work. I've seen Concerta (Schedule 2--we have to monitor pretty much everything with this in the States) is in a regular drawer. But we did get Oxycontin in an order today, and I think there is a special place for it because it wasn't in the drawer later where it would've been. I'll have to ask about it soon---you know, when there are 2 minutes to spare. Many of the brand names are the same, while some are different or very similar. Generic names are the same except with A's or O's on the end of them, plus the manufactures name. For instance, you might see Simvistatina SANDOZ right next to Simvistatina MYLAN. Another thing that I think is quite common throughout Europe is that aspirin is still the most popular anti-inflammatory, analgesic and NSAID. From what I can tell, ibuprofen is only available with prescription. In the states, aspirin is primarily used for blood thinning, anti-coagulation purposes, while its analgesic use is pretty uncommon. I'm interested to learn more about why this is so different--I haven't even seen any Tylenol yet! I hope to learn more about their system in the next few weeks, because there is still a lot to learn.
