Pharmacy 101

I am a dentist and we use drugs all the time but there are restrictions in how we get them, use them and record their use. Given the Essendon scandal I think almanac readers might be interested in the structure that surrounds the use, and prescription of drugs in a dental office.

My first patient of the day needs an implant placed. This requires a local anaesthetic to be administered. Before giving the ‘needle’ I place a bit of topical anaesthetic on the patient’s gum at the site of the injection to ‘numb’ the surface of the gum. This makes the ‘needle’ (love that word) less painful, but the topical anaesthetic I use cannot be bought by a member of the public, but can be bought and used by registered person. (I have a provider number!!!!!!)

I must, however, record several things: how much, who received it, when it was applied. If the APRA, or whatever the Dental Board calls itself today, investigate my practise, they will look to see that the use of topical anaesthetic has been recorded properly. For drugs falling into this category I do not have to write a ‘script’ and one very good reason for ALWAYS turning up on time for your appointments at your dentist is to ensure (hope?) that he will leave the topical on for long enough before plunging the syringe into your lip .

The patient who is having the implant placed, will take two grams of penicillin one hour before the procedure starts. There are several reasons to do this, but the point here is, that I have to write a script to be filled by a third party (the pharmacy) and once again, I have to record the same details on the patient’s history as I did when using the topical anaesthetic.

The injection contains a cocktail of ‘goodies’ including a preservative. In a few weeks I will go up to the Heathcote Wine Show where several wineries will claim that their wines have low levels of preservatives. They do not realise that they have just lost me. I like preservatives. I need preservatives. Every morning when I look into the mirror I realise that I have not taken enough preservatives. The cosmetic industry constantly goes on about ‘anti-ageing’, something as possible as proper governance at Essendon and I take my preservatives with alcohol.

Local anaesthetic has a stabiliser which keeps the anaesthetic in solution, like Essendon have kept several expensive lawyers from the poor house. The next ingredient is a vasoconstrictor, usually adrenaline. This vasoconstrictor increases the time the local anaesthetic will keep you numb and it reduces bleeding. I reckon there is plenty of bleeding in the future for Essendon.

Finally there is the anaesthetic agent itself, the wonderful drug Articaine which inhibits everything. Once this drug is administered, I have to record how much I have used, whom it was used on, and when it was used. This wonder drug inhibits performance. You just have to listen to someone trying to speak with a numb lip to realise that Articaine is an inhibitor. More importantly when I ‘ hit the nerve’ with Articaine on board my patients can no longer leap from the chair with a leap that would shame Gary Ablett senior. Indeed, in my not inconsiderable experience, only VB has the performance inhibiting ability of Articaine.

I am probably labouring the point here but please think: who was the one person who has been involved in this sad issue that would have the same knowledge that I have? There is a doctor involved in this saga. Who was the only person at Essendon who knows about the prescription and dispensing of medications?

It is my opinion that James Hird has been dealt a rum hand. He is not Johny Worsfold who has a degree in Pharmacy. He had no knowledge of the area that has exploded in his face and it is unreasonable to expect him to have this knowledge. Danks was not a registered person. Where Danks got the drugs is unknown. How they were imported and prepared is unknown. Who supervised the administration is unknown, and, is this person or persons, a registered person is unknown. There was no ‘recording’ of the ‘drugs’. Dosages, administration rates, dilutions, etc were not recorded.

The governance of medications at my surgery is well established by the regulations that we all learn at University. It protects my patients and it protects me. No one, except for a dentist, doctor or Pharmacist, could have protected James Hird and Essendon from a person like Danks.

As someone who has no love of Essendon as when I was a member of the Brisbane Lions Cheers Squad it was only when we played Essendon that we would be pelted from the second level at Colonial Stadium. It was only against Essendon that opposition fans would come down to bait us, but I do not want the Essendon Football club to go broke. I do not want the young men that were caught up in this sorry saga to suffer inappropriate penalties.

I enjoy Anzac day. I go down to the local RSL site and listen to Kevin Andrews speak. He speaks quite well and he has not repeated himself in twelve years. Actually, he probably has repeated a speech, but my short term memory?????? Then Claire and I go home, have a real spread for lunch, and sit down to Collingwood and Essendon; a bloody good day that could be spoiled.

Finally I have recently removed a tooth from one of my favourite patients, a lass from Adelaide, who many years ago introduced me to the mysteries of local Adelaide footy. She is a real footy person, an Adelaide tragic. One of her daughters works for a footy team and married an ex- Hawthorn player. She has bought Footytown and has enjoyed the South Australian stories, several of which she has personal connections. She used to hate Port Adelaide but she came in the other day, about a month after having an extraction of a tooth, and announced she was supporting Power in the finals!!!!

The question that needs answering:

How many teeth do you need to be missing before you morph into a Power (or Collingwood) supporter?

Comments

  1. I don’t get your argument Phil. A coach is a senior executive of a large organisation, and has the largest role in shaping its culture. I was once a hospital CEO, and I didn’t need to be a doctor to know that the qualifications of doctors had to be rigorously checked before they were hired. Many patients go overseas to less regulated dental/medical markets either to receive less tested treatments not available in Australia; or because they cannot afford the costs that attach to the regulated regime you describe. But everyone who makes that choice knows there is a risk/reward trade off.
    Hird took short cuts and risks with the standing of his club and the health of his players/employees. They were very well known and understood risks, but in his arrogance he chose to dismiss them as trifles at the time, and now refuses to acknowledge them at all.
    The emperor has no clothes.

  2. Neil Anderson says

    Your bio picture surely needs a shot of you with your back turned and the caption,
    “Hi! This is Phil. He’s a dentist, so we can’t show you his face.”
    You create a great image of cheer-squad members from certain teams and towns from South Australia and Victoria lining up at your surgery for teeth extractions, just to qualify for entry.
    Agree with Peter that you may have let Hird off the hook a bit. For some reason there hasn’t been much talk lately about Hird himself taking possible banned substances.

  3. Thay’re all into up to their necks, and all now thinking of self-preservation. Damn the players. Damn their families. Damn the Club. Damn the competition. It’s all about ME ME ME (and they’re not even Gen Y. Or doctors).

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