Day Twenty-nine

Today was one of those mind-numbingly uneventful sort of days. And while frustrating on Mirjana's behalf, I found just a tiny speck of excellent entertainment from a woman with a prescription for ramipril.

For those of you who are unaware (i.e. you, querido), ramipril is the name of an antihypertensive drug. It goes under several brand names including Tritace, Ramace, GenRX Ramipril, etc. They're all interchangeable, because they're exactly the same strength of drug with the same pharmacokinetic properties, manufactured by different companies who package them in different coloured boxes and charge different prices.

GPs can write on the script either a brand name or the drug name. Unless "brand substitution not permitted" is ticked, the pharmacist or patient can feel free to pick their favourite.

In today's case, the customer was a posh middle-aged woman wearing a stiff uniform with "NSW Art Gallery" stitched across the pocket. She handed Mirjana a script for ramipril from the same doctor who pulled out a blank piece of paper during my consultation and drew me a detailed diagram of the female reproductive system. He has a quirk of prescribing in drug name only.

Mirjana pulled a box of Ramace off the shelf. The woman frowned at it and asked why she was given Ramace instead of ramipril. Patiently, Mirjana explained that ramipril was the drug name, while Ramace was the brand name, yada yada yada. The woman explained that she had never taken rampiril before, and wanted to make sure that she was getting the right drug. Mirjana explained about generic substitution, and how there are a number of drug companies that manufacture the same ramipril tablet, and that because the doctor hadn't specified which brand to dispense, she took liberty.

"Why did you pick that one and not one of the others?" The woman asked.

Mirjana stared. "Because it was the first one that I saw on the shelf."

Bad answer, I thought. Here was a pedantic and confused woman who can't get her head around the difference between brand and drug, and you give her the impression that you're subjecting her health to your own convenience.

"I don't understand why I can't have what the doctor prescribed me." The woman was saying.

Barely hiding her exasperation, Mirjana grabbed a marker and underlined the word "ramipril" on the Ramace box. I tuned out at this point to focus on my bowl of strawberries.

A few minutes later, Mirjana had me call the doctor to ask which brand he would like to recommend. We exchanged a look, fully aware that this was possibly the most ridiculous call we'd ever make to a GP, and that we were lucky he happened to be one of the better-mannered. He was out to lunch. The woman decided to go back to the medical centre herself.

After she left, Mirjana sat down (to lower her blood pressure, I suspect). I deleted the script and peeled the label off the box of Ramace 2.5 mg.

Half an hour later the woman returned with a new prescription. It read "Ramace 2.5 mg". I retrieved the box I had just put back onto the shelf and processed a script that was identical to the one I had just deleted. She left happily. I suppose that was all that mattered.

God, I took ages telling that story.