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I remember from my visitation at St. Paul's Hospital that the dispensary was far and away different from the dispensary of any community pharmacy I've been to. What surprised me the most was that the dispensary did not stock the same formulary as do community pharmacies. With introspection, I can discern some reasons why - hospitals are publicly funded so they are bound to use the alternative/equivalent drugs that are the least expensive, and of which the government espouses, and most patients are in hospital for acute care and so generally don't need the same medications on average for chronic conditions as patrons of community pharmacies do. And home care is on the uptick.

Without being privy to all the regulations, I would guess that there are significant differences in hospital pharmacy practice from what I'm used to at work. Are the alternative/equivalent drugs included in a hospital's formulary the same as in PharmaCare? (I was told that they weren't all identical so common drugs for chronic conditions occasionally had to be substituted, or a patient's own supply would have to be brought in). This puzzles me, because though it seems in line with PharmaCare's policies, it can't be the same formulary (I should remember to research this). That makes me wonder, what other hidden differences could there be in hospital and community pharmacy protocol?

A large number of drugs used in St. Paul's are not prepackaged; is it because hospitals need to make IV/IM/SC drugs fresh? Sometimes only a few pharmacists are on staff in the underground pharmacy at any time, and most are needed in the dispensary so do they have a large role in formulation still?

How difficult is it for a retail/hospital pharmacist to make the jump from one to the other?

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When I was a kid, I used to read Reader's Digest a lot. My mom used to subscribe to the Chinese version, and when they came in the mail they always came with the English version for free. Those are the ones she usually never read but she kept a few issues in the bathroom, which I'd sneak out to read.

In one column in one issue, I read an anecdote by a physician about how he had a colleague who always addressed his patients as "mister" or "miss". When asked one day why he did that, he replied that he never addressed his patients on a first-name basis until they felt comfortable enough around him to use his first name.

It's been fifteen years since I read it, so I'm paraphrasing, and I might have missed his point. I had forgotten all about this for years, and I only remembered a few months ago, after corresponding with someone through email. I was addressing the president of a club at school, and I had never met her before so I addressed her in every email as "Ms. Dunn". I hardly ever use "miss" or "mister" now that I'm out of high school, so it felt out of place enough to jump-start my memory.

I think that's perfect. I want to start addressing all patients on formal terms until I've earned their respect, until they feel comfortable around me (although obviously, I don't have one so they never need to refer to me with an honorific). In fact, I would do this specifically so that one day I would transition to using their first names.

On the other hand, I don't know if I would even get my point across to most (when was the last time I had been addressed formally? (when was the last time I addressed anyone formally who I didn't have to? (answer: never))), or merely sound rigid and formal. I really have no idea, so I should just try it. When I'm in the practice lab, or when I'm discussing a case study, I'm handling information about an imaginary patient, but in real life, the information I'm given is really very private; it's too easy to use someone's first name especially when I am given so much information about them. It'll be a good exercise to intentionally not do this in practice.