The city of Bielefeld, near Spenge, Germany
Through the British Pharmaceutical Students’ Association, pharmacy students can apply to go almost anywhere in the world, working in community, hospital, industrial or academic pharmacy. Hopefully, after submitting your application, a pharmacist will invite you to his or her pharmacy.
In February 2008, I applied for a summer placement in Germany for a maximum of five weeks. In April, I received a phone call from German pharmacist Eberhard Groeger, who has hosted students for the past 15 years, inviting me to work in his pharmacy during August and September.
After a few e-mail exchanges, it was official and in August I arrived to meet the Groeger family in Osnabrück. We made our way to the small town of Spenge where I would be working and living.
The Hirsch Apotheke (Stag Pharmacy) has been running for over 150 years. Donning my new white lab coat on the first day at work, I began to learn the computer system and shelf layouts.
It is a spacious pharmacy. The front shop is stocked with cosmetic products, healthy fruit juices, herbal teas, pharmacy customer magazines and popular drugs, such as aspirin and diclofenac gels, behind the counter. Behind the front shop is a large room with sliding shelves, stocked with many drugs.
There is a separate office for the pharmacist to do paperwork and a laboratory that is used for compounding prescription creams and gels. There is also a room for storing and making herbal teas and sorting out deliveries, and the cellar where chemicals and other items are stored.
After a few days, I was putting away orders and removing expired items, the basic “has-to-be-done” jobs. However, it was not long before I noticed some customers claiming that they had been given the wrong medicine. I soon learnt this was not the case, but their claims were down to the insurance companies and the medical system.
In Germany, one must take out some form of health insurance. When a doctor writes a prescription, he or she would normally specify a brand of drug to give to the patient.
Unfortunately, insurance companies have many contracts with different manufacturers, which means every time a patient receives a specific manufacturer's drug on prescription, the insurance company will get commission from the manufacturer. This keeps costs low for the companies. It is the pharmacist's duty to find out whether the insurance company will authorise the medicine prescribed and reimburse the pharmacist for it.
The pharmacist can find out which brands of drug with the same active ingredient are available to the patient on his or her health insurance. However, some patients may be unsatisfied with the substitution because they are not receiving exactly what the doctor prescribed so a great deal of public relations skills, patience and counselling is required.
To add to the confusion, contracts are changing every month to different manufacturers so patients may receive a different brand of medicine every time they collect their prescription.
It is also the case that German pharmacies do not label the medicine with the drug name, dose and directions, unlike UK pharmacies. Because of this, the whole process of giving patients their medicines is faster. It is the patient’s responsibility to remember the dosage and directions or write them down before leaving the pharmacy.
Sometimes, customers come to buy herbal teas. A doctor writes a recipe/prescription for a specific herbal tea and then a member of staff follows the recipe and makes it. This is a popular and common practice in Germany because many plants are known for their medicinal qualities. An example is senna leaves in a tea acting as a laxative.
Customers are often asked to come back at a later time or day, thereby allowing staff time to find, make or order the ingredients. The ingredients are weighed, grounded with a mortar and pestle if required, mixed, bagged, labelled and priced for collection.It is interesting that herbal teas and medicines go hand-in-hand in German pharmacies, whereas, in the UK, teas are not a popular remedy in pharmacies.
One day in the pharmacy, I was shocked to learn a customer bought opium over-the-counter. On asking the pharmacist about this, I was told it was a homoeopathic remedy. The philosophy of homoeopathy is that a sick person can be treated using a substance that, in a healthy person, causes symptoms similar to the sick person’s illness.
This idea was first developed in the 18th century by Dr Samuel Hahnemann. To take the example above, a mass of opium in solution is diluted to 100ml, 10ml is extracted and then diluted to 100ml and this is repeated 12 times, shaking the solution at each stage to diffuse the particles through the solution. This example would be called opium D12, the “D” standing for the latin decimus — a tenth, and 12 being the amount of times it is diluted.
So why is homoeopathy so popular in Germany? It is because people have embraced the idea that natural products are better for you and doctors are happy to prescribe homoeopathic remedies to their patients. The best explanation from the pharmacist was, if the people believe in it, they should be able to buy it.
A few other items customers like to buy from the pharmacy were pharmacy-made stomach ointment, Swedish bitters and homemade liqueur. The liqueur aids digestion and a sore stomach.
The pharmacy used to compound and sell many medicines to customers and other pharmacies in the area. Now, only a few herbal items can be made and sold in the pharmacy because it is difficult for the pharmacy to provide clinical test data set out by the EU. The pharmacy liqueur is a popular Christmas present for drinking before and after a big meal.
Apart from increasing my pharmacy experience, I had opportunities outside working hours to enjoy the culture. I went out to the beer gardens with the pharmacist's sons, go-karting, and eating German food, such as schnitzel and bratwurst. I also went sailing with the pharmacist, his wife and daughter on my first weekend.
My experience of working in Germany has left a lasting mark on me and I believe it will influence my practice in years to come. It was good fun and I would recommend that other students take part in this programme to improve their knowledge, learn how pharmacy operates in another country and enjoy a good cultural experience.
David Lumsden is a second year pharmacy student at Robert Gordon University, Aberdeen
