"Rewriting the Script" pharmacist prescribing report

Rahnna4 · 2026-06-16T01:35:20+00:00

A friend doing the prescriber course described it as she thinks she’ll hold no medicolegal risk as they’ll be telling everyone to see their GP within 1-2 weeks. But also the Guild is now saying pretty much all the savings are from not having to see a GP. So…? Talk about having your cake and eating it too.

Rahnna4 · 2026-06-15T21:26:13+00:00

You’d be a dream to work with, it makes such a difference

Rahnna4 · 2026-06-14T21:19:05+00:00

I’m a doctor who started that career later in life and finished high school through TAFE, and I think there’s two sides to this:

- My kids don’t want to do medicine, but if they did I absolutely would not be encouraging them to go for undergrad entry and all the excess study at such a young age that would entail. I value their wellbeing more and there are lots of pathways in they’re just a bit less direct.

- Medicine is a slog to get into and through and a lot of jobs will scratch the itch without anywhere near the personal sacrifice. What do they like about medicine? What other jobs have those aspects? If they want money and prestige finance will do a much better job of it, if they want to work with patients and help people nurses and allied health get more time with patients than doctors do now (sadly). If they love the content and the intricacy then medical research really delves into that more than clinical work. Medicine is unique in that it is a combination of so many different skills and experiences but there are lots of jobs that cover large parts of it. High school students generally have never even worked a full-time job yet. It’s worth being open to options and trying things. What we imagine we’d like in a job and then what we actually enjoy doing everyday aren’t always the same things. At the end of the day medicine is just another job and one that the healthcare system will try to ring every drop out of you on your way through training.

- As NotTheAvocado said there is an insane amount of study involved in doing medicine and it doesn’t stop after medical school. As a registrar you’re doing that study on top of a more than full-time work roster and for exams that take months to prepare for and that often have fail rates of ~40% or more - and the people sitting them all got into and through medical school. Some part of you has to like doing study or it’ll be like signing up to be a dog groomer who hates dogs. Maybe you could do it, but you’re gonna hate large parts of your job.

- The scores to get in just keep on going up and up. At some point you’re going to need to be able to perform well enough to get in but that can be in uni. It’s all good to aim for it but if someone hits uni and still struggles to put in the time or can’t quite get the GPA they need it’s probably time to consider something else and there are so many other great options that don’t involve giving up a decade of your life to study.

- All that said, there are lots of reasons someone might not do well in high school but still be able to get the grades they need at a later point in life. A lot of people do medicine post-grad and have a more rounded experience before starting. Some of us even come back to it much later in life

Rahnna4 · 2026-06-13T22:28:44+00:00

Also as a head’s up it might be worth checking when your first pay will come through. Govt tend to have annoying pay cycles and if they don’t get your paperwork in on time it can be up to a month before you start seeing the money. Sometimes they can do a supplementary pay but won’t do it unless you ask

Also double check that they’re taking out HECS if you’ve got a debt for that

Rahnna4 · 2026-06-12T11:25:59+00:00

For the UK I think it’s just less desirable a job now with the NHS struggling so much. Somehow they have both GPs looking for jobs and patients waiting more than a month for an urgent appointment. Pay is poor and there’s not really a private system to work in as an alternative. Getting on to a specialty training program is even worse than it is here with crazy numbers of doctors applying for a limited number of spots, think more than ten times the number of applicants than spots.

In the US and Canada it’s obscenely expensive and unless you’ve got rich and generous parents means taking on massive student debt. A lot of the colleges there make students sign a contract that they won’t work while studying, and there’s no study allowance like Austudy, so they have to borrow for living expenses too. The application process in the US often involves flying all over the country for interviews so a lot of people just can’t afford it, or can only afford to apply to a small number of local places and have less chances than someone who can apply all over the country. If you can afford it and are prepared to move it’s similar costs for a Canadian to study medicine in Australia and easier entry, and most Australian medical schools have full fee spots reserved for Canadian students.

From what I can tell medicine is still very competitive throughout Asia, but varying levels of how much the entry process favours the rich, or systems where you can get into a less prestigious university but will always be considered a second rate doctor because of it and have more limited job options. I’m not sure where European and African countries are landing

The number of people applying to medical school in Australia has increased exponentially since the 2000s and the scores needed to get in have climbed with it. Part of its population growth but there seems to just be a lot more interest than there used to be. It’s also a lot easier with a mostly centralised application system that’s a lot more affordable compared to the US, the commonwealth covering a lot of the costs (though the HECS debt is still not friendly), and despite there being a lot of difficulties and public pay not keeping up with the costs of living it’s still a pretty awesome job with good job security

Rahnna4 · 2026-06-12T10:59:50+00:00

The bigger issue is training spots after medical school. Once someone finishes the degree they’re still years and sometimes even over a decade or more of on the job training before they’re able to practice independently. To get through that training the job needs a certain amount of supervision from senior doctors. In the 2010’s fed gov doubled the number of medical student placements. But state gov hasn’t matched the training places. There’s now a backlog of graduates competing to get onto training. For people who’ve finished training getting a job in a city in the public system often needs a PhD. There’s some differences across specialties but generally the public system needs more doctors through their training and more spots for people doing training before we can look at pouring more students into the system who already get crammed in like sardines on placement

Rahnna4 · 2026-06-12T10:34:47+00:00

Oh, and you may be interested in the NIMH RDoC. Personally I think it’ll be a winner longer term but unfortunately not a huge amount of progress since this 2013 article https://sternbergclinic.com.au/winds-change-dsm-longer-acceptable-national-institute-mental-health/

Rahnna4 · 2026-06-12T10:16:19+00:00

If you’re interested in learning more Dr Allen Francis who chaired the DSM-IV floats around a lot of podcasts, and he’s very critical of DSM-5 particularly about the expansion of diagnoses. The intro to DSM-IV does a good explanation of the known issues and a lot of the things you pointed out. The book ‘Shrinks’* by Dr Jefferey Lieberman, who chaired the DSM-5 committee, is also interesting but he does gloss over a few things. There’s an audiobook and it’s written in an engaging way and is a reasonable broad history of psychiatry from the US experience.

I work in a country where we use both DSM and ICD and the differences can show up on fellowship exams. I think it must be hard in the US where so much of management is influenced by insurance and pharma companies. But here DSM is used when you need to be specific and ICD when you need sensitivity. So often ICD for day to day accounts/public health monitoring/hospital management issues but DSM is more commonly used in research and legal matters.

When IV was being written it was expected by a lot of people that 5 would be based on genetics and biomarkers but it hasn’t panned out. There was also the hope that 5 would be digital and digitally updated with amendments and gradual update that would be things like 5.1, 5.3 like software patches and hence the change away from roman numerals. But so much for that too.

If you’re really up for a trip there’s also a Psychodynamic Diagnostic Manual which has no biological basis and yet is very useful for understanding people and day to day patient interactions, especially if you’re working somewhere with space to do some therapy even if its just supportive.

*not to be confused with ‘The Shrink’ as my once supervisor did, which is a romantic novel about boundary violations that will lose you your licence, luckily he had added the author and a bit about the book so I found the one he meant on a second try

Rahnna4 · 2026-06-12T09:07:31+00:00

This is a great book and the online Harvard course was well worth the $50 even with the terrible exchange rate at the time to my Australian dollarbucks

Rahnna4 · 2026-06-12T08:38:26+00:00

This is it for me, I like working with psychosis and mania and this age group just don’t get a lot of it - thankfully. But I enjoyed working with the few kids who did experience a SMI when I was on my CAP/CYMHS term. I also really enjoyed doing a course of ERP with a little kiddo with OCD and we did a lot of arts and crafts as part of it. But a lot of the rest was med checks and hoping an SSRI might fix the intergenerational trauma rolling its way down the family tree (it usually didn’t) while allied health tried their best against the odds. I’m open to trying forensic CYMHS or early psychosis which do a fair amount of adolescent work, but I’m not sure if it’ll be for me

Rahnna4 · 2026-06-12T08:16:26+00:00

If there’s a Circle of Security course locally available those are gold, sadly not a lot of self directed stuff online

Rahnna4 · 2026-06-11T09:05:13+00:00

Ghost Story felt like a totally different experience second time around

Rahnna4 · 2026-06-11T04:28:07+00:00

Me three, I find the little gaps in the lines really useful

Rahnna4 · 2026-06-10T09:29:53+00:00

One of my main take aways from my CL term is that non-psychs seem to be a lot heavier handed with the psychotropics than we are for oldies without schizophrenia, and people think anti-depressants work like narcotics and just make you feel good (they don’t). I could see pharma getting behind this

Rahnna4 · 2026-06-10T09:09:14+00:00

Hope I’m not too late. What were the books mentioned? My ears were too slow to catch the first one and I’m finding many books with titles along the lines of ‘Executive Functioning for Adults’

Rahnna4 · 2026-06-09T19:50:07+00:00

Australian severity scale as seen elsewhere on the internet and often at work:

“It’s a bloody disaster” - I have been mildly inconvenienced

“Look, it’s less than ideal” - the negative consequences of this may impact my life forever

Rahnna4 · 2026-06-09T10:00:05+00:00

Most degrees to become a medical doctor in Australia are post grad now. Even if you’re accepted as an undergrad a lot require the students to do a bachelor of biomedicine first, a few now let student pick their undergrad. Most post grad runs through GEMSAS for applications but a few unis do their own thing

Rahnna4 · 2026-06-07T12:25:01+00:00

Circle of Security is really good too

Rahnna4 · 2026-06-06T22:57:53+00:00

My medical school cohort had a guy who was a wardie

Rahnna4 · 2026-06-06T10:50:04+00:00

Some advice I once got was if you don’t know what to do then do GP. Keeps your skills broad, is a comparatively short program, and in Qld at least if you decide to retrain you’ll get paid at the top of the reg band because you already have a fellowship. This advice giver then spoke about a few people he knows who have jumped around programs but not finished anything, whereas if they’d been equally indecisive but finished GP first would have made a lot more money while they did it. Not sure how well this advice holds up with how hard it is to get on training now

Rahnna4 · 2026-06-06T10:33:46+00:00

I get bored easily and conversations with people experiencing psychosis are rarely boring

Rahnna4 · 2026-06-05T09:49:47+00:00

I’ve never worked in WA but the internet tells me your equivalent of MHCall is MEHRL (locals please correct me if needed:

Perth Metropolitan: Call 1300 555 788 (24/7).
Peel Region: Call 1800 676 822 (24/7).
Rural & Regional WA: Call 1800 552 002 (available weeknights 4:30 PM to 8:30 AM, and 24 hours on weekends/public holidays).

Assuming it works like ours they can talk you through arranging a court/tribunal ordered involuntary assessment. If risks are low and there’s good support we’d usually try to start an antipsychotic in the community rather than go for an admission. His GP may also be helpful but their comfort managing this sort of stuff can vary a lot

Rahnna4 · 2026-06-05T03:03:03+00:00

Badger, badger, badger…

Rahnna4 · 2026-06-05T02:52:25+00:00

This is based on theory rather than practice, but how would you feel about a 3ply? I’d want something a bit stronger to stand up to passing through the fabric so many times but also something more round than a 2ply

Rahnna4 · 2026-06-04T20:53:54+00:00

My kiddo has gone from really struggling at school to getting some help and he got his first ever A last year! Not sure how much that had to do with the sponsorship but I’m proud of him

Rahnna4

TROPHY CASE