Keep a cool head, and take it a day at time.

Posted by Jeffrey Huang at Thursday, December 17, 2009

I would have to agree with Shannon – November was an absolutely hectic, stressful, but very rewarding month for me. And though I was really pleased with how the month turned out, it was also the first time I have ever seen bags and dark circles under my eyes.

Let’s start off with the rotation: Detroit Medical Center Receiving Hospital – Inpatient Internal Medicine. For those pharmacy classmates who are not quite sure what internal medicine is, just combine all of P2 and P3 therapeutic notes, and that is basically what you will be responsible for the month. With the rotation also being my first inpatient rotation, I was definitely tested each day and stretched to my capabilities.

At first it was overwhelming. With 0800 morning rounds with the medical team, it required waking up around 0500 to 0530 in order to have enough time to drive to the hospital and work-up our patients. After rounds, Justin Julian and I would normally meet with our preceptor to discuss our patients, visit patients on the other team, attend grand rounds, or present a topic discussion. It was pretty normal to leave the hospital around 1700 to 1800 on some days.

What I found most rewarding was the progression I saw in my capabilities. It takes a while to get used to a new computer system, collect and assimilate data efficiently, and finally be able to present the data or really apply it in new situations. And the patients we saw at DMC ranged from simple asthma exacerbation, to a patient with multiple end-stage chronic diseases, no insurance, drug abuser, and homeless, all of which one has to take into account for their treatment and discharge medications.

Dr. Terry Dunn was a very knowledgeable preceptor who challenged us each day but also provided us the tools to progress and learn from our mistakes. I appreciated the time she spent with us as well as her flexibility when it came to scheduling our PharmD seminar practice times – that’s the other half of the very hectic November rotation.

Both Justin and I presented our PharmD seminars on the last day of the rotation. Though it was really difficult to balance the priorities between everyday rotation duties with the PharmD seminar, I was really happy with the final outcome of the month. By the end of the rotation, I felt comfortable with my daily tasks at the hospital, and I was also really pleased with the product of my months with the PharmD seminar. I guess when it seems you have too much on your plate, the best way approach is to let your supervisors know your exact situation, try to reprioritize certain duties, keep a cool head, and just take it a day at a time. It's funny how everything seems to work out in the end.

Why are you asking me stupid questions?

Posted by Shannon Hough at Wednesday, December 02, 2009

November really went by in a whirl! I finished up my rotation at the Ann Arbor VA the week before Thanksgiving. During the November rotation, I worked in a number of clinics. I really put my drug interaction knowledge to the test working with anti-coagulation patients on warfarin. I got to see patients on my own, write chart notes and educate patients on the proper use of injectable rheumatoid arthritis drugs. During my last day in the rheumatoid arthritis clinic, I provided teaching to three patients. I can say that the third patient certainly got the most organized information with the least amount of "ummm's". It was great to develop a method that worked for me to provide the information to the patients. My preceptor had given me a great model with which to start, and I could organize the information as I needed. And wouldn't you know it: I knew the answers to the questions the patients asked...

I had that revelation this month that "Umm, just a minute, let me get the pharmacist for you" is not a line that we'll be able to use very much longer. As interns, we are trained not to provide information without discussing it with our preceptor. As P4s, some of the questions we receive we HAVE discussed with our preceptors prior to the question, and we are able to confidently answer. It's a pretty great feeling when that happens. Kind of makes you feel like....a pharmacist?

I also had my first cantankerous patient in the anti-coagulation clinic. This older gentleman also had a cardiology appointment booked shortly after his anti-coag appointment, and our clinic was running behind by a few minutes. After I called him back from the waiting room and greeted him with a smile, he informed me that I had "Five seconds" for our visit. I kept smiling, but this was no joke.

As I started asking him the usual monitoring questions for patients prescribed warfarin, he became impatient. I quickly had to decide which questions were the most important for this patient -- who had a history of stable international normalized ratio (INR) readings for two years -- and was therapeutic that day. (INR is an international system for reporting the results of blood clotting tests.) I was trying to accommodate the patient and his appointment schedule and provide good pharmaceutical care, but I was not quick enough!

"WHY ARE YOU ASKING ME THESE STUPID QUESTIONS!?" he yelled.

Somehow, I was able to wrap up the interview, thanking the patient for the visit, and the importance of the visit and the questions, but a tiny part of me wanted to bop him on the nose! Earlier in November, I struggled with time management issues from the care-giver's perspective: how valuable clinic time is, how to be sure to see everyone, and how to provide good care as quickly and efficiently as possible. This time, I learned a companion lesson: How valuable the patient's time is.