Wednesday, December 2, 2009

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!


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.

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