To bleed or not to bleed...

Posted by BJ Opong at Sunday, August 08, 2010

My first rotation is at Crittenton Hospital in Rochester Michigan. On the first day of my rotation I was a little uneasy not knowing what to expect from an Anticoagulation Clinic. Aside from that, there was the mental adjustment that there would no longer be the late morning starts or half days as the days of class room lectures were long gone. In front of me stood long days working in the clinic and even shorter nights reading articles to build upon what I had learned during the day. I anxiously awaited my newfound challenge. One of the first things that I learned from my first few days in the clinic is that they have a very friendly and broad patient population. What I noticed is that these weren’t patients who were being forced by a doctor to be there, but patients who genuinely wanted the best therapy possible and who were very knowledge about there care. Let me get into what actually goes on at an anticoagulation clinic for those of you who don’t know. Patients are referred by their doctor for monitoring of their warfarin therapy for various reasons, be it long-term or short-term therapy. The patients who just started monitoring will have visits more frequently at the beginning of therapy. To make a long story short the patients come into the clinic (which is a typical doctors office/exam room) to have the INR monitored. This is done by the patients giving a drop of blood via a finger poke test similar to the one performed by diabetics. The blood is analyzed and an INR is produced. (I’m not gonna lie, but the 1^st time I had to poke a 90 year old lady’s finger I was nervous because I didn’t want to hurt her.) Given the patients admitting condition the range that we desire could vary but generally it is between 2-3. Depending on where the patient is the pharmacist will counsel the patient about various ways to either increase or lower their INR and alter the patients’ daily doses. It sounds simple enough but a lot more goes into than you would think. Aside from learning a lot of interesting stuff about anticoagulation and poking fingers all day the aspect that I have enjoyed the most from this rotation is the patient interaction. The patients’ are very friendly and are not hesitant at all to share their personal experiences, which makes for entertaining dialogue. I am looking forward to the rest of this rotation and the conversations that ensue.