Chugging Along

Posted by Matthew Lewis at Monday, November 07, 2011

First, I want to clarify something that I may have confused some people about. The Ann Arbor VA does have residency spots open for next year (2012-2013), and many of my classmates are quite serious about doing residency at some VA, either in Michigan or across the country. It's just that this current year there are no U of M grads as residents and all the current residents expected to have a Wolverine present due to our proximity. This coming year I'm sure we'll have at least one because of all the interest in the program and the Ann Arbor VA being a good fit.

Moving along, it's beyond the halfway point and I'm still feeling pretty good. I'm working on my projects and answering drug questions along the way. I feel pretty confident that most questions you will see on drug info has to do with "off label" indications or non-formulary drugs. As my preceptor explained, the doctors and nurses have more access to drug information from things like their iPhone or Blackberry than they ever had before.

Another thing I learned is that every pharmacist has their own way of practicing with their own habits and favorite drugs. It came to my attention for non-formulary drug requests, where doctors make their case for pharmacy to supply something that may cost more or be last line therapy for a patient. My preceptor does not like to approve particular tube feeding formulations without exacting data which shows a clear benefit which must be a better clinical outcome like going home earlier. On the other hand, he is more lenient with appetite stimulators for cancer patients. He's not a hypocrite since he does get data for both things, but in any evaluation, there is some subjective clinical decision making process that must go on. It'll be interesting to see when I practice what issues will be things I go on crusades for or against and what type of drugs I favor and try to avoid while keeping in mind the care the patient needs.