Sunday, July 1, 2012

What I want to be when I grow up!

Posted by Beejal at Sunday, July 01, 2012

Hi everyone!

Since the last time I wrote, I finished my General Medicine Rotation in block 1.  This post is going to be final remarks about that!  I did want to correct something I wrote in my first blog post though! I forgot to list a rotation! O:-)

Rotation 1: General Medicine (UMHS, Engle)
Rotation 2: Hospital Pharmacy, former “Institutional” (St. Joes Ann Arbor, West)
Rotation 3: Peds Hem/Onc (Mott, Howell)
Rotation 4: Amb Care Cardiology (VA Ann Arbor, Brenner)
Rotation 5: Meijer (Ypsilanti, Tanabe)
Rotation 6: Nontraditional Geriatrics (St. Louis, MO, Levy)
Rotation 7: Critical Care-Cardiac ICU (UMHS, Butler)
Rotation 8: Off
Rotation 9: Drug Information (DMC)

General Med weeks 3-4: I left off last time after finishing 2 weeks on teaching rounds at UMHS.  These next two weeks, I moved on to two “non-rounding” services where you juggle a lot more patients (the most I had was ~22), but you don’t see any of them.  If you see a problem or have a suggestion, you meet with the patient’s Attending physician in a conference room in the afternoon.   I ended up being bored (for lack of a better word) during these services.  I didn’t need to work up patients at home since the rounds were in the afternoon, but I also felt like I didn’t know my patients very well because I wasn't seeing them.  I also missed interacting with the team on rounds, and wasn't fond of looking at a computer screen all day.  So these types of rounds were not my forte, needless to say!

General Med week 5:  This week I had 1 teaching rounds service and 1 “non-rounding” service.  I thought this was the perfect combination.  I had enough change in my day-to-day activities and interacted with enough people to keep me sane.  I very much felt that I can be happy working in this environment forever!  I figured out a system to manage my time effectively and overall felt like a real pharmacist.  I started to catch the problems before my preceptor would ask, question renal dosing when appropriate, do the calculations before being reminded to, set alerts before being reminded to.  I know that my therapeutic knowledge will still need to improve, but I can identify which drugs are alarming to see, where to look the drugs up, and what questions to ask when confirming that these drugs are appropriate for the patient.

Reflections on the added 5th week to rotations: In this particular rotation, the 5th week was incredibly useful.  At the end of week 4, I was so scattered and disorganized that I didn’t think this position was for me.  The extra week gave me a chance to get my system figured out, and I felt like I became worlds more independent in those last 5 days.  A new week usually means starting fresh with new patients; I knew exactly what I would do differently with managing the patients and was lucky enough to have an opportunity to try it out (with success, I might add)! 

Reflections on this rotation:  Believe me when I tell you, I loved this rotation!  I have never felt more competent to be a pharmacist at any time during the last 3 years.  Not to say that I’m ready to be out in the world, but I am becoming more comfortable with the idea that I’ll have to be independent in less than a year.  I really do feel that it’s because you see so many different diseases and problems during this rotation.  You learn about the most common things patients come in with, but you also see really weird situations.  You are a jack-of-all-trades, master at none- but that’s what a consult is for! 

Dr. Engle did a great job precepting because she really gave me the freedom to run the show how I wanted to.  This was incredibly difficult at first because I lack the therapeutic knowledge to comfortably assert my opinion, but she was very supportive and encouraging to help me build the confidence.  I definitely learned a lot from all of the other pharmacists as well because when you have a substitute preceptor for the day, they have specific pet peeves too!  I will always look at max doses for zofran (props to Dr. Richards!).  I know now what a fungal ball is (props to Dr. Tupps!).  I quiz patients instead of lecturing for their anticoag education if they’ve been on warfarin for a long time (props to Dr. Harless!).

Alright, to give you all a break from me, I won’t talk about block 2 for another few days at least! 

Happy rotating!

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