Tuesday, December 30, 2014

Internal Medicine: A Pun-tastic Rotation

Posted by Katie Dudzinski at Tuesday, December 30, 2014

Deep breath... turn on your music... okay.... here we go.

I still remember those words that I uttered to myself as I turned on my iPhone and headed to UMHS for my first APPE rotation. During my P1-P3 year, I had shadowed my P4, paid attention to the orientation, and emailed my preceptor about the ways of the rotation. Yet, I walked into the hospital that day feeling completely unprepared. How early did I have to wake-up again? How much detail should I work-up my patients? And frankly, what does work-up even mean? I let these thoughts be drowned by my music, as I cleared my head and stepped into UMHS hospital.

My preceptor was Dr. Regal, a pun-tastic preceptor who uses his seemingly endless array of jokes to help students remember tricky concepts. Known for being challenging in his P1 pharmaceutical care course, I was worried that this rotation would hold me to the same level of difficulty. However, I learned that this rotation would turn out as one of my favorites, and it would completely change my mind in pursuing residency training after graduation.

At internal medicine, we would see patients for every-day conditions, from suspected hepatitis C diagnoses to severe infections to unresolved nausea and everything in between. Instead of learning a few disease states in great detail, I learned a moderate amount of information about many of the common conditions that can land an otherwise healthy adult in the hospital. On my first day, I gave a recommendation of a vancomycin dose for a middle-aged woman, suggested a warfarin dose for a patient with afib, and observed as the medial team tried to find a therapy for a woman with a persistent GI bleed. The simple variety in patient conditions made rounds every morning feel like a new adventure.

Differing from some specialty rounds, internal medicine rounds started at 8 or 8:30am. I usually arrived at the 8th floor of the hospital, where our medical team gathered before rounding, between 7 and 7:30 am to review the patients' charts. Since the medical residents and medical students present patients and offer recommendations to the attending, I did not have to have every patient formally worked-up SOAP note style before walking through the door. As the course of the 5 week rotation progressed, I learned what aspects of patient care I needed to know as a pharmacy student and I was therefore able to work up patients very quickly. By the last day of rotation, I could work up one patient in 10 minutes.

After the initial meeting with the medical team, rounds would go until 10am-noon. After rounds I would call my preceptor to summarize interventions that the medical team made and answer any questions that he had. If I did not know an answer to a clinical question, I would look up the answer during my lunch break. The afternoons were spent in Victor Vaughan, as Dr. Regal would print out articles for us to read and teach us therapeutic concepts. The main points I learned from this rotation included warfarin optimization, calcium and vitamin D supplementation, antibiotic therapy, and different types of anemia. These concepts were solidified with an exam during the last week.

Along with the above therapeutic concepts, I also learned how to be "annoying" as the clinical pharmacist rounding with the medical team. I learned to pester the medical resident to make sure the patient was taking iron due to a ferritin deficiency, that there was a specific indication for a patient's omeprazole use, and that the patient using over-the-counter pseudophedrine had well-controlled blood pressure. I was surprised that the majority of my interventions were medication discrepancies that could have easily been settled in the outpatient setting. From this rotation, I learned that our community and outpatient pharmacists must try to optimize their patients' medication regimen as well.

On my last day of rotation, I walked home from the hospital, again taking a deep breath and turning on the music on my iPhone. I had survived my first clinical rotation, and I had learned more in those past 5 weeks than I had the entire year before. And I finally felt ready to tackle the rest of P4 year.

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