Tuesday, March 26, 2013

March Madness with the Medicineheads

Posted by mariarx at Tuesday, March 26, 2013

Internal medicine - where specialists go to die. Ok, maybe not die, but definitely expand readily available therapeutic knowledge.

Rotation 8 had me back at UMHS for internal medicine with Dr. Regal. I know the saying is "jack of all trades and master of none" but this does not apply to Dr. Regal. He is more master of all trades. It's kind of scary sometimes. Internal medicine stretched my immediate memory of random bits of drug information, ways of getting the team to follow my recommendations, and not falling asleep on rounds after not having slept well.

Walking circles on rounds
My day usually started with working up patients. On a good day I only had 4-5 patients... bad days had me around 14-16 patients. I would check out doses, indications, labs, relevant drug levels, and their past medical history/reason for hospital stay.

The medical team (shout out Med Dock!) really utilized having a (future) pharmacist on hand to help with dosing and drug selection. I loved working with them, and I really felt useful and a major part of the team. I also felt like a butcher sometimes, chopping down options I knew weren't ideal before they got to Carelink. I'm looking at you, fluoroquinolones. I was also responsible for anticoagulation monitoring, teaching, and documenting. Any time a patient was started on warfarin, LMWH, or UFH we had to be on it. Warfarin INR monitoring is a fickle thing, especially with the bazillion drug interactions you have to look out for. We had a few interesting anticoagulation patients including someone with antiphospholipid antibody syndrome. Quite the tongue twister.

The Bench Test
One thing I heard about, and was scared of, coming in was the idea of the Bench Test. Dr. Regal wants to know how much we've crammed and retained through 5 weeks; and that comes in the form of a written and oral exam. The stack of articles looks pretty daunting, but it's not so scary once you find yourself actually using the information and giving references to justify recommendations to the team. I'd say the worst part was the oral exam - sitting at a table watching Dr. Regal scratch notes down while you're trying to recall a tiny detail from one article that is at the edge of your memory. But, I survived!

The End
On the first day Dr. Regal said that his rotation is built to prepare P4s for the intensity of residency training. As daunting as that was I'm grateful for it. I think I'm a bit less scared about the next 2 years knowing that I can do well in a clinical setting and that I have been prepared by a great clinical pharmacist.

To future P4s - Dr. Regal's rotation sounds scary, but isn't in the end. Start practicing your jokes!