May: Ambulatory Care

After much anticipation, the day was finally here!¬† I was equal parts nervous and excited–nervous because I wasn’t sure what to expect and I’d heard stories about how intense APPEs can get, but also excited because I love the idea of ambulatory care and have been talking about potentially pursuing it after graduation.

Before I go any further, let me define “ambulatory care”.¬† It does not have anything to do with ambulances, contrary to what freshman me thought.¬† It’s basically a fancy term for outpatient care.¬† My rotation was at a primary care clinic called Rocking Horse Community Health Center¬†that has providers who care for both pediatrics and adults in a wide range of specialties.

I know a doctor’s office isn’t the first place people think of a pharmacist working, but the set-up makes a lot of sense and gives everyone the opportunity to use their expertise.¬† The doctors and pharmacists have what’s called a “collaborative practice agreement” that’s basically a protocol that describes what the pharmacists can do under the doctors’ name (this is necessary because pharmacists are not considered providers in Ohio, but that’s another discussion).¬† The current agreement includes four indications that the pharmacists can treat: diabetes, hypertension, dislipidemia, and warfarin therapy.¬† As long as we stick within those indications and practice evidence-based medicine according to the guidelines, we had the freedom to add, remove, or change medications for our patients.¬† To be clear, the pharmacists do not diagnose.¬† That’s not where our expertise lies.¬† The physicians handle that and, if a patient’s diabetes remains uncontrolled, he can be referred to the pharmacists who take over managing his diabetes therapy.

A Typical Day

I got to the clinic at 8:30 every morning.¬† Currently the pharmacists see patients in the afternoons Monday through Thursday and on Wednesday mornings.¬† That’s probably going to change soon with their first resident starting but while I was there, I had most mornings to look at patient charts to prepare for the day’s appointments and work on projects.¬† Most of our appointments were either diabetes or INR (for warfarin therapy) so I also focused on studying those guidelines and medications.

I had the opportunity to meet so many people throughout the month and hear about successes from some and encourage others that it is possible for them to achieve their goals.¬† I absolutely loved getting to sit down with a patient one-on-one and ask them, “What do¬†you want to do?¬† What are¬†your goals?”¬† The whole philosophy of the pharmacists is that our grandest plan means nothing if the patient doesn’t buy into it.¬† So¬† the care is patient-centered.¬† When a patient gave me a hard no on giving up his chewing tobacco, I didn’t press.¬† Instead, we kept brainstorming and found something he was willing to change to improve his health and diabetes control.

The other piece of that philosophy that I loved was the chance to let patients have input on their medications.¬†¬†What?!¬† With diabetes medications, there are so many different options and, while not every one is a good fit for every patient, there are probably a couple of good choices for each patient.¬† That meant I got to sit down with a patient and tell him I had two options and I was going to leave it up to him.¬† I explained the pros and cons and explained why I thought one would be a better option but, because that one was an injection and the other was a tablet, I wanted to leave it up to him.¬† That was such an empowering experience for both of us–I got to use my full span of knowledge about diabetes and he got to have a say in his care!

As I neared my final day, I couldn’t believe the month was already over.¬† Unexpectedly, it never became routine or boring.¬† How could it when you’re always playing detective?¬† You could be figuring out why someone’s INR is crazy out of range (could be smoking, pickles, kiwi, or a new medication) or why their A1c suddenly spiked (could be the chocolate milk they started drinking every day…) or how to have an open conversation with the patient with a double-digit A1c about how the cinnamon supplement isn’t doing the trick.

All in all, I had a great experience.¬† I know direct patient care isn’t everyone’s cup of tea, but I definitely love it.¬† I may not be making changes for the masses, but I could leave for the day having had five solid appointments where I made a positive change in each life and that’s a big win in my book!

Advice For The Month

Make a list of all of the big topics covered in your NAPLEX prep book of choice and match each of those topics to at least one rotation based on type.¬† For example, this month I did anticoagulation, diabetes, hypertension, and dislipidemia.¬† Commit to reading through those sections during the month.¬† This had two purposes: it helped me prep for projects and patient case discussions and now I won’t be seeing those chapters for the first time when I sit down to study in 2019.

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366 days to PharmD

Another school year has ended and, with it, the inevitable slew of well-meaning “aren’t you graduating?” questions is sure to follow.¬† No, my dear friends, I am not.¬† Yes, I have been in school for six years but I am (still) not finished.¬† I am close, though!¬† Here’s a breakdown of what my pharmacy journey has looked like thus far and what is in store for me:

UNDERGRAD: fall 2012 – spring 2015

These years included gen chem, organic chem, cell biology, and anatomy & physiology.¬† Those classes ruled my life, stretched me, and taught me how to keep going after failing.¬† They were hard and the source of many tears and I wouldn’t trade them for anything.¬† Freshman year I thought there was no way I’d make it through pharmacy school with how much I was struggling with gen chem.¬† I wanted to switch majors.¬† I started making plans and finding out what paperwork I’d need to fill out.¬† That’s when I told my adviser what I was thinking and he encouraged me to finish out the year then do some shadowing before I made any changes.¬† He had me talk to another faculty member who connected me with a pharmacist at Nationwide Children’s hospital and that’s where it finally clicked for me.¬† She let me spend two days there shadowing a bunch of pharmacists in all kinds of jobs.¬† I finally saw and began to understand what a pharmacist actually is.¬† I was so excited to continue pursuing this profession!

That fall I got a job as a pharmacy technician which was one of the best decisions I’ve ever made.¬† Going in, I had no clue what the job actually was.¬† All I knew was that I needed to experience pharmacy for myself.¬† And I am so glad I did!

GRAD SCHOOL: fall 2015 – spring 2019

Year 1 (’15-’16):¬† The idea is to kind of get your feet wet this year.¬† To be exposed to a little bit of everything with the caveat that, over the next two years, we’ll go into more detail.¬† The reality is that you’re drinking from a firehose that’s somehow in another language (?? my metaphor really broke down there).¬† Everything is new, drug names are weird and hard to say, and what do you mean I have to do a 3 year research project??¬† It’s intense but I’m proof it’s possible.

Year 2 (’16-’17):¬† I started to get the hang of things and really enjoyed diving into different topics, learning all about disease states and how to treat them (spoiler alter: a good pharmacist will not say drugs are always the answer).¬† While this year was still intense, I felt like I finally had a handle on things.¬† Mental breakdowns were quite possibly at an all-time low (at least during first semester) and I managed to also train for and run my first marathon!

Year 3 (’17-’18):¬† The first semester was spent finishing off our exploration of different topics.¬† Hello neuropsych and oncology, goodbye sanity and social life.¬† I also somehow found my way into 3 leadership positions this year (compared to 1 each year during the previous two years).¬† Oh, and I ran my second marathon after promising myself I wouldn’t attempt marathon training during school a second time.¬† *facepalm*¬† Second semester was different.¬† Our major class was Capstone, a class devoted to reviewing everything we’ve learned thus far.¬† Yeah, the amount of material you think we’re covering?¬† Go ahead and triple it.¬† We also wrapped up that research project I mentioned, praying like we never have before that the statistics program will spit out numbers that mean all the work was worth something (then crying literal tears of joy when it does).

CU SOP Class of 2019

Class of 2019: the fun ones

Year 4 (’18-’19):¬† On May 1st, I left the classroom and headed out into the real world to learn how to apply everything we’ve learned to real patients.¬† Over the course of this year, I will complete 9 different 1-month-long rotations in various practice settings.¬† We had the opportunity to rank the sites in our region so, as faculty created our schedules, they could try to give us rotations we were hoping to experience.¬† When I ranked my sites, I knew this would be my one chance to test out a bunch of different areas of pharmacy.¬† With that in mind, I made a schedule that was as varied as possible, with in-patient, out-patient, general, and specialized rotations.¬† I may not love every one of my rotations, but I won’t live with the regret of never trying it.¬† Here’s what my schedule looks like:

  • May: Ambulatory Care at Rocking Horse Community Health Center
  • June: Managed Care at CareSource
  • July: Community Pharmacy at Target
  • August: Psychiatric Pharmacy at Haven Behavioral Hospital
  • September: off: celebrate my 25th birthday!
  • October: General Hospital at Atrium Medical Center
  • November: Neuro Critical Care at Miami Valley Hospital
  • December: off
  • January: Critical Care at Kettering Medical Center
  • February: off
  • March: Oncology Ambulatory Care at Kettering Medical Center
  • April: Internal Medicine at Miami Valley Hospital
  • May: graduate and take the NAPLEX!

I’ll be writing reflections each month for school and I’m planning on using those to share my experiences at each site on here.¬† As I go, I’ll try to remember to come back here and link the corresponding post in the list above.¬† Fellow final-year pharmacy students, I’d love to hear about your rotations!¬† And pharmacy students looking ahead to future rotations, tell me what you’d like to know about rotations and I’ll include it in my posts!

Here’s to beginning the final chapter.¬† Let’s get that PharmD!

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might as well finish!

Per usual, it’s been quite a while since I posted!¬† My summer was much more full than I’d expected–full of unique opportunities at work, lots of family time and tons of driving!¬† Then the school year started and, wow, has it been busy.¬† I have the privilege of serving in leadership positions within a couple of different pharmacy organizations as well as within the school of pharmacy and it’s been stretching and challenging and so very worth it.¬† I wish I could dedicate all of my time just to those positions but, alas, I am still a student and those are naught but extracurriculars.

I’m in my last semester of focused modules (currently in oncology) then we’ll be doing capstone next semester (a review of everything we’ve learned the last three years!) then we’re off to rotations in May!¬† It’s hard to believe I’ve made it this far but, at the same time, there is a lot of¬†hard work between me and the finish line.

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If only you could have seen us after this! We were like zombies but instead of brains, all we wanted was chocolate milk.

When I ran the Nationwide Columbus Marathon last month, my absolute favorite sign throughout the whole course was around mile 23 (out of 26.2 miles) and it said, “What the heck?¬† You’ve made it this far…you might as well finish!”¬† At that point, Dad and I barely had the energy to keep putting one foot in front of the other but that sign made me laugh (something that’s very difficult to do at mile 23!).¬† That’s exactly how I’m feeling with school right now.¬† Year 6 is mile 23.¬† I’m only 18 months away from the finish line and I’m starting to feel weary.¬† But I’ve made it this far so….what the heck?¬† Might as well finish!

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podcast highlight: Stuff You Should Know

A few years ago, I started listening to podcasts because I wanted something different while I ran. ¬†Little did I know that this timid venture into a single podcast would open up an entire world of entertainment and education! ¬†Since then, I’ve fallen in love with podcasts and¬†follow a plethora of podcasters in widely varying topics and genres. ¬†I think this medium is relatively unknown/misunderstood/underestimated and I would love to share some of the podcasts I’ve grown to appreciate. ¬†So, periodically, I’m going to be doing a podcast highlight to share a specific podcast I’ve really enjoyed.

Since this is the first podcast highlight, I thought it would be appropriate to begin with the first podcast I listened to: Stuff You Should Know.

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Who: Josh and Chuck are the hosts for this show and have been doing this for a while.  In fact, I believe their 1,000th episode will be late this summer!  Josh and Chuck work for HowStuffWorks, a company that puts out a bunch of different podcasts covering nearly any topic you can think of.
This show can be for pretty much any age group. ¬†A lot of parents and teachers use these shows as an engaging form of education. ¬†If there’s ever any potentially concerning content, the hosts are really good about including warnings in the description of the show and at the beginning of the recording.

What:¬†Literally anything. ¬†These guys tackle all kinds of topics from boomerangs to how to live off the grid to Evel Knievel. ¬†They cover physics, medicine, politics, historical figures, animals, cannibalism…seriously anything. ¬†They do thorough research but always acknowledge they’re not professionals in any of these topics and invite listeners to write in to add information or correct them. ¬†If you ever want more information on a show, they include links and resources in the show notes on their website.

When: Episodes are usually around 45-60 minutes long and are released on Tuesdays and Thursdays. ¬†Recently, they’ve also started re-releasing an old episode on Saturdays to highlight some of their favorite past episodes.

Where: Episodes are available on Spotify, stuffyoushouldknow.com, and apple podcasts (just search ‘podcast’ in the app store), to name a few places! ¬†You can connect with the guys on their website, Facebook and Twitter under both the show’s name and their personal profiles.
I like to listen to this show while I’m running and when commuting between my apartment and home. ¬†I’ve also turned it on while on the road with my family and we still talk about the episode on exploding head syndrome! (Spoiler: it’s not quite a dramatic as it sounds)

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an update: yes, i’m still in college

Well, it’s been more than a¬†year since I last posted which means it’s time for another update from me! ¬†Wow, where do I begin? ¬†I am now in my second year of pharmacy school which means two and a half more years and I have my PharmD! ¬†Honestly, part of the reason I’ve been so absent is that the past year has been a whirlwind.

 

Let’s see if I can round up some highlights. ¬†Last year I was president of my class and had the (terrifying) privilege of giving a speech at our white coat ceremony. ¬†I attended GMHC (Global Health Missions Conference) 2015 with my classmates. ¬†I had a Captain America movie marathon with my sister and cousin. ¬†I arranged a sleepover with all 19 cousins on my mom’s side of the family. ¬†I got to dress up and go to Junior/Senior banquet with one of my best friends. ¬†I graduated! ¬†I went to Cedar Point with my siblings. ¬†I helped take care of my brother after his ACL surgery. ¬†I got to help with my cousin’s wedding. ¬†I trained for and ran my first marathon with my dad! ¬†I went to MRM (Midyear Regional Meeting) put on by APhA (American Pharmacist’s Association) where I had the opportunity to meet a couple hundred student pharmacists in my area. ¬†I got to explore a little bit of downtown Cincinnati with another of my best friends (and housemate), pretending we were professional adults out to brunch in our blazers.

It has been such a fun year, full of all kinds of stretching challenges and beautiful friendships.  My sister took a trip to Europe then moved to Texas and I miss her more than words can say.  My brother started high school and has been a champ recovering from his surgery and I am so proud of him.  My dad ran his ninth (yeah, you read that right) marathon and my mom ran her first half marathon this fall and I loved every chance I had to run with them over the summer.

These few years of my life are hard. ¬†I’m stuffing my brain with more knowledge than I ever thought possible and and growing and maturing and just generally growing up and sometimes I just have to sit down and make it all stop for a few minutes. ¬†But these few years are also beautiful. ¬†I have wonderful classmates, amazing friends, a good job with awesome co-workers, a great church where I’m challenged every week, and I go to a school where the professors and faculty genuinely care about each student. ¬†So, though I occasionally collapse on the living room floor when I can’t keep drug names straight the night before an exam, I really am loving this beautiful life.

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watch your tongue, examine your heart

parisOver the last couple of days I have watched the world respond to the events of Friday and, while much of it has been beautiful support, I have also seen some discouraging responses.

While the hashtag #prayforparis has been trending more than any I have ever seen, I’ve seen much more anger than prayer. ¬†Friends, this should not be our response. ¬†Yes, we should be angry about the presence of sin and destruction in this world. ¬†But we should not lash out in that anger. ¬†I have seen some comments from several people saying we should bomb the Middle East, blaming Muslim people at large for these tragedies.

This is wrong.

Do not let your anger devolve into racism.  Yes, the people involved in these horrid acts may have been Muslim.  Does that mean every single Muslim was involved?  By no means!  Does that mean every Muslim agrees with and supports these actions?  Most definitely not!

So, in the wake of these events, be mindful of your words. ¬†There are many Middle Eastern people living in America. ¬†Let your words and actions be kind. ¬†These are not the ones who committed the crimes; do not punish them. ¬†Rather, put action to your beliefs and show them the love of the Christ you claim–the One who¬†died for you while you were actively rebelling against Him. ¬†Let this time be remembered as a rising up of the Church, an outpouring of love, a people transformed by prayer, not simply a time when everyone promised to pray for Paris.

“With it [the tongue] we bless our Lord and Father, and with it we curse people who are made in the likeness of God. ¬†From the same mouth come blessing and cursing. ¬†My brothers, these things ought not to be so.” ¬†James 3:9-10 ESV

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educate yourself: how to find accurate healthcare information online

The internet is a beautiful thing! ¬†We can connect with people all across the globe; we can watch cat videos for hours; we can find facts and opinions on (probably) literally any subject. ¬†In today’s culture, it is our go-to for information. ¬†We no longer trek to the library and check out books, taking notes and comparing authors. ¬†We simply types a phrase into a search engine and we’ve got thousands of websites vying for our attention, all claiming to have the information we want. ¬†But with the unchecked ability for anyone to post anything on the internet, how can we find accurate information about things that matter? ¬†Being in grad school with access to (almost) unlimited resources and having actual, real researchers teaching me how to do research, I’ve learned a few things I thought I’d pass along.

Number 1:¬†Wikipedia is not a credible source. ¬†Your teachers weren’t just saying this because they wanted you to look past the very first thing that popped up (seriously, why is it¬†always the first thing?). ¬†Anyone can edit that website. ¬†Yes, anyone. ¬†Did you see the mess it was after Peter Capaldi was announced as the next Doctor?

Number 2: Blogs are not credible sources.  Yes, I realize the irony of that statement.  But think about it; anyone can write a blog about anything.  Where did they get their information?  Was it from a credible source?  If so, they should cite that source so you can go check it out yourself.  (And you should go check it out yourself.)  If not, why should you believe them?

Number 3: Neither is the news. ¬†I’m not saying they’re liars but I’m not calling them truthers. ¬†The news is always biased. ¬†Again, if they’re not citing sources, how can we believe them?

Number 4:¬†Don’t believe everything you read. ¬†So you know not to look at Wikipedia and you found a credible-looking website that’s not a blog. ¬†That means you’re good, right? ¬†Not necessarily. ¬†if I had the cash and the care, I could pay to have an official website with my own domain rather than this free one. ¬†That wouldn’t make my words any less opinionated.

Number 5:¬†Don’t read just one source. ¬†Please, don’t do this. ¬†If one person tells you there’s a massive tornado heading your way, you’re going to ask someone else or check the weather or look at the sky or something before you drop everything and skip town. ¬†You’re not going to simply take them at their word. ¬†So why would you do that with the internet? ¬†If you’re looking for information on Taylor Swift’s dating life, I don’t really care how few sources you use. ¬†But if you’re looking for something important to base opinions and decisions on, such as (let’s get controversial!) vaccinations, look at many sources. ¬†There are pros and cons to¬†everything and no one person is going to tell you the full story. ¬†You have to figure it out yourself.

So how do you find good, solid information? ¬†This is going to sound like I’m a lying liar, but blogs and Wikipedia aren’t terrible places to start. ¬†Keyword: start. ¬†Find out where they got their information, go to those sources and start digging. ¬†You are now a detective. ¬†If someone says the flu vaccine is ineffective against a certain strain, find the study that reported that. ¬†Find the primary literature. ¬†What is primary literature? ¬†The article written by the people who conducted the study. ¬†There will be tons of big words, jargon, graphs and data sets that make no sense and some more stupid-big words. ¬†But at the very beginning of the article there will be a section titled “Abstract”. ¬†That’s your best friend. ¬†It’s a reader-friendly summary of the entire paper. ¬†If it looks interest, you can glance through the rest of the paper (Introduction is background information; Methodology is how they set up their research project; Results is the raw data; Discussion is the interpretation of the Results; Conclusion tells you what to do with the information).

Next questions: Where do I find these dense, stupid-long articles?
They’re all over the place! ¬†Google Scholar is a great, free place to go to find articles and it’s easy to search. ¬†Pubmed is another great place. ¬†It’s probably a little different from what you’re used to as far as layout and aesthetics but it is a huge database of credible information. ¬†Just like with Google Scholar, you don’t need an account to access most (if not all) of their information. ¬†While this is still pretty easy to search, you can get some really specific search results if you use Boolean search terms.

Earlier I mentioned that blogs¬†can be credible if they cite their sources. ¬†I want to give you an example of one. ¬†If you look around on this blog, you’ll notice that every time the author says something as a fact, there is a little number somewhere nearby. ¬†Scroll down to the bottom of the post and find the corresponding number. ¬†After that number there will be a citation for the article or website where they got their information. ¬†If you’re skeptical or want to learn more, you can go to that article and check out the information yourself. ¬†This blog is a great example of what you’re looking for.

Now I know some people might object to these articles, saying they are funded by pharmaceutical companies who just want to sell their product. ¬†True, some of them are; but there are many more that are not. ¬†There are also come very rigorous regulations in place to guide both research and its reporting. ¬†Pharmaceutical companies aren’t the only ones funding research and not all research has the hypothesis that you should take X medication. ¬†There are¬†tons of articles out there about alternative treatments (see above blog) and they will tell you both the pros and the cons. ¬†In fact, I would encourage you to look those up. ¬†Just because it’s “natural” doesn’t mean it can’t hurt you. ¬†Perhaps your body doesn’t eliminate something as fast as you’re taking it in. ¬†Could there be side effects if it builds up? ¬†There may be research that has looked into that possibility.

Have you used resources like this before to fact-check what you’ve read on the news or seen on Facebook? ¬†Will you use this process in the future when you hear about a new treatment option or are discussing a controversial topic?

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