notageek

Someone should start a depressingly bad American-style Chinese restaurant chain, and name it “Sad Panda.”

I’m just sayin’.

I had a delightful encounter while I was stuck in the pharmacy by myself the other day.

Young gentleman and his mother came up to my counter with a new prescription. Mother realized she didn’t have the insurance card and ducked off to call the dad to ask him to fax it in. Young gentleman and I filled out his patient profile, including allergies, current medications and insurance carrier, and then his dad’s fax came in. I verified the profile information with his mom, and everything was correct. And he spoke clearly and he was patient and polite.

And he was 13. I have 21-year-olds who can’t do that. Hell, I have 35-year-old patients who can’t do that.

I’m forming a theory on culinary similarities between Southern China and the Southern US. I’ve covered the Chinese obsession with some of the pork products before, but tonight I made a very traditional Cantonese sweet-potato dessert soup. It contained sweet potatoes, jujube fruits, ginger and brown sugar.

It tasted like sweet potato pie.

Also, Cantonese-style mooncakes taste an awful lot like pecan pie. And why do we also make sweet-sauced roasted pork?

Some of the similarities are undoubtedly due to economy—mom’s parents are from some kind of Toi San hicksville—and climate. But still, it’s kind of weird. Maybe I need to eat more Southern food.

I worked slightly over half of today’s pharmacist-hours. Of the pitifully small number of scripts processed in that time, I dispensed half our Relenza and all of our Tamiflu, and I sold a bajillion boxes of surgical-style masks. Oh, and some lady freaked out because the cheapo off-brand surgical-style masks don’t have a particle micron-size filter label but the 3M ones do.

What the hell, people? We are nowhere near any of the documented swine flu cases. It is not a bad idea to have surgical-style facemasks around. It is not even a bad idea to read up on the situations in which an antiviral would be of use. But it is really, really dumb to go freaking out because somebody else already snapped up the last available box of Tamiflu in this neighbourhood. There is a supplier shortage of Tamiflu precisely because so many people are inappropriately panicking and filling scripts inappropriately when they will be of no anti-infective benefit.

YOU DON’T NEED IT, people in my patient population. And by taking it now, you are ensuring that, should this swine flu actually go pandemic, someone who needs it will go without; moreover, if you even do have flu of some kind, you are almost certainly not taking the antiviral in a manner which will reduce your symtomatic illness at all. Take your multivit, get enough sleep, eat un-crappy food and for fuck’s sake wash your hands and don’t pick at your nose. Take vitamin C, if you want. And quit listening to the “news coverage” on the “not-a-pandemic-YET!” because it will just make you stressed, paranoid, and ready to waste antivirals.

I wish someone had told me how medical teams at hospitals are structured, given that they are the units in which most pharmacy students end up on hospital rotations. Well, and as a corollary, I now wish I’d known how physicians are educated, because they call the shots on most hospital rotations.

From what I’ve gleaned, MDs have two academic years followed by two years of rotations, which are roughly homologous with pharmacy APPEs; graduation from medical school yields licensed but inexperienced physicians, who are seasoned with several years of residency before being unleashed upon an unsuspecting public.

Medical students are termed M1 through M4 and residents R1 through R3 and up, though first-year residents are usually called “interns”, and being a drug slug I didn’t meet anyone claiming a designation of R4. At that point of specialization, doctors may have taken monastic vows and withdrawn from public view, or acquired new titles that don’t indicate how long they’ve been plugging at this ridiculous endeavor. Readers in the pharmacy field may recall being called P1s our first year of pharmacy school and then not caring because we spend so little time in clinical environments that we don’t have the same clear labelling requirements.
The hierarchy of the medical team at teaching hospitals is arranged by who has the most clinical experience, which is logical. What I found so baffling is how much each person shits on the people below them in the hierarchy. Not all teams engage in this behaviour, and it varies by institution, but as the pharmacy student, your entire team has carte blanche to shit on you. You might be able to shit on a couple of the nurses or healthcare assistants, but I don’t recommend it, because your allies are pretty sparse.

This is the basic structure I saw in my inpatient rotations:

• Attending physician (”the attending”). The medical analogue of our preceptors. Has been working in the field several years, and often an unfathomably long time.
  • Medical resident, who looks after things while the attending isn’t around; seems like usually an R3.
    • Interns; it seems like there’s usually two of them so they can take turns staying up all night looking after patients.
      • 1 or more medical students, either third-year or fourth-year
  • Your pharmacist preceptor
    • Pharmacy resident, if a resident is not occupying the pharmacist role on the team
      • You. Ha. All the way down here. Seriously, don’t piss off the nurses.