notageek

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.

I now have a license, students and completed preceptor CE credits, which means that once I’ve been licensed for a year, I’ll also be a pharmacy preceptor.

I think this—in conjunction with other signifiers like the house, car and spouse—qualifies me as an adult, and true to adult form I cannot stop mining my past to try and figure out what actually happened, that my fifteen-year-old fuckup self ended up a “skilled professional”. The retrospective analysis is never enough, but it’s also all we have.

So this is something new for me and my weblog: a series. I had originally begun a list of “things I wish I’d known before rotations” as its own entry, but it was too long and too scattershot to be an entry, or even a FAQ. These aren’t the answers to frequently asked questions, anyway; they’re the answers to questions I didn’t know needed to be asked before I was a student extern, or a pharmacist. I want to tell you the material we should have learned in dispensing lab; the real complement to the PK/PD and medchem and therapeutics.

Also, I promise this series will still be about how I hate everything.