Whispering Wind
Wednesday, September 24, 2008
When I was offered a place in medicine, my boss predicted that my style of pharmacy would change markedly. He predicted that I'd move a lot more toward self-management of many conditions, that I would maintain patients on OTC medication, and that due to an enhanced knowledge, I could throw caution into the wind...
Half of the prediction was true; my pharmacy style changed markedly. Far from taking risks, however, my style, as such, has become more conservative. How did this happen?
At pharmacy school, we are indeed taught to refer conditions which fit the following; a) conditions which require obvious treatment by a doctor, b) anything we can't diagnose and c) symptoms that may have variable causes, one of which may be dangerous. Thus, sticking to these rules hard and fast in your early practice will make you a safe pharmacist.
Once you hit the workplace, though, things change it up a little. Safety, of course, is paramount. But the patient in front of you wants an answer and a solution. Now. Your experience adds up, and you know what's probably wrong and even how to treat it. Oftentimes, the patient might not understand the gravity of the situation. This is pharmacy's greatest challenge; often you're telling someone that they're seriously sick, but that you can't tell them what's wrong. If the patient has some odd symptoms, you might choose to treat them if you're convinced that all is safe and well.
Medicine teaches an entirely different kettle of fish. We have drilled into us that safety is in the understanding. According to Dr Murtagh, we adopt five principles; a) what's likely, b) what's deadly, c) what's often missed, d) the seven masquerades and e) what is the patient trying to tell me? As students we are taught to always consider the worst case scenario.
Consequently, that's exactly what I do at work. A good example unfolded last weekend; a middle-aged patient presented onchyolysed fingernails. She hadn't seen them for two months thanks to her french tips. Usually, I'd be thinking fungal infection, but two days earlier, I'd read up on thyroid exams. It seemed like it could be a case of Plummer's nails. Plus, she was in the demographic for hyperthyroid. So, I suggested that perhaps she'd want to see a doctor... just to check it out.
Ironically, my boss' prediction was in fact the opposite; my style is now much more careful, and markedly less maverick. Far from throwing caution into the wind, I'm hearing whispers of warning through the breeze.
Thats interesting. Will you still practice pharmacy when you are graduated from medicine? (I know other health professionals who plan to do both when finishing, particularly if doing rural GP, doing a sort of "one stop shop" setup).
That's a tough question, Dragonfly :) I certainly haven't ruled it out, but I guess keeping up with the state of play through intern and residency would be an interesting challenge.
As you've said, in a the rural setting with few providers, it would be ideal, and I reckon that it'd be an great model of patient care.
Legally, though, I'm not 100% sure which states will let you hold dual registration.
Of note, one General Practice near me currently has on staff six of their eight doctors with B.Pharms!