High school mentorship journal entry No. 4, AILEEN BI

Today’s Date: Oct.  12, 2011

Total Mentorship Hours: 61.5 hours

Mentorship Research Journal #4

My fourth journal entry begins on Sept. 7, when I returned to shadow at the VCU School of Pharmacy.  Dr. Stevens was conducting a lab with the class, while Dr. Mawyer tested the students’ counseling skills. Dr. Mawyer was a pharmacy resident interested in clinical pharmacy, like that practiced in the Ambulatory Care Clinic, due to her desire to practice “clean medicine.” 

The second-year pharmacy students were required to be able to counsel on Warfarin, a blood thinner used to prevent the formation of blood clots in the blood vessels.  The drug works by blocking Vitamin K, which aids blood clotting.  The students must have had to memorize myriad facts about the drug in order to sufficiently answer questions the patient might have.  Their directions had to be very specific, or else they could be putting their patients at risk.  Most importantly, they must be able to communicate their directions sufficiently, in a manner that was more like a conversation than an order.  In this class activity, Dr. Mawyer played the role of the patient, while the students assumed the pharmacist role. 

In addition to Warfarin, students were also required to research the INR, or International Normalized Ratio, which determines a patient’s risk for bleeding.  The ideal ratio is between two and three; a high INR indicates risk of bleeding, while a low INR indicates the risk of painful clot formation.  If the patient’s INR was too high, then the dosage of Warfarin would be lowered.  Practicing counseling skills required that the students demonstrate their understanding of the medication while preparing them for their future careers.

I participated in another class activity on Sept. 14, which focused on genetic testing.  In this activity, students researched different kinds of genetic tests from different companies.  For example, the company Navigenics offered genetic analysis that could be conducted with a saliva sample.  DeCODE offered genetic tests that could be conducted with skin cells from the side of one’s cheek.  The students were responsible for reviewing these different means of genetic testing and determining which kinds of tests they would recommend to their hypothetical patients.  When making these recommendations, the students kept in mind patient convenience, counseling services provided, level of privacy and confidentiality, and possible test limitations, which are all very important factors for patients.  This activity served to allow students to practice their research skills, which are essential for pharmacists, who must frequently research drugs and pharmaceutical companies as more and more enter the market.

After observing several classes from the students’ perspectives, it was time that I explore pharmacy school education from the teacher’s perspective.  Over the next few Mondays, I mentored with Dr. Donohoe, an assistant professor at the School of Pharmacy.  My task was to help create PowerPoint presentations for her class, using the text “The 200 Most Common Drugs.”  During my time with her, I prepared presentations on cardiovascular agents and lipid-lowering agents.  I relied on the text as my guide– by looking up terms with which I was unfamiliar, I recognized them more easily over time. 

Dr. Donohoe gave me additional help by explaining the terms I did not understand.  Through this process, I came across a slew of new medical terms.  While working on the cardiovascular agent unit, I learned about ACE inhibitors, which treat hypertension and heart failure.  Drugs that fall under this drug group typically end with “–pril.”  ARBs also treat hypertension and heart failure and typically end with “–sartan.”  Amiadorone, which also treats the heart, is known for its many side effects. Clonidine is used to treat hypertension and has to be taken often.  Pertaining to lipid-lowering agents, cholestyramine binds with the gastrointestinal tract to block bile acid, which in turn helps lower cholesterol.  LDL and HDL are two of the main groups of lipoproteins: LDL is more commonly known as the “bad cholesterol” while HDL is the “good cholesterol.”  Myopathy is associated with intense muscle pain.  This experience gave me a small glimpse into the vast amount of vocabulary students must pick up over time in order to function as pharmacists in the work field.

I returned to the Ambulatory Care Clinic on Sept. 20. This time, I mentored with Dr. Mayer, who also works as an assistant professor at the School of Pharmacy.  While reviewing a patient’s medical history, she noticed that he had Oslo-Weber-Rendu Disease but was not familiar with that particular disorder.  I watched her put her researching skills to the task and find out that it is a genetic disorder that causes abnormal blood vessel formation.  On Sept. 28, a patient with hypothyroidism, a condition in which the thyroid gland fails to produce enough thyroid hormone, came into the clinic complaining of symptoms that she believed might have been caused by the medication she had been recently prescribed.  These symptoms included intense swelling of feet, dizziness, and headache. 

The pharmacist with whom I was shadowing at the time allowed me to check the patient’s medications, just like I had seen the residents do at my earlier visits.  I found many of the medications challenging to pronounce, but the patient was very patient and knowledgeable of her medical needs.  The resident suggested that the patient’s swelling might have been caused by amlodipine, which had been prescribed to help lower her blood pressure. 

While in the workroom, I overheard another resident discussing her latest successful motivation interview with one of the physicians.  She explained to me that sometimes motivation interviews are conducted to improve patient compliance.  The patient is asked open-ended questions about his perception of his health and other matters.  The pharmacist must give empathetic responses throughout the interview and focus on assessing the barriers preventing the patient from taking more responsibility for his health, then steer him in the right direction.  She explained that it was essential that the patient understand why he should take care of his health and the steps that will take him to that direction.  She seemed content with her recent achievement, as she expressed how much she liked “making a difference” in that patient’s life.  As someone who views pharmacy as a likely career path, I was encouraged by this reaction.

As my mentorship experience has drawn to a close, I would like to sincerely thank Dr. Ballentine for arranging the numerous shadowing opportunities I received in the Main Hospital, Ambulatory Care Clinic, and School of Pharmacy.  I had initially chosen to pursue a career in pharmacy because I felt that it fit well with my personality, according to the research I had conducted on this field. 

No amount of research, however, could have taught me as much as going directly to the professional scene, where I was able to observe many different types of careers in the pharmaceutical field, from education to ambulatory care.  The students and residents I met along the way were also extremely helpful in informing me about this career path.  Overall, this experience has painted a much clearer picture of the pharmaceutical field than the one with which I had began this mentorship experience.  Now I am much more confident in my decision to pursue a career in pharmacy, and I am very grateful to this experience for allowing me to enter college with this newfound sense of direction.

“RAM is one of those experiences that define you … ” ANDREW CARMICHAEL, 7/24/11

RAM is one of those experiences that define you as a professional. I think this is because you engage a population of people that usually have nowhere else to go, but typically have the most complex disease state management. More often or not, as pharmacy students we live in a bubble of lectures, homework, studying  and day-to-day decompression. We forget that the patients who need us most often do not have the resources to come to our workplace’s doorstep. We also forget, trying to get through our schooling, that the most important lecture we can ever have is patient engagement.

It’s very different to study disease states and how to treat people without a face or life’s complicating problems. It’s also completely different to develop therapy plans when you realize that your hesitations, your nonverbal communication  and your empathy directly impact how a patient receives the information or recommendations you propose. You can have the best therapy plan on the planet, but if you are callous, cold, unconfident or unsure, your patients will pick up on these things just like we do without any other social interaction.

We become excellent practitioners not because we are expansive in breadth in knowledge alone, but because we learn to be empathetic, relaxed, confident and sensitive to our patient’s needs. Often these qualities become more important. RAM is one of the places I have developed these traits, and I try to hone as sharply as possible. It’s worth every mile, hour of lost sleep and uncomfortable night of hot, sticky sleep. If anything, it gives you an appreciation for everything you have and how lucky we are to be the givers and not the receivers.  I also feel like it’s a sad excuse to not spend a little time in such a setting because most of us spend more time watching television, texting/calling/facebooking each other, and doing other nonessential activities than we devote to helping others.

 So many more things crash into focus when you treat patients who often cannot afford their medications, have social and cultural barriers that make counseling difficult, and whose situations are almost never ideal. Things are never as simple in practice as they are outlined in a classroom or a book. You almost never run across best-case scenarios or clearcut answers. RAM helps you make sense of this. It is also is one of the most rewarding things I’ve undertaken. I feel it is our duty not just as community members, but as professionals, to take a couple days out of our schedule to go to those who cannot come to us. We cannot have good health care without engaging in free health care.

There will always be economic divides, but we can help close them a bit, even if only for a couple days, if we go outside ourselves and give our time freely. We also talk constantly about team-based therapy in school and how medicine is going to this model. There is no place where this is truer than at community outreach events such as RAM.

At RAM, you have all the health-care professional specialties working together, instead of in bubbles, to form an integrated form of care, because there are no issues of who gets paid what or whose plan is more important. We come together to give the patient as much as possible. We also learn each other’s strengths and weaknesses and rush to fill in those cracks to form a more seamless plan of care. You also hear the gratitude, the tears of happiness and humility from your patients. I even often hear the phrase, “Thank you for everything you do. This is the best care I’ve ever received.” I also hear, unfortunately, “Thank you for actually spending time with me. My doctor, nurse, pharmacist, etc., does not spend this kind of time with me, and they charge so much money.”

This is my second time at RAM, and my role is much different this year. This year I’m learning to lead my peers to this same great opportunity and trying to develop ways to expand our presence at this event. I try and focus on what things went well, what needs work and which things not to continue or repeat so that next year, when I lead RAM, I can make it a little bit better than the year before and leave another scaffold on which my successor can build and make better after me, as well.

I’m incredibly excited by this prospect, but also very nervous. I want this experience to be as rewarding to others as it has been to me over the last two years. I want my peers to become better professionals. I want to show our communities that pharmacists are willing to go outside of their 9-to-5 work schedules to make sure that their health needs are met. So many of these things will worry me, but they will also focus me to ensure that I put everything I can into making RAM more successful. RAM has been one of the biggest honors I have been given because it has given me the chance to take care of my fellow man without the restrictions of insurance, prestige or management.

Thank you, RAM, for making me a stronger practitioner and a better human being.

Editor’s note: Andrew Carmichael was assistant team leader for VCU School of Pharmacy’s trek to Remote Area Medical 2011 in Wise County, Va.