Over the next year, I will be sharing my unique experiences while on rotation. To speak honestly and openly with you, I will write this column anonymously under the name “Veronica.” It is my hope to provide you with insights about rotations and the many pharmacy opportunities I encounter.
In September, I had the opportunity to get fully immersed in an ambulatory care setting. For me, ambulatory care has been somewhat of an elusive, mystical creature. Housed somewhere between Minotaur and Pegasus, this specialty is something that I have heard a lot about, but did not fully experience as a student pharmacist until this
rotation.
I believe that ambulatory care is the happy medium between the two extremes of clinical pharmacy practice and traditional community practice. It allows for the application of clinical skills while having a fairly consistent patient base. Depending on the practice setting, it can also provide the opportunity to focus on chronic disease state management.
The site for my ambulatory care rotation is a federally-qualified health center and a level 3 patient-centered medical home, with a pharmacy that participates in the 340B program.
The grapevine effect
Now that I am a few months into the rotation cycle, I have started to experience the “grapevine effect”—hearing about rotation experiences from classmates who have gone before me. This can be both helpful and not helpful. How do you balance allowing others’ opinions and experiences to inform your experience without clouding your own perspective going into your own experience?
In this case, the biggest piece of forewarning that I received (from multiple sources) was regarding another practitioner that I would be working under in a clinic for homeless individuals. This person had a reputation for an excellent bedside manner but lacked the same disposition toward student pharmacists.
Fast forward to day one of my rotation when I found out that I would be working with this practitioner several days of the week throughout the month. Never one to hide from a challenge, I was determined to win him over on my first day in the clinic. Bracing myself for the worst, I instead found a knowledgeable practitioner who genuinely cares for his patients. Much of his stern exterior came from the sheer amount of work, referrals, and red tape that accumulates during the steady stream of appointments each day.
As my time in the homeless clinic passed, I learned that by not taking things personal and giving him his space, he became much more receptive to being my part-time preceptor. In doing so, I was able to appreciate the way that he interacted with patients by seeing past their current situations and treated them like valued individuals.
Dabbled in specialties
While some ambulatory care rotations may be associated with a specific disease state or primary care, this site had multiple specialty clinics as well as a fully-staffed primary care area.
Though changing focuses each day can tend to feel like you are becoming a “jack of all trades, master of none,” I enjoyed the opportunity to dabble in specialties such as the sickle cell clinic, infectious disease clinic, neurology clinic, and gastroenterology clinic.
How to challenge myself?
One of the things I learned about myself through this experience is that I thrive on projects with deadlines. These types of challenges motivate me to stay on my A-game. You can imagine my reaction when my preceptor told me that there were no specific projects associated with this rotation and to just work on things as the need arose. While that may be a relief to hear later in the year in the midst of “senioritis,” it certainly wasn’t encouraging. I wondered about the best ways to challenge myself during a preceptor-proclaimed easy rotation.
My approach was to offer up tasks that I enjoy, like organization and editing, as potential services. As a result, I developed a protocol for handling the hepatitis C prior authorizations that the gastroenterology clinic encountered regularly.
Patient care in action
Throughout this rotation, I learned about the role observation plays in being an effective member of the health care team. During specialty clinics, I observed as medical residents, fellows, and attending physicians discussed patient cases and saw how my input was valued when it wasn’t forced upon them bombastically. In the patient rooms, I observed physicians interacting with patients who had rough pasts and many whose present situation was not what they ever envisioned for themselves. I witnessed health care professionals console people as they wrestled with their diagnoses.
What I have learned
I can easily say that this rotation taught me that, while being a student of medication management and disease processes is important, it is just as important, if not more so, to become a student of people.