Day 5 of residency, 4th ADS, 3rd post…things are starting to really ramp up, but I am very excited for this!
Today’s ADS was Introduction to Clinical Patient Workup and Therapeutic Thought Process with Tila. In preparation for this ADS we were asked to review a chart and create our version of a workup of it as though we were the pharmacist following them. Despite having ample practice doing care plans in undergrad and rotations, this felt challenging and partly unfamiliar, as to this point my thought process is very spotty and non-systematic.
The following are my take home points from this ADS (with regards to thought process):
- INITIATIVE: if you take the initiative you can help prevent delay in decision/therapeutic making.
- Ask about aspirin/NSAID (generic and brand names) specifically, and herbal (like from the health foods store) *beyond just asking about OTCs*
- Lab values: always include abnormal findings and finding that are normal but pertinent because of the drug therapy or disease.
- Write everything that you think is relevant, this will help you figure out if you have a DTP that you missed, why you missed it and where in your process you have issues. If you don’t write everything that is relevant than missing a DTP won’t allow you to think of what ur missing in the process.
- Final question to the thought process: does every drug have an indication? does every indication have (the right) drug(s)?
- Write QTc under diagnostics on each pt (seems to be more and more relevant in practice nowadays).
- ALTs and ASTs LFTs is a bit of a misnomer… only shows you acute liver damage (hepatocellular damage), not chronic liver damage… so not really reflective of liver damage.
- Full 14 months pharmanet: Looking for meds that were stopped/DC’d ; this will change the way you recommend stuff.
The following are my take home points from Tila’s advice for us as a resident and how to approach our learning:
- Ask your preceptor: “what’s your model? do the biggest disease state thoroughly or a bit of every disease state?”
- Ask for feedback daily from my preceptor on my thought process! This will help identify issues before they snowballs.
- Be comfortable asking my preceptor where on my process I am having issues if I am having challenges to self-identified.
I will speak further in my general objectives and clinical orientation objectives as to how I hope to employ Tila’s lecture and advice into my practice.