Learning To Fail

During my residency interviews, I remember one question more vividly than the rest.  I was asked this question by multiple programs, and it stuck in my head long after the match was completed.  “How will you handle failure?”  At the time of the interview, I discussed picking up the pieces, learning from my mistakes, and becoming a stronger pharmacist.  Yet in my head, I was thinking that I will just be proactive and never fail.  If I work harder than I have ever worked before and make personal sacrifices of sleep and sanity to be a good resident, I will avoid failure.  Six months of residency has proved me wrong.

Regardless of how hard you try, as a resident there will come a point when you are trying to juggle so many balls that one of them drops.  As cliché as it sounds, one of the most important lessons I have learned in the last month of residency training is learning to forgive yourself for dropping the ball. I make mistakes, I sometimes cry after a bad day, and I am not always as prepared as I should be for a topic discussion.    Today, I had a topic discussion about Rapid Sequence Intubation as part of my Emergency Medicine Rotation.  I found articles and read about the topic, yet my mind completely blanked when it came time to discuss with my preceptor.  Once it became painfully obvious that I did not know the answer to most of her questions, we decided to call it quits and try again tomorrow.  She told me it was okay, and emphasized the importance of reviewing the material tonight.  I haven’t stopped beating myself up since.   You might be smiling right now that my learning to fail moment was not being as prepared as I should be for a topic discussion, but if you would have heard the deafening silence in the room during my failure to produce the correct answer, you would understand.

This is my declaration to the pharmacy world that I have let the ball drop, and I have forgiven myself for it.  I have picked up the ball, read more articles, made an outline of my notes, and reviewed the material with my supportive co-residents.  Tomorrow is a brand new day, and I am going to give the best topic discussion of my life.  Will I fail again?  Yes.  Have I started to develop the essential life skills to know how to handle a dropped ball? Absolutely.

My crystal ball is not speaking….yet

I had my first of five residency interviews today, and while I feel that I was prepared enough and had thought enough about why I am pursuing residency, I was not expecting to be asked by several different parties where I see myself in 5 and 10 years. More importantly, I was not expecting to doubt my answer, so I told the truth. I DON’T KNOW. While some may not like it, I keep my answers pretty broad. I keep the few essential necessities as must-haves in my life, and then I let my life flow, taking advantage of opportunities as they present themselves while pursuing a long-term goal. I described the type of practice I want to be in…dynamic, at the forefront of whatever I am involved in, collaborative and progressive.  I stressed that one of the main reasons I am pursuing residency is to further identify and hone my strengths, to plant some roots so that I may flourish.

So, I had to say that I honestly don’t know specifically where I will be in 5 years. I feel  like my whole life is in limbo until the Match in March, when I find out where I will be heading off to residency.

Putting a Face on Anticoagulation Management

I made a new acquaintance this week. We asked the usual questions: what do you do, where are you from, do you have siblings. He mentioned that his mother had recently passed away. It was unspoken, but also clear that he wanted to talk about it. So I asked, “What did she die from?”

“A pulmonary embolism. She’d just had knee replacement surgery and was scheduled to go in for a follow-up procedure the day she died.” The last he’d heard from her was an e-mail that very morning—she wasn’t feeling well; her surgery might be delayed.

I was silent for a moment. Even as a health professional, it’s hard to know what to say. 

“I’m so very sorry.” Another moment of silence and then I added, “A large part of my job is helping to ensure that doesn't happen.”

Based on the evidence, I believe that most instances of pulmonary embolism or DVT following surgery or hospitalization are preventable. I'm not alone in this interpretation. CMS recently added these conditions to the list of hospital-acquired conditions for which facilities will not be reimbursed should they occur during hospitalization. A Joint Commission National Patient Safety Goal addresses the appropriate and safe use of anticoagulants.

Click to read more ...

Undone by Scott Brown(?)

So, picture this... as editor of ASHP InterSections, I've spent the last three months overseeing the production of a magazine that features an in-depth cover story about what health care reform might mean for pharmacists in hospitals and health systems.

I've shepherded a new writer through his paces, contacted members who have been highly involved in national reform efforts, worked with an illustrator to create a beautiful piece of art for the cover, and brought this jam-packed issue to a close.

And, on the very eve of publication, Scott Brown (R-Mass.) manages to take away a Senate seat that has been Democratic for 47 years. In that instant, he changes the national reform conversation, throws President Obama's legislative agenda into doubt, and threatens to derail the very issue that is the centerpiece of this edition of the magazine.

At first, I was dumbfounded. What was going to happen to health care reform, environmental policy, enhanced support for our nation's institutions of higher education? But more importantly (at least to me), what were we going to do about the cover story? How could we make it relevant for members?

And then, I took a breath. Health care reform will happen... it may not be exactly like the bills that passed both the Senate and the House, but the tide has turned. We have been talking, as a nation, for almost a year about inequities in coverage, about an inefficient and often wasteful health care system, about patients who often have to make agonizing choices between paying for needed medicines or buy groceries. That conversation will go on.

And President Obama's State of the Union address Jan. 27 supported that notion. He really threw down the guantlet, challenging Congress to get it done. So, the cover story, as written, is still incredibly relevant. The efforts of the ASHP members who have worked so hard educating their Congressmen and women about what pharmacists do every day have not been wasted. And I hope the story inspires you to pick up the mantle of reform and get involved.

And I'll move on, to the spring issue... and a cover story about ASHP's new national effort to develop pharmacy practice models that fit the needs of today's patients. (No Scott Brown here!)  

So. What Do We Do Now?

Recently, I knocked over my crystal ball and destroyed my only tool that helps me see into the future to help advance the profession of pharmacy.  My timing is pretty bad.  As I write this, the fate of the health care reform legislation is in serious doubt.  Congressional Democrats are scrambling to decide what course of action to take while Republicans are re-affirming their presence on Capitol Hill as a party that cannot be brushed aside because they lack the numbers to block the Democrat’s agenda.  Welcome back balanced government.

Then it occurs to me (yes, all good ideas do happen in the shower) that instead of trying to predict the future and acting on those predictions, we look to our past achievements as our guide to impact the future. 

So what does the “Massachusetts Message” and the resulting scramble on the Hill mean for health-system pharmacists?  The answer is actually pretty simple. The provisions in both the House and Senate bills that recognize the medication use expertise of pharmacists are non-partisan and non-controversial. They are considered by many to be common sense, workable solutions that everyone can get behind.  In fact, since we already have them written into legislative format, it appears that we have our legislative agenda for 2010 already written.

It’s an agenda that is supported by all pharmacy organizations and presents opportunities for all practice settings.  I am referring of course to the medical home model that includes medication services of pharmacists, the medication therapy management grant program, and efforts to reduce hospital readmissions and promote safer medication use.  Whatever fate the current bills suffer, these items were included in the proposals because Congress sees value in them.  Ideally, we’d probably like to add funding for second-year, specialty residencies or stronger payment mechanisms.  But these are mere tweaks to legislative proposals that we already support. 

The moral of the story: While Congress may need to go back to drawing board on the broader issues of health care reform, our agenda is still largely a finished product and should be considered a live wire.  While others regroup, we will be pushing on!

Springing into the Light at the End of the Tunnel

This past week I began my “last” first week of school. I started the spring semester of my P3 year. It was with much excitement and a little trepidation that I entered the classroom and started the therapeutics module on cardiology. I felt a new sense of urgency to be a “sponge” and take in as much information as possible.  This semester will be the last chance I will have to take in this important didactic information. Already in our first week, we have covered the JNC 7 and ATP III guidelines.  We learned that these important documents are critical tools for pharmacists as they guide patient therapy with evidence-based medicine.  While I try to take in all the important points, I realize that just knowing where to find these resources will be a great help to me during rotations. Given this realization, I started a new folder entitled “guidelines” on my computer so I can keep all of these critical resources in a convenient place. It was upon making this folder, that I truly realized that rotations are just around the corner – I am really starting to see the light at the end of the tunnel! 

In a few short weeks we will choose our 4^th year rotations. With this challege coming up soon, as P3 students, we have a renewed urgency to focus on our career goals and what we want to choose for our elective rotations.  I encourage all P3 students to start researching what rotation options your school offers now. If you are interested in "out of program" rotations, make sure your school has agreements in place with the health-system or organization and get your paperwork in early.  When surveying your options for rotations make sure you provide yourself with a wide variety of experiences, you might even want to check out the rotation offered at ASHP!  Most importantly, take this time to decide what impact YOU want to make as a health-system pharmacist. While your interests may change as you go from rotation to rotation, the impact you want to make, and your passion for helping patients should shine through no matter what practice setting you are in. Given this, I challenge you to discover what your IMPACT will be on the profession!

“Top 10 List” for APPE rotation preparation

I just came home from rounding with the ICU team on 19 patients. I was actually able to keep up and know what was going on with each patient (of course, my preceptor was around for guidance). This morining at 6:00 a.m. the adrenaline was running through my veins as I prepared for rounds in the ICU. It is a race against time! Patients are hemodynamically unstable and therefore more than likely medication dosages must be adjusted, fluids and electrolytes must be replaced, and nutrition must be provided. All this before we report to rounds! But I am happy to report that I have a plan and a system that I use in monitoring patients and I have learned how I can make an impact on patient care as a pharmacy student.  (Steep learning curve... I cannot wait to see how much I will learn in my residency next year!)

So, what do I think you have to do to optimize your experience on rotations? Here is my advice for pharmacy students who are about to embark on their clinical rotations.

“Top 10 List” 

10. You do NOT know everything nor will you remember everything. Have your Lexi-comp, calculator, and Sanford guide in your pocket.

• Micromedex and Up-To-Date Online are helpful tools. If you have an iPhone or other handheld, try a program like Lexi-Comp w/ AHFS!
• It is OK not to know the answer but be able to know how and where to look it up. (Very important).  Believe it or not, rotations are where all your drug information classes will come in handy.

Click to read more ...

Earthquake In Haiti

Like everyone else around the world I am saddened and stunned by the massive devastation caused by the earthquake in Haiti.  The loss of human life, and other physical and mental suffering caused by this catastrophic event is impossible to comprehend. 

ASHP will be working with public health officials and relief agencies to provide assistance, and we will share information with our members about ways that you can help.  I know that many of you have already found ways to help, including by donating money to the many groups that are helping to get resources to where they are needed most.  I suspect there may even be pharmacists who serve on disaster response teams and work with various relief organizations that are currently in or are on their way to Haiti to provide assistance. 

I know that as human beings we are all united in our sadness about what has happened to the people of Haiti, and that we are all looking for ways to help.  I look forward to reading your thoughts about this event, learning about the things you and groups you are affiliated with will be doing to help, and things that you are aware of that others are doing.    

Kasey K. Thompson, Pharm.D.
Vice President
Office of Policy, Planning and Communications
American Society of Health-System Pharmacists