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Posts Tagged ‘pharmacy’

Which Pharm Book For An Intern’s White Coat?

(In the interest of full disclosure: some of the links in RookieDoc posts are affiliate links, meaning that I might get a small commission if you purchase them through my link.)

One of the RookieDoc members shot me an email asking me about the pharmacology references I recommend to carry around in your white coat as an intern or a resident.

Here was a portion of our exchange:

I noticed you recommended Tarrascon Pocket Pharm – which edition is better, shirt pocket or lab coat pocket? I know the shirt pocket is a lot smaller, but will that be enough? It would be nice not to have to tote around a bigger book…if you could let me know what you think that would be great! Thanks again! I appreciate you getting back to me so quickly.

You’re right, it’s better to carry around the smaller book.

  • Heavy stuff in your pockets eventually causes neck pain, back pain & headaches… and it usually takes people 6 months to a year to realize that that’s the problem.
  • Too many sources of information can be distracting.
  • Too many sources of information can be a time suck & leads to inefficiencies.
  • The more you can learn to use the resources around you, without depending on a single resource, the better… this isn’t necessary early on, but eventually, when you’re out in the working world, it will be priceless.
  • Internet access is everywhere – check to see if your program has access to some of the online resources – the online version of ePocrates, UpToDate, etc.
  • If you have a phone or a PDA, I’d skip the book & get ePocrates (even if you just get the free one)
  • Lastly, along the way, stay conscious of those times you say “Darn, I wish I had such&such”. If that occurs more than once, go out and get such&such.
  • Whatever you buy, save the receipt… and submit it for reimbursement if you have an education stipend.

    I hope that helps :)

    Dr. Tori

    All Eyes on Your Charts

    Have you ever thought about who looks at your charting? Too often, what is written in the chart is thought of in real time only. When we write down our history, our exam, lab values, etc we’re thinking about providing good care to the patient right now. We may, at times, realize that a little later down the road a consultant might need what we’ve written, or something, but rarely are we thinking much further down the road.

    You need to change that, and do it now. If you think about the full context of what you’re writing now – in your training – you will form good habits that will stay with you throughout your career. Check this out…

    I once received a note I had written 4 years prior (from when I was a resident). It was faxed to me for my review. It turns out that another hospital was being sued by a patient they transferred to my hospital on a night I was on-call. I wasn’t being sued, but they needed my deposition, since I was the first doc to see the patient after transfer was initiated. And even though I wasn’t being sued, I felt nauseated seeing a note I had written years ago come across the fax… from Dewey Soo Em and Howe.

    Here’s an incomplete list of (potential) eyeballs on your hospital charting. Please add more in the comments if you think of others…

    • Attending physician
    • Covering attending physicians – usually on weekends
    • Nurse – usually a new one every 12 hours
    • Consultants
    • Pharmacists
    • Pharmacy techs
    • Unit secretaries
    • Interns and residents
    • On-call coverage, moonlighters, etc
    • Coding department
    • Billing department
    • Utilization review personnel
    • Social workers and case managers
    • Insurance company reps and reviewers
    • Other hospitals’ staff/docs (on future hospitalizations)
    • Lawyers
    • Patients, themselves (Google and Microsoft are both have patient-directed health care records)
    • (medical charting funnies – whatever you do, don’t end up here)

    Be careful with what you write or enter into the computer.

    Managing Expectations – Part 1

    Don’t shoot yourself and everyone you work with in the foot!

    If you’re a doc, then you shoot others in the foot when you tell patients in the hospital that you’re going to order a certain medicine or a certain test – without telling them that it’s going to take some time.

    If you’re a nurse, you’re shooting the doctor in the foot when you say, “I paged the doctor, but they never called back.”

    The fact is that both may be true… but you need to give more information. Think about it from the patient’s point of view…

    “The doctor just now told me that pain medicine is ordered. Why doesn’t the nurse get it right when I ask for it?”

    “Why isn’t my doctor calling back? I’m sick enough to be in the hospital, you’d think they’d call back. He comes in for 5 minutes a day, at least call back when the nurse has a concern!”

    It takes less than twenty seconds to change the way you say things, and in the process you can save the patient, other nurses, other doctors, patients’ family members, etc a lot of grief.

    It’s all about managing expectations…

    Many patients have never been in the hospital before. Many family members have never had someone so close to them in the hospital. Listen to what you say with their ears. See what they see.

    They see the doctor in their room for 5 minutes a day… They don’t see the doc

    1. Checking labs
    2. Discussing things with consultants
    3. Reviewing old records
    4. Discussing the dispo with the case managers and social workers
    5. Arguing Advocating for the patients with the insurance companies
    6. Writing progress notes
    7. Dictating consults
    8. etc.

    If you’re a nurse, you can change all of that if you just say something like, “Behind the scenes, we’ve all put our heads together and the doctor has reviewed your labs. Although she’ll be by a little later, she’s up to date on everything that’s been going on. She has some pretty sick patients on another floor.”

    Likewise, the patients don’t know that when the you (Doc) write an order that…

    1. The secretary has to take that order off
    2. The secretary faxes it to the pharmacy or enters it into the computer
    3. The secretary alerts the nurse or flags the chart
    4. The nurse reviews the order
    5. The pharmacy checks for duplicate orders, drug interactions, therapeutic substitutions, etc
    6. The pharmacy sends the med up
    7. And, finally the nurse brings the med to the patient

    All it takes is saying something like, “I’m going to order a stronger pain medicine for you. But, I apologize, it’s going to take a little while for it to come up from the pharmacy.”