The Right Thing

When you're talking about morals and ethics, there are a few different types of people.  There are those who know what's right and have an internal drive to do that.  There are also those who know what is right and what is wrong, but don't have that drive and may choose to do the wrong thing, without much guilt, if it suits them better.  And finally, there are those who either have a skewed view of right and wrong or simply can't make the distinction.  Of course, this is a spectrum; people may fit more than one of those descriptions depending on the circumstances.  A person's ethics are constructed at an early age and molded throughout childhood.  When they reach a certain age, these things can't be changed and become part of who they are.  (I don't have any references or citations supporting this; just an observation).  Side Note: It makes me wonder why they have classes at some schools called "moral decisions."  I can't really judge since I've never taken one but hopefully they're not trying to teach the difference between right and wrong to high-schoolers.  It's probably a little late at that point.

The reason that this topic came to mind is that a young friend of mine was faced with an ethical/moral decision recently.  It basically came down to making the choice to go somewhere he was told he couldn't.  Very soon after he snuck away, he was given the choice to turn back or face consequences.  He made the right decision to abandon his plan and turn around.  His reason for making that choice wasn't because of the consequences, but because of something less concrete to him; that he "just couldn't do it."  What that meant to me is that he thought about the guilt and the breakdown of trust that would likely follow doing the wrong thing and, as much as he was looking forward to his ultimate plan, couldn't go through with it. 

These qualities are one of the most important factors for me when I'm choosing who I want to associate with and who I can consider good friends.  We've all been around people who try to get us to do something with phrases like "no one will find out" or "it's not that big of a deal" but when it's not the right thing to do, that should be reason enough not to do it.  The people I want to be around are those who have that inherent ethical decision-making ability and are honest.  Doing the right thing should take precedence over a borderline or definite unethical decision that's more convenient or is only made to serve your own interests.  Everyone makes stupid mistakes from time to time, but what matters at the end of the day is what you learn from them and that you ultimately make the right decisions regardless of the missteps in the process.  Many things about a person (as we all have our faults) can be overlooked when certain character strengths are present.  There are a number of people that I can still consider good friends in spite of various shortcomings because they are enjoyable to be around and, more importantly, have "strong moral fiber."  There seems to be an association between these qualities and many people on camp staff.  After all, all of my best friends are "camp people."  Hmm…coincidence?

I want to be a druggist, not a doctor!

When I was deciding what I wanted to do for a living, one of the things that made me want to be a pharmacist is the way that independent community pharmacies run.  We (pharmacies/pharmacists) are an important part of the health care system, bridging the gap between people and their doctors.  We serve as a resource for people who don’t understand their disease states or their drug therapies.  We also serve as somewhat of a triage for people who don’t know if a minor problem warrants a trip to the doctor or just some over-the-counter option.  We are there to help people with deciding which OTC to choose as well as which medical device to choose and how to properly fit it (knee braces, compression stockings, etc.)  We are also a resource for the rest of the healthcare community when it comes to drugs.  However, those things are not what I am learning in school.  I have become more and more disappointed with my education at UW as the last few years have unfolded because we spend way too much time on clinical diagnoses and “doctor stuff” instead of the things we will encounter most often working in an outpatient pharmacy.  If I wanted to be a doctor, I would have gone to medical school instead.

I understand that some of each graduating class will go into residencies and later move into positions in hospitals as clinical pharmacists, who actually do rounds with physicians, but something like 80% of us will end up in the community.  It’s important to get a basic knowledge of clinical issues for wherever we end up, but it’s asinine that we spend probably less than 10% of our time on the things that 80% of us will be doing on a daily basis.  Clinical knowledge of disease pathophysiology and diagnosis is important to an extent (when explaining things to our patients and when evaluating their drugs) but our classes go way too far in-depth. 

Some of the things we have just glossed over are the most common things that community pharmacists do.  We spent a very small of time on patient counseling in first year, before we had learned anything about the drugs (so it was difficult to apply the little bit they taught us).  Only one class discussed OTC choices, and as a once-a-week class, I didn’t learn a whole lot.  Mostly because he used “team-based learning” … refer to a previous blog for my feelings of hatred towards that approach.  The only class that discussed medical devices was a once-a-week elective that involved student presentations instead of lectures.  So the little we learned was basically whatever that particular group of students presented.  Apart from that class, we haven’t learned anything about orthopedic devices, compression stockings, wheelchairs/walkers/canes/crutches, incontinence supplies,… the list goes on. 

I think I know the reason that so little time is spent on these things.  It’s because of the huge amount of time we spend on “doctor stuff.”  In labs, we have spent hours on full heart and lung exams.  It’s good that we learned what findings of those exams may mean, but I think it’s just stupid how much time we spent learning how to actually perform them.  And it wasn’t even from someone who does that; it was from a person only 2-3 years ahead of us in their education.  We also spent a lot of time learning how to read ECGs.  I’m glad to know what a ST-segment elevation means (as it affects drug therapy decisions), but when is a pharmacist ever going to be the one to look at an ECG and determine that that is what is going on?  Never.  That’s going to be the job of a cardiologist, an ER doc, or maybe even a general physician, but never a pharmacist.  Why not devote some of the time spent on these things to things that will be more relevant in the majority of students’ careers?  If you’re going to specialize in clinical cardiology-pharmacy, you’re going to do a residency in that, which is where these specific things would be better suited to teach.

I am inexpressibly thankful for working at a drugstore while I’m going to school for two reasons.  First off, it’s where I learn all of these things that I am not being taught in school.  It’s great that I know the structure of a drug and the decision-making that goes into picking that drug, but that barely helps me explain to a patient the big picture of their disease and how to take their drugs and what to expect from them.  I’m glad I have such knowledgeable pharmacists at work that I can learn all the useful stuff from.  A cycle I have kind of developed this year is after I learn about something at school I go to work and ask what that means practically and what is important for patients to know when we counsel them.  The other reason I enjoy work so much is that it is a constant reminder of why I’m putting myself through this program in which I am not learning what I set out to learn.  Sometimes I wonder why I’m sitting through 4x/week three-hour lectures and excruciating lab sessions to learn a lot of things I’ll never actually do and only a little that I will.  But working regularly reminds me of what attracted me to pharmacy in the first place: the juxtaposition of healthcare with quality customer service, two things that both interest and excite me.  Regular dealings with real people and helping them improve their health in ways they can understand is what I truly enjoy. 

So school has basically become a means to an end.  I go through all my classes with two objectives: learn everything I need to know to pass the exams, but more importantly, learn everything I can about the pharmacist things in such a way that I can retain them and apply them in the future.  If some of the doctor stuff gets forgotten a couple weeks later, that’s fine, as long as I remember the things that I’ll need and the things that matter to a pharmacist who isn’t also trying to be a doctor (which is kind of what they’re trying to push).  Then I can augment that with the practical things I learn at work as well as the practical things I’ll learn from preceptors in my 4^th year rotations.  Who knows what the future of pharmacy schools will bring.  Maybe there should be a movement towards separating the education between future clinical pharmacists and future community pharmacists.  Since both roles are changing so quickly, it makes sense to cater education to what someone's ultimate destination is.

Using Time Wisely

One of the biggest conundrums I face sometimes is deciding whether or not to go to class.  I am not one to skip class just for the heck of it, but if my time is going to be wasted, it’s not worth going.  I am a huge fan of traditional education.  If someone experienced in their field (not someone whose career is solely education) and is going to give us an actual lecture (not reading PowerPoint slides they’ve already posted), I will attend 100% of the time.  However, when it’s going to be an interactive, group-discussion, pull-teeth-to-get-a-volunteer presentation, it’s more a waste of time than anything else.  Sometimes I think that these types of presentations are an excuse for the instructor to be lazy.  They don’t have to present their own information; they rely on students to do that.  So what is the point?  I’m not paying $6500 a quarter to hear fellow students regurgitate something we’ve all already learned, I want to hear from people that can actually teach me something. 

It’s not only the waste of time in the classroom itself, it’s the time surrounding it.  If I go to school for just one hour-long class, from the time I leave home until the time I return is about 2-1/2 hours because of how long the bus takes and how long I have to wait.  So, if I’m not going to learn a whole lot, it’s well worth the time to stay home and study the material on my own.  I can be much more efficient at home, even if I take frequent breaks.  I would rather not waste time with useless classes because that translates more time studying after class and therefore fewer and fewer hours of sleep (especially with 7 classes this quarter…)

Given all that stuff I just said about how much time school takes, I still spend the majority of my weekends at Camp Parsons, paying absolutely no attention to school.  My argument for that is that if I actually did spend all of my time studying (which I could easily do, considering how much there is to do) I would go insane.  Volunteering at camp is the one thing I do that gets my mind completely off of school.  Spending last weekend with most of my best friends, getting a LOT accomplished on various projects, and enjoying the company of many generations of camp staff is what makes it so I can tolerate the agony and torture of school.  Matthew Broderick said it well: “Life is packed with things you have to do, but sometimes you’ve got to live a little.”  During the week, I might spend extra time studying to make up for being gone on weekends, but as long as I learn everything I can that will be useful once I graduate and pass all of my classes and have some time left over for camp and friends, I’m content.  (All the stuff we’re supposed to learn that is impractical is a subject for a future blog…)  So in conclusion, I think I made a good decision to go to the library and get caught up on some studying than sit through a class where I wouldn’t learn much.  I guess I did just waste a little time writing this, but now I can start studying…