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.