Pharmacy Students

The summer of 1985; I was in my third semester of pharmacy school, 21 years old, and had just received my pharmacy intern license.  I attended a school of pharmacy that condensed a four year (8 semesters) doctor of pharmacy program into three years by having summer school for the first two years.  In essence, we went to school year round, semester after semester, until all eight semesters were complete. 

The first six semesters were done on campus as class work while the last two semesters were done off campus and were called our clinical clerkship.  This clinical clerkship consisted of six rotations, each lasting six weeks.  The theory of the clerkship rotations is to expose the pharmacy students to various pharmacy practice settings, with the opportunity to learn which particular field we may like to pursue after graduation.

When I was a student, we were required to participate in four required rotations, including hospital, clinical, ambulatory care and out-patient pharmacy.  We then had the opportunity to choose two elective rotations and I chose psychiatry and oncology.  For me, the entire nine months was amazing. 

During the clerkship I had the opportunity to work side by side with 4th year medical students, discuss medication therapy regimens with medical residents, participate in daily psychiatric rounds, watch a baby delivery, view a colonoscopy through the scope, hang and administer chemotherapy medication, develop and deliver an out-patient education program, participate in the placement of a central line in the I.C.U. and deliver a 30 minute presentation at grand rounds to the medical students and residents regarding anti-depressant medication therapy and treatment options.

This was an incredible learning experience; however, the one area that was not covered in any great detail was how to talk with patients.  Let me back up to the summer of 1985.  I had just received my intern license and was ready to get a job as a pharmacy intern.  Our pharmacy school didn't necessarily encourage or discourage students from getting a job in a pharmacy, it was up to the student to see if they could find one and then work it into their schedule; school came first.

The city I was going to school in had plenty of pharmacies and it didn't take long to get hired on as an intern pharmacist at a retail/grocery store pharmacy.  Of course, the first few days involved learning my way around the pharmacy, answering the phone and pulling files, practicing on the type-writer, putting the order away, and learning about filling out the third party insurance forms. 

After a week or so, I remember I was doing just fine typing prescriptions, so I was left for two hours with a retired-relief pharmacist at the end of the day.  At this particular store, patients would pick up their prescriptions at the pharmacy counter and then take them up to the front of the store to pay at the register.  This particular customer came to the counter to pick up her medication, I found it and then turned to get the pharmacist so he could come out and tell her about her medication. 

In 1985, patient counseling was not yet a requirement; however, for most pharmacists it was still the current standard of care.  It wasn't until the Omnibus Reconciliation Act of 1990 that patient counseling and education regarding their medications became a required practice. 

Anyway, as I turned to get the pharmacist, he looked at me and said, "You're an intern, go ahead, tell her about her medication."  No problem I thought!  This is great.  I turned to her and promptly started an in-depth discussion of all I had learned about atenolol, her medication.  I took five minutes explaining beta-blockers, how they worked, and a thorough discussion about beta receptors on the blood vessel wall and the specific neuro-transmitters that were blocked by the beta-blocker medication she was going to take.

She stood there, glassy eyed, not understanding a thing I had said.  The pharmacist came up behind me and in 30 seconds described to her how she should take the medication, what side effects to look out for and how it interacts with her other medication.  This pharmacist wasn't much for words; however, I do remember him telling me to keep it simple and make sure the patient know what your are talking about. 

I feel I learned more about patient interaction and counseling that specific evening than I learned during my entire nine month clinical clerkship rotations.  In the few short moments, when the pharmacist approaches the counter to discuss the medication regimen, the pharmacist needs to evaluate the patients barriers to receiving effective medication counseling; including social, educational, and language barriers, just to name a few.  Each patient has a different capacity for learning and the pharmacist is in a position where they need to quickly evaluate the situation and design the medication education session to meet the learning needs and ability of the patient in front of them.

In pharmacy school, much time and effort is put toward learning clinically, how the medications work; however, I don't recall spending anywhere near the same amount of time learning how to educate patients so they understand their medications and more importantly, the consequences of not taking their medications. 

As pharmacy students, I invite you to listen to the Medication Specific Counseling SessionsTM offered through AudibleRxTM.  These sessions are designed to help patients understand what they do and don't know about their medications so they may take educated questions back to their own pharmacist.  Had I, as a pharmacy student/intern, listened to the patient education session about atenolol prior to my first counseling session with a patient, I would have addressed the counseling session in a much more effective manner.


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