The invitation to join pharmacy school comes to many as the best feeling, or at least to me it was. The pride of being called a Dr....
Through this piece I would like to gradually introduce the concept by using my personal journey and then we will further look at recommendations I feel could work for us.
My preclinical years made very little sense. What with the biochemistry, organic chemistry's Markovnikov's reaction. I barely survived those two years.
It is in third year that things began to make sense. Pharmacology, Pharmaceutics, Medicinal Chemistry and Pharmacognosy were introduced and for once I began to feel like a pharmacist in training. Later clinical pharmacy was introduced and everything made even more sense.
Our patient came into the picture and now I could go to Kiambu and clerk patients. It is so rewarding when you get to be of help to a patient and clinical pharmacy afforded me that opportunity. It allowed me to incorporate my knowledge of the pharmaceutical sciences and preclinical sciences to best manage my patient.
It's the expectation of preceptors that at the end of this training we are able to at least handle common disease conditions confidently.
How many of you reading this now can confidently manage someone suffering alcohol intoxication?
Perhaps some of you managed to hack it, some managed to throw in ABC, fomepizole, dextrose in no particular order. Some probably had no idea what to do. To those who were not able to, worry not, we can still learn, after all, that is why we say practicing of pharmacy... It's a continuous learning process.
I believe clinical pharmacy is the solution to shifting from theoretical training on patient management to a practical one. Now I know that almost everyone by the time they get to fourth year have gone for a ward round or two and know how to clerk and follow the SOAP format of patient assessment. It has been my observation however, that very many students have a hard time translating what they learn in theory to solve real life challenges, point in case; the above case of alcohol intoxication. This I believe is mainly because of how we structure our training.
From experience we would go to the wards, crowd a patient and query them then leave and go discuss the case in a lecture hall, away from the patient.
In my opinion that is not clinical pharmacy because at the end of the day the goal of clerking is to make any necessary interventions that will help the patient. Rarely and this includes during my attachment rotation in one of the leading hospitals in the country did we make an intervention that was followed up.
My view is that the best way to care for a patient is to do a multidisciplinary team kind of care. As institutions that train in pharmacy we can structure our clinical pharmacy ward rounds in such a way that the patient cases review is at the bedside level. Also, instead of a group of say 10 students crowding one patient and querying them why not assign a maximum of 3 students per patient and these students are to be responsible for the patient, do follow ups and prepare a PCP in collaboration with their preceptor (preferably with a clinical pharmacist based in the facility in which the students rotate as well as the lecturer from the school).
Also, since we are being trained to handle any disease condition, instead of limiting ourselves to only conditions being learnt that semester why not say, assign a few groups the patient conditions in that semester but also other groups to handle other disease states.
The students, working with preceptors will make recommendations that can be followed up on.
After the ward rounds we can sit down in an integrated team and discuss our cases and plans. From here we can get input from other colleagues and make conclusions.
Let the ward rounds have an impact in the lives of the patient. I for one would have loved to be assigned someone I called my patient and cared for them and knew them and their condition to the best level.
As we introduce the concept of PCP which is the pharmacist's tool of patient care, and do practical bedside care we will inculcate use of our knowledge in problem solving and that I believe is the end goal. No one wants a smart fool who is all words but with no action.
Next we will look at the PCP, what it is and why each clinical pharmacist should have a knowledge of how to compute on...
Written by:
Dr.Kelvin Odhiambo Odongo
Pharmacist
Co - Founder Medware Supplies Limited
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