Sunday, June 3, 2012

Interning part 1

I'm interning at a community hospital that has about 150 average daily census (that would be the number of people in it on an average day across the year).  It's part of a health system with a bunch of hospitals ranging from a 50 bed rural hospital to a 500 bed urban tertiary hospital that has a level 1 trauma rating (that would be the most severe trauma cases).  Random terminology: "tertiary" means that somebody who started out at a very small hospital (also called critical access hospitals where patients only stay a few days at most, generally in rural areas), then was transferred to the regional hospital, would have to make another transfer to reach this hospital. Tertiary hospitals handle every procedure imaginable, and some states don't have one at all.  The pharmacists and techs I have talked to have nearly all talked about it being "only a small hospital" which entertains me.  I figure this is my chance to be in a "big" hospital.

I'm having a good but busy time.  I'm learning lots and lots (no shocker there).  One of the cool things is the fancy electronic health record.  It has almost all the bells and whistles you could ask for, so it's been fun to get exposed to how it all works.

Other fun stuff I've done: I got to visit in the operating room pharmacy and go over what they do (at 6am no less), I spent 3 or 4 hours in the emergency room with the pharmacist who works as part of the interdisciplinary care team there (amazing, and I was surprised to be really interested in it), and I've gone on interdisciplinary rounds in the ICU.  When they say interdisciplinary at this hospital, they really mean it.  The doctor, nurses for each patient (each nurse steps in for his/her patients then steps out, the charge nurse is there for all patients), pharmacist, and social worker have been there all three days, and 2 of 3 have included a social worker, a physical or occupational therapist, a respiratory therapist, and a dietician.  The hospital chaplain was also there one day, and 2 days there was another person whose job isn't really clear to me (I should ask about that).

Interdisciplinary teams are a pretty big deal and pretty new as a formal thing in hospitals, so I was really excited to see this.  It works really well and has been neat to see in action.

On the agenda are two more sets of interdisciplinary rounds that are still new to the hospital.  One is discharge care conferences (where everyone, including the patient and maybe their family/caregiver) goes over what happens when the patient leaves the hospital - where they're going (home, nursing home, somewhere in between), what medications they'll take, what pharmacy they'll use, if they'll have physical or occupational therapy (PT and OT, respectively), and any questions they have get answered.  I'm not really sure how this is going to work out because pharmacists' time is pretty limited and this is a long process, so to do it for the 10ish patients on this unit who leave each day is going to be a big job and take a lot of time.

The other set of new rounds is the one with the pain management team (not sure who all is on that team exactly).  I'm not totally sure why a pharmacist is needed to manage pain, but I'm interested to see how it all works.

In the realm of "what do I want to be when I grow up?" I think that if it works out, I'd like working in a hospital well enough.  I kind of think that ambulatory care (that would be where you see the pharmacist, then the doctor, or maybe the other way around if you don't have any chronic meds to manage) might be neat.  In the long run I have a rotation in that, so that's something to look forward to in another couple of years.  I had been pretty sure I wasn't interested in working in the ER, but now I'm pretty sure that it does interest me some or moderately.  The trick about working in a hospital is that (at least right now) to get a job in a hospital larger than about 75 beds (ie those in cities/urban-ish areas) in my region [TRI STATE AREA!], you need a residency.  My grades just aren't pretty enough for a residency (I think, but I could be wrong) so it's kind of out as a result.  BUT who knows what happens next?

In my dream world, I still have a job doing something informatics/computer/database-related in mind as "perfect" but my idea of "pretty amazingly awesome" has expanded considerably.  It's nice to keep my options wide open, I think.

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