Rolling out at clinic #3 this week

I'm too tired to post anything except that today was rollout to clinic #3.

Stressful

Tired

Feel like I have no support

Charts are disorganized

IT situation was a mess - couldn't print out notes from laptop because no access to printer, couldn't print from computer because no access to note

Which patients need the most help?

Outreach/Meet and greets, schedule crib, orient staff to purpose of project need to be done prior to pharmacist visit #1

Lead physician and admin person needs to be at clinic on first day to orient program to MDs, discuss inclusion criteria, and answer logistical questions

Need an admin day to organize notes, answer emails, follow ups, programming meetings..relax.

Really thinking whether dream job is worth all of this?

Desire to change the profession but the powers above say no

There are some tasks you lay ahead due to necessity, for example going to work, buying groceries, but there are some tasks that you commit yourself to out of desire ( shopping for a new pair of shoes or crafting a birthday card for a friend). What is the fine line between an obligation and a desire? How do you differentiate your sense of responsibility to your desire to help someone who has selflessly helped you? Does the feeling of obligation encroach into your desire? If so, is there a need to differentiate a sense of obligation from your sense of desire?

I was asked to write a paper that would benefit not only the pharmacy profession but myself and the clinic. Granted the paper would take much of my free time, researching, drafting, outlining, but I wanted to commit the time due to the aforementioned reasons. However when I approached my other colleagues, my commitment was interpreted as an obligation to the person who asked me to write the paper. True, the individual stands in an influential seat and has spent countless hours of non-work time to refer patients to my clinic, to advertise on my behalf and to promote and elevate my position to other colleagues. But my desire to write this paper was not out of obligation but from pure selfish desire! I want to write the paper DAMMIT but the forces above me have not granted me permission. *Sighs*

Change of culture

What a difference a salutation makes.

A physician told me, in order for the pharmacist to practice at the top of their license they must first be acknowledged by the correct salutation. " You guys are doctorates, you went to school almost as long as I did. You look at medications so much more differently than physicians. As a young practioner you need to build your credibility with patients and colleagues. It's about time the system recognizes what a vital component a pharmacist is of the care team. "

When you feel like no one understands

The hero's journey involves 3 steps. Step 1) Move away from home . Step 2) Self discovery through hardship and relationship fortification. Finally Step 3) Return back home to find you have changed.

The hero's journey is lonely but you'll find that there are people to help you along the way. But what if the people you need the most help from aren't there for you, professionally? What if they just don't understand your situation or the time commitment you take to serve your patients and ensure that their needs are met? The depth of research and extent you go through to help your patient pay for their monthly HCTZ and Lisinopril or diabetes medication because another day without their medications could mean another day closer to getting a heart attack?

What if your superior cannot offer you the emotional and professional guidance you need no matter how much you explain to them that there just isn't an infrastructure in place yet for you to efficiently serve your patients? That in fact, 3 patients on your schedule amounts to 6 to 8hrs or paperwork? Instead they push for reports and numbers that are not time sensitive? Do you quit because you think to yourself.."Is this really worth it?"

That's when you turn to your colleagues and good friends for sound advice. Seek a mentor who possesses qualities you admire and cling onto them. They can offer wisdom beyond textbooks or clinical guidelines. Be communicative, be grateful of their time and you'll succeed.

first patient of the day...

he came in with a plastic bag of medications and placed 3 empty prescription bottles on the desk. His plastic bag was still full. I looked at him and smiled, " What else do you have in there?" He then proceeded to bring out bottle after bottle of dietary supplements until half of the table was covered in green vials. " I stopped taking my prescription drugs a long time ago because I couldn't afford them. I don't want chemicals in my body anyways, eventually I want to be able to get off all these meds". I rechecked the list I had with what he showed me and did not see any of his diabetic medications. " I've been taking cinnamon. I read on the internet that cinnamon lowers my blood sugar".....I looked at the last A1C the patient had on file and was shocked.

apparently, the patient turned to dietary supplements to control his blood sugars after his medications became ridiculously expensive. " I'm getting depressed because I don't know what to do anymore. " His prescription drug plan did not cover any of his medications until he paid his share of cost out of his own pocket. Somewhere along the line, the patient got screwed over.

i spent 2 hrs with him, navigating through the Medicare Part D website to find a plan that would cover all his meds but stumbled upon a system issue. Even though the patient had what they call "medi medi or dual eligible" - meaning that the patient has Medicare and Medical, the Medicare system itself would not recognize the patient as dual eligible. Great, the patient can't switch plans today. No meds.

Then we applied for his low income subsidy which won't kick in for another 2 weeks. Pt still has no meds.

Then I tried checking the walmart and target $4 prescription drug list. Some meds were covered but the pt wasn't interested in his diabetes or blood pressure meds, he wanted his $140 brand name antibiotic for his ears. Pt has some meds but not the med he wants. *sighs*

What do you do when your patient runs out of resources?