Rotation Experiences

[owlegrad]

So I thought it would be cool to have a thread where we discuss rotations. Cool stuff, uncool stuff, w/e. Maybe help out the underclassman with what to expect, that sort of thing. I might as well get us started.

First rotation: Global Health Outreach Trip
Pros: Very awesome. The experience was great and very rewarding. It lasted a week and counted for four weeks (winning!).
Cons: Expensive, time consuming pre-rotation preparation, extensive paperwork involved, vaccines, etc. Probably didn't do much to prepare me to actually be a pharmacist.
Final Thought: Likely to be my favorite rotation. Would certainly do it again.

Second rotation: Community (Independent)
Pros: The staff was friendly, got LOTS of experience counseling, also got to compound and do some other cool retail stuff
Cons: Not many. You do feel like free help sometimes I guess. When it is busy it does not exactly feel like a learning environment, to put it mildly.
Final Thought: I feel like most people who put down communty rotations probably don't take advantage of the opportunity as much as they should. I worked at CVS for two years before this rotation and still learned a lot from my preceptors about how to counsel, different facts about medications, being a pharmacist, etc. Have an open mind and just absorb as much as you can.

Third Rotation: Amb Care
Pros: Great hours, staff was friendly, preceptors challenge me more than my first two rotation sites (but not in a stressful way ), by far the most 'professional' setting I have seen a pharmacist in.
Cons: After the first hundred INR checks I doubt there is much more to learn. It gets monotonous.
Final Thought: Pretty cool overall, but it is just doing the same thing over and over and over...

And that is all I have so far. Hopefully others find this idea helpful and contribute.

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[rxlea]

Is this thread going to be just for APPE or can we post about our IPPEs?

 

[owlegrad]

Is this thread going to be just for APPE or can we post about our IPPEs?

When have I ever excluded anyone?

 

[hereticmnk]

May I ask where you went for the global health outreach trip? It seems like an awesome experience.

 

[SHC1984]

You already did THREE rotations? I am still on my first one! Classes just ended in May...how did you have the time to be finished with three rotations already?

My first rotation is at Wellcare. I am on the computer all day and that is all....pretty good job...my preceptor never worked a weekend in her life....Her job can't be too bad...she already took off 4 days since I was there. LOL

 

[sprwmn88]

You already did THREE rotations? I am still on my first one! Classes just ended in May...how did you have the time to be finished with three rotations already?

My first rotation is at Wellcare. I am on the computer all day and that is all....pretty good job...my preceptor never worked a weekend in her life....Her job can't be too bad...she already took off 4 days since I was there. LOL

At UF, we start rotations in March and go through until the following March and come back to campus for 8 weeks before graduation.

 

[gsRx]

My first rotation is at Wellcare. I am on the computer all day and that is all....pretty good job...my preceptor never worked a weekend in her life....Her job can't be too bad...she already took off 4 days since I was there. LOL

I guess she can afford it when she has students there doing her work for her.

Speaking of rotations, I just finished my fourth.

1st - Rehabilitation Center/ LTC - mostly doing Drug Reconciliation
2nd - Not much of anything
3rd - HIV Specialty Pharmacy
4th - Poison control center
5th- coming up, Home Infusion

 

[owlegrad]

May I ask where you went for the global health outreach trip? It seems like an awesome experience.

It was Nicaragua. The experience was pretty awesome.

You already did THREE rotations? I am still on my first one! Classes just ended in May...how did you have the time to be finished with three rotations already?

At UF, we start rotations in March and go through until the following March and come back to campus for 8 weeks before graduation.

Yup

 

[SHC1984]

At UF, we start rotations in March and go through until the following March and come back to campus for 8 weeks before graduation.

So I guess you and Owlegrad still have classes left then??? I am sooooo GLAD classes are over for me for the rest of my life! lol....

I guess she can afford it when she has students there doing her work for her.

Speaking of rotations, I just finished my fourth.

1st - Rehabilitation Center/ LTC - mostly doing Drug Reconciliation
2nd - Not much of anything
3rd - HIV Specialty Pharmacy
4th - Poison control center
5th- coming up, Home Infusion

LOL...I have been making a lot of powerpoint presentations and word documents for her! I hope she likes my work though.....This is my first rotation and I been trying to do the best that I can.

You still have classes left like the students at UF?

Where do you go to school at?

My preceptor told her sometime she goes to doctor's offices and give them a presentation...I hope she doesn't make me do that though...I am not big on giving presentations...

 

[sprwmn88]

So I guess you and Owlegrad still have classes left then??? I am sooooo GLAD classes are over for me for the rest of my life! lol....

Yeah, but it's no biggie. In those last 8 weeks, you just present cases for Pharmacotherapy VI, take an herbals class, and get certified in immunizations. It's a breeze compared to a normal caseload but it will probably definitely be a drag to go back to "school" after rotations which I am currently loving.

 

[owlegrad]

Yeah, but it's no biggie. In those last 8 weeks, you just present cases for Pharmacotherapy VI, take an herbals class, and get certified in immunizations. It's a breeze compared to a normal caseload but it will probably definitely be a drag to go back to "school" after rotations which I am currently loving.

I hear that!

 

[SHC1984]

Yeah, but it's no biggie. In those last 8 weeks, you just present cases for Pharmacotherapy VI, take an herbals class, and get certified in immunizations. It's a breeze compared to a normal caseload but it will probably definitely be a drag to go back to "school" after rotations which I am currently loving.

I hear that!

You guys liked all your rotations so far?

I only had ONE so far and it's waaaaaaaaaaaaaaay LESS work than school....but I think those hospital rotations will be much harder though...

I did immunizations my P2 year...I was so nervous my doctor had to give me Xanax to take before I did it just so I can CALM DOWN!

 

[Sparda29]

So I thought it would be cool to have a thread where we discuss rotations. Cool stuff, uncool stuff, w/e. Maybe help out the underclassman with what to expect, that sort of thing. I might as well get us started.

First rotation: Global Health Outreach Trip
Pros: Very awesome. The experience was great and very rewarding. It lasted a week and counted for four weeks (winning!).
Cons: Expensive, time consuming pre-rotation preparation, extensive paperwork involved, vaccines, etc. Probably didn't do much to prepare me to actually be a pharmacist.
Final Thought: Likely to be my favorite rotation. Would certainly do it again.

Second rotation: Community (Independent)
Pros: The staff was friendly, got LOTS of experience counseling, also got to compound and do some other cool retail stuff
Cons: Not many. You do feel like free help sometimes I guess. When it is busy it does not exactly feel like a learning environment, to put it mildly.
Final Thought: I feel like most people who put down communty rotations probably don't take advantage of the opportunity as much as they should. I worked at CVS for two years before this rotation and still learned a lot from my preceptors about how to counsel, different facts about medications, being a pharmacist, etc. Have an open mind and just absorb as much as you can.

Third Rotation: Amb Care
Pros: Great hours, staff was friendly, preceptors challenge me more than my first two rotation sites (but not in a stressful way ), by far the most 'professional' setting I have seen a pharmacist in.
Cons: After the first hundred INR checks I doubt there is much more to learn. It gets monotonous.
Final Thoughts: Pretty cool overall, but it is just doing the same thing over and over and over...

And that is all I have so far. Hopefully others find this idea helpful and contribute.

I wish I went on one of the international rotations at my school. Our school does trips to Peru for a rotation on Medicinal Plants of the Amazon, Ghana for global heath/getting a knowledge of how healthcare is outside of the US, and to India for another global health rotation. I wanted to go to either Ghana or Peru but my parents refused to let me go/pay for the trip. Instead I had to do some bull**** Omnicare rotation like the one Mikey always complains about.

 

[pharmacisttobe]

So I thought it would be cool to have a thread where we discuss rotations. Cool stuff, uncool stuff, w/e. Maybe help out the underclassman with what to expect, that sort of thing. I might as well get us started.

First rotation: Global Health Outreach Trip
Pros: Very awesome. The experience was great and very rewarding. It lasted a week and counted for four weeks (winning!).
Cons: Expensive, time consuming pre-rotation preparation, extensive paperwork involved, vaccines, etc. Probably didn't do much to prepare me to actually be a pharmacist.
Final Thought: Likely to be my favorite rotation. Would certainly do it again.

Second rotation: Community (Independent)
Pros: The staff was friendly, got LOTS of experience counseling, also got to compound and do some other cool retail stuff
Cons: Not many. You do feel like free help sometimes I guess. When it is busy it does not exactly feel like a learning environment, to put it mildly.
Final Thought: I feel like most people who put down communty rotations probably don't take advantage of the opportunity as much as they should. I worked at CVS for two years before this rotation and still learned a lot from my preceptors about how to counsel, different facts about medications, being a pharmacist, etc. Have an open mind and just absorb as much as you can.

Third Rotation: Amb Care
Pros: Great hours, staff was friendly, preceptors challenge me more than my first two rotation sites (but not in a stressful way ), by far the most 'professional' setting I have seen a pharmacist in.
Cons: After the first hundred INR checks I doubt there is much more to learn. It gets monotonous.
Final Thoughts: Pretty cool overall, but it is just doing the same thing over and over and over...

And that is all I have so far. Hopefully others find this idea helpful and contribute.

Thanks Owlegrad that's a great idea. I'll contribute once I'm done with my rotations and hopefully more students can contribute as well.

 

[Ackj]

I wish I went on one of the international rotations at my school. Our school does trips to Peru for a rotation on Medicinal Plants of the Amazon, Ghana for global heath/getting a knowledge of how healthcare is outside of the US, and to India for another global health rotation. I wanted to go to either Ghana or Peru but my parents refused to let me go/pay for the trip. Instead I had to do some bull**** Omnicare rotation like the one Mikey always complains about.

Our school goes to a different place every year. They've done Kenya, El Salvador, and a few others that I can't recall. Like Owle said, expensive and doesn't help you to be a pharmacist. I passed on that, but everybody seems to have a good time doing it, and it's probably nice for your CV.

I'm actually at Omnicare now, and I think it's a pretty cool place. Sure I have to fill some orders, but you'd do that in retail too. I make tons of compounds (so much vanco solution and butt cream) and IV meds. We do vanco dosing and chart reviews on all the IV abx . We're doing an inservice next week for nursing staff about central lines and tpns. However, we're the main facility in this region, so we cover the other smaller Omnicares who do not have IV capacity. Maybe if you were at one of those places it wouldn't be as interesting. My preceptor is also a great guy who goes out of his way to show us interesting things and make sure we're getting something out of it. Actually, all of the pharmacists there have been like that: "Oh hey, check this out, have you seen this before?" "Have you seen the study about this kind of dosing?"

Cons: Large staff, too many names to remember. Especially with the casual dress code, sometimes you don't know who's an rph and who isn't. I guess that was really only an issue for the first week though.

 

[Its Z]

I did an international research rotation paid for by my school. It was fun.

 

[rxlea]

I did an international research rotation paid for by my school. It was fun.

Back when there were like two schools

 

[Its Z]

Back when there were like two schools

69

Should have stayed there.

 

[rxlea]

69

Should have stayed there.

I concur. Good number. So what year was that?

 

[Its Z]

I concur. Good number. So what year was that?

Not the summer of 69.

 

[joetrisman]

I concur. Good number. So what year was that?

From past posts, it looks like Z graduated in '96. Perhaps he was hinting at it with a quasi-anagram of 69 pharm schools?

 

[cycloketocaine]

From past posts, it looks like Z graduated in '96. Perhaps he was hinting at it with a quasi-anagram of 69 pharm schools?

Don't give him the credit of being that intelligent.

 

[rxlea]

Don't give him the credit of being that intelligent.

lol

 

[Its Z]

Don't give him the credit of being that intelligent.

There goes that job I was holding for you.

 

[cycloketocaine]

There goes that job I was holding for you.

Whatev. Somebody here's gotta keep you in check.

 

[Its Z]

Whatev. Somebody here's gotta keep you in check.

I'm docking your starting salary by 20%

 

[cycloketocaine]

I'm docking your starting salary by 20%

And I'm docking my starting productivity by 20%. So ha!

 

[enoti]

Thank you for starting this thread! I am starting rotation in 2 weeks. I have ambulatory care, cute care in surgical ICU, specialty pharmacy, drug information rotation so far. Did you review before your rotation and what do you suggest?

 

[joetrisman]

Thank you for starting this thread! I am starting rotation in 2 weeks. I have ambulatory care, cute care in surgical ICU, specialty pharmacy, drug information rotation so far. Did you review before your rotation and what do you suggest?

I start rotations in ~2 weeks as well. I'm currently studying (well trying to anyway) for my last set of pharmacy finals Pretty stoked too as I just got word that one of my rotations got cancelled so I get an opportunity to get a clinical rotation before midyear which I previously did not have. This will make 3 acute care rotations

 

[owlegrad]

Thank you for starting this thread! I am starting rotation in 2 weeks. I have ambulatory care, cute care in surgical ICU, specialty pharmacy, drug information rotation so far. Did you review before your rotation and what do you suggest?

Is your amb care at an anticoag clinic? If so, the chest guidelines are what you primarily want to review. Of the rotations I have had so far, only amb care required any prep before hand.

For DI I would think you would want to know how to use Pubmed and whatever your favorite database is (clin pharm, lexi, w/e).

Can't speak to ICU or specialty.

 

[enoti]

I start rotations in ~2 weeks as well. I'm currently studying (well trying to anyway) for my last set of pharmacy finals Pretty stoked too as I just got word that one of my rotations got cancelled so I get an opportunity to get a clinical rotation before midyear which I previously did not have. This will make 3 acute care rotations

if you don't mind me asking, where are you doing your acute care rotations? how are you planning to prepare for it?

 

[owlegrad]

Just got back from rotation number four, a camp for children with type 1 diabetes. It was great, I cannot say enough about it really.

Pros: Great way to get a small taste of how these patients live every day (injections, BG tests, ketone tests, etc.). Also a lot of fun (it is camp after all). Went for one week, it counted as four. Learned a great deal about counting carbs, tracking sugars/adjusting doses accordingly, carb:insulin ratio, correction factor, ect. Can't say I learned anything that I didn't know about pathology or 'academic' topics, but I am certainly more comfortable with the topic in general than I was before with a MUCH higher appreciation of the level of effort required to properly manage insulin dependent diabetes. The food was good (and free!).

Cons: Well, it is children, so that can get tiring for so many reasons. Also it was HOT. And I am not used to that much physical activity.

Overall: Best rotation yet. Lots of fun, great insight into some of the practical concerns of insulin management, 'would do again'.

 

[Sparda29]

Just got back from rotation number four, a camp for children with type 1 diabetes. It was great, I cannot say enough about it really.

Pros: Great way to get a small taste of how these patients live every day (injections, BG tests, ketone tests, etc.). Also a lot of fun (it is camp after all). Went for one week, it counted as four. Learned a great deal about counting carbs, tracking sugars/adjusting doses accordingly, carb:insulin ratio, correction factor, ect. Can't say I learned anything that I didn't know about pathology or 'academic' topics, but I am certainly more comfortable with the topic in general than I was before with a MUCH higher appreciation of the level of effort required to properly manage insulin dependent diabetes. The food was good (and free!).

Cons: Well, it is children, so that can get tiring for so many reasons. Also it was HOT. And I am not used to that much physical activity.

Overall: Best rotation yet. Lots of fun, great insight into some of the practical concerns of insulin management, 'would do again'.

That's the bull****. I had a classmate who got one of those 4 month internships at Novartis but the school only counted it as 2 months of rotations.

 

[Ackj]

That's the bull****. I had a classmate who got one of those 4 month internships at Novartis but the school only counted it as 2 months of rotations.

Well, if Owle stayed at the camp, that's 24 hours x 7 days = 168 hours, which is more than 40 hours x 4 weeks.

The Novartis thing sounds like your buddy got gypped.

 

[owlegrad]

So I am halfway through rotation number 5, Hospital Practice. It is fine, if a bit dull.

PROS: Getting to learn the workings of hospital practice, sort of. I have been shadowing different people doing pharmacy tasks (and some nonpharmacy stuff for the matter). The preceptor is great and keeps quizzing me about stuff and having me look stuff up. I have been on rounds and working with other departments, so the exposure is great. I got a few days off to do homework due to my preceptor having a few days off, so that is nice (again, sorta). She gave me some prep stuff to help with the NAPLEX, which is awesome.

CONS: I work in a hospital, so watching people do stuff that I already do is super boring. I do not need to watch IVs being made for 2 days, I already make IVs thankyouverymuch. Same for many of the menial tasks, I get everyone needs to learn them, but goodness I already do them, can we pleeeeeease focus on some higher ordered learning here? I do not need DAYS to learn how to do cart fill or fill labels. And WAAAAY to much time spent doing busy work. Way too much.

Overall: My most boring rotation to date. Thankfully the preceptor is nice and tries to make everything a learning experience (e.g., instead of just filling the crash cart, review ACLS guidelines while doing it and quiz yourself about when each drug is used), plus she has been great about other stuff as well. But still, this would be a better rotation for someone with no hospital experience.

 

[Rockinacoustic]

Rotation 5

Did you let your preceptor know beforehand about your previous hospital work experience?

 

[All4MyDaughter]

Did you let your preceptor know beforehand about your previous hospital work experience?

Yes, good question!

 

[owlegrad]

Yes, and she did customize some of the workload for me. Overall she has been great, but some of the shadowing has just been mind-numbing, that's all. For example, in the IV room I am not allowed to mix stuff until a fingertip test and a media fill test. The person who does those was not available for the first part of my rotation, so I was stuck shadowing.

YAWN!

And the time spent doing cart fill and filling labels is pretty boring as well, though I don't mind that as much - at least I am being somewhat helpful, though I am slow on account of not having the particulars of their setup down pat.

 

[rxlea]

IPPE 3
Site: Rural Critical Access Hospital

Pros: very hands on. The pharmacist is an integral part of the team. The physicians, nurses, pharmacist, all work well together. Very laid back atmosphere. Got to do everything the pharmacist does in addition to observing a surgery, shadowing a physician and playing pharmacist that day, running a diabetes clinic at the IHS down the street, going to the larger hospital in the region and shadowing ICU, and giving an in service to nurses. I learned a ton.

Cons: hour commute from where I'm staying but I got to carpool with my preceptor anyway. Don't get to handle super complicated or intensive care cases because they are transferred out (although I still got to do patient workups on them). Limited formulary. Always worry about cost for everything. Not the level of care I'm used to which was different.

Overall: amazing rotation!!!! Loved it and love my preceptor. Best IPPE rotation of the three. It was definitely beyond my expectations. The preceptor took into account my previous hospital experience so I got to do a bit more than other IPPE students.

 

[joetrisman]

APPE Rotation 1: Advanced Community

Pros: 5 weeks of going into nearly automatic as I already work retail. Rph gave me his logins and told me to go while he did tech work or did manager work the whole rotation. Learned a lot about the rph perspective in the pharmacy. Got heavily involved in clinical services (well, compared to past experience). Made several interventions that I felt proud of and felt like I really helped.

Cons: Did not get as much MTM experience as I wished as the chain I'm at is still putting 99% of their staffing hours towards dispensing and therefore time for MTM was limited.

General: I really think I could dig retail if I didn't match. I'll grant that some days are hard and there currently isn't enough time for as much clinical analysis as I'd like, but I really did feel a LOT of satisfaction going home most days after helping people out and getting genuine feedback about their appreciation.

 

[Digsbe]

Seeing this makes me very excited to start school in a week and a half. In my program we begin our IPPEs the second week of classes I'm looking forward to my 4th year now.

Thanks for sharing your experiences.

 

[Ackj]

So I am halfway through rotation number 5, Hospital Practice. It is fine, if a bit dull.

PROS: Getting to learn the workings of hospital practice, sort of. I have been shadowing different people doing pharmacy tasks (and some nonpharmacy stuff for the matter). The preceptor is great and keeps quizzing me about stuff and having me look stuff up. I have been on rounds and working with other departments, so the exposure is great. I got a few days off to do homework due to my preceptor having a few days off, so that is nice (again, sorta). She gave me some prep stuff to help with the NAPLEX, which is awesome.

CONS: I work in a hospital, so watching people do stuff that I already do is super boring. I do not need to watch IVs being made for 2 days, I already make IVs thankyouverymuch. Same for many of the menial tasks, I get everyone needs to learn them, but goodness I already do them, can we pleeeeeease focus on some higher ordered learning here? I do not need DAYS to learn how to do cart fill or fill labels. And WAAAAY to much time spent doing busy work. Way too much.

Overall: My most boring rotation to date. Thankfully the preceptor is nice and tries to make everything a learning experience (e.g., instead of just filling the crash cart, review ACLS guidelines while doing it and quiz yourself about when each drug is used), plus she has been great about other stuff as well. But still, this would be a better rotation for someone with no hospital experience.

I was a hospital tech for a bit during undergrad, so I sort of had this feelingon the first part of IPPE. Thankfully, my preceptor said "You already know this stuff, just spend this week knocking off those assigned tasks, then we'll do the cool stuff" and that's exactly what happened.

I am not allowed to mix stuff until a fingertip test and a media fill test.

At my most recent APPE, one of the pharmacists did his on his desk, rather than the hood, to make a point. His passed just the same as any 'proper' test did.

 

[joetrisman]

APPE Rotation 2: Long term care

Pros: A lot of vanco, AG, and TPN dosing. While not an expert, I can at least come up with a reasonable recommendation with confidence now. Also led to a great understanding of the continuity of care with patients, especially in seeing how OPAT is handled. Very laid back atmosphere.

Cons: Unless doing consulting at a NH or doing abx/tpn dosing, pharmacy has practically no clinical function sans the occasion drug-drug interaction flag. The role is mainly dispensing (and business problem solving) which could be problematic to people who need clinical mental stimulation at work.

General: I didn't realize how much satisfaction I get from helping patients with questions and OTC selection until they weren't part of the equation. I kinda understand what people mean now when they tell you to pick things outside your comfort zone so that you can find what you like. By adding the contrast of LTC, I really affirmed my desire for patient interaction. Just not about insurance

 

[owlegrad]

Rotation 6: International Studies - Visited several European countries to learn how pharmacy is practiced there.

Pros: Great experience if pharmacy systems is an interest or if interested in practicing international pharmacy somehow. Of course the obvious benefit is getting to travel around Europe and get school credit for it.

Cons: Cost, duh. Also not the most "practical" rotation for preparing to be a pharmacist (though we did several patient cases that were harder than any I did in school or on other rotations).

Overall: Would definitely do it again as well as recommend to others. Cost is punitively expensive obviously.

 

[SHC1984]

My APPEs so far.

1) PBM- LOVE IT! (MY FAVORITE ONE SO FAR!!!)
2) Hospital managing TPN orders-LOVE IT!
3) Home infusion pharmacy-LOVE IT (but don't care for my preceptor)!
4) Informatics pharmacy- HATE IT! (Can't wait till this hell is OVER!!!!)

Can't wait till I start my nuclear pharmacy rotation next block!

 

[cycloketocaine]

My APPEs so far.

1) PBM- LOVE IT! (MY FAVORITE ONE SO FAR!!!)
2) Hospital managing TPN orders-LOVE IT!
3) Home infusion pharmacy-LOVE IT (but don't care for my preceptor)!
4) Informatics pharmacy- HATE IT! (Can't wait till this hell is OVER!!!!)

Can't wait till I start my nuclear pharmacy rotation next block!

MountainPharmD better watch his back....you're gonna come take his cushy PBM job!

 

[SHC1984]

MountainPharmD better watch his back....you're gonna come take his cushy PBM job!

Yep!

I believe we are in the same city right now too.

 

[SHC1984]

manage care is the only residency I might apply for...that's how much I loved my PBM experience! lol

 

[pharm B]

Seeing this makes me very excited to start school in a week and a half. In my program we begin our IPPEs the second week of classes I'm looking forward to my 4th year now.

Thanks for sharing your experiences.

How has this semester's IPPE been so far? What set up do you guys have? We get assigned a site, and go each Friday during the semester for a full day. The other 4 days are long days on campus. The setup has its pros and cons.

 

[joetrisman]

APPE Rotation 3: MTM

Pros: Learned a ton of drug-disease, drug-drug, drug without an indication, disease without a drug, BEERS, etc stuff to look for. I found myself doing this at work in community when waiting on patients during the weekend. Hopefully it stays with me. Very laid back as well. It really was the whole get-out-as-much-as-you-put-in sort of thing.

Cons: While a great rotation, I am continually reminded by my peers how much I am missing out on by not having hospital rotations before midyear. I feel pretty great about chronic disease treatment right now, but with exacerbations or acute care it is pretty obvious who has and hasn't been in a hospital the last few months. Specific to MTM, I found the rotation to be difficult often as patients really did not understand the value of the service and therefore were often reluctant to participate. Definitely made me feel the importance of profession advocacy.

General: Its very surprising to see how much stuff is less than optimal on multiple chronic disease state patients in terms of treatments. This applies to both the way that patients take the medication and what the prescribing patterns are (which can be worlds apart "my dr says to take it this way but I do xyz....). It rrrrreeeeeallllllyyyy brings home the importance of continual patient counseling and education on all meds, not just new ones. It also makes me feel we're the last line in making sure physicians stay up to date on the standards of care as not all keep up.