Clinical pharmacist info

[PharmDr.]

I was wondering how often do clinical pharmacists use physical assessment in their work. I am interested in UF, NSU, and FAMU in florida and when I was checking out admissions for Nova I saw that they have a class and certificate that can be earned by completing 32 hours of lecture and lab. It says that the program entails: perform medical history, general assessment of a patient, mental status examination, vital signs on a patient, examination of the integument, perform ear exam. utilization the otoscope, perform eye exam. utilizing the ophthalmoscope, perform head, nose and throat exam.,neck exam.,thorax and lungs, cardiac exam., abdominal exam., vascular, neurological, musculoskelatal, and properly record physical exam. findings and interpret the physical assessments of other clinicians. Sorry for long post.

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[Samoa]

We had a physical assessment class at my program. There aren't many pharmacist jobs where you will actually use the skills with any regularity, but hopefully that will change. It is, however, extremely useful even now in helping you understand what your team members are talking about on rounds, and where they are getting their info.

It's one of those things that if you know how to do it, and express interest in practicing those skills during your training, people will let you. In fact, on day 1 of my first pharmacy rotation (which was internal medicine), one of the interns asked me to go do an H&P on the team's new admission. I would have really loved to go do it, but I'd only really been taught the physical exam, and how to sift through someone else's H&P for the relevant data--not how to perform the full H&P myself. And believe me, learning how to understand someone else's H&P, and learning how to do one yourself are completely different skills. So if you have the option of going to a program where you get to learn AND PRACTICE how to do one, that's a great opportunity.

 

[Dr JPH]

In my experience with clinical pharmacists, they don't have much to do in the way of performing physical exams or being involved in that portion of the case. They are usually called upon for their expertise in polypharmacy patients (every patient in the hospital, basically) or in the ICU where there may need to be a fine balance of meds as to not over stimulate the pt.

Haven't seen clinical pharmacists in Anesthesiology...those people know their meds cold. ER stuff is really limited in the amount of meds and the ER people know the drugs in their grasp. Heme/Onc folks run their own show too.

Again, clinical pharmacists play a vital role in working with the docs (particularly interns and residents) in managing pts on warfarin/heparin therapy on the floor, picking up key interactions between the pts current meds and what they will be on in house and also the best way to go from the pts out patient meds to what they will be taking in house.

If you are truly interested in the physical part of it then working in the prison system may be of some interest to you. My girlfriend did several of her PharmD rotations in the prison system and you get a lot of experience with hands-on pts because they are very understaffed and most of the people there are suffering from chronic ailments (Hep and HIV) so the exam is basically "check-ups" (as opposed to a new pt admission) along with their drug regimens.

Hope this helped.

 

[28657]

To the OP, I'm not sure what benefit the patient would receive by having their clinical pharmacist perform physical assesments. Maybe I'm naive to how the whole hospital stay works, but I would assume nurses take pretty good care of the patients and keep the pharmacists up to date on pt's physical assesment. Of course pharm students should learn about some of the general things you listed, like: perform medical history, general assessment of a patient, mental status examination, vital signs on a patient, and interpret the physical assessments of other clinicians.

But these other things seem beyond the scope of a 32 hour lecture/lab session and are very specific: examination of the integument, perform ear exam utilization the otoscope, perform eye exam utilizing the ophthalmoscope, perform head, nose and throat exam,neck exam,thorax and lungs, cardiac exam, abdominal exam, vascular, neurological, musculoskelatal, and properly record physical exam findings.

I agree with Samoa that knowing "about" all of this will help on rounds and communicating with other health providers. However, actually performing all of these exams is a little much in my opinion and should be left to those who's jobs specialize in that sort of thing.

Maybe I just think this way because I chose pharmacy so I wouldn't have to do any sort of physical examinations of patients! If this is what clinical pharmacists do, then count me out!

 

[Triangulation]

My hospital rotation at LA Country Hospital had us follow a clinical pharmacist and their use of H & P was limited. Their understanding of it was critical, but for the most part, she came in downstream of the H & P. She would get paged for emergencies, but that was, once again, after findings were found and she was needed to select the therapeutic response.

I will say, for w.e. reason and perhaps not a good one, pharmacists are gonna land up doing more of px exam kinda stuff. I don't mind doing rudimentary stuff at a health fair or screening, but doing that stuff as part of my job really turns me off.

 

[MNnaloxone]

We also had a class in physical assessment. I agree that it is helpful to have a slight idea of what the physicians are looking for/at. However, I never did a physical assessment of a patient on any of my clinical rotations, and never saw a pharmacist do one. It isn't in our realm. It took me witnessing a 3rd year med student doing a occult blood stool sample from a overweight incoherent Native American to thank God for that. I wholeheartedly agree with a P4 from the U of MN who once told me-"I went into pharmacy because I liked medicine and healthcare, but didn't want to touch naked people all the time."

 

[PharmDr.]

I thought that performing physical assessments on patients was a checkup kind of thing. When you are seeing a patient you can do a brief check of those skills listed to check if their meds are working properly and if there are any new complications that arise. If any do arise then you can tell their physician and he or she can deal with it. If a clinical pharmacist wanted to see other things they would order lab tests and then interpret them to plan another course of action. As far as I know, only in VA hospitals at the moment give clinical pharmacists the last say with a patients medications. I have read that if a physician rights a script for something and you see that it is either incorrect (containdication or side effects etc.) or their is something better to prescribe then the clinical pharmacist can either modify a drug regiment or change it all together. Other small areas of specialty in clinical pharmacy (internal medicine, psychiaty,pediatrics,oncology,nutrition,critical care,primary care,infectious disease,nuclear, etc.) also give the pharmacist certain prescription authorities but not like in VA hosp.

 

[sweetcalie08]

I wholeheartedly agree with a P4 from the U of MN who once told me-"I went into pharmacy because I liked medicine and healthcare, but didn't want to touch naked people all the time."

My thoughts exactly.

 

[Triangulation]

Under CA law, pharmacists have the right to prescribe, and you will see that fairly commonly with clinical pharmacists in certain areas. LA County Hospital has an array of pharmacists that actively prescribe under their charge of therapeutic management of pts, particularly those in certain disease states. The two i encountered managed hypertension and the other diabetes. It's definitely not only at VAs. For the County of Los Angeles it was a cost-effective way of improving therapy and preventing ADRs.

 

[spoons]

Hello guys, from your experience at rotation, what exacly is daily task of clinical pharmacist? It seems their task is to make sure physicians are prescribing right medication. I would assume that physicians know what they are doing. I know that pharmacists make big difference in patients lives, but is this one of these areas?

 

[Pilot]

You all can have all the vag exams as well as the Hemoccults. Just tell me what the result was, and I'll manage the patient appropriately.

Seriously, I think that a teaching a pharmacy student to perform a physical exam would be good, strictly for the knowledge base to assist in understanding what the physician means when writing the Admit Note/H&P. I however, would not want a pharmacist performing check-ups and initiating/discontinuing therapy based on their exams.

Just for background info- I am a practicing pharmacist, and will be graduating from medical school next month. I am opposed to pharmacist's obtaining prescribing authority, as well as prescriptive authority for chiropractors, naturopathic physicians, and physical therapists. Nothing personal against anyone - just my opinion.

 

[spoons]

So you have both pharmD and MD? Did you have to take all these basic courses over again as medical student, or do they exempt you from these courses?

 

[Pilot]

I went to pharmacy school before the Pharm D was mandatory, so I am a BS pharmacist (interpret BS however you want ). The state I reside in changed the law so that all pharmacists are licensed as "Doctor of Pharmacy, or D.Ph., rather than Registered Pharmacist (R.Ph.) - I just have a hard time using that title myself, so I still call myself an R.Ph. I will be graduating from medical school as a D.O. in less than 1 month. I had to take every course - there was no testing out of classes. I looked at pharmacology as a good review course, as well as biochemistry and physiology. Anatomy, well, that's a whole different story

I will be placing my "pharmacist" heritage on my prescription pads and white coat since I am as proud of my pharmacy education as my medical education.

Pilot, D.O., R.Ph.

 

[Samoa]

Just FYI, I do know a few other people with pharmacy degrees who went to med school, and most of them didn't have to take it. Some chose to, for the review and easy A.

 

[Pilot]

That wasn't an option at my school. Even the people who took Biochemistry in the master's program at the school had to repeat the course in medical school, irregardless of their grade. I always felt they got ripped off because the master's students sat through the same lectures, took the same tests, and had to complete a project that the medical students didn't.