Over the past decade or two, the profession of pharmacy has undergone a sort of identity crisis. As an adjunct healthcare professional, where do we fit in the grand scheme of medicine?

The easiest answer to that question is basic retail and hospital pharmacy. We dispense drugs. A doctor writes a prescription, or (in a hospital) orders a drug, the pharmacy makes sure it's a valid prescription and that the doctor didn't make any obvious errors, and the patient gets the drug.

A broader definition, though, and one that lets us fulfill a larger role, is that a pharmacist is a drug expert. In the community, the pharmacist is the most readily accessible healthcare professional. They get questions from patients, family members, and occasionally doctors, and if they're lucky and don't work for a high-volume store, they talk to as many patients as possible about their prescriptions. In drug companies and insurance companies, the pharmacist is the drug information specialist, and answers questions and makes formularies and such. In the hospital, this has given rise to the idea of the clinical pharmacist, who is able to play a much more active role in a patient's care.

A clinical pharmacist (which is what I want to do) is the hospital's expert on drugs. They round with doctors and follow patients, make recommendations, do the dosing on things like gentamicin and vancomycin (which have to be calculated), deal with anticoagulation, catch any drug-related medication errors, and whatever other drug-related things they can fit into their day. Some have become nutrition specialists and handle all the TPN orders; some go into academia and do research and teaching. The job really is whatever you want it to be.

And essentially, they are a consult service for other healthcare professionals. A nurse might ask if two IV medications can be mixed together without precipitating; a doctor might ask for help calculating a dose. A student might ask about pharmacology or pharmacokinetics, and a patient might ask about side effects.

It's a new and ever-changing field, but it's getting bigger, especially as younger doctors graduate and have some idea of the kind of resource a pharmacist can be. And as new pharmacists (like me!) graduate and work to make pharmacy a bit more progressive in the next decade.

I've had the pleasure of being paired with a pediatrician in private practice, Dr. D, as a part of the M1 Mentorship Program at my med school. He's already told me many things that one simply doesn't learn in the classroom - some of them are common sense but need to be said anyway. There are things he told me that I would do well to remember. Simple things that can make all the difference in the world:

- show proper respect to patients and colleagues (including doctors, nurses, PAs, etc)

- check up on your patients and call them back in a timely manner

- be conscientious and hard-working

- be good at what you do

If one meets the above criteria, word spreads and patients will come. It actually somewhat amazes me when he calls patients* 3-4 days after a visit just to check up on them, or make a call to let a patient know about the results of a lab test. Most patients don't expect him, as a doctor, to be taking the time to call them back.

But in the spirit of the holiday season, I will comment on the compassion that great physicians should ideally possess.

During my first visit to shadow Dr. D, he told me of instances where some of his patients lost their health insurance or were otherwise unable to pay. Yet he saw them and treated them anyway as their doctor by accepting what they could afford or even without repayment. He just reassured them to pay him next time when they get health insurance again. Most of the time patients respond in good conscience but a handful have "abused" his altruism. Often at the harping of colleagues and with great reluctance does Dr. D let these patients go. Alas, private practice medicine is ultimately a business and needs to be in the black, not in the red.

During my latest visit to shadow Dr. D, a patient came in with his mother. Dr. D instantly noticed that the mother didn't seem to be well either and inquired why. It seems the mother has had a rather severe headache for the past week, severe enough to be almost debilitating. So after treating the patient, Dr. D went to lengths to find a number for a neurologist at my med school's hospital. After spending almost half an hour (with some help from one of his nurses), he was able to locate the secretary for a neurologist and helped the mother schedule a visit for that same week.

This instance, that I had so fortuitously observed, demonstrated Dr. D's compassion as a physician. That he was willing to go to lengths at all to help out a patient outside his "jurisdiction" within medicine - this is a hallmark of a great physician. It had me in a momentary awe that after decades of practicing medicine he was still able to let his altruism and compassion guide his actions, rather than becoming jaded and burnt out as reported on so often nowadays in the news.

Perhaps this was part of his secret that has "second generation" parents (formerly kids that he once treated as patients) bring their own kids to see him. He even has some "third generation" families, where he used to treat not only the parents, but the grandparents as well. o_O

Happy holidays everyone and have a happy New Year! :-)

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* Note: For the purpose of this post, when I say "patients" it almost always means the parents of the patients, by the very nature of a pediatric population.