bad thinking?

[Asterix]

it is varied.

[Pharmanaut]

I am wanting to do my pre-reg in a hospital as I feel it gives a good clinical background and it is varied. Also, I am not a fan of retail as much. However as soon as I finish my pre-reg, I want to move out into retail due to the money difference, I think either lo-cumming or taking up a permanent position would be something I would look for in a shop.

Is this is a bad idea, making the step out straightaway?

My advice FWIW : go for the hospital pre-reg and job.
Conversion from hospital to retail at a later date is much less traumatic than retail to hospital.

At beginning of career ended up in retail because no hospital pre-reg available.
Could not get into hospital post-registration so stayed in retail. It took years to get over the frustation.

[bleepholder]

Conversion from hospital to retail at a later date is much less traumatic than retail to hospital.

very true! and money isn't everything..nothing stopping you from staying in hospital, and further build up your clinical knowledge and doing locuming on the side..for the extra ££££

plus after being in community for about a year you would have "lost" your knowledge gained from the hospital

[Pharmanaut]

very true! and money isn't everything..nothing stopping you from staying in hospital, and further build up your clinical knowledge and doing locuming on the side..for the extra ££££

plus after being in community for about a year you would have "lost" your knowledge gained from the hospital

Has the OP done any vacational work in a hospital environment?
I managed to get 6 weeks between second and final year (3 year course).
That experience put me streets ahead of fellow students who had done community during summer vacation.
Hands on experience of sterile, aseptic, small-scale manufacture, QA.
Much better than merchandising end gondolas for a chain beginning with B.

[shan]

you would have "lost" your knowledge gained from the hospital

I sometimes feel like laughing loudly when this topic comes up that Being in hospital builds up your knowledge more than when in Community. Isn't it funny that the society has a single registration examination for both the categories and expects all the pharmacists to be of similar knowledge level, yet we always say hospital pharmacists have more knowledge than community pharmacists. In my opinion, the knowledge possessed by each individual generally matches to the role he is playing. In hospital you have all the time and resources including the complete patient history along with the notes from the consultants, you have set guidance/ local formulary to guide you whether to prescribe certain drugs or not. In this scenario you would expect that the hospital pharmacist has more clinical knowledge to perform his/ her duties. In community, you have very impatient patient who thinks all we do is pick things from the shelf, put a label and hand it back. Even when you do get a chance to discuss a particular problem or during an MUR, you only have 5 - 10 minutes to finish the converstation and give a right solution that is in the favor of the patient. In this time all you get to look at is a poor old BNF, no medical records, no laboratory records, no consultant's notes, etc. etc. And in most of the cases the community pharmacist ends up in correcting a mistake done by either the hospital or a consultant.

Now tell me, who has the real knowledge ?? and what is the use of clinical knowledge if that can not be used for patient care. And anyway what are you going to do with all that extra knowledge if you can't use it. In that case I would say the univarsity lecturers are the most knowledgeable as they have almost complete knowledge about the drugs they teach.

Also, you don't need to be in a hospital set up to learn or improve your clinical knowledge. All you need is spend some quality time analysing the scripts you dispense and read different topics that are currently being highlighted in different journals. It is unfortunately a misnomer that community pharmacists don't have enough clinical knowledge just because they don't get exposure to real inpatient situations ) Let me tell you that most of the hospital pharmacists struggle to answer questions about any drug other than they specialise or deal with on a regular basis (particular ward/ branch of hospital they are responsible for) yet they act as if they are god.

I have completed 5 CPPE modules on different chapters as a pre-reg and got my MUR accreditation done. Show me one hospital pharmacist/ pre-reg who has seriously considered even attempting one of the modules. In my opinion, knowledge levels are better judged based on their need and utilisation than just possession.

Shan

[Asterix]

as you said, the fact there is no time to talk to patients, no time to do an mur, no time for a smoking cessation, in all these instances how can you build up your patient skills. Well done on doing your modules but what's the use when you can't use them in a retail environment where business is all that matters. This for me is why you can build up knowledge in a hospital...


uni lecturers are not really the most knowledgeable, at the end of the day many of them copy pages out from a book and stick it onto a powerpoint.

[shan]

as you said, the fact there is no time to talk to patients, no time to do an mur, no time for a smoking cessation, in all these instances how can you build up your patient skills. Well done on doing your modules but what's the use when you can't use them in a retail environment where business is all that matters. This for me is why you can build up knowledge in a hospital...


uni lecturers are not really the most knowledgeable, at the end of the day many of them copy pages out from a book and stick it onto a powerpoint.

Either you misread or misintrepeted my post. What I want to say is, having knowledge is one thing and the ability to use the knowledge to its full potential is another thing. I never said we don't have time to do these things, all I said was within the shortest available time we are able to use even the scarse resources and the practical knowledge, in order to advice the patient properly and almost always accurately !!! And unless you don't have basic knowledge how can you build up knowledge ??

And for your information, business does not grow by only handing out medicines. Patients always prefer a pharmacy where they know that, the pharmacist has good knowledge to handle any of their queries. You need to have more clinical knowledge in the hospital because you are exposed to situations that are more clinically oriented based on in patient settings where all the relevant biochemical reports and medical expertise are available to you. Whereas in community you need a fairly good clinical knowledge with more of drug related knowledge like interactions/ side effects and to a certain extent an ability to suggest an alternative. Also in community the must and most powerful skill you need is how to communicate effective with the patient. Unlike in Hospital where maximum number of patients you may see are possibly 20 - 30. And most of the time you take decision based on the patient record than actually talking to the patient. In community you speak to a minimum of 50 to 100 and (sometimes even 300 - 400 patients, like what we did during christmas) these are patients real and walking on their feet taking every opportunity to ask a question to the pharmacist (leaving those constantly ringing phone customers) So it is not true that community pharmacists don't have good knowledge. Its only that hospital pharmacist talk more in line with the guidance they are following and we talking about how best a treatment can be tailored to meet patient requirement. In hospital first thing, before prescribing any drug, that comes to your mind is whether it is allowed in the local formulary and not whether the patients needs it. Anyway as I said earlier, in my opinion both community and hospital pharmacists are more or less on the same platform in terms of knowledge with difference of need and utilisation of the knowledge they have.

Coming to the modules I have done, how do you know whether I would use them or not ???? You don't even know what modules I have done ?? For your knowledge let me share with you certains modules I have done, then you decide whether I will be using them or not.
1. Minor ailments.
2. NHS repeat dispensing.
3. Diabetes -- Evidence based management.
4. MUR skills.
5. EHC.
6. Travel health.
7. Substance misuse.
8. Smoking cessation.

There are more I am planning to undertake whenever I get time, hopefully after passing the exam. You can not generalise that people don't use their knowledge in community because of some people you might have come across who don't.

Shan

p.s: the time it took me to post this one, I could have studied one more module ;-)

[SolomonQ]

"as you said, the fact there is no time to talk to patients, no time to do an mur, no time for a smoking cessation"

What my respected friend is forgetting is that in retail you are in TOTAL control of what you do unlike in hospital where you are bossed around by doctors and nurses.

So if you want to do an MUR, you'd have to give longer waiting times, same with any other service.

As with targets, area manager etc.... what people forget is that their roles are advisory roles, they say this is your MUR target, the pharmacists duty is due to commercial nature of the job to try to reach this target IF FEASABLE, no one can turn around and sack you or dicipline you if you don't meet this target. It is the area managers job to set targets, if they are decent human beings, as long as they see you making an effort and giving your best they will be happy with what you are doing.

But In hospital, if person x tells you to do something i.e. ward rounds, paperwork, ttos etc..., this isn't a request, it's an order and you will get in trouble if you don't do them.

Another thing people forget is that there are targets in hospital just like there are in retail but unlike in retail, the pharmacists aren't important enough to be included in helping to reach these targets in the majority of cases. Although one example that may apply to pharmacists in hospital is drug spending. I don't have any rock solid facts but I know that patient health suffers due to hospitals trying to save the most they can on drug costs. e.g. Many times i've known the hospital not to provide a med because its expensive. e.g. I remember a patient coming in once to ask us to give him the one of the medicine (i think Aricept) out of his wives next MDS tray who had been hospitalised. he said the hospital had refused to supply them and asked him to collect them from the pharmacy and bring them back. we abviously took them out of the tray and dispensed them in a bottle, but it boils down to obviously a hospital pharmacist on the other end telling this patient all this, which is quite sad.

Knowledge in retail and hospital: In hospital the pharmacist may appear to know more but what is actually happening is you are observing information regurgitated that was learnt parrot fashion, whereas in retail it's more about understanding i.e. in hospital you get to use the same information again and again even if it is very clinical e.g. doses in renal failure patients. This is especially true if specialising in a certain field. but in retail you might learn something but only get to use it in the near future so understanding is imperative otherwise a patient might ask you a simple question and if you don't know the answer you might end up looking like a pillock. which would lead to losing respect from patients.

In community, a pharmacist has to earn respect by showing these chunks of knowledge and expertise but In hospital patient's don't respect you for being a pharmacist. If you're a man they will most definitely mistake you for a doctor, if a lady the same might apply but most won't be too sure or might think you're some sort of" nurse".

A hospital friend tells me when HE first started as a pharmacist, he used to walk into work in the morning and have nurses and other hospital workers greet him with "Morning Doctor", sound familiar guys? During my placement I'm sure many people confused me with being atleast a trainee doctor. A senior looking doctor even asked me one time in a very friendly way what I was (i.e. asking at what level of doctor training), when I told him xyz pharmacist, he changed his tone, said "ohhh ok", turned around and got on with what he was doing. Unless you're a doctor, you're no one in hospital. Nurses only have say because of their sheer numbers and because of the support they provide junior doctors.

What position do pharmacists hold in hospital despite their clinical knowledge? Imagine having to tell people all the time that you're "not a doctor, ONLY a pharmacist"!!!

[Asterix]

Resident Pharmacy...wots it all about?

Look at the 1st post by solomon in that thread, where he himself says you need a 10000 more brain cells to work in hospital.

shan you say we see a lot of patients in hospital but do we really, all I ever see is the pharmacist checking and then the meds put into a bag and then handed out to a patient. No counselling and is this not due to time constraints?

You have said you did diabetes module but when will you ever be able to put that to use in a busy retail outlet? you worked in boots before, are you telling me that store was quiet enough to enable counselling and murs?


as for drug interactions etc, most of the techs and support staff are too lazy to even mark whether the drug is new for the patient so how can you possibly check for interactions?

[shan]

Resident Pharmacy...wots it all about?

Look at the 1st post by solomon in that thread, where he himself says you need a 10000 more brain cells to work in hospital.

shan you say we see a lot of patients in hospital but do we really, all I ever see is the pharmacist checking and then the meds put into a bag and then handed out to a patient. No counselling and is this not due to time constraints?

You have said you did diabetes module but when will you ever be able to put that to use in a busy retail outlet? you worked in boots before, are you telling me that store was quiet enough to enable counselling and murs?


as for drug interactions etc, most of the techs and support staff are too lazy to even mark whether the drug is new for the patient so how can you possibly check for interactions?

Resident Pharmacy...wots it all about? shan you say we see a lot of patients in hospital but do we really, all I ever see is the pharmacist checking and then the meds put into a bag and then handed out to a patient. No counselling and is this not due to time constraints?

Nick either you are misguided about the whole work style in community or you have been overinfluenced by those Pharmacists who always moan abut loads of work and no time to do things. I never said "patients in hospital" I was reffering to a busy community set up, where despite being so busy if you are skilled and determined then you can still do all the activities as mentioned by me earlier. If you are considering to be one of those pharmacists who just bags and hands over the meds then you will end up retiring at the same level of knowledge as you started.

Resident Pharmacy...wots it all about? You have said you did diabetes module but when will you ever be able to put that to use in a busy retail outlet? you worked in boots before, are you telling me that store was quiet enough to enable counselling and murs?

The question is not only with Diabetes it applies to wide range of disease conditions. By undertaking the module I have understood and learnt how the diabetes can be managed based on the latest evidences. You dont need to use the knowledge on every patient with diabetes who walks in to your pharmacy just because you have knowledge, but this would definitely help me to councel those patients where I come across any unusual prescribing/ inappropriate use of newer meds. I don't know about people who keep locuming in different pharmacies over the week without any established stability in a single shop, but where I work I have good contacts with all the GPs around the area and they do take seriously whatever we suggest based on evidences we give. So I would still continue to focus on prescription interventions and keep reccommending/ suggesting changes where appropriate. My policy is learn whatever you can and relevent to your field. One day or the other it will come to your help.

Resident Pharmacy...wots it all about?as for drug interactions etc, most of the techs and support staff are too lazy to even mark whether the drug is new for the patient so how can you possibly check for interactions?

You can choose to simply rely on the techs/ dispensers and end up either being struck off or if lucky then retire as I mentioned above. My friend, you are a pharmacist ( 4 years of degree study + 1 year pre-reg + gruelling exam) and your job is to identify any unusual things about drugs and inform/ advice patient accordingly. You have different computer systems giving different interaction levels, which you cannot trust solely on. It is a common sense that if you come across a drug where you suspect serious interactions then you will go back to the patient's PMR to check if had/ has any other meds that interact. Again, a good pharmacist will do all these and will never complain of time shortage for not doing so. Otherwise, you can still just bag amd give out the meds and hope the patient if fine and will never complain against you for any adverse event.

Shan