You just paged me and, I must admit, I’m not feeling excited to call back. I estimate that I probably get paged, called, texted or stopped in person by you exactly X·102 per day, where “X” is the number of days I’ve been on service. Despite all of the interactions over the years, I have never stopped to really consider our relationship. Here are a few of our most memorable moments:
You once paged me while I was driving home from clinic. I had just finished a hellish day filled with overbooked patients, prior authorization requests and last minute walk-ins. I was relieved just to make it to the end without pulling my hair out (and I’m bald). I finished seeing my last patient, who I diagnosed with pneumonia and prescribed a fluoroquinolone. You called to ask me if I wanted to change the patient’s multivitamin from the morning to the evening; since, (“as you know”) taking supplements that include divalent cations with fluoroquinolones render the antibiotic ineffective.
“Of course!” I said, “Thank you for ‘reminding’ me.”
Meanwhile, I took a moment to file that away, because — as a so-called infectious disease specialist — that’s probably something I should already know. I’ve learned many helpful tips like this from you over the years.
You once paged me while I was working in the ICU. I was admitting a patient to the unit in wide open septic shock and multi-organ failure. In fact, I had just finished intubating, placing two central lines, placing an arterial line and writing dialysis orders — all in just 1.5 hours! I was fist-bumping the nurses and feeling on top of the world; and, just as my head was expanding with the rare moment to stroke my ego, I received your page. You reminded me that, despite being the day’s procedure king/line master, this awesomeness didn’t prevent me from ordering the wrong diluent for the vasopressin. You asked if I could “kindly” reorder it so that the patient could — you know, while I’m celebrating — actually have a blood pressure that was compatible with life? During our history, you’ve been able to refocus my energy and avert errors multiple times.
You were once rounding with me and my team. You politely demurred when I incorrectly stated that (*insert gobbledygook*)-umab was a new monoclonal antibody that inhibits the RAOP (random and obscure protein) pathway to do something I don’t quite understand but am told is good for MGUS. You waited until I had finished stumbling through my rather weak teaching point to correct the record. By the end, I could only muster, “At least I got the monoclonal antibody part right.”
Though I remember busting my tail in medical school pharmacology, it seems that most of what I learned is now either outdated or irrelevant (I’m still waiting for the day I get to use methyldopa in a pregnant patient). To be honest, I can’t keep up with the new drugs as well as I would like to—especially the monoclonal antibodies, which seem to be multiplying like mogwais caught in a rainstorm. Since I began my training, you’ve helped keep me keep up to date when I fall behind.
To all of my pharmacy colleagues: It’s important for me to acknowledge the critical role you play in the care of my patients. Integrating pharmacists into patient care teams leads to better patient outcomes for diabetes, congestive heart failure, urgent care and hospitalization, inpatient length of stay and a host of other conditions and metrics. Many of these studies also show that the benefits come while decreasing healthcare costs. Despite clear evidence that they contribute to improved outcomes, a survey of pharmacists shows that a majority report job-related stress, due to role ambiguity and conflict with providers. After speaking to several pharmacists, I learned that they are often left feeling like an annoyance to doctors and nurses as a result of their interactions with us. So despite knowing how important their job is, many feel underappreciated.
So while the pharmacist is rounding on their special rolling table labeled “for pharmacist only,” their laptop loaded with software I’ve never seen, head down and toiling away, it’s important to recognize that they directly contribute to saving lives, improving outcomes and make it all more affordable. It is far better for us, and most importantly for our patients, to have them around making up for our shortcomings and pushing us to deliver the highest quality patient care.
So I will make a promise: the next time I hear, “Pharmacy on line 3,” instead of using my rehearsed “What is it NOW” voice delivered with a perfectly flat affect, I’ll listen courteously, assure you that I will check a QTc before giving that dose of Haldol, and thank you for the good work that you do.
Taison Bell is an internal medicine physician.
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