I am seriously sick and tired of listening to Mr Pharmacology . Over the last few weeks, he is crowed in every single journal and paper I have seen. I had to write something today because he and his GMC cronies are annoying me now. The GMC and the Royal Pharmacology Society have now continued to attack junior doctors with a vengeance. Of course, its an easy target. Both bodies couldn't organise a piss up in a brewery themselves and here they are criticising junior doctors. Isn't life difficult enough for them?
And whose fault is it that the training is so crap - yes, the medical top dogs. Whose fault is it that they lack supervision - yes, the medical top dogs? And when will these top dogs be held to account? Never!
By the way, the Royal Pharmacological Society and a Consultant Cardiologist felt that 10mg of Haloperidol IV PRN for an cardiac patient was an " appropriate" dose. Mr Pharmacology can ask me for the evidence and I can give him the drug chart, the decision by the Royal Pharmacological Society. As Dr India will tell the world, this is not the appropriate dose for a frail old person who is acutely breathless.
In my view, imperfect, faulty, inefficient organizations shouldn't spend time criticizing junior doctors whose lives have been made extremely difficult so far. They should spend time implementing systems to prevent drug errors. They should spend time educating senior doctors on how to teach their juniors.
In any case, did anyone forget that the Pharmacist checks every prescription chart and in the end the buck stops with the consultant if the prescription is wrong. Of course, everyone forgets that - its just a convenient way to blame the junior doctor again. So whats new in the world?!
How about we do some research to find out how crap the GMC and the Royal Pharmaceutical Society are?!
NB - To All Junior Doctors.
The best way to learn pharmacology is to read Lecture Notes in Pharmacology [cause you have to know how they work]. If you are someone like me, you end up reading Pharmacology at a Glance which is just as good [see link below]. These books can be read on the bus or tube.
You should then ensure you read the BNF. I read the entire BNF by the time I was in the 5th year then first year PRHO [F1]. In fact I must have swallowed it while oncall. After that, you should be superb at prescribing :). I would limit yourself to small books so that you can memorise the important features. Medical school teaches you a load of crap that you don't even need in the real world. You need to swallow small books off pat because you need to be fast, have the knowledge at your finger tips and you need to be accurate. There is no room for mistakes when you are in the fast lane. That is an important aspect of practical medicine to grasp.
The trick of fast and accurate prescribing is never mastered by true swots. It is mastered by those who know their stuff because they read books where the maximum intake is achieved in the minimum time.
Orientate yourself around each drug chart when you start at any particular hospital. If in doubt, ring your senior or the pharmacist oncall. For psychiatry, the Maudsley Prescribing Guidelines are the best. I have listed them all below so you know which ones to get. BNF can be joined online for free and its worth doing this.
You then have to pay some attention to people. Elderly people may require dosset boxes. Some patients cope better with liquid formulation. It is important to prescribe then discuss the prescription with the patient, explain what you are doing and then discuss with nurses in charge. This ensures you have checked your prescription, it ensures patient compliance and minimal miscommunication. Patient compliance is best achieved if you work with the patient and they understand what you are doing. It may help them for you to write the name of the drugs down. You must always explain the side effects. This means the side effects have to be memorised and you can only do that by reading the BNF back to back until its covers are falling off. I think I have read it about 6 times back to back in total and thankgod I never did Oncology!
The above advice is given following my teaching sessions with medical students. Just for the record, all my medical students passed their exams with 80 percent or above. It is true that during my clinics, each medical student learned pretty fast especially about patient communication and achieving your best management plan. I hope they have grown up to be good human beings as well as good doctors. That is because, there is a way to think about patient management and sinking into large textbooks isn't the right way :).
By the way, the Royal Pharmacological Society and a Consultant Cardiologist felt that 10mg of Haloperidol IV PRN for an cardiac patient was an " appropriate" dose. Mr Pharmacology can ask me for the evidence and I can give him the drug chart, the decision by the Royal Pharmacological Society. As Dr India will tell the world, this is not the appropriate dose for a frail old person who is acutely breathless.
In my view, imperfect, faulty, inefficient organizations shouldn't spend time criticizing junior doctors whose lives have been made extremely difficult so far. They should spend time implementing systems to prevent drug errors. They should spend time educating senior doctors on how to teach their juniors.
In any case, did anyone forget that the Pharmacist checks every prescription chart and in the end the buck stops with the consultant if the prescription is wrong. Of course, everyone forgets that - its just a convenient way to blame the junior doctor again. So whats new in the world?!
How about we do some research to find out how crap the GMC and the Royal Pharmaceutical Society are?!
NB - To All Junior Doctors.
The best way to learn pharmacology is to read Lecture Notes in Pharmacology [cause you have to know how they work]. If you are someone like me, you end up reading Pharmacology at a Glance which is just as good [see link below]. These books can be read on the bus or tube.
You should then ensure you read the BNF. I read the entire BNF by the time I was in the 5th year then first year PRHO [F1]. In fact I must have swallowed it while oncall. After that, you should be superb at prescribing :). I would limit yourself to small books so that you can memorise the important features. Medical school teaches you a load of crap that you don't even need in the real world. You need to swallow small books off pat because you need to be fast, have the knowledge at your finger tips and you need to be accurate. There is no room for mistakes when you are in the fast lane. That is an important aspect of practical medicine to grasp.
The trick of fast and accurate prescribing is never mastered by true swots. It is mastered by those who know their stuff because they read books where the maximum intake is achieved in the minimum time.
Orientate yourself around each drug chart when you start at any particular hospital. If in doubt, ring your senior or the pharmacist oncall. For psychiatry, the Maudsley Prescribing Guidelines are the best. I have listed them all below so you know which ones to get. BNF can be joined online for free and its worth doing this.
You then have to pay some attention to people. Elderly people may require dosset boxes. Some patients cope better with liquid formulation. It is important to prescribe then discuss the prescription with the patient, explain what you are doing and then discuss with nurses in charge. This ensures you have checked your prescription, it ensures patient compliance and minimal miscommunication. Patient compliance is best achieved if you work with the patient and they understand what you are doing. It may help them for you to write the name of the drugs down. You must always explain the side effects. This means the side effects have to be memorised and you can only do that by reading the BNF back to back until its covers are falling off. I think I have read it about 6 times back to back in total and thankgod I never did Oncology!
The above advice is given following my teaching sessions with medical students. Just for the record, all my medical students passed their exams with 80 percent or above. It is true that during my clinics, each medical student learned pretty fast especially about patient communication and achieving your best management plan. I hope they have grown up to be good human beings as well as good doctors. That is because, there is a way to think about patient management and sinking into large textbooks isn't the right way :).
2 comments:
I'll have you know, my dear, that I'm well known amongst my peers for my prescribing skills..
"Talk to ***, he's good at drug names"
And yes, the BNF is the bible. Peerless. . .If you know how to use it.
Good post Rita
All these people wanting respect but not earning it!
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