midpoint musings

As I'm halfway through my summer, I think it's a logical time to sit down, think about what my goals were and what I've accomplished, and to jot down some small lessons that I've learned along the way these two months. It's been somewhat of an unspectacular summer so far, which is fine by me. I've learned and reviewed a lot, but I know I've also missed out on some things that I should have pursued harder.

In May, I moved back home (presumably for a longer time, as I'm not planning to live on residence for the upcoming year) and tried to set up shop. There were some things I had to adjust to, such as no longer cooking for myself (which is good in that it's much easier, but it also limits your creativity and your ability to control what you eat) and living in the same room as my brother (with identical alarm clocks, but obviously different times when they ring, which is frustrating at times).

I started SPEP in second week at a small Burnaby pharmacy where the clientèle was predominantly Indian people. This made things interesting, as I found it difficult to understand accents or even tell whether people were male or female just from the names. It also made things somewhat frustrating, when patients wanted to speak specifically with the people who've been working there for so long and know them, or because they'd prefer to not speak in English. Oh, and many of them were concerned about prescription costs even if they don't have actual financial limitations, and as this was a small pharmacy lacking in buying power, that contributed more headaches.

What did I learn? I learned a lot about the people side of pharmacy. Not only did I (finally) get the opportunity to counsel patients, but I encountered so many different scenarios and personalities. Some patients were very keen and interested in what I had to say, but only after I proved that I knew what I was talking about. Conversely, other patients were very brief and I had to learn how to ask the right question in order to make sure things were safe and effective; occasionally this led to identifying significant problems that we could address.

I learned about what it takes to own a pharmacy. I saw all the paperwork and all the accounts for patients to help finance their medication. More notably, I also saw the compounding expertise, the use of natural health products, the personalized counselling and importance of connections in the local community, taking advantage of using the same language as your patients, and also some billing "techniques" that they needed to keep their business running. The compounding was really cool; I got to see their special ointment jars and devices, and some of the formulas they used.

I don't really want to talk about SPEP and the rotation side of things. However, as I mentioned, I did get the opportunity to counsel patients, and I think I've managed to start developing my own style when it comes to certain drugs - particularly antidepressants and antibiotics.

I also got somewhat of an attitude check during my SPEP. I had been stressed out with the amount of paperwork I needed to do, but on site, I spent most of my time being a tech, as one of the techs did all the organizing, billing, and compounding and the other one did inventory. In fact, sometimes my preceptor would send me to the back of the pharmacy to type prescriptions up, because we ran out of computers up front. I think I started resenting the tech work and typing, because it wasn't why I was there - I know how to be a technician and I don't get credit for doing that work. However, during my final evaluation, my preceptor mentioned that he/she noticed my reluctance and said that he/she was trying to give me work that a pharmacist would have to do, which includes all this stuff that we don't like doing.

After I've had a month to think about it, it's pretty clear that I erred there, and that I would take back my behaviour if I could. Yes, there was a gap between my expectations, SPEP's expectations, and my pharmacy's expectations of what I should do on rotation. But I should still be professional about it and do the work that needs to be done, because the bottom line is that I'm there to help the patient. So there was some personal maturity that happened (I hope) as well.

Moving on to June, where I spent three weeks at Shoppers Drug Mart at a very large and busy location. The first week was difficult for me; not only was I trying to finish up my PCPs from SPEP, but I was trying to re-learn T-REX and how to integrate myself into the pharmacy. The people I was working with were very diverse in their work styles, personalities, and competencies. I was really happy I was able to integrate myself with (most of) the team and work well with everyone, despite occasional tension. Thankfully, they let me counsel and do OTC consults, and those were very helpful for my learning. My work term was still occasionally frustrating, especially when I made mistakes, when I couldn't find something, or when I didn't know how to do something. However, it was nice when everyone seemed to want me not to leave. Overall they were very nice to me and I’ll miss them, and I wonder if I’ll have the time and opportunity to go back and work for them.

One interesting dimension this work term provided for me was the opportunity to mentor someone. There was a pharmacy technician student as well as a UBC student who was volunteering (interested in applying for UBC Pharmacy), and since everyone else was (mostly) too busy, I took on the role of showing them the ropes. To me, it was a little bit of payback, because I gave them the training that I wish someone had given me. I really enjoyed being in that preceptorship role. It was challenging to do that on top of my own work and I would often have to deal with their mistakes, but at the same time, they did an excellent job most of the time.

There were some other things that happened this summer, but don’t fall neatly into my work- or school-related activities. I met with Eric (twice) and I wonder if I won’t be seeing him for a very long time, as Boston is quite far away. It’s pretty clear that out of all my friends, Eric stands out the most. He has a unique perspective on most topics and has never been afraid to do things “his” way, including challenging me on many of my own thoughts. Over the last few years, we’ve mostly grown separately, in our own fields and support groups, but it is always refreshing to hang out with Eric and I’ll miss him when he does leave.

I also managed to go to the Steveston Farmer’s Market with Rachel, Nicole and Vinci; have a student council (high school) reunion with Crystal, Beatrice, Kevin, and Sarah; meet a Burnett student who remembered me from Awards night; and meet up with Tzu, Danny, Jenny and Julianna when the girls finished their SPEP rotation for June. These friends mean more to me than I think they know, because if I don’t think about them every day, it’s at least every other day. An interesting observation is that we tend to greet each other with hugs but not really during the school year, so maybe we need to remember to value each other just as much when we’re seeing each other every day.

Two more things that I don’t want to forget. One is my surprise “going-away” cake that my sister baked for me the night before I left, with two of her friends. I think it’s been a while since I’ve been celebrated that way (another that comes to mind is Christine’s gift after I posted my class notes) and it was special to me because it was all homemade, and because it was tinged with my own guilt for leaving her (mostly) alone for the summer.

And the last thing is of course Joey’s trip to such exotic lands as Hong Kong, Malaysia, (South Africa) and Swaziland. There were a lot of things that she did (and thus, I was subsequently involved with) in terms of logistically and emotionally preparing for such an exciting trip. Certainly her being away for so long is new for us, and when she starts school again our time together will continue to be limited. I think we’re almost at that stage in our lives now where we’re finally going to live independent lives – not that we need or want to stay apart, but that in terms of our daily lives (without each other) that it’s not really going to include the other. I think our respective trips will teach us a lot about ourselves, and that we will learn to story-tell and enjoy each other’s experiences without having been a part of it.

time to be honest

May 14, 2010 is a momentous day. Not for most people, but it is for all the UBC med school hopefuls. As I have had the privilege of knowing so many bright, motivated, and (most importantly) kind-hearted people at UBC who are striving to be all they can be via a medical education, today is the day when many of my friends get the good news (unfortunately, some getting the bad) - and as I finish my fourth year here, most of the people in my entry year have applied for Sep 2011. So, apart from me first offering my congratulations to everyone who was successful and my encouragement to those who were not ("successful" meaning only in terms of the news. I am sure all med school applicants are capable, talented and motivated people and that sometimes it is luck of the draw among other equally talented people), and apart from having my life affected by having people really close to me enter such a rigorous program for the next 4 years and such a prestigious profession (and apart from me and my run-on sentences): why I am writing is about my own visceral reaction in regards to my chosen career, which is (right now) Pharmacy.

You may have wondered why I am not applying for med school. It's not a question I'm not familiar with. I have given many different responses to different people, and the variety is partly due to the sensitive nature of this topic (if the other person is also planning to apply), due to my preference for humility, due to others' usually inflated opinions of myself, and also due to the fact that I didn't really know myself. But right now, I think it's important that I come clean, at least in this regard. I'm going to try and rationalize why med school is not in my immediate future. I'm also going to try and explain why deep down, I feel some jealousy that is easily limited by confidence in my own abilities and by realism (read this sentence again when you finish the whole entry). And because I've obviously been crippled so far in my ability to explain this, I'm going to have to be explicit and honest, without my usual satire or self-depreciating approach.

Why Med School is an Option:
-Med school would give me the tools that I would need to help people easier. As many of you know, pharmacists are limited (by data availability, by interprofessional barriers, by their business model, by legislation, and by training) in our ability to help patients. On the flip side, the ability of doctors to help their patients seems unlimited by comparison. If you wanted to do anything as a doctor (except perhaps sell drugs), you probably could. Oh, and this is only relevant because indeed, in my career, I do want to be helpful and make a positive impact in people's lives. But it would be nice to be a doctor, and if I had to pick a degree to have, it would be the MD.
-In many ways, I am the perfect applicant. I have good marks, a resume that makes me sound better than I am because it is well-rounded (awards, volunteerism, work, interests). I would probably do well on the MCAT, I would probably do OK on the MMI, and I could probably get into a med school if I dedicated myself to this and applied. (Recall that I've promised not to be self-depreciating here; not trying to be egotistical, just honest.)
-People think I would be a good doctor. It's the easiest question to answer. Versus, justifying why I'm in pharmacy is harder, because the medicine question is always looming and people tend to wonder why you don't shoot for the stars, especially if they are within reach. I think that in several ways I would be a good doctor. I care. What I mean by that is that I would actually want to be a doctor, not for the status, not for the money. I'm perfectly happy with being part of a practice that is only somewhat profitable. I already have a good background in health care and would be able to identify DRPs or other health-related problems reasonably well.
-Med school would teach me things I would want to learn about. The best thing people usually cite about Pharmacy school is the people you meet, and that is no different for me. People I've met are generally very nice, and I consider myself also generally nice, but in a different way than most people (this is a tangent). However, parts of the curriculum have been a disappointment and med school is better funded, allowing for better lecturers / lectures and a more holistic approach (hopefully?) to learning.

Things holding me back:
-A reason I tell a lot of people is that I'm tired of school and want to get into the workforce. This isn't true. I'm not tired of school, but I'm worried I won't do well in med school. I'm sure that whoever's reading this is thinking that that shouldn't be a reason, but I know how I study better than anyone else does. And the way that I study (over my entire schooling) is a mechanism to achieve marks rather than that of lifelong learning. I am one of the best students / learners you will meet, given time. Given time, I can learn and become adept at most things that are either memorization or process-related - a good example is running chromatography columns. I got really good at it over 3 months in the lab. However, I'll admit that this is a minor reason, so we won't consider this one.
-As I've mentioned before, one of the reasons that I've been coy about this topic is that others around me are applying. What I may not have mentioned is that that is a reason too for me not applying. One of the things I don't like to do is to show others up. So if my friends / Joey apply and don't get in, and I do apply and get in, what does that do to our relationship? And it's not just the relationship I'm worried about, it's about the other person's ego, or confidence, or what they're going to do with their lives after they get rejected. They are going to feel less than me, and it would be difficult for me to share any learning or excitement I had in med school. It's easier if I say I'm not interested, and we can encourage each other in our own paths. (this is somewhat of a moot point after today, though.)
-Another reason is that I've told so many people that I'm in pharmacy and not going to med school. That is a reason, even though it shouldn't be. I don't like the idea of going back on what I've been telling people; it's difficult to explain and I will guess that some will think poorly of me for flip-flopping (and perhaps, also lying on the Pharmacy entry interview, etc.).
-Another reason is that I don't think I'll be a good doctor. I started talking about this above. Generally, I'm not really a people-person - not that I don't care, because I probably care too much - but I'm not engaging and I find it hard to communicate sometimes. Language isn't my strong suit. In the pharmacy for example, I find it hard to do little things like remember patients' names, remember their faces, and I'm horrendous on the phone. I have a hard time making out what the other person is saying, if the voice is soft or accented. And I speak oddly - I slur words together, trip over my own tongue. It is frustrating particularly when I have my own stereotype to overcome as well. I know that my strong suit is more of an analytical style of thinking; assessment if you will, and so this is suited for pharmacy-style checking and optimization. It's not a holistic, synthesis style of thinking, which would be needed for diagnosis and care planning. I don't have much life experience either, which makes it difficult on occasion for me to connect with people.
-This train of thought above is what led to my previous post about med school interviews, and basically leads to the idea that I don't deserve to be a doctor. My resume is, to be blunt, inflated. It does reflect the amount of effort I put into my volunteering. I sometimes comment on how some people I know can "waste" so much time, but that's just the way things are for them. For me, I like my life to be efficient, to be productive, and so for me, it's important that I am spending my time at university giving back and volunteering. This leads to others commenting on how smart I must be to do all that I do. I say that people have this wrong, which isn't entirely true; this is just a small piece of it. I care a lot, I am efficient, and in some areas of my studies I have the ability to deduce things that others can't, which explains the smart part. In general, I do all that I do because I want to. The problem that I have is that I'm not actually doing or accomplishing anything. I spend so much time on my volunteering, but the outcomes that I expect are not there. That's frustrating for me, that's disappointing for me, and it doesn't reflect well on how well my marks / resume / potential med school application will correlate with my ability to serve the population as a doctor.
-Another reason is that pharmacy isn't bad. In fact pharmacy is very promising for me. It fits my skill set in many ways. The direction of the profession is changing. My pharmacy education and perhaps residency is interesting to me and I think that if I start keeping the big picture in mind and not so much the marks, I can really learn a lot and help some patients, which is what I've wanted to do all along. It's (usually) a 9-5 job, pays well (which is a consideration when we think about my priorities in life, which is a good family and the career after that, and I still need to figure out my religion and spiritual life), and I see flashes of neat things within this profession that I want to get involved in.


If I have more reasons to add, I'll do so. I'm not going to try to conclude this because I don't think the chapter's finished; the door's open, and obviously not to the exclusion of professions other than med and pharm. If you're planning to comment, please do, but I would encourage you to tell me face to face and not electronically.

NB If this ends up biting me in the butt when I apply for interviews and stuff, so be it; I'm just being honest. So if you are a human resources person stalking me on the Internet before considering hiring me, I hope you consider that I am a caring and analytical person that isn't afraid to criticize myself and to try to improve, and please consider whether my faults I've listed above are any worse than those that other applicants would have hidden or (?worse) not taken the time to understand themselves or be honest with themselves or others.