I had a doctor a year or two ago ask for my input (off the record) on a patient that she was struggling with. Coumadin and INR management was the issue. I think I recall the term “roller coaster” when the doc described the case to me. So we sat and chatted for a few minutes, and put our brains together as to what could cause this gentleman’s INR to be all over the place. Diet changes, adherence, new medications, discontinued medications, over-the-counter use, disease state changes, different generics being dispensed, etc. Even the possibility of a medication error was considered. None of this made any sense to the doctor as she felt the patient had always been very trustworthy. She had also asked him all those questions several times. I had asked if they were a candidate for one of the newer anticoagulants, but the doctor did not feel they were. I was perplexed like she was on what to do with this patient. Where am I going with this?
I tell you this story, because there’s been a lot of chatter going on about the value of board certification for pharmacists. There’s all sorts of specialties now – oncology, pediatrics, pharmacotherapy, geriatrics, and on and on… I’ve worked clinically for about 5 years since I graduated in 2009 and have worked closely with a lot of really good people, many of whom have worked 10+ years in the field as clinical pharmacists. Would I rather have board certification or the experiences I’ve had? The experience certainly trumps the certification. However, I tell you the above story because in the effort of preparing for the BCPS exam, I learned (or relearned) that patients with variable INR’s can be sometimes be prescribed supplemental vitamin K to help with difficult management. http://www.ncbi.nlm.nih.gov/pubmed/18695375 This bit of information would’ve been nice to remember when discussing this case to give the patient and doctor one more option.
The benefit of certification is not the letters or passing the test, the gold is found from the acquisition of information through time invested in preparing for the exam, which ultimately will help you do your job of helping patients better.
Last year when I was doing my internship at the University of Arizona Medical Center we had a patient who was on 10 mg Coumadin yet his INR was still 1.1. Interesting case, I don’t remember the outcome but I have it my notes. Maybe I should follow your example and post something about those cases we encountered as well.
You’re welcome to guest post as well if you’ve got a good case to share with an education point – I’m certainly willing to proof/edit as well…let me know!
I will put it together and send it to you. Thanks for the opportunity!
Lookin forward to a good case/piece of meducation!
I will try to do my best. Thanks! Expect it soon.
This brings up the really good point about credentials and in my present time, residencies. School keeps pushing people to apply for residencies telling them how valuable they will be for their career but ultimately does it matter how you got the experience if you can do your job efficiently and with confidence in your own abilities? Something to think about.
I would say if you’d like to get to a more clinical position more quickly in your career, networking residency and certification is probably the most successful path for younger pharmacists. If you enjoy retail and are excited about that opportunity, a residency might not make as much sense.
Credentialing may be important in terms of picking up golden nuggets of information not obtained through practice, but with enough exposure to a new discipline these snippets of information you could pick up anyway, although it could take longer than going through the formal route of certification would probably yield quicker results.
Residency is nice and all, but the number of students interested vs the number of residencies doesn’t match up. I think excluding people from clinical positions because they didn’t match with a residency is pretty ridiculous. And a lot of these nuggets that you supposedly only learn from residency or board certification has filtered down to the school curricula. We learned the Vitamin K tidbit almost on day one. I’m not saying board cert isn’t worth it and I’m certainly going to work towards one, but there’s an awful lot of looking down on people who are only “retail” pharmacists or merely “staff” pharmacists at hospitals.