Memorization, the Power of Mnemonics

Now that I have committed to the large mental task of taking on the BCPS exam, I'm finding memorization for the sake of memorization to be lacking. Rather than waste the moments I have studying repeating over and over what organisms doxycycline covers, I've started creating this microorganism world mentally that will connect all aspects through the use of mnemonics. Another technique I've debated is the use of songs. But creating songs still requires more memory time. Oh, and a different part of the brain.

Three things: association, memorization, and location. So, for example let's say that we want to memorize community acquired pneumonia (cap). I imagine a room full I healthy men wearing caps and their choices are a macrolide or doxycycline. To memorize the macrolide I imagine them with macro lenses (macrolide) and they are shooting pictures of dachshunds on cycles (doxycycline). They have no other illnesses going on, and the treatment is at least five days.

See the technique? Men wearing caps, no other underlying illnesses to interfere with shooting macro images of dachshunds on cycles.

You may never forget it! Or at least I hope I don't come October.

Google mind maps to gain more information about these techniques!

The Top 10 iPad Apps for Pharmacists

Want to know the top 10 apps I use in pharmacy practice?

1. MedCalc Pro - is a medical calculator that gives you easy access to complicated medical formulas, scores, scales and classifications.MedCalc has been available on mobile platforms for more than a decade, so it leverages years of experience in bringing medical equations to physicians in an easy to use, yet very powerful format. The Pro version offers premium features such as native iPad support, a patient database to store results and many ways to export results (email, airprint, copy to clipboard). If you're on a tight budget, you can always check out the cheaper but still amazing MedCalc.

2. Sanford Guide - The Sanford Guide is the essential resource for healthcare professionals who care for patients with infectious diseases. The Sanford Guide to Antimicrobial Therapy 2011 application provides fast, convenient access to critical information on treatment of infectious diseases, for timely, effective decisions at the point of care. Always a pocket guide, still a pocket guide. Portability has been a hallmark of The Sanford Guide for over 40 years. The Sanford Guide to Antimicrobial Therapy 2011 application extends that portability to iOS4 devices: iPhone, iPod Touch and iPad. The most trusted infectious diseases treatment resource in print now presents the same comprehensive, treatment- focused coverage of infectious diseases and clinical conditions, anti-infective drug information, therapeutic adjuncts and comparative spectra of activity in a clean, uncluttered, device-optimized interface. Based on the Sanford Guide Web Edition, the application features expanded coverage of topics compared to the print edition.

3. Medscape - The #1 free medical app in iTunes containing drug reference, daily medical news, CME/CE, drug interaction checker, disease and condition reference, procedure and protocols, and other special features. A must!

4. MedPage - MedPage Today is the only service for physicians that provides a clinical perspective on the breaking medical news that their patients are reading. Co-developed by MedPage Today and The University of Pennsylvania School of Medicine, Office of Continuing Medical Education, each article alerts clinicians to breaking medical news, with summaries and actionable information enabling them to better understand the implications.

5. WebMD - WebMD helps you with your decision-making and health improvement efforts by providing mobile access 24/7 to mobile-optimized health information and decision-support tools including WebMD’s Symptom Checker, Drugs & Treatments, First Aid Information and Local Health Listings. WebMD also gives you access to first aid information without having to be connected wirelessly – critical if you don’t have Internet access in the time of need. Personalize your app by saving drugs, conditions and articles relevant to you — through secure access and easy sign-in.

6. Epocrates - Get quick access to reliable drug, disease, and diagnostic information at the point of care. Epocrates is the #1 mobile drug reference among U.S. physicians. Trusted for accurate content and innovative offerings, 50% of U.S. physicians rely on Epocrates to help improve patient safety and increase practice efficiency.

7. Lexicomp - Committed to improving medication safety with innovative products and technology designed for healthcare professionals, Lexicomp offers a variety of drug information and medical applications for iPhone, iPad and iPod touch. These applications are tailored to meet the point-of-care needs of pharmacists, physicians, nurses, nurse practitioners and dentists by storing content directly on the mobile device. Access to Lexicomp's up-to-date drug information and clinical content is a must for the busy healthcare professional who desires the necessary tools to make important medication and clinical decisions from the palm of their hand! Download your Lexicomp mobile drug information application on the app store.

8. Redi-Reader – the reader I use to read articles, studies, etc…

9. Pharmacy Times – Keeping up with pharmacy news. I choose this app.

10. PACID - Last, but certainly not least, ID Compendium, A Persiflager's Guide by Mark Crislip, MD and programming by Walter Crittenden, PharmD (shout out to the PharmD!). This app is sweet for infectious disease!

p.s. I saved the best for last ;)

Pharmacy and Your Niche

What led you to choose pharmacy as a career? For me, it was a mention of "oh by the way, I am not only a chemistry advisor, I am a pre-pharmacy advisor" by a brilliant analytic chemistry professor, Dr. Anthony Harmon. I was just 21 years old, and I did not know what I wanted to be when I grew up. He pointed me toward pharmacy. I envied the quiet genius a lot of the serious chemistry majors seemed to possess. I was a more outgoing having fun type. Dr. Harmon told me a career in a chemistry lab may not mesh well with my personality. Well, let's be real... I wasn't an A student in his quantitative analysis class either. Pharmacy was suddenly on my radar.

I took the PCAT. Who knows what I made. My undergrad GPA was 3.2. Being female used to be a minority, but not in pharmacy in 1993. In fact at the time, being male was the minority. I was finishing my third year of undergrad and decided I'd apply to a handful of universities.

I had a couple of acceptances but really wanted the University of Tennessee at Memphis. I was told on the phone I was 99.9% in, so go ahead and respond decline to the private universities who accepted you. I turned down the schools and then received a rejection letter from UT. Guess i was that 0.1% eluded by the assistant dean. Talk about a downer. A lot of students do go the political route and a lot of acceptances are based on who you know, but I didn't until the rejection.

I reached out to some "who you know" types with my story and got accepted for the next year. So... I spent my fourth year in undergrad finishing a degree and biding my time. At least I did not have to reapply.

So there you have it. I remember thinking the pharmacist who worked in my small hometown had a large house. I didn't realize it wasn't pharmacy more than the sheer fact he had his own business. This is key.

Thirteen years later I realize you can make a good living in pharmacy or a great one in finding your niche within.

Have you found your niche?

Management 101

Why is it more important for pharmacy schools to teach pharmacotherapy and kinetics but avoid teaching management? While it is important to understand how a reaction between Bactrim and warfarin will change previous outcome, isn't it equally important that a pharmacist manager knows how to manage? I spent hours memorizing classes of drugs but never once learned the rules of being an employee or a manager. I thought I'd go over those now... 1. A good manager communicates well. He not only communicates thoroughly and succintely in email, he will pick up the phone to schedule the more serious things. Emails and text messages should only be used for short messages. Anything serious in nature should require a phone call.

2. A good manager will not under any circumstances make promises that can't be delivered. Not only does this build distrust, it also gives an employee something to bitch about.

3. A good manager would never ask an employee to write up or monitor their peer. Again, mistrust.

4. A good manager thinks about how decisions affect their employees. If the employee is going to be deeply affected, a personal touch with explanation is probably the way to go.

5. A good manager doesn't keep the riff raff around to use for all the crap jobs.

6. A good manager isn't a manager obsessed with punitive action.

7. Remember positive feedback is more important than you think!

These are just a few of the tips I'd highly recommend a pharmacist manager begin with learning. Be fair, trustworthy, and logical. Care about your employees. Call them rather than blasting off an instant message or email. Don't accuse them for lack of communicating when all of your communications are short sentence fragments via email.

Walk the walk.... don't just talk the talk!

Integrity is Lost in Wakefield

Hypothesis testing and the outcome, all part of the scientific process, shows integrity whether positive OR negative. In the Wakefield study, he focused his attention on 12 children who had been referred to for GI problems. Dr. Wakefield had already been toying with the idea of a connection between bowel problems and the MMR vaccine. At the same time Dr. Wakefield was paid to find out if children who had already had the MMR vaccine and a corresponding decline had a case. Some of these children were in both studies. That in itself is called "conflict of interest." Dr. Wakefield did admit that more research was needed but that he insisted on the MMR being administered individually rather than the 3-in-1 jab. Today, this study has been retracted as an elaborate fraud with Dr. Wakefield vehemently denying such an accusation. The British medical journal BMJ, which published the results of its investigation, concluded Dr. Andrew Wakefield misrepresented or altered the medical histories of all 12 of the patients whose cases formed the basis of the 1998 study - and that there was "no doubt" Wakefield was responsible. The journalist who wrote the BMJ articles said Thursday he believes Wakefield should face criminal charges.

Is this an example of a doctor who wanted recognition and to be the pariah in the medical community for autism OR is this an example of Big Pharma winning out and going on a witch hunt?

Because of this article, I have personally witnessed the attitude toward vaccinations shift from lifesaving to poison even so far as one parent telling me that she would not vaccinate her three children because it was wrong and if I did the same I was a bad parent. Tell that to the parents of the infants, babies, and children who have died since 1998 when Dr. Wakefield's study appeared.

In the prevaccination era, pertussis (ie, whooping cough) was a leading cause of infant death. The number of cases reported had decreased by more than 99% from the 1930s to the 1980s. However, because of many local outbreaks, the number cases reported in the United States increased by more than 2300% between 1976 and 2005, when the recent peak of 25,616 cases were reported.¹ The disease is still a significant cause of morbidity and mortality in infants younger than 2 years. Pertussis should be included in the differential diagnosis of protracted cough with cyanosis or vomiting, persistent rhinorrhea, and marked lymphocytosis. (link)

In the prevaccination era, pertussis caused more than 270,000 cases and nearly 10,000 deaths annually. This rate reached a low of 4 reported deaths in the United States in 1982 and has recently risen to an average of about 25 deaths annually, with 39 being reported in 2005.

It's not so much that if you don't vaccinate your child that your child will die. It's that you are now taking advantage of herd immunity. You are taking advantage of a scenerio where most follow the rules and thus pertussis was on the decline. You are saying, "I don't have to vaccinate my child because pertussis isn't here." It is here. You are helping to carry it along. I am grateful for the recent push to booster dTaP in the adult community.

MMR was the focus of the study, though. I did cringe as both my children received the MMR and watched them like a hawk for the next six months wondering if "the light bulb would turn off suddenly." It did not. I do feel relieved that I don't have to worry about mumps. Mumps is back, folks. Ask those who are deaf now how THEY feel about those parents that will not vaccinate their children.

Read this post from back in May. Exactly. I couldn't have written it any better.

Please, for the love of God, stop putting our children at risk. Vaccinate your children. I truly believe that those that don't are negligent.