Bill's Blog

Red Team GO!

Today was the final day of Orientation. The Social Work Manager gave a presentation about what social workers do in terms of the interdisciplinary team, as well as the Chaplains. Then we talked for a while about the meat and potatoes of hospice in terms of insurance covered (i.e. levels of care, what services are covered, etc.). This was particularly interesting because it’s much different from insurance processing that I’m familiar with in the community setting. It seemed to have qualities reminiscent of the MTM services Walgreens provides through Outcomes and Mirixa. I mention this because MTM services, particularly in the community setting (where I’m familiar with it), is very documentation heavy, and each claim seems to be individually reviewed by a human being, instead of some kind of computer program that has predetermined criteria for approval or rejection of each claim. Basically, there is a baseline level of service (i.e. “Routine Care”) that offers a certain level of reimbursement “per diem.” Beyond that, under certain circumstances, and with appropriate documentation, patients can be moved to an alternate level of service (in hospice, there are three others: Continuous Care, Respite Care, and Inpatient Care), each with their own reimbursement scheme. After that, we revisited a story from a previous day of orientation, talking about the patient’s journey from start to finish. We talked about different goals along the way, how to document them, and what barriers might be encountered along the way. It was really helpful to visualize the course of hospice care in a holistic sense, from start to finish.

After that, I attended a team meeting. A little back story, first. So, the hospice does have an inpatient facility with full nursing staff and all that jazz, but the vast majority of patients are being cared for in their homes or in a “skilled nursing facility” (i.e. nursing home). Each team is composed of chaplains, social workers, nurses, a physician, and a host of other support staff, and they are assigned to a group of patients that will be visited by each team member periodically. Each week, they hold a meeting to discuss each patients and their current state of comfort, as well as revise and adjust the current care plan to suit each patient’s needs. This was an excellent experience, though it was hard to keep up, being that I have no background on any of these patients. Additionally, due to my lack of clinical experience, I had a lot of trouble following what was going on and what they were discussing. It was an educational experience, none the less.

Next week, I’ll be rounding in the IPU, where each inpatient has their own room in the hospice facility. These patients are under a specific care level and typically are struggling with symptoms that are difficult and complex to manage on an outpatient or even continuous care basis. I’m still a little unclear on what rounding completely entails, but as I understand it, we’ll visit each patient, assess their current symptoms, and see what changes we can make to their medications in order to facilitate improved comfort. I’m not sure how I’m going to prepare for rounds, but I’ll have all week to figure out what works, and what I need to do better. No, I do not feel like PTX fully prepared me for what I’m about to get myself into. Also, I’ll get my assignment for my final presentation tomorrow. I’m looking forward to the next couple of weeks to see what I can learn, and what I can contribute with my limited experience and purely academic knowledge. Also looking forward to the extended weekend ahead of me!

Hospice and Palliative Care

So, this first rotation seems a little bit unorthodox, in that I’m still going through orientation, but today’s topics of discussion were pretty interesting.

End-Stage Disease Processes - In this section, we talked about the sort of things that happen, on a physiologic basis, to patients when they are experiencing end-stage disease. Mostly, it was a review of the epidemiology and prognosis data of the different varieties of cancer, end-stage heart disease, and pulmonary disease. Additionally, we talked about the different symptoms and complications associated with these disease processes, particularly with respect to hospice care.

Pain Management - In this section, we talked about the different classifications for pain, assessment techniques and tools, as well as the pharmacological management of pain. This was basically a brief review of the first portion of the Pain Management elective.

Symptom Management - In this section, we talked about other symptoms that arise in end-stage disease such as nausea, fatigue, delirium, agitation, etc. Additionally, we talked about the pharmacologic management of each of these symptoms. It was nice to get a chance to test my knowledge and discuss what I know about certain drugs with people who have years, even decades of experience in the field. 

Understanding Dying Experience - In this section, we talked about the stages of dying, what sort of things the patient may experience, and how to comfort the patient and family. In addition to the information covered, the nurses shared interesting stories of patients and the conditions in which they passed. One nurse was talking about a patient who was basically comatose for several days before, who suddenly had a burst of energy, woke up, and talked to his family for a short period of time before passing away. It doesn’t happen for everyone, but there are reports of patients have unexplained increase in energy and cognition just before they pass away. It really says a lot of about the strength of an individual, to resist death for just long enough to tell their loved ones goodbye, before passing away.

For those who don’t know, Hospice is a service provided primarily by non-profit organizations (at least here in Florida) that represents a style of medicine that we typically don’t study in school. Most of our course work focuses on curative treatments (chemotherapy for cancer, management of chronic conditions like diabetes and heart disease, etc.). However, in the Hospice setting, the focus shifts from curative treatments to palliative care. In a sense, all avenues for curative treatments are abandoned in favor of treatments that serve only to alleviate and manage end-of-life symptoms. For this reason, patients are required to have a terminal diagnosis and prognosis of 6 months or less. This benefit is also covered by Medicare, Medicaid, and most private insurance payers.

Beyond the medical and pharmacologic management of end-of-life symptoms, there’s also a slew of other members that compose the interdisciplinary team. There are highly trained nursing staff, social workers, chaplains, as well as greif counselors. Additionally, these benefits are extended to the family and friends of the patient, for up to 13 months following the patient’s death.

Next week I’ll be rounding in the in-patient unit with the interdisciplinary team. I’m really looking forward to it! While this rotation has the potential to be very emotionally draining, I expect that it’ll be a worthwhile experience and incredibly rewarding. With that, I’m off to bed. Early morning tomorrow!

Keep Quiet

I’ve seen your face in the shadows.
I’ve seen your face in the places I wasn’t meant to be.
I’ve heard them whisper about you.
I’ve heard the men in the bars and I’ve seen the women lock their doors at night. lock your doors tonight.
They say your eyes are on fire.
They say you’d kill a man for walking the wrong side of the line. wrong side of the line.
But men, they say a lot of foolish things
and in the end the only words I can find to believe in are mine.

They say [this City]
This city [she’s been dead]
she’s been dead for years now [for years now]
for years now [for years now]
So death is [so death is]
not something [not something]
not something that scares me [that scares me]
that scares me [that scares me]
There’s worse things [there’s worse things]
than death here [than death here]
They told me [keep quiet]

I will not be told where to stand!
I will not be told what to say.
Not by man or machine, not by you,
not by anyone tonight!
You’re gonna have to do better than fear.
You’re gonna have to step out of the shadows and fight.
And when they see your face again,
They will know what it means to have fear dragged out into the light.
Drag it out!

They say [this City]
This city [she’s been dead]
she’s been dead for years now [for years now]
for years now [for years now]
So death is [so death is]
not something [not something]
not something that scares me [that scares me]
that scares me [that scares me]
So come on! [ah-ah-ah]
Come on! [ah-ah-ah]
Step into the light!

OOH, this city [this city]
she’s been dead [she’s been dead]
for years now [for years now]
for years now [for years now]
So death is [so death is] [not something]
not something that scares me [that scares me]
that scares me [that scares me]
There’s worse things [this city]
than death here [she’s been dead] [for years now]
There’s loss and there’s silence and sadness [for years now]

[so death is] So come on
[not something] come on
[that scares me] just open your mouths and revive it [that scares me]

What a great frickin’ song…

Journal Entry #13

It’s been a while since I’ve posted to this. I have a whole back log of journal entries for thinking skills that I need to post here. Perhaps I’ll have the chance over winter break. It’ll be interesting to go back and see what I was thinking and feeling over the course of this turbulent semester. Anyway, I have a butt load of more work to do this week, and I’m already behind. So, read below for this week’s journal entry.

Topic: Compare and evaluate the style of teaching and learning in this course with other courses you are taking or have taken.

There are many types of learning and teaching styles, only a few of which appeal to each individual student. For instance, a learner like me, who is very hands-on, needs to be fully engaged in the lesson. I find that I learn the best when I get to play with and hold whatever it is I’m learning about. Of course, this is pretty unrealistic in pharmacy school. It’s not like we can actually handle drug molecules and receptors, and put them together to see how they work. Unfortunately for me (and many like me), the majority of what we do is book type learning. However, I try to visualize things and make them as hands-on as possible.

Another thing that helps me learn is learning the “system,” rather than trying to memorize all possible scenarios. For instance, when talking about β-blockers, α-agonists, and other sympathomimetics and sympatholytics, it helps me to understand precisely what is going on at rest in the body. I like to relate the actions of these drugs back to the fight or flight response. The fight or flight response is a very simple tool to understand what happens when the cholinergic system is activated or inhibited, versus the adrenergic system. The only thing one really needs to remember is what systems are important in each response. Let’s say, for example, that we’re chillin’ at home, having a nice dinner with family, friends and/or a significant other. We’re totally relaxed, nothing stressing us out (provided we’re not a pharmacy student) and enjoying a nice meal. Systems that would be activated are the digestive system in order to break down that delicious meal, we’d be storing the nutrients for later so our liver would be synthesizing glycogen. Other tissues would also be generating higher-energy organic compounds. There’d be no need for elevated blood pressure, so our kidneys should be operating at full capacity, removing fluid from circulation and producing lost of urine for us to excrete later.

Now, let’s say that for no reason and bear busts through the wall and starts wreaking havoc on our beautiful home! There’s widespread panic. Nobody knows what to do… but the human body does. The fight or flight response kicks on virtually instantly. So, what do we need in a fight or flight response? Well, first things first, we don’t have time for any breaks to take a leak, so we’ll shut that system down. While we’re at it, most of our tissues are going to need plenty of that oxygen-rich blood we’ve got coursing through our veins. We’ll increase blood pressure, increase heart rate, increase respiration, and decrease kidney function. While we’re on the subject of blood, let’s divert the flow to more important organ systems. Forget the digestive system, we need all our blood to go to the central nervous system and muscle tissue. That way, we’ll have plenty of focus and energy to escape this most rude dinner guest. We should probably divert blood flow away from the skin, you know, just in case he does catch us, we don’t bleed out too fast. Oh, and let’s not forget, all those nutrient rich tissues are going to start dumping their nutrients to spread around. The liver starts breaking down glycogen and even forming new glucose from fat and protein sources (gluconeogenesis), and our flabby mid-section is gonna start dumping high-energy fats into the blood stream too (lipolysis). We’ll need excellent vision, so we’ll go ahead and dilate our pupils too. There, now we’re all set to outrun this uninvited guest.

So, right there, I’ve created a scenario where I know pretty much the whole picture and general idea about what sympathomimetics, sympatholytics, cholinergics, and anticholinergics really do in the body. Of course, each tissue has different sub-populations of receptors, but that’s why there’s two semesters of pharmacology. But anyway, this is how I learn best: being able to visualize what exactly is going on, why it’s happening, and what would happen if we were to change something. While this doesn’t cover everything, it covers a majority enough of information that the outliers can be memorized no sweat. I personally learn best from teachers that are willing to teach this way, too. This is probably why I’ve always excelled at math and science. Both of these disciplines are all about learning a system and how to manipulate it within an infinite number of scenarios. This is also one of the reasons I found music theory so fascinating. In a way, it took the “art” out of music, and turned it into science. This is why this sounds the say it does, and this is why this composer did this little thing here. Now heres hundreds of examples of the exact same thing. Once you know the system, you can manipulate it however you choose.

Thinking skills is a lot like this! However, there is still a degree of reading (yuk!) and writing (not as yuk, but still!) that goes along with it. There is a standardized system we’re working with, in terms of defining conclusions and reasons, looking for assumptions… there are general rules we are able to utilize in identifying these aspects of an opinion. However, purely on the virtue of it being a reading/writing type course, there is a lot of wiggle room, and a lot of opportunity for “creative license.” While other courses in pharmacy school are very “by the book” as I like to call them, others have some degree of wiggle room as well. Pharmacotherapy, for instance, has a lot of wiggle room. Really, you’re allowed to do “anything” (in quotes because I don’t mean literally anything) as long as you can find the research and data to back it up. As long as there is evidence that it could or should work, you can do it in an effort to treat your patient(s), and hopefully produce a positive outcome.

Ultimately, there are many different learning styles and teaching styles available. Some students learn best by one or two. Some students can remember something forever after only hearing it once. Others can do the same after only reading it once. I can do the same after only visualizing it once, or manipulating it once. However, the best teachers of all can teach and appeal to all these learning styles. I’ve learned that over the years, as I reminisce about my favorite teachers and what great knowledge they gave me. There were many teachers that I absolutely loved, but many would disagree. Perhaps I enjoyed them because I learned so much from them, and perhaps I only learned so much from them because they were able to teach in a style that appealed to me. However, perhaps they were disliked by my classmates because they couldn’t teach in a style that appealed to them. The more I remember and the more I think about it, the teachers that were universally liked were the teachers that had the skills to teach in all these different styles, were still willing to offer some extra help if you needed it, and were all around good people that you were simply grateful for having the pleasure of knowing. In each of our educational careers, we all have some teachers we dislike, some teachers we love, and some teachers we’ll never forget. Lucky for me, I’ve got a decent memory.

Top 10 Reasons Why This Sucks.

I’m a pretty computer-savvy person (not like, expert super ultra pro 1337 h4x0rz or anything), and so I know a thing or two about responsible computing. For instance, the age old double-entendre “Jesus saves… often.” One of the many rules I’ve learned to follow over the years. Another good one is “always have a backup.” Ideally, I’d liked to have had triple redundancy, but no. Instead I was lazy and had NO back up, and had ALL my data on one tiny little hitachi POS hard drive. So here’s my top 10 reasons why not having a backup sucks (in no particular order, but starting at 10 and going to 1 for style):

10. TONS of pictures from trips to Chicago, San Francisco, All my animals (including Jazzy, Cody, and Boomer that are no longer with us), Trips to Daytona, Pictures from Band trips, etc. etc.

9. I’ve lost about 80-100 gigs of music, most of which I have no idea what it was or where it came from (probably never listened to it, either, but meh.)

8. All my financial records. Taxes, quicken files AND backups, etc.

7. Speaking of which, Quicken itself. WTF is with this “Quicken Essentials?” It’s total GARBAGE!

6. Countless emulators and ROMS that I’ll probably never be able to 

5. All that music… T_T

4. Countless desktop patterns that I’ve downloaded from some of the sketchiest places on the internet. Probably never see those again either.

3. All my artwork from back in the day when I was a pro at Bryce 5 (there wasn’t much, but that shit is irreplaceable.)

2. ALL THAT MUSIC!!! T_________________T 

1. I’ve lost two years of pharmacy school in notes and information, potentially forever.

Don’t mind me, just eatin’ some bugs and stuff!

Chicken flavored ramen, salt and pepper cashews (boiled with the noodles), and cheese. Pretty tasty.

09/23/11 - Pharmacy School is now more like the education I had hoped for

Pharmacotherapy is by far the most demanding course I have taken in the history of my education. It seems like every day, I am doing something to prepare for the next time we meet (which more often than not is two days from the last time). It is very research intensive, requiring us to study on our own, often with little guidance, and no fail-proof way to determine that we’re adequately prepared. I find myself staying up late at night to study or endlessly search [insert your favorite database/indexing service here] in the hopes of gathering as much information as physically possible to be prepared for the next meeting. And invariably, my efforts are insufficient. I come to class, feeling well prepared, fully knowledgeable of the information expected, only to find that I missed something, somewhere, and wouldn’t you guess, that something is the most important thing of the day.

With the exception of a select few, the faculty and instructors don’t do a lot of alleviate the anxiety and stress that is a direct result of being enrolled in this course. We go for verbal defense, get asked 1001 questions to which we didn’t think to find the answers for, and leave with no feed back. It feels like they make sport of watching us crash and burn, knowing all along that they’ve done nothing to steer us in the right direction. There is no empathy (a quality that is all but literally drilled into our skull from day 1) for our situation, and the fact that we have 6 other courses we’re trying diligently to succeed through. I consistently leave thinking I’m not good enough, or I’m not worthy of being a pharmacist, or I need to improve dramatically, and never get any advice or suggestion on what I can do better next time.

However, like most educational experiences, every so often, there is an instructor/professor/teacher that outshines the rest. Every so often, it becomes plainly clear that the person in front of you, the instructor, genuinely wants you to succeed, and genuinely wants to help you do that. I feel like I experienced that today. Today I was told it’s okay to not know everything, that it’s okay to not have an answer, that it’s really quite impossible to see the whole picture in our current situation. Far too often we see instructors that seem to forget where they came from. They seem to forget that at one point, they too were a student, and they too were struggling to succeed. That was certainly not the case for this guy.

Today, I was reminded of all the great teachers I had through grade school, junior, and high school. These were a different kind of teacher. Not the teacher that tells you you’re approaching the problem wrong, and then offers no advice on finding the right solution. Not the teacher that tears you down, only to leave you wallowing in your own failures. Not the teacher that tells you that you simply don’t have what it takes to succeed. No, the kind of teacher I remember is the one who tells you it’s okay. The kind of teacher that will help you find the right solution. The kind of teacher that knows it’s okay to tear you down, as long as they’re willing to build you back up in a way that makes you stronger the next time around. The kind of teacher that reassures you that you do have what it takes to succeed, that you are doing a good job, that understands that you’re not an expert yet, and is willing to offer help and guidance in how to become the expert you’re expected to be.

This kind of teacher has always been an asset I have held close to my heart through my long and arduous educational career. All the way back to my 5th grade teacher Mrs. Harpest that was able to identify “hey, he’s not paying attention because he’s bored. I need to challenge him more.” She was the first to identify my affinity for mathematics and get me involved in an advanced placement program. In 6th grade, Mr. Savage did a handstand in class to explain what a reciprocal is. In Freshman year Miss Aureus that used a water gun to explain hydrolysis (she lined a few students up, had them lock arms, told them they were monosaccharides in a polysaccharide chain, then proceeded to squirt them. Naturally, they unlocked their arms to defend against the water). My junior year, Mr. Kennedy introduced us to the world of physics. He made the world look like a math problem. It was incredible to be able to quantify forces, and velocities, and see how the world works on the most elementary level. There are many more, but I’d have to write a novel.

These are teachers I will never forget. These are teachers that changed my life, left me wanting more our out of my education, and gave me the drive to succeed. Not once did they demoralize us. Never did they leave us feeling like we would inevitably fail. When we were unsure, they helped guide us in the right direction. Now, don’t get me wrong, I get that this program is supposed to be about being able to find the information ourselves, being able to assess our own understanding, identify our own gaps in knowledge, and knowing where and how to fill in those gaps. But on the contrary, it’s very difficult to have that drive, that motivation, when you leave class feeling less than dirt. Honestly, I’ve been beginning to feel more and more like this when I leave class each day.

Today was different. Today we learned that we are still, just students. Today we learned that we’re not supposed to be experts, but we’re supposed to be learning to be experts. Up until today, Verbal Defense always felt like a test. It always felt like we busted our asses to prepare, only to be told it’s not good enough. Don’t get me wrong, it’s supposed to be that to some degree. Verbal Defense is our opportunity to be able to stand up and defend our clinical judgement, and for us to prove that we know what we’re doing. But, it’s nice for the faculty to illuminate our judgement, and actually let us know if we really do know what we’re doing, instead of being left in the dark to make the decision ourselves.

All things considered, it was truly refreshing to speak to someone who was empathetic to our situation. Someone who remembers that it was tough going through the program, that it’s very demanding, but is able to see through our shortcomings and be able to honestly tell us that we’re doing well. We need more faculty like this. These are the kind of instructors that make learning fun and give us that drive to improve. Through all of this, it’s important to remember that we’re not always going to have the right answer. Sometimes, there is no right answer. But telling us we’re wrong only leaves us broken. When you can pick up the pieces and point us in the right direction, then we’ll be on our way to becoming the real experts.

Topic: Reflect on how you rate relative to the characteristics of a critical thinker.

For this weeks entry, we were given a list of nine qualities that a critical thinker would have. Here is what I wrote.

  1.  Open-minded about new ideas - I am very much open-minded to new and abstract ideas. I am often willing to try new things and approach problems from a new angle when tried and true methods seem invalid or ineffective.
  2. Does not argue about something knowing nothing about it - Often times, when I find myself in a political debate or discussing something out of my scope of understanding, I sometimes close with “I’ll have to research it myself” or “Let me find some more information.” I am a firm believer that part of the gift of knowledge, is knowing where your knowledge ends. Far too often, we are guilty of jumping to conclusions and developing opinions that aren’t really founded on fact or available information. Though I sometimes fail, I try my best to not only understand what I know, but also understand how far my personal knowledge extends. When I find gaps in my knowledge and understanding, I try to fill them in and re-evaluate my conclusions and opinions.
  3. Knows when more information is needed - This kind of ties into the previous characteristic. Part of knowing when more information is needed is knowing not to argue about a subject where more information is needed.
  4. Knows the difference between a conclusion which might be true and one which must be true - This one, I tend to struggle with. Often times, when I am thinking about an issue and developing my opinion, it’s far too easy to choose a conclusion that aligns with my own beliefs, regardless of where the information points. This is particularly difficult when information points in both directions. For example, anthropogenic global climate change has a large amount of information pointing towards it, but whether or not this is caused by humans largely remains an opinion with little or no evidence backing it up. In terms of what we’ve learned in Biostats and Evidence-Based Pharmacy, we haven’t actually established “causality.” However, a large portion of the data points in the direction of global “warming” (really a misnomer, more on that in the next point) being man-made. As an environmentalist, it’s easy for me to jump on the bandwagon and say we need to be more careful about the pollutants we dump into the atmosphere. I strongly believe that as evolved, intelligent creatures, it is our responsibility to insure that we do not destroy the environment in which we live. Of course, this is just an opinion. Others are equally entitled to believe otherwise. Personally, I think this is where a lot of the dichotomy between global warming theorists and the “industrialist,” as I like to call them, arises from.
  5. Knows that people have different ideas about the meaning of words - The english language (and many others) are highly subjective. What means something to me, may mean something totally different to others. Often times, this is why it is incredibly important to discuss the inner workings, the “meat and potatoes” so to speak, of an issue in debate. Going back to the global warming discussion, this is a prime example of when a term or description means something totally different to different people. I personally believe it is a misnomer, as it doesn’t adequately describe the processes at work. Some others I’ve discussed global warming with have, at times, opened my eyes to the true meaning of the term.

    WARNING: SCIENCE CONTENT - If you think about the atmosphere as a fluid (it is by technical definition), then its temperature greatly affects what substance can be “dissolved” in it. Just like warmer water can have more sugar dissolved in it, warmer air can carry more moisture. What this means in terms of Global Warming, is that warmer air carries more moisture, which results in higher levels of precipitation in the areas where that air travels. This precipitation directly effects the environment, as areas that didn’t normally receive rain very frequently, might get more (this is good!). On the other hand, areas that receive a LOT of rain regularly, are much more likely to flood (this is bad), washing away important soil for plant life, and potentially destroying ecosystems and areas where people live (Hurricane Catrina comes to mind).

    To me, the term Global Climate Change is more accurate and more descriptive of what’s actually happening, in terms of the lay person. But again, this is merely an opinion.
  6. Tries to avoid common mistakes in his own reasoning - I do this pretty frequently. Whenever I am formulating a new conclusion, I often check and re-check my reasoning, to insure that I haven’t made any false connections, or utilized “logical fallacies” like circular logic. I think this is absolutely important because a lot of logical fallacies could ultimately results in a poorly formed conclusions.
  7. Questions everything which doesn’t make sense - Whenever I am discussing a topic of debate with someone, I do this inadvertently. Often times when someone mentions a belief that doesn’t align with mine, I ask questions like “what information causes you to believe that?” or “Why do you think A instead of B?” Often times, when they present the information that supports their conclusion, I can find weaknesses in their reasoning and call those to their attention. Sometimes, I’ll do the research myself and see if what I believe to be a weakness in reasoning is in fact valid and possibly based on data I may have missed.
  8. Tries to separate emotional thinking from logical thinking - We humans, as emotional creatures, often times let our feeling get in the way of legitimate, logical reasoning. Whenever I discuss this, I like to refer to my “bar fight” analogy. Say you are in a bar, just got a delicious beer from the bartender, and you’re walking back to your table to socialize with any friends that might be joining you for the evening. As you’re walking, some (presumably drunk) person is not paying attention and bumps into you. You spill your beer, get it all over your clothes, and the glass falls on the ground, shattering. Our first emotional response is anger. Maybe you just got out of work, had a really awful day with your boss yelling at you, maybe some of your team members weren’t pulling their own weight, but either way you were looking forward to enjoying that beer with your friends. If you’re like me, that beer might have been pretty pricy, too. However, when you step back and examine the situation from an objective stand-point, one cannot rule out the idea that perhaps it was an accident. I mean, let’s be honest. What rational human being intentionally destroys someone’s tasty beverage when they probably don’t even know the person? In this case, though you may want to take out your frustrations on the patron that just bumped into you, that would be unwise, as it will invariably escalate to an altercation, presumably ending in physical violence and being kicked out or worse, arrested.

    Now, if we examine the situation from the other perspective, you’re minding your own business, you go to turn around and return to the bar, and you bump into some poor stranger, spilling their new, full beverage everywhere. You might get angry, and tell them to “watch where they’re going,” but as in the scenario above, this only leads to escalation. The correct approach is to apologize (even if it’s not your fault), and offer to buy them a new drink. Who knows, you might even make a friend in the process.

    So, if we examine the situation from a mode of emotional thinking, we’re looking for blame. We get angry at the other person, and potentially escalate the problem. However, if you step back and approach the situation from a basis of logic, it was an unfortunate accident. If you apologize to the other individual, offer to buy another drink for them, and move on. On the emotional side, you’re angry, just lost a drink and are out the cost of the beverage, and you’re less likely to enjoy the rest of your night. From the logical side, you’re only out a couple bucks for a replacement beverage, but you haven’t engaged in a confrontation. You may even make a friend out of the experience.
  9. Tries to build up vocabulary in order to understand what others are saying and to make his own ideas understood - As pharmacy students, we must do this a LOT. On the one hand, we understand things in an intensely scientific frame of mind, with a lot of big, specific words to describe them. However, if you say “left ventricular hypertrophy” to a patient, they’re probably going to say “bless you.” Though I need to work on this, I think I do this pretty well. Often times when I’m discussing school related things with my brother and girlfriend, I have to use words that they understand. Let me make it clear that it is not because they are less intelligent, but because they don’t understand the information in the same context as me. As an effective communicator and critical thinker, it is absolutely important to express your conclusions and ideas in a form that are easily understood for those that don’t have the same educational background as you, but that you’re also able to communicate them in detail with those who do. Analogies are a great tool to use in this context, because they help to put the information into a perspective that the individual can understand. For instance, if I were to describe the way β-blockers work to my brother, I would probably make an analogy with a car (he’s very much a gear head). I would say something about how in a car, the speed of the engine is largely dependent how much fuel is getting into the cylinders, just like the speed of the heart is largely dependent on the strength of the sympathetic signal it gets from the nervous system. What a β-blocker does, is throttle back that signal, just like how you can throttle back the idle in a car by decreasing how much fuel gets into the mixture.

As with my usual writing style, thoughts seems to be broken and scattered, but the point seems to come out pretty clear. Let me know what you think! or don’t. I’m apathetic.

Nessy is outside my porch…

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