just finished 2 months in the outpatient and now in "Therapeutic Drug Monitoring" (TDM)...
when you take certain medication...there is a window, a range...take too little its ineffective...take too much its dangerous...
most of the drugs...the window is quite wide...for example...Paracetamol (better known as Panadol)...
1000mg is effective for pain relieve...and you can take up to 4000mg a day...
so the upper range is 4 times the lower range...and it is generally safe as long as you don't take more than 4000mg a day...
but some drugs are very sensitive...the window is very narrow....especially when used in ill patients...for example...vancomycin...the last of the antibiotics which is active against the notorious Methicillin Resistant Staphylococcus aureus (MRSA)..
therefore we need to monitor the level of the medicine in the blood...and to adjust the dose to be given accordingly...to ensure it is enough to be effective...but not too much to cause any side effects...this is done in the department i'm currently in...
we get the blood sample...process...analyse...and interpret result...more or less like lab technician...but i don't mind at all...for more than a year i wasn't working in the lab...and now i'm enjoying myself again...with all the vacutainers...blood sample...micropipette...centrifuge...instruments...hehehe...
but i have to constantly remind myself to be really careful with the samples...these are not from my rats...i took good care of them...i knew they were disease free...
but these are real hazards...confirmed cases of bacterial infection...often notorious bugs...we don't even know if the patient had Hepatitis or HIV...
the workplace is like a mini lab..but ironically i find this department do even more clinical work than when i was attached to clinical pharmacist...
i feel more involved in a team...where we can discuss with the doctors and make decisions together...i mean real critical decisions...
i follow the case...monitor the drug level...suggest new dosage...discuss with the doctor...which to my surprise really taken into consideration by the doctors...
and the next day i will want to go up to the ward again...monitor my patient's progress..to see if my patient is still alive (i'm serious)...to check if there is any improvement...if the antibiotics are killing the bugs...as well as my patient's kidney...
i can really feel i'm doing real patient care...not just based on the texts we read in the university...
by the way...i don't think we need a course to teach people how to care for other people lah...its natural...either you have it or don't...this also have to study meh?...if i tell Mr Lim this...he will say...for exposure mar...create awareness mar...
sometimes i wonder how will i feel if when i go up...my patient wasn't there...
i know some day i may have to experience this situation...
sometimes i do hope i can have this experience...at least for once...
but not now...please
i hope when i go back on tuesday...my patient is still there...please...
(i really want to share some stories from the Out-Patient Dept...maybe later...the patients i met...1st world mentality? 3rd world mentality? kiasuness? considerate? inconsiderate?...i guess you can see them all in OPD)
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