Posted on December 02, 2019 in: Professional Practice
Joseph M. Cusimano, Pharm.D., and Grace Baek, Pharm.D., Michigan Medicine, Ann Arbor
Michigan Medicine is home to two new residency programs: the PGY-2 Pain Management and Palliative Care and PGY-2 Emergency Medicine programs. We spoke with the current residents of these programs to better understand their fields through their eyes.
PGY-2 Pain Management and Palliative Care Pharmacy
Kyle Quirk, Pharm.D., sat down with us after what had been a difficult day in his residency. Palliative care comes with its own unique and emotional challenges. However, Dr. Quirk spoke of the immense good that pharmacists do. “We are interested in helping people live the rest of their lives as best as possible, no matter how long that is.” He described how the goals of treatment were different from most other fields. “We’re not obsessed with fixing people, or curing them,” and palliative care seeks to help patients meet their own goals, whether that is “not suffering, being awake enough to talk to their loved ones, or getting home.” Dr. Quirk noted that the career provides an opportunity to “flex your pharmacist muscles” due to the paucity of data. “It’s the wild west in a way. And hospice is the wild, wild west. What works on the sixth floor [inpatient, acute care pharmacy] may not be the same answer for a patient in hospice.” We discussed the significant variability between pain management and palliative care programs. Speaking to the Michigan PGY-2 program specifically, Dr. Quirk pointed out that, instead of focusing narrowly on a specific area, his program seeks to be balanced and flexible based on residents’ interests. When considering the future of his field, Dr. Quirk expressed enthusiasm, stating that while health care has traditionally not effectively managed pain, “everyone is starting to appreciate that. There has been a huge sea of change with how we are now approaching pain. It’s a very exciting time to be able to help drive that ship.” One myth that Dr. Quirk encounters in his practice concerns the definition of palliative care itself. “Everyone thinks that palliative care means ‘hospice.’ Palliative care can encompass care for patients at any point in their disease progression, not just in their final moments.”
PGY-2 Emergency Medicine Pharmacy
Vivian Kum, Pharm.D., had never thought to pursue emergency medicine until she began staffing in the emergency department as a PGY-1. She described a particularly difficult case and opened up about how it made her doubt herself. However, a colleague reassured her, “We want you on our team because you care.” Reflecting on her job now, Dr. Kum described the importance of resilience: “In emergency medicine, some days are tougher than others. You may have stressful days and lose patients, but we keep doing what we’re doing because it’s what we love to do.” Dr. Kum expressed gratitude for the phenomenal teamwork she witnesses every day in her practice. “There is a lot of open communication, and you always know what’s going on in your ED.” She explained that there is a lot of variation in how an emergency medicine pharmacist might practice; while some have an emergency medicine satellite pharmacy, others completely separate the pharmacist from where medications are dispensed. Personally, Dr. Kum prefers having control of pharmacy operations, explaining, “It doesn’t sound glamorous—verifying orders and procuring medications—but if you don’t know how to get the drug, then it doesn’t get used.” The “up-close and personal” part of her job is her favorite, though she noted that what an emergency medicine pharmacist can do will vary by state law. “There are probably some students that don’t realize how pharmacists can get out from behind the computer.” One myth that Dr. Kum wanted to dispel concerned what her practice looks like day-to-day. “You’re not saving lives every day—there will be days when people just come in with a cough.” However, she sees this as an opportunity to provide other services, such as discharge medication counseling. “You can make an impact, but it’s up to you to make the most of it.”