Meet P4 Jonathan Holan, from Morristown, Tennessee, and hear more about his rotation experience at Johnson City Internal Medicine with his preceptor, Dr. Rick Hess, Pharmacy Practice faculty member who specializes in diabetes care.
What did your day look like on rotation?
JH: We would typically arrive at the clinic early in the morning, as patients are scheduled starting at 8: AM. Prior to patient encounters, we work up the patient we are about to see, which involves performing a deep dive into their profiles and pulling out relevant information. From recent lab and physical exam findings to their current medication list to notes from previous visits, all of this information is summarized into a reference sheet that we can take with us into the encounter. With a plan in mind, we would discuss the patient with Dr. Hess briefly before seeing them. Patient encounters are either 1 hour long for new patients or half an hour for follow-ups. At each one, we perform a medication reconciliation, with extra focus being placed on their diabetes care. Beyond their medication usage, we collect information on their diabetes monitoring, smoking history, adverse effects, diet/exercise, and much more. We then come up with a plan, including adjusting insulin dosing/timing, utilizing the plate method or other forms of meal planning, adding or removing medications, smoking cessation, blood glucose monitoring, etc. After the main encounter, we may perform some tests, such as a diabetic foot exam or blood pressure check, before leaving to discuss how it went. We would then summarize the encounter into the patient's chart. Beyond the typical clinic activities, we also have a variety of different projects and assignments throughout the month, including review sessions on diabetic drug classes, drug info questions, insulin practice questions, and even a unique debate assignment.
What is something unique about this rotation you might not experience elsewhere?
JH: This is a diabetes-focused rotation, and while there are some other disease states discussed, diabetes is certainly the main one. With that being said, there is no better rotation to learn about this very common disease state. In my eyes, Dr. Hess is working at the top of his license, and he has a fun and unique style of questioning you to ensure that you are learning. I have certainly never learned so much about cardiovascular outcome trials (CVOTs) for diabetes medications! You even get to wear a CGM and insulin pump, which was a very interesting experience. This rotation has the advantage of providing a large amount of direct patient care time, which allows for many unique learning opportunities. This is a great rotation to recognize how much of an impact pharmacists can truly have on the long-term care of patients.
What did you learn from this experience?
JH: It would be difficult to name everything I learned; I would describe it as innumerable. However, to name just a few, I gained a much more thorough understanding of diabetes medications, including their mechanisms, cardiovascular and/or renal benefits, costs, adverse effects, and more. With insulin in particular, I learned a significant amount about how it is dosed initially and how it is adjusted based on many different factors. Beyond medication usage, I learned about dietary counseling and the differences between the plate method, carb counting, meal replacements, and the keto diet. Finally, with my interest in technology and informatics, Dr. Hess was kind enough to provide numerous opportunities to work with diabetes-related devices, including glucometers, CGMs, and insulin pumps.
Why did you choose Gatton?
JH: My two initial draws to Gatton were the location, with it being a beautiful campus close to home, and the availability of the Early Admission Pathway, allowing me to start two years early and finish my bachelor's degree in Pharmacy Studies concurrently with my first year of the doctorate program. However, what truly solidified my choice was when I met the faculty and staff at Gatton, with everyone from my future professors to the dean treating me so kindly, as if I was a member of their family.