X-Rays and Prescriptions

Last week Monday I began the hospital internship portion of the Spanish for Medical Professions class with my médico-tutor (doctor-tutor) Nazareno at the Hospital Príncipe de Asturias. He offered to meet me at the general hospital entrance so I wouldn’t get lost looking for his office. He greeted me with a kiss on each cheek and we went to the radiology department in the basement where he generally works. We spent our time looking at x-rays of abdomen and thorax regions; it was really interesting to see how various body parts/organs appear on x-rays. I learned that the clavicles have the shape of an elongated “s”; the trachea shows up darker because of the air inside it; and there can be darker “bubbles” in the area of the diaphragm which represent gas in the stomach. After going through the x-rays, we had to check it over with the jefa (boss). I mentioned to Dr. Nazareno that I would like to visit the hospital pharmacy and see how it operates, so we went to the pharmacy, talked to the boss, and arranged for me to spend the next day there with a resident.

The next day, fourth-year pharmacy resident Marta took me on a tour of the hospital pharmacy. It was smaller than what I’d imagined as I was picturing something more like what I’ve seen at UW Hospital (the outpatient pharmacy, the central pharmacy, the American Family Children’s Hospital pharmacy, and pharmacists working throughout the hospital). Marta showed me the two patient consultation rooms where for the first and second time patients receive a medication, they have to come in for a consultation with a licensed pharmacist. There was also the ensayos clínicos room (clinical trial room) where all of the medication used for clinical trials is kept at a certain temperature. Since these are used for clinical trials, the medications are only labeled with the lot number and expiration date, not the name of it; so, it is extremely important for the pharmacists in charge to keep track where each medication is stored. There were also two separate lab rooms with a ‘green elastic booty-shoe protector dress code’. The first lab is called ‘the vertical’ and the other is referred to as ‘the horizontal’, named based on the air circulation/flow. In the vertical lab, they worked with medications and chemicals relating to chemotherapy (ones that could possibly be dangerous for the people working with them) and in the horizontal lab room, they worked with all other medications. The main floor of the pharmacy (it had two floors) was for unidosis (single dose medications). In a room on the second floor, there’s a machine that packages one-dose medications and labels each container with the lot number and expiration date. These one-dose units are sent to the first floor where they are sorted and pharmacists fill each inpatient’s medications with these and put them in a labeled drawer on a cart which is then taken up to the patients.

I also learned about the different educational and residency requirements for pharmacists in Spain, as compared to the US. In the US, pharmacy school applicants take a standardized exam called the PCAT and various pre-requisites which at UW-Madison include 68 credits of classes and labs such as calculus, physics, biology, microbiology, chemistry and organic chemistry. For many Doctor of Pharmacy (Pharm.D.) programs, an undergraduate degree is not required for admission though students often choose to earn a degree first. The typical Pharm.D. program is four years total and after passing state and/or multi-jurisdictional exams you are a licensed pharmacist. Many Pharm.D. graduates also complete one or two-year residency programs in order to specialize, though this is not required for licensure.

This compares to Spain, where Marta explained that students begin college already admitted into a four-year pharmacy school program, which is then followed by four years of various residencies. After the residencies, you are a licensed pharmacist. Also, for pharmacists employed in the hospital setting in Spain, they work in the hospital pharmacy and are not integrated with the other healthcare providers (nurses, doctors, physical therapists, physician assistants, etc). At UW Hospital, there are pharmacists who work in central pharmacy which is similar to what the Spanish pharmacists do at the Hospital Príncipe de Asturias, but there are also pharmacists at UW Hospital who work with other health professionals in providing direct patient care.

I spent my last hospital internship day with Dr. Nazareno looking at more X-rays and MRIs of patients’ brains. We also took a walk around the hospital so we could talk about my experiences and I could practice my Spanish with him. I explained that I am writing a 5-page paper for class about celiac disease and he quizzed me all about it. Good thing I had written most of it and had the information fresh in my mind! Since we still had some time left, we walked to a nearby supermarket so he could buy some cheese and meat for a barbeque dinner he was planning (he bought me some nice French cheese to try as a gift!). We walked back to the hospital and that was when we parted ways. He was extremely kind, generous and always willing to teach me and answer my questions. I couldn’t have asked for a better mentor!

This week we are back in the classroom, getting ready for oral presentations on our paper topics.  There is no final exam to prepare for since we spent the previous week shadowing our mentors in the hospital. I really enjoyed this class and am grateful for the worthwhile experience!