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10 tips for learning pharmacology

Do the work!

“There is no secret. Sit down and repeat the drug cards to yourself. Do it all day, every day. In the bathroom, at work, while eating. Memorization isn’t something that’s easy.” — Richie Zolskiy

Start with the mechanism of action

“Start with the body’s responses and learn the drugs that do them. i.e. antihypertensives, diabetic, increase heart rate, slow heart rate. Then once the students understand how the body is affected, slowly move to the classes and categories.” — George Surber

“Learn what the meds are used for associate them with the things you’re using them to treat. Works well as a base to build on.” — Sam Edwards

“Break drugs down by indication and then by class. When I started at my job we carried a lot of meds that weren’t covered in medic school so I broke them down by what they were used for, then by class. Meds in the same class tend to have the same indications, contraindications, etc. Learn them broadly, you can always refer to your CPGs for specifics but you want to have an idea of what to use first.” —Jonathan Farrow

Flashcards, notecards, and dry erase boards

“Flashcards, flashcards, and more flashcards. Name on one side and information on the other. You get repetition and memorization from writing them, and recall from studying from them.” — Scott Kier

“Use note cards and put your drugs in their classes, take the drug out of the drug box and look at it as you look at your notecards.” — Melissa Stuive

“Flash cards and bring them EVERYWHERE with you! Worked for me.” — Crystal Brown

“Use a dry erase board and keep writing them out until you have them memorized.” — Daniel McCuan

“We took index cards and wrote one card for every drug. Indications, contraindications, etc. It was an hour and a half ride to school 3 nights a week. We used them like flash cards.” — Jon Morgan

Understand the big picture

“Learn physiology inside and out first. Then learn the drug classes and their effects. Then memorize the individual drugs used in your local protocols.” — Stephen Husak

“Learn drug actions as you’re learning the anatomically corresponding system (respiratory drugs/cardiovascular etc.). Stressing purpose of use links it together. Heart problems? What fixes those?” — Kerri Gross

Create study aids

“I made a chart in alphabetical order. During my ride time I would read it over and over. The chart had the drug name, the generic names, the dosages, the indications, the contraindications, as well as the mechanism of action and the drug type and diseases or conditions it is given for.” — Lea Dingman

30 second drug guide lookup

“Take the 30 seconds to look it up and after some time you won’t need the protocol book as much. If you still are not sure, CALL SOMEONE WHO CAN HELP YOU!!! We need to stop this macho know all be all medic attitude and teach students that it’s okay to get a second opinion or quickly the find the answer to something if you are not sure. If you don’t maximize the resources that are made available to you and you fail just because you are scared to ask for help then you truly did let yourself and your patient down. Study, memorize, make reference, but if you’re not sure ask!” — Anthony Maestas

Touch the meds

“Go through a med box. Pick up each individual drug, look at it and review indications, contraindications, how to administer and side effects. Kind of a hands on approach, because just reading and memorizing doesn’t work.” — Bob Henderseon

Constant quizzing

“Everyone learns differently. Ask every medic that you ride with to constantly quiz you and actually look at the medications.” — Dan Madigan

Use word association

“Get Creative with your drugs and how you remember them. Quick example:

Diphenhydramine (Benadryl): Adult Dose

Ben is a construction worker, Ben Drills 25-50mg in 4-6 hours.”

Marco Williams

Drug guide books and apps

“Buy and read your latest edition pharmocopeia, keep it up to date, know it back to front, keep it on you and read it during down time. Don’t just regurgitate information from it either, learn a page or two in depth a day.” — Brady Lloyd

“Keep a copy of the drug reference book in the cubby hole at the head of the patient care area for quick access.” — Glenn Gerber

“I’ve always trusted the pocket reference guides called Informed Guides, and now I have the app for IPhone.” — John Murphy, Jr.

Final thought: Pharmacology is important!

In addition to the tips several readers commented on the importance of understanding pharmacology.

“Remember that you have no business giving a drug if you can’t explain to a five year old how it works and why you give it.” — Matt Michalowski

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Can an Average Student get into Medical School?

Many potential medical students ask questions about what it takes to be accepted into a medical school. One of the most common questions is: Can I get into medical school as an average student? Can you really be admitted to a medical school with a 2.00 G.P.A.?

The admission guidelines for medical school have changed over the last few years. Most medical schools have recognized the importance of diversity in student applicants. Therefore they have put more weight on the “well-rounded” student for entrance to medical school. The days of the total emphasis on grade point average and high test scores for admission have ended. Now there is more emphasis on experience, background, personal philosophy, letter of recommendation, and the personal interview. If you do well with all of these factors your chances for admission will be much greater than just grades and test scores alone.

The basic requirements for medical school remain the same. You must usually have a B.S. Degree in some fieldFind Article, but it does not have to necessarily be in science. The basic courses for admission generally are the same for all medical schools. You must have coursework in:

General biology
Physics with lab
General chemistry with lab
Organic chemistry with lab
English composition

Almost 90% of US medical schools require an AMCAS application. This can be downloaded on your home computer and completed. It will cost about $35 per application. Some medical schools also charge a secondary application and processing fee that can range from $50 to $100 in cost. Most experts suggest applying to at least ten medical schools to increase your chances of acceptance at a medical school of your choice.

The cost of attending medical school is high. Make sure to apply early and complete your financial aid forms early as well. Many medical schools have a single deadline for admission. If you miss that deadline you will have to wait another year to apply again. Make sure that you meet all deadlines for a smooth transition. If everything is in order your application process should go well. All you have to do is sit back and wait for your acceptance letter.

Going to medical school is a lifelong dream for many. It is quite an achievement to be accepted into a medical school. It is the beginning of an investment for your career as a medical doctor. It will pay dividends for your entire life to serve your community and neighbors as a physician.

Twelve Etiquette Tips for Physicians and Medical Staff

Declining reimbursements, increased overhead, implementation of the Affordable Care Act, the rush to litigation are but a few of the reasons to “sweat the small stuff” in the medical arena. If you don’t think you need to pay attention to the details when it comes to making your patients happy as well as healthy, think again. If ever there was a time to mind your medical manners, it’s now.

Patient satisfaction is becoming the key phrase in healthcare. That is not to say that patient outcomes are no longer important. However, it is now obvious that there is a direct correlation between how patients are treated personally and how they are treated clinically.

Using good manners and following the rules of proper etiquette can make an incredible difference in how physicians and their staff are viewed by their patients. If patients feel valued by their physicians and have positive interactions with the staff, they are most likely to become longtime loyal customers. Yes, patients are customers, too.

Let me suggest twelve simple rules of etiquette that can have a positive effect on patient relations and outcomes:

1. Stop, look and listen. This rule does not simply apply to the train rumbling down the tracks. It has great value in a physician’s office. While doctors can rarely spare as much time with patients as they once did, the people they treat need not wonder if their doctor is wearing a stop watch or has set an alarm on his smart phone or on his new Apple watch. Slow down. In some instances, stop.

2. Make eye contact with patients while talking with them. Focus on the patient and not on the computer screen. If your computer is placed in such a way that you must turn away from the patient, get a laptop or reconfigure the computer’s placement.

3. Listen. What a novel idea. When you ask the critical questions, pay attention to the answers. Use good listening skills such as nodding at the person, repeating what you have heard and paraphrasing what was said. Avoid the urge to interrupt or finish the patient’s sentence. You could miss valuable information.

4. Practice professional meeting and greeting. Make your introduction warm and friendly.

5. Smile and make eye contact. This helps to put people at ease and makes them feel welcome and valued.

6. Use the patient’s name as soon as you can while adhering to patient privacy laws. Address people by their title and last name until you receive permission to call them by their first name.

7. Introduce yourself even if you are wearing a name badge, which you should be. Don’t forget to give your title or position so patients will know if they are speaking to a nurse, a technician or a housekeeper.

8. Let the patient know what is going to happen next. For example, “I am going to get your vital signs now. Then you may have a seat in the waiting area until the doctor is ready to see you.” That is something that is done in my own doctor’s office. The usual custom is to tell the patient that you will be leaving the room and that the doctor will be in shortly.

9. Someone should keep track of how long the patient has been waiting in the exam room and check back from time to time. Even a prolonged wait will pass more quickly if the patient sees other humans from time to time.

10. Dress like a professional. Most physicians offer a professional appearance if for no other reason than that they wear a white coat to hide their sins. The office staff is another issue. Some employees wear whatever they choose. Others are required to dress in uniforms. The result is that there is a wide variety in office attire-some of it neat and professional and the other not so much.

11. Dress policies should be put in place and enforced by the officer manager. Lack of attention to office attire can give patients a poor impression and even lead to doubt as to the level of care they will receive.

12. Keep office differences under wraps. Not everyone in the office is best friends with or even likes their co-workers. This should not be the patient’s problem. If employees cannot resolve the trouble between themselves, they need to take up their problem with the office manager, not gossip to others in the office and definitely not make their issues public.

Invest time and money in training physicians and medical staff in the importance of soft skills. While interpersonal skills may not seem as critical as clinical skills in a physician’s practice, without them there soon may be no patients to treat. People have choices in where they go for their medical care; you want that to be in your office.

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The Difference Between Good Doctors and GREAT Doctors

“Do you like your family practitioner?” my sister asked a few weeks ago. “Would you recommend him?”

“Absolutely! I adore my doctor-he’s great!” I answered immediately, and then I started a long, emphatic testimonial, as if I were my doctor’s publicity manager. During my monologue, I used words like “smart,” “logical,” “listens,” and “respectful.” Afterwards, I realized I had not uttered the words “qualified” or “well-trained”-not even once.

The conversation with my sister made me ponder the factors and characteristics that set the great doctors apart from the good ones. Websites rating and ranking doctors crowd the Internet. On these lists, medical professionals earn the title of “Top Docs” based on surveys filled out by their medical peers. And so I posed questions to a panel of six doctors, nurses, and health care professionals. I asked: What do you look for when considering a doctor to oversee the care of your own family? In your opinion, what qualities do the very best doctors possess?


By choosing a doctor who is Board Certified by one of the twenty-four American Board of Medical Specialties (ABMS) Member Boards, you can feel confident he or she meets nationally recognized standards for education, knowledge, experience and skills to provide high quality care in a specific medical specialty. Board Certification goes above and beyond basic medical licensure. Determining if a particular doctor is Board Certified is fast, free, and easy. Simply visit the ABMS website, register, and plug in the doctor’s name and city.

Mike Lipscomb, MD, an Emergency Room doctor at North Fulton Hospital in Roswell, Georgia and a physician with Apollo MD believes that doctors at the top of their fields have solid educational and training foundations to draw upon as they practice medicine. But Lipscomb also offers a warning.

“I wouldn’t put much weight on the big-name schools,” he says.

He explains that tuition expenses at these elite schools can reach well over $50,000 per year making them unrealistic options for many medical students.

“Many state schools are less than a third of this,” he continues. “High price doesn’t correlate to a better education. Some of the best physicians I know went to large state universities for school, and they made the choice to come out with as little debt as possible.”

“And I wouldn’t put much stock in research,” says Lipscomb. “Being good in the lab doesn’t necessarily correlate to being clinically competent.”


“When seeking a physician for myself or family, I regard credentials as a bare minimum and the physician’s experience as a second layer, depending on the nature of care required,” remarks Adedapo Odetoyinbo, MD, SFHM, Chief Medical Officer and Director of Hospital Medicine at Emory Johns Creek Hospital in Georgia. “Experience plays a key role when the need is more technical in nature or when decisions need to be made quickly in an emergency situation. More important to me than research itself, is the physician’s ability to integrate research results and evidence-based medicine into their everyday practice.”

Odetoyinbo refers to the doctor’s practical ability to decipher a puzzle-to select pieces of knowledge from his or her education and experiences and correctly apply them to the situation at hand. In the physician’s pursuit to protect and restore a patient’s well-being, knowledge enhances reasoning and rational decision-making, and experts agree that some doctors are simply better than others at applying what they know.


Many of the experts polled remarked that the best of the best have a toolbox full of excellent soft skills-those personal attributes and qualities that enhance an individual’s one-on-one interactions and performance.

“What separates the good doctors from those we consider top docs is their ability to listen to patients-to really hear them and respond to what they are saying,” says Cindy Hardy, a Physician Relations Manager at North Fulton Hospital who worked as a nurse for years.

She notes that master physicians allow patients to set the tempo for the first few minutes of an interaction while listening and gathering valuable information. Only then, do they respond.

A study published in The Journal of the American Osteopathic Association in 2005 (Travaline, Ruchinskas, and D’Alonzo) found that in many cases, effective patient-physician communication can improve a patient’s health as quantifiably as many drugs. Patients who understand their doctors are more likely to acknowledge health problems, understand their treatment options, modify their behavior accordingly, and follow their medication schedules.

“And the great ones communicate with the patient and the family,” notes Hardy. “The great ones listen to input and speak at a level ensuring everyone in the room understands what’s going on, which is particularly important when a physician, patient, and patient’s family are discussing a plan of care.”

Dr. Robert Campbell, Chief of Cardiac Services at the Children’s Healthcare of Atlanta Sibley Heart Center adds that great doctors usually surround themselves with staff members who are committed to listening, as well.

“Good communication helps support our team culture,” Campbell says. “Given high volume, high patient acuity, and high patient throughput-both inpatient and outpatient-it’s clear that no one single provider can function alone. Therefore, it’s important that we work as a cohesive team and that requires excellent communication to coordinate our efforts.”


Top docs not only maintain technical competence, but also nourish and exercise humanistic qualities-kindness, warmth, and compassion-when a patient needs it most.

“Again, the credentials are a given,” says Debbie Keel, Chief Executive Officer of North Fulton Hospital. “But when a patient isn’t feeling well, or they are afraid, or they are facing long, expensive care and are concerned about the costs, they need compassion, and the very best doctors have a compassionate presence about them.”

Keel, a mother and grandmother herself, encourages her staff to see patients in a different light.

“I say, ‘That’s your mother in that bed,'” she adds. “Top doctors treat their patients with the same compassion that they would have with their own family members.”

But showing compassion is harder today given that doctors are stretched thin and must care for more patients than ever during the course of the day.

“We can’t create more hours in the day,” she says. “It is hard to show their caring sensitive sides when they only have a few minutes with a patient, but the most-respected doctors do it.”


All physicians pledge to promote and encourage the highest level of medical ethics, a system of moral principles that apply values and judgements to the practice of medicine. But most healthcare experts say that ethics go far beyond a doctor’s moral obligations. Ethics encompass how they perform when no one is looking and how they treat others.

“When I interview physicians who are joining us, I tell them they will not survive long if they are lazy or unethical,” says Steve Waronker, MD, Department Chair of Anesthesiology at Emory Johns Creek Hospital. “I also tell them that if they cannot live by the Golden Rule and treat the environmental services employee as well as they treat the CEO, they need not apply.”

Indeed, many doctors-especially the really great ones-view the Hippocratic Oath as a sacred covenant. By reciting it, physicians swear to practice medicine honestly, avoid acts of impropriety or corruption, keep conversations confidential, among many other codes of moral conduct. It’s their guide to ethical behavior.

Among other attributes that transform good doctors into truly great ones are intuitive perception-a sixth sense, accessibility, common sense, bedside manner, and a doctor’s willingness to be a team player. But perhaps it’s a doctor’s ability to be multifaceted and multidimensional that makes some shine more brightly than others.

“They possess compassion, common sense, command of a large body of knowledge, and the humility to ask for help when things get complex and confusing,” Waronker says. “Ultimately, the best physicians have it all.”

Amber Lanier Nagle has published hundreds of articles in national and regional magazines.

She is the brainchild behind Project Keepsake (, a published collection of nonfiction stories about the origins and histories of keepsakes-a pocket knife, a cake pan, a quilt, a milking stool, etc. She says, “Everyone has a keepsake, and every keepsake has a story to tell.”

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Treating Pain Without Drugs – 5 Tips to Feel Better and Use Less Medicine

Most patients think doctors never hurt. Not true. I’ve lived with pain every day for the last 40+ years, so I know a thing or two about what I’m saying. Not that I never take pain medication, but Tylenol or an occasional Advil is about it – no narcotics.

Does that mean my pain isn’t worthy of anything stronger? I don’t think so. But I would say my attitude toward pain is different than many of my patients. For me, it’s just a part of life. Many older adults would say the same thing.

But in 20 years as a family physician I’ve met thousands of people who see pain differently. For them, pain is something to be avoided at all costs. Fear of pain is a big issue for them. Also, many people spend too much time resenting that life isn’t fair. Get over it! You’ll be much happier.

Pain isn’t all about a physical problem. It is shaded by our emotions, or energy level, or degree of happiness. If the underlying problem cannot be remedied, controlling other factors will help you find ways to deal with the pain without resorting to addictive drugs.

Here are 5 proven tips that have helped me as well as my patients deal with on-going pain.

1. Get enough rest. Pain is often a cumulative thing. If you can nip it in the bud, your body can reset to a lower level of discomfort. I learned long ago that I’m not a person who can live on 4 hours of sleep. It is counterproductive for me to even try. Although occasionally I’ll go with 5 or 6, for the most part I must have 7 to 8 hours nightly to function at my best. Sometimes this means taking a nap. Nighttime rest helps the body recover from the stress of life and gravity, but afternoon naps also give the body a boost in several ways. They help muscles relax, and temporarily relieve the pressure on joints and body parts that are subject to the compressive effects of gravity. A nap can refresh the mind, allowing a person to tackle a job with renewed energy. Also, as the body is falling asleep, chemicals are released (endorphins and others) that are natural pain killers and muscle relaxants. You do not have to sleep long for this to occur – 20 minutes will do – but it does require falling into at least a light sleep.

2. Do things that make you happy. I love music and direct a choir, which requires standing continuously for two hours. Now, if I had to wait in line that long for a roller coaster, I’d find myself in terrible torment. I hate wasting my time, especially for something I don’t much want to do in the first place. But as long as I’m engaged in my music, the pain is at bay. Of course, I may collapse into my seat afterward, but an activity that engages your mind in a positive way will not only take your mind off your discomfort, but helps release endorphins as well.

3. Use wraps and supports. Pain medication is not the only answer to swollen limbs, bad backs, and aching joints. In fact, pain is our friend. It tells us that our body requires maintenance or TLC. Sometimes taking pain medicine just hides the problem, like a fresh coat of paint over a mildew-stained basement. In fact, pain medication may disguise a problem, allowing you to be more active that your body can tolerate, resulting in additional damage. It can be a fine line, however, knowing how active to be – a good question to discuss with your doctor. However, little if any harm will result from using splints, ACE wraps, compression hose, or back supports that relieve part of the exertion-related strain on an injured body part.

4. Be careful how you sleep. A pillow under the knees can relieve lumbar strain for a back-sleeper. A flatter pillow can relieve neck strain for a stomach-sleeper. A pillow between the knees can decrease pain related to the knees, hips, or lower back. A carpal tunnel splint can keep your wrist in an anatomical position so you don’t awaken with a painful hand.

5. Find a comfortable exercise. For many people with back problems or arthritis, swimming is the best answer. For others, walking 20 minutes a day helps maintain sufficient limberness to decrease joint pain. Some amount of exercise helps nearly every physical problem, however too much can worsen the condition. It’s really up to the patient to determine what is best, although your doctor, chiropractor, or physical therapist can offer you guidance and advice. For example, I’m sure I have a torn cartilage in my knee, but it doesn’t usually bother me. I can walk 25 minutes without a problem, but at 35 minutes it’s starting to ache. However, it actually feels better if I do walk daily than if I rest it all the time. My back feels better if I do a little weeding, however 10 seconds of tugging my 70-lb. goldendoodle into the car can do me in for several days. Get to know your body, your tolerances and limits, and stop short of what causes pain.

In summary, get up with a smile, try to keep it all day, get a good night’s rest, don’t push yourself unnecessarily, and remember: early to bed, early to rise makes a man healthy, wealthy, and wise.

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Top 10 Reasons Your Blood Sugar is Too High

Are you diabetic? Is your blood sugar too high?

In 20 years of seeing diabetic patients, one becomes familiar with certain patterns of illness and behavior. Any seasoned physician can list a dozen reasons why a patient’s blood sugar may be uncontrolled.

Here is my top 10 list of reasons why your blood sugar may be too high.

1. Your overall calorie intake is too high. For most Type 2 diabetics, the body is still capable of producing some insulin, but perhaps not enough to help you metabolize your food adequately. Cutting your calories back by a third may be all you need to do.

2. You eat foods with a high glycemic index. When it comes to diabetes, not all food is created equal. Simple carbohydrates (sugars, bread, cereal, rice, potatoes, pasta) are absorbed quickly, thereby elevating the blood glucose level quickly – too quickly for the pancreas to respond adequately. Eating the same calories in the form of foods that are absorbed more slowly (protein, fat) will cause less of a spike in your blood sugar.

3. Your body mass index is too high. Having too much adipose tissue within the body makes it more difficult for the body to utilize insulin. Once you’ve dropped your extra weight, you may be able to eat the same number of calories, but have your diabetes under better control.

4. You don’t take your medication as directed. Many patients not only ‘cheat’ by eating a cookie now and then, but by skipping their medicine more frequently than they admit to. Lying to yourself will make it difficult for both you and your doctor to keep your diabetes under control.

5. You’re not on enough diabetic medicine. Although your diabetic treatment probably started with only a single medication, it’s quite common to require additional medicine as time goes by. This may be accomplished by using either a higher dose of the drug you’re already on, or by taking a combination of two or more medications.

6. You don’t exercise enough. Exercise not only helps lower blood sugar, but also builds muscle mass, which utilizes blood glucose more efficiently than fatty tissue does.

7. Your pancreas is wearing out and you need to be on insulin. By the time you are taking three or even four oral diabetic medicines, you are getting to the point where your pancreas is just not able to produce sufficient insulin to counteract your blood sugar. If your pancreas is simply wearing out, there is no medication that can make it ‘young’ again.

8. You have an infection. Some infections are obvious, others less so. Urinary tract infections, for example, frequently elevate the blood sugar, but may cause few other symptoms. Patients also commonly confuse the frequent urination associated with an infection with that caused by diabetes. Any type of infection may raise your blood sugar, from stomach flu, to ear infection, to influenza or pneumonia.

9. You’re taking medicine that elevates the blood sugar. Steroids and diuretics are the two most common drugs that elevate the blood sugar in both diabetics and non-diabetics. Any time you start a new medication and notice that your blood sugar is running higher, you have cause to question your doctor whether the medicine might be the culprit.

10. A combination of several of the above. This is really the most common. Diabetics often eat too much and/or too much of the wrong foods, exercise too little, are already overweight, and are taking multiple medications.

If your blood sugar is too high, the above list is a place to start. Talk to your doctor about what you can do to modify your lifestyle. Diabetic teaching classes are a good idea and can provide you both general information and specific guidance relevant to your particular situation. Once you’ve identified the cause, you’re well on your way to finding an answer.

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