In pharmacy school, I cringed every time my professors told me clinical experience was the only thing that would explain the difference between Patient A getting therapy X and Patient B getting therapy Y. What is meant by clinical experience? There is a whole chapter on this topic in DiPiro’s “Pharmacotherapy,” and there are published clinical practice guidelines. Evidenced-based medicine abounds, so how can it only be personal experience that determines the best course of treatment for a patient? So, dear reader, believe me when I tell you that it is with much chagrin that I admit that clinical experience is, in fact, a real thing. In practice, I can see therapy being “off” without always having a clear idea of the issue at first glance. I joke with my technicians that my Spidey-sense is tingling. Sometimes the alarm is unfounded. More often than not, a minor detail needs to be clarified before it is appropriate to dispense to the patient. But sometimes, that sense identifies a nonauthentic prescription order that a less experienced practitioner may have missed.
Is medicine a science and therefore measurable? Or is medicine more abstract like art? The practice of medicine has been referred to in both arenas. As a pharmacy student, I absolutely detested being told that I would know, through clinical experience, that treatment option A was superior to treatment option B. There was no written guideline to back it up, but it would be accurate. Now, 10 years out, I can absolutely say that clinical experience is something I use every day without thinking about it. And if it is a thing that makes me a better practitioner but is not concrete, how do we measure that?
So what is clinical experience? In short, it is what separates a student from a seasoned practitioner. Sure, exposure is part of the curriculum, but not all patients are textbook examples. Part of that is actually job security because artificial intelligence cannot wholly replace a seasoned practitioner, especially for our more obscure cases. But how do we teach knowing when to run every test in the book and when to say it looks atypical but should just run its course?
Clinical experience is understanding that guidelines are just that, a guide, a framework to help focus your practice. Not all patients are going to be cookie-cutter duplicates that fit neatly inside the lines.
My favorite explanation of this phenomenon involves music. It has been said that the Beatles were not necessarily better musicians; they just spent more time practicing. It has also been said that 10,000 hours of practice makes you an expert. With a 40-hour work week, that translates to just under five years. But even with all that time practicing, if you ask John, Paul, George, and Ringo to play Bohemian Rhapsody, it will not be as good as Freddie Mercury doing vocals for Queen. This follows with any medical specialty; the practitioner will not be as good at it if they do not do it all the time.
Clinical experience is weird in some ways because it is less a tangible skill and more second nature. While writing this article, the best analogy I can come up with is that clinical experience is a balance. It is something that is learned through both practice and exposure. But some people are naturally better at it. I guess then this balance is something that can be taught, because children learn to walk every day. And patients who have experienced strokes attend physical therapy to remaster these skills.
How do we give this clinical experience to our less seasoned practitioners? Part of it is that they don’t know what they don’t know. So, share those clinical pearls or institutional knowledge when you come across them, even when they may seem insignificant. We don’t know what is unknown, and it has to be expressly pointed out. When working with pharmacy students and new practitioners, I make it a point to try to verbalize my thought process as much as possible when I come across things that I know I learned by experience. This is not to say that there is only one way to do everything and we don’t want new ideas. Innovation is definitely needed in medicine. But there is no need to reinvent the wheel continually. We can all work together to empower the next generation of clinicians.
So, what clinical pearls do I incorporate into my everyday practice? The biggest would be that I rely on the word of patients about their care, but I understand that they are not always the most reliable narrators. In short, I trust but verify. I also rely on my support staff. I can’t catch everything, and I need everyone working at the top of their license. One of the biggest tenets of pharmacy is that medications are to be used for a legitimate medical purpose. Generally, in community practice, it is assumed that legitimate use is true until proven otherwise. However, as a seasoned practitioner, there are specific medications like oxycodone immediate release 30 milligrams or promethazine with codeine that I assume are not legitimate until proven otherwise.
But it is more than the ability to catch fakes or more quickly understand that the sound of hoofbeats, in this instance, means zebras instead of horses. Clinical experience comes from exposure. It comes from time put into the practice of medicine and should be valued and appreciated. So, students, I know it’s rough to get the answer wrong because you didn’t know more than the text that was provided to you. But know this: keep practicing. One day you, too, will have a Spidey-sense that tingles. And then you will sense the right course of treatment between seemingly identical options.
What clinical experience pearls of wisdom can you share?
Emily Wetherholt, PharmD, BCACP, lives in Schaumburg, Illinois, with her husband, three active children, and dog. She is passionate about advancing the cause of pharmacists everywhere, serving on the Illinois Pharmacist Association Board of Directors. When she isn’t advocating for pharmacy, you can find her exercising with her Fit4Mom friends. Dr. Wetherholt is a 2022–2023 Op-Med Fellow.
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