Dr. Likhitha Tadituri on Patient-Centered Pharmacy Care and Hypertension Awareness (Part-1)

Dr. Likhitha Tadituri: Sure. I’m a PharmD graduate and completed my degree in 2022 from Visakhapatnam, Andhra Pradesh, where I also did all my schooling and college. Right after graduation, I was drawn to clinical pharmacy because it focuses on personalized and evidence-based medicine. I joined Care Hospitals as a Clinical Pharmacist and began exploring everything related to clinical pharmacy. After evaluating different hospitals and their clinical pharmacy roles, I felt Care offered the best opportunity. I’ve been working here for two years now, and I believe I’ve gained solid knowledge and skills.

As a Clinical Pharmacist, my primary responsibilities include checking medication compatibility, a process known as medication reconciliation. We also perform prescription audits to detect and prevent medication errors, raise awareness among the responsible staff, and ultimately enhance patient safety, which contributes to overall treatment quality. Our role involves medication management, including handling narcotics, high-end antibiotics, and other critical drugs. We also manage the hospital formulary. At this point, I feel quite well-equipped in the field of clinical pharmacy.

Dr. Likhitha Tadituri: Absolutely, I understand your concern and appreciate your interest. You’re right— many PharmD graduates, especially from North India, don’t get to work as clinical pharmacists and are instead limited to roles in clinical trials.

The first step is doing solid background research and setting clear goals. It’s important to know what you want, so your interests align with your job. During the last few months of my internship, I was very clear that I wanted to work in clinical pharmacy for at least two years. Initially, the field may not offer a great salary, so it’s often passion over paycheck. But I chose it knowing that, and I don’t regret it.

I evaluated several hospitals and their offerings. In many hospitals in North India, the clinical pharmacist’s role is minimal— often just doing prescription audits. Sometimes even the pharmacy dispensing staff handles these audits. There's no specific clinical pharmacist role or training.

Let’s say you’re given a prescription audit tool with certain parameters. If there’s a therapeutic duplication, many just tick "yes" or "no" without truly understanding what that duplication means, why it matters, or how it affects patient safety. That lack of understanding leads to poor practice.

However, hospitals accredited by NABH usually have more structured and defined clinical pharmacy roles. NABH is a strict accreditation body that mandates effective implementation of clinical pharmacy practices. That’s one key factor I considered when choosing my workplace.

Regarding clinical research— it’s different from clinical pharmacy. Clinical research involves roles like clinical research associates, site inspectors, and principal investigators. We have a clinical research department in our hospital too, but it’s managed by professionals with an M. Pharm background. Clinical pharmacists focus on medication management, while clinical researchers study medications through different trial phases.

I’ve been involved in a few studies myself, though I can’t disclose the names due to confidentiality. So yes, clinical pharmacists can contribute to clinical research too.

As for equipment, it depends on the hospital’s standards. In NABH-accredited hospitals, all equipment is maintained properly, and multiple committees oversee quality and safety. At Care, we have a Patient Quality Assurance and Safety Committee that looks into clinical audits, medical records, biomedical equipment, and more.

However, I’ve also visited a NABH-accredited hospital where guidelines weren’t being followed— water was leaking from AC units, and there was no proper staffing. Eventually, NABH withdrew its accreditation. So, students must research and choose hospitals where their goals align with the job role and standards are maintained.

I hope that answers your question. Let me know if I missed anything.

Dr. Likhitha Tadituri: That’s a universal experience— not just in pharmacy, but in many fields. We study one thing and end up doing something else. During my six years of study, we focused heavily on pharmacology and pharmacotherapeutics. We learned about drugs, their mechanisms, side effects, how they interact in the body— all of that.

But when I started my job, the first thing I saw was an Excel sheet. I was asked to enter data, and I thought, "I wanted to avoid math, that’s why I chose BiPC— now I’m doing formulas in Excel with VLOOKUP!" It was hard at first, but I adapted.

During my internship at a government hospital, we worked side-by-side with MBBS interns. We handled emergencies, rotated through departments, wrote case sheets, took calls, and monitored patients and medications. But even with that experience, when I joined Care, I still had to learn new systems and workflows.

That’s why I chose Care— they at least had programs aligned with what we studied in medication management. Still, the transition from theory to practice was challenging.

And like you said, even after an internship, we’re still taken as trainees when we join a new role. That’s because academic training is different from real-world hospital operations, whether it’s in clinical, industrial, or hospital pharmacy.

During the IPC panel discussion, I raised the same concern— we study one thing, do something different in internship, and yet something else in the job. If we already know what we’ll be doing in our jobs, why not align our training accordingly?

Instead of just shadowing doctors during rounds, we should train students in prescription auditing and other actual job responsibilities. Our curriculum needs to evolve to include these aspects.

Also, we spend hours studying subjects like pharmacognosy and writing pages in exams, yet they have little real-world application. That’s something that needs rethinking.

Dr. Likhitha Tadituri: In simple terms, hypertension means elevated blood pressure. A normal blood pressure reading is around 120/80 mmHg. When it consistently rises above that range, it’s called hypertension.

It’s known as a silent killer because it often doesn’t present any noticeable symptoms. For example, a migraine causes headaches, and arthritis causes joint pain— but hypertension shows no obvious signs. Many people don’t realize they have it until they experience major cardiovascular events like a stroke. That’s why it’s so dangerous and earns the name “silent killer.”

Dr. Likhitha Tadituri: I started observing this during my internship itself, when we dealt with patients directly. Age is a major risk factor. Additionally, alcohol consumption and smoking contribute significantly. Sometimes, it is genetic. Poor lifestyle habits, such as eating junk food and consuming too much salt, also play a role. This is why it is important to go for regular blood pressure checkups. Regular monitoring helps us detect any increase early on and ensure it is under control, thereby preventing hypertension and major cardiovascular events.

Dr. Likhitha Tadituri: The right medication depends entirely on the patient. Not every medication is suitable for every individual. That’s why we have different classes of antihypertensives. We assess the patient’s specific condition and, based on that, prescribe the appropriate class. Factors such as age, gender, and existing health conditions influence this decision.

Dr. Likhitha Tadituri: We perform what is called medication therapy management. This involves counseling patients thoroughly. We ensure they understand the importance of taking their medication on time, explain the reasons behind it, and inform them about possible side effects of missed doses, which we call dose omission. We also assess drug compatibility, especially in patients with comorbidities. For instance, if a patient is diabetic or has thyroid issues, we adjust the dose accordingly. If target blood pressure levels are not met, we modify the dose or switch to a different medication. In cases where patients cannot afford a particular medication, we recommend affordable and equally effective generics. This is the core of our role as clinical pharmacists.

Dr. Likhitha Tadituri: This is actually very personal and interesting. It happened at home, with my father. I'm thankful for being a clinical pharmacist because I was able to help him at a critical moment with just a change in his hypertension medication. My father is hypertensive and also has diabetes. He had undergone a fissurectomy surgery and was in Pune at the time, on Atenolol 50 mg. After the surgery, he started feeling very anxious and uneasy. He called me and said, “I think I’m about to die. I feel extremely anxious and stressed. I feel like I might have a heart attack.”

I told him to calm down, drink a glass of hot water, and send me a list of his current medications. When I checked the list, I saw Atenolol 50 mg. Based on his symptoms, I suspected a hypertensive episode. Given the anxiety he described, I thought an Angiotensin Receptor Blocker (ARB) would be more suitable. Atenolol, a beta-blocker, is good for reducing aortic pressure, but it does not address stress or anxiety well, particularly when angiotensin may be a contributing factor.

So I suggested Telmisartan 40 mg instead. I told him to go to the pharmacy immediately and get the medication while I booked a flight to be with him. Initially, he hadn't informed me about starting Atenolol because he didn’t want me to worry or leave work. He assumed it was a simple surgery he could manage alone. After taking the Telmisartan, his blood pressure stabilized.

Later, we visited his consultant, who appreciated the decision. He said, “You made a smart choice by identifying the issue and selecting the right class of antihypertensive.” I think I will always be proud of that moment. It remains one of my greatest professional accomplishments.

Dr. Likhitha Tadituri: This is a very important question and something every PharmD graduate grapples with. Let me break it down. As you said, the typical cycle involves a doctor prescribing, a pharmacist dispensing, and the patient taking the medication. But clinical pharmacists are the ones who connect all these roles. We serve as the bridge between departments. You can think of us as the connecting link who ensures smooth coordination between doctors, nurses, pharmacists, microbiologists, and others.

We are the ones who deeply understand medication. Wherever the medication travels within the healthcare system, the clinical pharmacist should be present. So no, I do not believe the current system is enough. Every patient and every prescription should go through clinical pharmacy consultation. Each prescription should be reviewed to ensure treatment is both safe and effective.

Let me explain further. A doctor prescribes and moves on. The nurse may be confused about which brand to administer if multiple options are available. Sometimes, they are unsure about the correct route of administration but may hesitate to ask for clarification. Pharmacists, on the other hand, focus on turnaround time — dispensing the medication as quickly as possible. In that rush, detailed counseling is often skipped.

This is where clinical pharmacists come in. In my father’s case, he was seeing a general surgeon who advised him to continue the same BP medication post-surgery. There was no cardiology reference. A surgeon cannot be expected to know the best choice of antihypertensive in such a scenario. But a clinical pharmacist can step in and assess the patient’s condition, comorbidities, and medications to make informed decisions.

We also assist nurses in selecting appropriate brands, understanding dilutions, and administering medications correctly. We work with microbiologists on antibiotic stewardship, ensuring optimal dosing based on sensitivity patterns. We coordinate with pharmacists to make sure patients are properly counseled. Doctors don’t always have time to explain everything in detail. Pharmacists may also be limited by time or training. But patients need to understand when and how to take their medication — for instance, why pantoprazole must be taken before food.

I truly believe that clinical pharmacists are the only professionals who can connect all these dots in the healthcare system to ensure treatment is comprehensive, effective, and, safe.