Back in Part 1, we took a brief look at the pandemic’s impact on pharmacy and the substantial wave of change we face from primary dispensers to primary clinicians.

This evolution has been occurring over the past decade since medication reviews and minor ailment prescribing were first offered in a number of provinces. With post-pandemic reopening, the difference now is that pharmacists are no longer carrying all of the burden to promote and create public awareness of accessible, pharmacy-driven clinical services. You could easily argue the opposite; members of the public are coming to expect and demand that pharmacy fill gaps in the healthcare system, particularly with assessments and disease-state management. This demand is driving innovation and challenging the very image of a standard dispensary that has existed for as far back as most can remember: a pharmacist in a white coat standing in the middle, surrounded by support staff who are greeting customers and filling orders.

To wit, I am very proud of my company’s latest partnership here on the east coast! It’s a pharmacy model that eschews the reliance of imagery that uses counting trays, pills in bottles or ointment jars to promote pharmacy. Instead the focus is on allowing pharmacy to be available for orphan patients, and better triage healthcare needs. This should help reduce the glut in emergency rooms, decrease wait times for services, and aid in the management of various disease-states.

So with all of this pushing forward, is there any hesitation? Perhaps, so let’s dive in.

First off, I have never spoken to anyone in the profession, from students, to recent retirees in all pharmacy environments, that hasn’t endorsed giving pharmacists increased latitude with respect to clinical decision-making. I have heard plenty of stories where pharmacists did indeed have a better understanding of a patient’s needs but recommendations to a prescriber were either ignored or rejected. When they first appeared in the standards, some held trepidation that they could perform injections or diagnose minor ailments. When the title of pharmacy technician became regulated around 2010, it took awhile for the profession to integrate the role.

Counting my university degree, this marks my 25th year as part of the profession. Relating my introduction into pharmacy practice with PharmD graduates of today is quite the discussion. I do tend to forget how much has come and gone until someone reminds me of something notable. For example, I recall when statins were being hyped in the late 90’s as a game-changer in lowering cholesterol and reducing cardiovascular risk. We learned the mechanism of action of these HMG-CoA reductase inhibitors in lecture. When Zocor (simvastatin) was approved in Canada during 1999, Merck shipped sleek boxes containing foil packs of shield-shaped tablets that served as a conversation pieces in the dispensary. There were a bunch of similar drugs introduced in the coming years and most are still available in generic form today. One notable molecule lost in the annals of time was Bayer’s Baycol (cerivastatin), that was pulled from the market in 2001 due to alarming reports of rhabdomyolysis, a condition caused my damaged muscle tissue releasing proteins and electrolytes into the blood. Another emerging drug class in the early 2000’s were the COX-2 Inhibitors for arthritic conditions. Effective for inflammation but less corrosive to the stomach lining than previous therapies, physicians were handing out samples for Celebrex (celecoxib) and Vioxx (rofecoxib) to patients eager to find relief. Unfortunately, the sheen came off of this therapy class due to evidence of increased heart-related events, and subsequent removal of rofecoxib from the market in 2004. It’s worth noting that these variants were pulled voluntarily. Both classes are still widely used and provide significant benefit to scores of patients worldwide. The takeaway from me was recalling the countless conversations with our scared and/or upset patients that needed to look for alternatives.

Further skipping down memory lane, we reminisce of the days of writing third party credit claims on carbon copy forms and counting pill bottles to manually create drug orders. There was no internet, no email, or laser printers. Every store had an outdated Remington’s reference and CPS versions dating back to the 70’s. Smoking was still permitted in workplaces until the mid-2000s. Older physicians wrote for arcane drug names like Ilosone, Ledercillin, and Doral. We wished that all pills were shaped like Premarin because of how they spread out on the counting tray just right.

The good news is that some things haven’t changed too much:

1. Patients still need us to guide them through the healthcare system and trust us to be their advocate.
2. An appropriate drug regimen can manage disease and significantly increase quality of life.
3. Relationships made within the pharmacy community last for careers and beyond.
4. We still feel rewarded when patients bring their baking at Christmas as a show of their thanks.
5. Mentors are valuable no matter when or where you are on a career path.

The last point is resonant on a few different levels. When I graduated, the world was an oyster. I had a brain chock full of the latest guidelines, all the me-too drug names (brand AND generic) and 15 minute counseling monologues to deliver on each. My preceptors valued my ability to find the best answers to clinical questions, and my eagerness to create algorithms for the staff. They would admit to feeling like dinosaurs; their knowledge was a bit dated, and that we forced them to step up their games. On the other hand, I would marvel at how they would be so relaxed with a cancer patient, or be able to pick out the three most important items on a counseling document. It amazed me at the ease of which interaction risks were contextualized with the history and desires of the patient. Finally, I appreciated when they had the perfect piece of friendly advice for every situation I would encounter.

So now that I am a full generation away from that first shift, I could acknowledge that I’m too far behind, start coasting and risk being eaten whole, but I refuse to throw my hands up in the face of massive change. The work experience gained and relationships forged over the years will serve me better now than ever before. I may offer perspective and guidance to ensure new clinical tools are properly integrated into a struggling healthcare system. The advice that I still receive from my mentors may now be dispensed to the next wave of practitioners. We will complement and support each other on our respective journeys.

For those of us beyond the first leg of our careers, the dinosaur running behind us is fading further behind. The only thing at risk of extinction is the notion that our value to the profession is somehow diminished. Whether you have 5 years, 15 or 50, the quality of patient care you deliver every day will never get old.

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.