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Engagement of One

There are things in this world about which I hold strong opinions. Most often these are in the realms of personal development and group change. There needs to be an inherent trust between members of a team. It doesn’t matter how big the team is; two people in a partnership, or a global brand spread across continents all require a level of engagement to truly be effective at executing strategy. There has to be an emotional attachment to the mission and a shared satisfaction to reach a goal.

The most successful organizations understand that their greatest strength is their people. Taking that one step further, it’s the development of those people that set them apart. I could use a collection of cliched buzzwords here that have a tendency to say everything and nothing at the same time, but the gist is this: it’s one thing to have quality people in leadership roles to succeed today, but it’s another to have those same people prepared and inspired to take on tomorrow.

I am confident and proud to work for an employer that takes engagement seriously from the top down. They recognize the differences in learning styles between generations, and have an evaluation process that focuses on behaviors that contribute to the business, trusting that desired results will follow. I currently feel that I’m valued, and have mentors looking out for my best interests personally and professionally.

So how does one engage another person or group for a common goal? Job satisfaction means different things to different people, so one approach is to try and understand what motivates and rewards different groups.

A quick Google search brought me to this document discussing staff development from none other than the United Nations.

The link is a fairly easy read, but the content is nevertheless fascinating. The title is: ‘What Matters and How They Learn’ and breaks down the generation gaps in the workplace. I’ll let you have a skim and then we’ll continue the post. I’ll wait for you here…

(Interlude music)

So the groupings themselves: Baby Boomers, Gen X, and Gen Y comprise the vast majority of the current workforce. There are some Traditionalists, but their number is declining into retirement. By grouping generations in this way, commonalities emerge around the fault lines. For example, I fall near the tail end of the Gen X timeline, meaning that I may share a similar value set as a 50-year-old colleague with respect to being goal-oriented and self-reliant. At the same time, there are flickers of the Gen Y group that I recognize as well; when it comes to sociability and collective action, I completely embrace that culture in the workplace.

[As an aside, one of the distinctions between Gen X and Y as written in the document of Techno-literal vs. Tech-savvy. One needs step-by-step instructions and the other finds technology intuitive. If I was able to start a blog, but have no idea of any advanced features, does that make me advanced-techno-literal?]

So, we know the workplace is comprised of blended learning styles. Training should therefore contain elements that appeal to most workers. Gen X apparently respond well to graphics/design and brevity of training materials. Gen Y wants to learn when and where is comfortable, and being connected online is very important to them. The key is knowing the audience, and it takes a significant investment of time to learn how to relate to the individuals. Once that emotional attachment is established, you begin getting back more than you put in. You challenge one another and learn together. On a personal note, the occasions that I am wrong tend to be the most rewarding experiences in the end.

One final point I’d like to make is that there are many tools or devices being used for engagement, be it team-building exercises, group dinners or retreats, in-house competitions, monetary rewards, surveys or even one-on-one meetings. What tends to get missed is that engagement starts with people and ends with people; the tools are not the answer by themselves, nor do they have an endpoint. When used by someone who is already engaged, any strategy has a chance to reach others who may in turn, pay it forward by seeking to engage their other colleagues.

If you’re like me and truly engaged, that passion will keep you coming back for more, and you’ll have confidence that someone will always be waiting for you to challenge, learn and grow. Take advantage of that feeling and the opportunities that will present, just be ready to create those same feelings and opportunities for others when the time comes.

 

 

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.

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Resolution Follow-up

For the first time ever, I have accompanied my morning coffee with an ample bowl of Lucky Charms. Hey, when you’re on the go you need to eat some kind of breakfast in the morning. If you can’t get excited about sugary marshmallows with the consistency of dense styrofoam floating in your cereal, then I guess that makes you older than six. It just so happens to be the perfect combo of sugar and caffeine to get the writing juices flowing.

It’s a bit overdue, but with the new school year upon us it seems like a good time to revisit my New Years Resolution Post. Eight months is a good yardstick to see if I’m making progress, albeit a completely arbitrary mid-point.

So first off: gym. I’ve been steady at getting there twice a week between shift-work and evenings at home with the kids. Sometimes it’s not the most energetic session, but my cardio is decent and remains fairly stable.

#2) Guitar – Ah yes, my muse. ‘I know chords’ is a sure fire way to let people know you own a guitar and mess around with it on occasion. A small update on that front: since January, a few friends and I have started a garage cover band and I’ve discovered the bass. So to anyone who is interested in how that’s going, ‘I know chords’.

#3) Getting the house in order – There is always stuff to do around the house. By my standards, I’ve been rather slack. My father and I were successful at tearing down the rotten deck on the back of the house. Landscapers have since put in a french drain and flagstone patio. I’ll take that as a win.

Finally, the practice resolutions:

#4) Letting go – I couldn’t be more proud of how my team has developed over the past year, both in cohesiveness and as a visible presence in the grocery store where we work. I made a key hire in November 2013 for an assistant supervisor and even though I had high expectations, she is well on her way to exceeding most of them in less than a year. This has allowed me to delegate many of my dispensary manager duties. Functions including evaluating and hiring assistants, payroll, accounts receivable, team communication, scheduling, budget reviews, and department meetings are all shared between us. I’ve had more time to focus on promotion, special projects, succession planning, and most importantly spending the time I need with patients (occasionally I get an idea for writing as well). It has been a pleasure to watch her grow into the role and flourish.

5) Inviting a prolonged patient interaction – believe it or not, this is still not as instinctive as I once thought. We still have daily pressures that can make conditions for such an interaction difficult. That said, my relationship with many of our patients gets stronger every day. I enjoy seeing them visit and they will ask for me. I recently had an extremely positive interaction with a patient frustrated with his diabetes control. The doctor appreciated my recommendations and now we have a baseline from which to work. Another gentleman with chronic pain shook my hand the other day to thank me for ‘being good to (him)’. One more off the top of my head is a man who underwent surgery for cancer and is doing well. Through a miscommunication with his wife, they accidentally transferred out, then immediately transferred back and apologized profusely.

Overall, have I met my targets? Not all of them, but I’m not beating myself up over it. There are so many positives I can point to that make the exercise worthwhile. We’re positioned better than ever to provide injections through the flu season, we’re providing medication review services to a larger number of patients, and my team is still growing and improving. The biggest winner in all of this is me; they make me better, and I resolve to ride this wave as long as I can.

 

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.

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Thoughts on Technician Regulation

Guess what? There are some marked differences between hospital and community pharmacy.

As the blueprint for pharmacy practice transitions across the country, these two working environments really serve to highlight those differences, especially from a training and orientation standpoint. My personal experience in hospitals over the past decade is pretty much non-existent. I have be on some site visits, and have marveled at how the dispensaries were run. My curiosity led me to question how such large teams can become so consistent in their discipline to complete tasks. Like cogs in an assembly line, if one piece gets shifted or removed, another is prepared to repair or replace without missing a beat. Through my observations and discussions, it has got me thinking: in many ways, hospitals are holding back technician regulation because they’ve been too effective in their integration of current assistants to roles requiring more training and responsibility.

Let’s back up a bit…

Here in Nova Scotia, hospitals operate under different regulations than community-based practice. I’m sure this is true in many jurisdictions. Health professions can collaborate freely within the confines of the hospital and have some flexibility to re-define roles in response to new service demands. Tech-check-tech processes were introduced in the hospital long before it was being used in long-term care or community settings. Specialized technical roles had non-pharmacists in charge of sterile preparations, stat-box management and unit-dose dispensing. Dispensary managers are often former technicians that are now administrators, developing and enforcing policy and procedure, while overseeing site-specific training modules that may require upwards of 6 months to complete.

This has allowed pharmacists to spend more and more time in clinical, collaborative practice and minimal time in the actual dispensary. Many full-time positions are entirely clinical in nature, opening the door to take full advantage of approved expanded scope services (i.e. – lab test requisition).

Therein lies the rub: technician roles have been leveraged so well that regulation doesn’t appear to have the same dramatic impact on hospital technicians as it would in a community setting.

As a community pharmacist in both retail and previous long-term care environments, I can see the potential in the investment towards tech regulation to free up pharmacist time. The main difference is that we need the regulation in place to take advantage of some of the opportunities before us, where pharmacists aren’t the ones who primarily verify a completed prescription or compliance packaging, and instead can spend more time injecting, reviewing medications, and documenting interactions with patients. Hospitals were able to integrate those functions without the formal regulations in place, and are thriving as a result.

In closing, although it’s taken a long time, regulation is finally here. There are excellent people in pharmacy assistant positions that are stepping up to support the pharmacy profession. The glass ceiling is cracking and is primed to shatter. A new profession, with new leaders being recognized as the professionals they are, will push us to the next level.

 

 

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.

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The Payback of a Little Charity

A couple weekends ago I hopped on my bike and pedaled close to 100 km in my 4th MS Bike Tour.

The distance is one thing, and the need for a good pair of padded undergarments always provides ample fodder for tour volunteers and non-riding supporters. This year turned out to be one of the best yet, though very different than my previous three. This difference was for reasons that didn’t occur to me until afterwards.

We rode from the Windsor Exhibition Grounds to Acadia University under a comfortable, cloudy sky. After the first day, my new team settled into the residences at Acadia for an afternoon of swimming before the annual banquet. After dinner, we ended up back in our rooms to have a wobbly pop or two. During the evening, the dozen of us took turns explaining our reasons for being there. All were insightful and inspiring, and topics always involved family members or close friends with multiple sclerosis. Some were diagnosed at a young age and deterioration ran the gamut from slow (decades) to rapid (<2 years). You may get the impression that I can sometimes be rather long-winded, and you would probably be right. I’ll share the condensed version here for the sake of brevity:

Thirteen years ago, a mentor and friend began an MS Bike Tour team in support of a longtime colleague’s wife. I was aware of the team, but saw it as a cause with which I didn’t connect. I knew little about the disease, the progression, or the treatment options. Year after year, along with her wife, she would invest time in planning fundraising events, theme designs for the team picture, and seeking corporate donations. Each year she would ask me and I’d hedge. Perhaps I had plans the weekend of the event, or I didn’t have a decent bike, or even worse I was in terrible shape and wouldn’t survive it. It all changed when I found out my aunt was afflicted with a mild form of the disease. As kids, sometimes playdates with the cousins were cancelled for unknown reasons. Come to find out that her fatigue would persist for days or weeks, and she would be unsteady on her feet. At this point, my excuses rang a bit hollow and I made up my mind to commit to the cause.

2011 – The Cycledelics were celebrating their 10-year anniversary on the tour. Our black t-shirts were printed up as tuxedos with red-bow-ties. We sported top hats on our helmets and twirled canes into the banquet hall. I was 30-lbs overweight and my cargo shorts didn’t have a lot of padding. On the way back, I couldn’t stand to sit back on the seat and couldn’t walk for the better part of a week, but I made it.

2012 – We had a cowboy theme this year: plastic ten-gallon hats on our helmets and rodeo shirts. We rode into the banquet on hobby-horses. I bought a better bike, some padded shorts, and lost 20 lbs. Raised more money than the previous year and I wasn’t the last rider on the course this time.

2013 – ‘The Swarm’: dressed as bees, with bright-yellow t-shirts and electrical-tape pinned in place for stripes. We all wore headbands with antennae and big-round shades. This time the banquet attendees had us buzzing around their tables. All in good fun. I felt I was in the best shape of my life to date. I had trained for the 3-months before and my riding partner and I flew through the course. Even managed to do the extra 38 km loop on day 1 for good measure.

This brings us to 2014, and I had since taken on the pharmacy manager role at Sobeys. I was connected to a store manager in town who had also ridden on the tour and wanted to start up a corporate team. We brought 5 stores into the fold and pooled our riders fundraising efforts with a goal of $10,000. We had store BBQs, a poolnight, and two paintball afternoons. We had casual days for staff, we sold MS oatmeal cookies from the bakery, and sold 50/50 tickets. We went on to raise almost $14,000 for the fight against MS. Not too bad for year #1.

2014 MS Team

I was apprehensive leading up to the ride. I had hoped to see members of my former team but wasn’t aware of where they were staying or who would be attending. This new team was a hodge-podge of riders from different stores, and none I knew well. My fears were allayed once we arrived at Acadia. My former team members were two floors down in the same residence and we hung out exactly the way we did in previous years. I even ran into a friend I had not seen in well over a decade cutting fruit in the cafeteria (Nice to see you HB). Our team was the newest of the three corporate teams on tour and managed to take home some hardware for our efforts:

 

Corporate Hero Award 2014-MS  Team Cheer Award - 2014-MS

Our cheer was to the theme of Gilligan’s Island. Not everyone in attendance got the reference.

 

So why was this the best one yet? I didn’t train as much, and had a pair of dead legs 3/4 of the way through, so that wasn’t it. I doubled my previous personal best in fundraising, but that wasn’t it either.

This was the first tour that I felt like a leader. New riders would come to me for their preparation and itinerary. MS Society staff called me by my first name. Most importantly, I had a new appreciation for the passion and dedication shown by the staff, volunteers along the route, and the 330 riders who participated. People were giving of their time and energy to help others not because they were forced to, but because they wanted to. It’s contagious;  we spent the whole night planning fundraisers for next year’s event. I know I’ll be recruiting some of you to join me on the 2015 ride.

When it’s all said and done, we really did pull together to make a difference in the lives of those suffering from MS. Drum-roll, please…

MS Tour Total 2014

Makes it all worthwhile, doesn’t it?

 

 

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.

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Quick…To the Lab!!

I can’t help it. Every time I see the word, ‘lab’, it evokes images of smoke, arcing Tesla coils, boiling green flasks, and crazy Christopher Lloyd hairstyles.

When a pharmacist in A community setting refers to lab values, they’re usually asking a patient directly to ascertain whether all the bases have been covered. More often than not, the patient does not know what they’ve been tested for, let alone the actual LAB values. Fortunately, With our newly expanded scope of practice, coupled with the incoming drug information system, these awkward conversations with patients will soon come to an end.

As clinicians taking on broader responsibilities, performing lab requisitions is one more unknown that we need to navigate. There are numerous applications that scream for pharmacist intervention. A1C and INR are at or near the top of the list, but I suspect that many other practical uses are waiting to be discovered.

In speaking with a close RN friend of mine, she thought pharmacists having access to lab values was a wonderful idea, but brought up a number of pitfalls that we’ll need to consider when we officially begin:

– Shall we be authorized to request all tests, or be restricted in some fashion through a permit system?

– The cost of a test.

– The appropriate monitoring frequency for a given test.

– Are tests to be used to aid diagnosis or strictly to monitor existing therapies?

– Who owns the test results and the right to intervene if necessary?

– What is the lab capacity in a given jurisdiction?

 

There is a fear that once able, pharmacists in community settings will want to create baselines for all patients. Some of these will be absolutely reasonable and will fill gaps in patient care. Others may be open to interpretation and potentially create conflict with other care providers. I offer a couple of examples from my time in long-term care. At the time, the Nurse Practitioner and I routinely spent a couple of hours reviewing 50 patient charts at a time ahead of meeting with the nursing staff and medical director of the 200-resident facility where we worked.

1) B12 – We performed a focused medication review on patients receiving vitamin-B12 injections, noting that many did not have blood counts requested since their admission years prior. Out of a dozen patients, we were able to discontinue six of them that showed upwards to three times therapeutic levels. Although the long-term toxicity was not much of a concern, it was one more injection to track (and thereby eliminate for the time being) and in two of the cases, blood counts had not rebounded due to a relative iron-deficiency that had gone unchecked.

2) T4/TSH – As per accreditation standards at the time, we aimed to have a complete medication review performed with 6 weeks of admission. Often patients discharged from hospital were relatively stable on their current regimens, and needed time to get acclimated to their new surroundings. Usually at this time, we determined monitoring parameters for bloodwork and obtained baselines if the file was incomplete. During one session, we decided to review all patients taking thyroid hormone and discovered that some residents had not been screened in years. Many were frail and drawing blood was difficult, but we didn’t see that as a reason to stop monitoring. Almost all required a dosage adjustment and corrected some previously unexplained symptoms due to hyper or hypothyroidism.

It was not always easy. One of the stumbling blocks was the impact to workflow on Thursdays. Blood was normally collected in the mornings and shipped to the lab in the early afternoon. This of course added some extra work that wasn’t always easy to plan. Another was the attending physician’s apprehension in having us discover an issue that was missed or ignored due to a plausible reason. He would then need to possibly defend his/her action/inaction to us, nursing staff, and perhaps even the resident or their families.

I guess it will be another learning experience for all of us, but I look forward to the day when we can ask and receive a clearer picture of an individual’s health from a lab test. I’ll even bring my own Tesla coils.

 

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.

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The Necessity of Grief

I consider myself a lucky man. I have a good career, a supportive family and all of my needs (along with some wants).

I attended a funeral service this week in support of a friend who lost someone very close to her. It made me realize just how lucky I’ve been; I have never had to go through the tragic loss of someone so near and dear to my heart. Yes, there have been people I’ve known and respected who have passed that have left a hollow feeling. Acquaintances, people I’ve met through my career, and mentors have been taken before their time. All of these experiences have left me searching for solace. Before a life can be celebrated, there is a profound sense of loss among family and friends.

A dear friend has helped to put the experience into perspective:

Here are some things you should think about:  It can take people years to get over a profound loss. I am only now, 2 years later, just getting back to the old me (prior to the loss of a close friend). If a person hasn’t experienced that type of grief, it can be hard for someone who HAS experienced it not to feel bitterness towards them.Fortunately, after you get through all that, you are able to look back at the life and smile. I can now talk about her without crying and can recount the hilarious tales of our adventures together without breaking down. It comes as a huge relief but it took years and lots of therapy to get there. Basically, the death of someone really close to you truly messes you up for a long, long time. The grieving process is necessary but at times it can feel like it’s crushing you. They don’t teach us about this in school.

As pharmacists, we build relationships with people and their families. We stand beside them through diagnoses, hospital admissions, surgeries, lengthening medication lists and the associated emotional roller-coasters. When the inevitable happens, you may find out through an obituary, but more often than not, a family member builds up enough courage to bring a plastic bag full of medications that they won’t be needing anymore. Suffice it to say the interaction is brief and as they walk away, it can be accompanied by a stunned silence in the dispensary for a moment or two. Even if the news is somewhat expected, the mood changes instantly.

Perhaps a card, or a bouquet follows. In the subsequent interactions, there may be a change in their demeanor, or new prescriptions to fill. We may only be a small part of their lives, but an important support during a difficult time.

Circling back to the comments above, I would have to agree that school does not really address the subject of death. Granted it wouldn’t be easy to do unless units or lectures were introduced addressing therapeutic considerations at end-of-life or in palliative care programs. It wasn’t until I had been brought in to consult at my first nursing home before I really understood Do-Not-Resuscitate orders and medicating for comfort. I do try to apply that experience when interacting with patients in their homes as they prepare for what lies ahead.

Knowledge may be power, and as pharmacists, we’re trusted because of our knowledge. When folks are at their most vulnerable, they may lean on that trust to listen, to share, and to help make sense of an emotional crisis that isn’t supposed to make sense. Everyone grieves differently, and you don’t have to know how to help or what to say. If you want to help, you will.

 

 

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.

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Honouring a Colleague

On these pages last September, I referred to the unfortunate passing of one of our own pharmacy community. Karen Zed was someone who has had an impact on my practice for my entire career. Working with the same company since before graduation, her visibility within the profession as a mentor and advocate was evident through her work with our Nova Scotia regulatory body as well as the Dalhousie College of Pharmacy.

My working relationship with Karen developed over the years. I worked first as a student, then as a relief pharmacist, before transitioning into management roles. With each step, I was reminded of the respect she commanded from her peers. We may not have always agreed with her opinions, but they carried weight and inspired healthy debate. Although I did not know her well on a personal level, it was obvious how much she thrived when precepting students, interns, or anyone with an interest in pharmacy. She was staunch in defending her practice site as a true ‘real-world’ experience; you learned by doing, by making mistakes and fixing them, all with an eye towards the patient above all else.

In the 10+ months since, I have been lucky enough to be appointed as secretary of our pharmacy alumni division at the university. With Karen being taken away so suddenly, there was an appetite to celebrate her contributions on a grander scale. That is why the Dalhousie College of Pharmacy Alumni Division (DUCPAD) is pleased to announce the annual Karen Zed Spirit of Community Pharmacy Award. This award recognizes students who share Karen’s passion for community pharmacy as both a place to learn and to provide caring support for those in need of our medication expertise.

Details on how to donate to the award fund may be found in the June 2014 issue of the DUCPAD Dispatch, or by following the link below:

http://alumniapps.dal.ca/giving/giving.php

Rest in peace Karen. May your spirit endure in the next generation of community pharmacists.

 

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.

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Spring Has Sprung…Finally

As I was out mowing the grass today, I began to think back to the lawn metaphor I used to describe why I write this blog. I do it to help make my own environment a little bit better. Hopefully I can help others do the same.

As a tip of the mortarboard to new graduates entering the profession across the country, I’d like to re-visit this metaphor one more time.

I give you: new practitioners – the grass seeds of pharmacy.

Are you still reading? Work with me on this.

 

Grass seeds start out as tiny things but with huge potential. They require water, sun, and a little TLC to germinate and grow. We may need more of them in rough patches: brand new lawns, places where planters have been or where weeds have gotten out of control. However with some nurturing and protection from the elements (birds, digging animals, intense sun, etc.), they can grow into a beautiful, resilient lawn.

New grads are just like grass seed. And not just any seed, let’s get the coated seed that supposedly absorbs ten times the water and grows anywhere. They too hold a large amount of potential but need some coaching and moulding, especially at the beginning of their careers, to truly become great practitioners. New graduates are ready to make their mark on the profession. Bringing new energy and a certain naivete to current practice environments can be a real advantage to filling clinical service bare patches.

If your new clinical leads are faced with too much exposure without proper coaching, they too will burn, and it may take awhile to reverse the damage. I’m sure most of us have performed a med review and stumbled upon a concern justifying a recommendation to a primary care provider. Unfortunately, these recommendations aren’t always well-received. I’ve heard horror stories where physicians refused to share lab values or provided snippy replies to reasonable recommendations.  The most extreme case involved a patient taking advantage of minor ailment prescribing in Nova Scotia. Unfortunately it ended with the physician threatening the patient by asking them to choose between them and the pharmacist. This kind of salvo can be a blow to even the most seasoned clinician, let alone someone who is green (pardon the pun). On the bright side, these cases are becoming exceedingly rare as other professions recognize benefits of the new contributions we can make.

Coaching and support doesn’t need to come only from the manager or supervisor. It should be a complete team approach, with every clinical success, from identifying new ways to help, to appointment bookings, to follow-up being shared and celebrated.

So here’s to a greener lawn! Grow a robust clinical patch. Your yard, and your work environment will be a source of pride to share and show off. It’s amazing what a little water can do.

 

 

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.

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The Anatomy of Error

Quick show of hands…How many of you are perfect? 

Everyone? Well I agree you are all perfect in your own ways but I really need to get this post started.

Okay, how many enjoy messing up?

 

There are very few people out there that don’t have a fear of failure. For every task there’s a plan, and for every plan there’s an action. The action produces results. This oversimplification leaves out one crucial element: expectations. Every plan has an expected outcome, or at least it should. Some plans are doomed to fail. They fail if they aren’t addressing the task, are too complex, or don’t have realistic expectations worked into the plan itself.

Even with the best plan, the best people, and solid execution, mistakes still happen. In the world of pharmacy, we refer to these mishaps as ‘medication discrepancies’, forerunners to the dreaded ‘medication incidents’. After new pharmacists have completed their degrees and written their licensing exams, everything becomes so real. There’s an professional institution to uphold, and standards are high. Every slip of concentration may result in a missed interaction or an inappropriate dose that holds potential for harm. If that mistake comes back to you, panic can set in:

Will the person sue me?

Will I be disciplined?

Will I be fired?

All of these questions rattle around and try to defeat your resolve. By my estimation, new grads take upwards to 6 months after licensure to begin feeling comfortable with their style of practice. They feel less paranoia about making mistakes and maybe don’t need to quintuple-check the things they do.

Mistakes happen to everyone. They always will, and the human condition will manage to attach a negative emotion to a mistake each time one occurs. The feeling of letting a patient or teammate down is bad enough, but most of the time, you’re letting yourself down. That’s the one that really hurts.

I have had my share, and I’ve counseled others who have been unlucky enough to experience an error fallout. My approach is summed up by the legendary John R. Cash:

You build on failure. You use it as a stepping stone. Close the door on the past. You don’t try to forget the mistakes, but you don’t dwell on it. You don’t let it have any of your energy, or any of your time, or any of your space.

Johnny Cash

 

For someone who wrote well-known songs such as ‘Ring of Fire’, and ‘Folsom Prison Blues’ (neither bringing to mind the imagery I’m looking for in this post), the above quote is perfect for any situation.

To become a health professional, there has to be a genuine desire to help people, and ensure no harm comes to them. Mistakes that may result in harm are not intended by anyone involved. Discipline is usually reserved for instances when someone willingly sabotages a system, or is neglectful in their maintainance of a system. Once someone has accepted that mistakes happen, addressing the circumstances that led to the error will help prevent it from recurring.

For some, that personal failure is a lot to handle. It can create anxiety, it can create doubt. At the beginning of a career or at the end, that heightened awareness sometimes works against you and more errors result. Why? My theory is that the focus sharpens on the aspect of the process where the error occurred. Wrong strength on a medication? Next 100 times, we’ll be extra vigilant to confirm with the doctor. Missed interaction? Like a branding iron, that drug-drug combo will be etched in the brain forever, and similar ones will be heavily researched from that point on. By dwelling, and putting that extra effort to prevent a similar mistake, perhaps a wrong doctor is missed, or the label instructions are vague. It can spiral, and owning mistakes is stressful at the best of times.

Circling back to the genuine desire to help people, it’s important to remember that we help hundreds of people every day. Errors are and will be a part of life, but if we own up to them and help minimize any impact on those affected, we can show that we care. If the uncomfortable interaction causes us to put a guard up, it may prevent us from investing ourselves in all of our subsequent interactions. Those other folks need our best as much as the person affected by the error.

With expanded scope responsibilities, we will make errors in new ways. We could misinterpret a lab value, perform an injection that doesn’t go as smooth as we’d like, or prescribe for a minor ailment and later find a missed red flag. If we stay true to ourselves and our capabilities, we will use them as stepping stones to constantly improve the quality of care we provide.

Dissect the anatomy of an error. Understand it. Control it. Learn from it. Move on from it. You will be better for it.

 

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.

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My 60/40 Rule

Every job has its drawbacks. That’s one reason it’s called a job in the first place. If work always felt like play, we would have reached a utopian state where we made a living doing only what we loved to do, be it counseling, writing, or playing golf. We wouldn’t need to worry about pesky things like ‘stress’, ‘pressure’, or ‘tact’ when dealing with others.

On the other side of the same coin, destroying your mental health for the sake of advancement or financial gain doesn’t strike me as a worthwhile endeavour either.

My personal rule is simply 60/40: three days out of any given work week need to be rewarding in some way. The 60/40 split is hardly cutting edge, it’s used for investing, relationships, and describing rear-seating in newer sedans. In my case, it serves as a guideline for contentment with my job, and a personal threshold to feel I bring value to my current role. Projects I may take on, people with whom I interact, and results I can help generate all contribute to that ever-elusive job satisfaction. Those other two days? Maybe it was a terrible night’s sleep, or one of the kids is sick, or perhaps I run into the wrong customer that day (see ‘No-Win Situation‘). Regardless of the reason, I can accept the not-so-fun 40% if I can freely enjoy the other 60%.

I used to work a lot of overtime. Through travel commitments and a seemingly endless cascade of crises to manage, a 55-60 hour work-week away from home happened more often than I want to admit. In addition, when I was home, my mind was still focused on that next task, and the incoming urgent email. My workaholic tendencies were born out of a fear of failure, and it wasn’t that I always loved the work, it’s that I didn’t know how to effectively remove myself from it.

It took awhile for my brain-hamsters to illuminate the lightbulb. My work-week was woefully out of balance, but instead of stepping back to evaluate my routine and maybe learn to appreciate the more mundane facets of the job, my approach was to add an extra day or two and fluff it up with things I wanted to do. I was able to re-establish my 60/40 and it worked…for a bit. With a wife and two kids, I wasn’t making it any easier on them or me. Change was necessary and ultimately, a relief.

Truth be told, there was plenty I enjoyed about that time, and with very few regrets. I’m still an ambitious person with a strong passion for pharmacy, but I needed to step back to rediscover my own personality and how my unique skill set can best contribute to the profession. If I hadn’t, there would be no committee work, no successful foray into advocacy, and no PharmAspire. I feel that my professional life is much richer, and my corner of the world is much more well-rounded…by more than 60% anyway.

 

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.