Over the past four years or so, I’ve attempted to make physical fitness more of a priority in my life. What began as training for an upcoming Multiple Sclerosis (MS) Bike Tour has perpetuated to present day. This is something about which I am a bit proud. I’ve also come to embrace the infernal elliptical machine as a necessary evil. A muse most cruel in punishing your body so that you may feel ‘good’. The  elliptical burns energy but as the body recharges, it gives you more than it uses, allowing you to push through the pain it causes the next day.

On one particular day, I found myself watching Joel Osteen on stage in Texas. Mr. Osteen is an evangelical preacher known for extremely large congregations, writing inspirational self-help books, and constantly needing lots of money. In case you’re curious, watching this wasn’t really my choice; my Sunday morning cardio just happened to coincide with a program lineup of fishing shows and infomercials peddling foot-massagers. Pickings were rather slim.

Stripping out the religious portions of this particular sermon, one message that struck me as stunningly obvious (though often forgotten in daily life), was that of positive thinking. You really need to believe that something will be successful before it has the possibility of being realized. Consequently, proving that something can not be done doesn’t take much effort or forethought. Be it a project, or personal goal, how many people do you know who predict colossal failure but accidentally succeed? Unless you’re describing my attempts to bowl or play pool, I would say the answer is very few people.

We’re all a bit apprehensive about trying something new. The pharmacy world has experienced plenty of new in the past half-dozen years. I, for one, have been guilty of wanting to feel ‘safe’. Let someone else take the lead on minor ailments for example; whatever mistakes they make, or third party audit claw-backs they receive, staying on the sidelines until the bugs get worked out is certainly easier. The level of negative energy has been on the rise because the industry has taken a series of hits without enough visible wins. There has been progress, and we do try to highlight the works of specific pharmacists or sites in hopes they inspire others to follow their lead.

The phrase ‘keep your eye on the ball’ isn’t just meant to be a sports reference. A firm endpoint or goal is extremely important, for motivation and for measurement. If the endpoint is carefully developed and visualized ahead of time, the unforeseen challenges that could potentially create hurdles won’t slow you down. Not all negative energy is bad; it may uncover those hurdles earlier and allow for better planning, but just like a battery needs two terminals to create fuel, there has to be a balance.

So, I’m thinking we need to lean on each other to create a positive charge to bring that balance back. Our thoughts need to stay positive during these precarious times. We need to act,  and to charge toward those goals. Collaborative practices may be better developed in other provinces, but are beginning to take root in Atlantic Canada. With that comes a wealth of possibilities for prescribing, monitoring plans, authorizing lab tests, and outcome research.

Direct the current. Stay grounded. Feel the electricity.

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.

A chill is once again in the air. Oak leaves are covering my yard and the daylight savings time in this part of the world has wreaked havoc on our daily routines. Morning feels closer to normal, but suppertime feels like bedtime. I’m getting ready for an off-site flu clinic this afternoon that was requested by a nursing home facility for their staff and their residents’ families. After our last appointment, we get to spend an hour driving in the dark all the way home.

Remember back to the first flu season that pharmacists were trained to vaccinate? We really didn’t know what to expect in terms of public acceptance or overlap with services provided by other health providers. I wrote about it back in 2013 and the temperature at that time was rather lukewarm. Pharmacists were tentative, cautious and, in many cases, reluctant to jump in.

Oh how times have changed.

Each successive year has pushed the practice to new heights. Year 2, the public health office had a better idea of distribution and vaccine supply was more accessible. In the first year, a number of pharmacists hadn’t yet obtained their injection permits. That limitation was abated in year two and pharmacy capacity for accommodating walk-in appointments skyrocketed.

Year 3, all staff were ready from the October announcement. Not only had workflow been adapted to accept appointments and walk-in requests, pharmacists were now out in their communities making it all the more convenient for employers and community groups alike to receive flu shots. Some were in community rooms and schools, meeting rooms and church halls. Loved ones visiting a parent at a nursing home may have been greeted by a pharmacist from a local dispensary.

This year, flu shots seem like they’ve always been part of pharmacy services. Not only are all of the experiences in previous years being repeated, but now the pharmacists are being sought out to provide these clinics. Word of mouth has led to invitations from previously unknown locations. Employer groups have started to recognize the cost-savings gained by having their staff vaccinated at work to minimize illness. Many of them had never received a shot and would not have made a special trip to the physician’s office. Rural communities with minimal medical services have enjoyed improved vaccination rates due to pharmacist injections. Entire families are coming back to see the same clinician, and are able to shop and run other errands at the same time. ‘Done for another year’ is a common quote as another satisfied customer pulls on their jacket sleeve.

The best part is the team pride. Pharmacists impress themselves with the number of shots they can comfortably do by themselves…on a Monday night…on seniors’ day…with an extra doctor in the after-hours clinic. Managers wait to see the latest aggregate counts year-to-date to see how they stack up to previous years. They speak wistfully about the reluctant child that left with a smile, or the administrator that sends chocolates as a thank you for such a smooth workplace clinic. Awareness is at a high, with more people getting their shots earlier in the season, with minimal disruption to their lives.

It hasn’t been a fluke, but rather a testament to our profession’s resilience; we have risen to meet a new challenge, and after 3+ years, the results are nothing short of impressive.

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.

June 17/16 was a historic day in Canada. It was the day that bill C-14, legislation on medical assistance in dying (MAiD) received royal assent.

Picking the title for this post was tough. The pun idea was what initiated the post in the first place, but reading it may imply a lack of respect which is unintentional. My feeling is that Canada took the bold step to acknowledge that dying with dignity belongs in our consciousness and in how we care for those suffering the unimaginable. Now that this step was taken, and the discussions have occurred, there is no putting the toothpaste back in the tube. Providing patient care in this setting is a marked departure from anything most of us have been involved with in our careers. We are trained to be exacting in our standards and level of detail to prevent patient harm from dosing errors or drug interactions. Recognizing what was always viewed as the most extreme degree of harm as holistic patient care is not an easy feat.

It’s no surprise the debate was prolonged. The subject of death in any form is an extremely sensitive topic. It’s never supposed to be a planned event, and when it is, it’s associated with tragedy and unanswered questions. There is now a provision in the criminal code for an individual to seek assistance in ending their personal suffering on their terms without penalty to themselves or the healthcare providers involved in carrying out those final wishes.

In Nova Scotia, the regulations make clear the pharmacist’s involvement. In my opinion, the document is transparent, and is well-written. Should our team be approached with a request, we’ve discussed our comfort with the sourcing and dispensing of the medications (some of which we’ve never actually dispensed in retail). We understand our role in the process, and those of the physicians and the nursing staff. Still, when the request is actually made, it’s difficult to predict the emotions we will feel…and that’s perfectly okay. I’ve spoken with colleagues that have been approached and they describe the process as extremely collaborative and supportive. In the lead-up, it’s all about following the protocol: receiving the orders, collecting the medications and associated supplies, labeling the kits, and arranging dispensing to the responsible physician. It’s usually only after the required notification is received that the gravity tugs a little stronger.

The CBC published an article in May of this year with a province by province snapshot of the developing guidelines based heavily on the Supreme Court ruling in the case of Carter v. Canada in Feb 2015. All had defined criteria for eligible candidates, and all outline ‘effective referral’, a clause requiring any health professional unable to provide service themselves to ensure that it is received. Not everyone will be comfortable with medically-assisted dying and we respect those who decide not to participate. Since that point, there have been additional provisions and court challenges that deem the laws too restrictive, so the conversation is far from settled.

In closing, I don’t usually like to provide opinions on controversial topics. We are a community of mostly pharmacists and complementary health care providers, meaning one opinion is one voice, and no more or less important than that of a fellow pharmacist, nurse, or physician. I have been asked, and to me it really comes down to the individual making the request. If they were my loved one; a spouse, a sibling, a parent and they were suffering helplessly, would I wish for them to have that choice? Would I wish to have that choice should my health decline to the point where comfort measures are the only form of therapy available? As many times I’ve replayed the arguments, I seem to always settle on ‘Yes’.

If you have not already done so, please read the decision and the MAiD materials before you are called on to respond. Whether you participate is a deeply personal decision that can not be made lightly. History will never be undone, so we all need to be at peace with how we move forward and evolve with this change.

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.