Category Archives: Advocacy

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The Term Accessibility: It’s Gaining a Double-Edge

It was a hot sunny Thursday in July and I’m finally starting to feel a bit better. The previous two weeks were a collection of progressive symptoms from dry cough, then wet cough, then sinus block, then pain in the diaphragm, culminating in a wheezy mess with some shortness of breath mixed in. I’ll save the vibrant descriptions of the sights and sounds emanating from my lungs, but let’s just say that both my condition and demeanor were quite phlegmatic.

I was just recently contacted for a new family practitioner. My former physician retired in November of 2022 and the waitlist finally reached my name. Unfortunately the intake appointment was not for another three weeks, so the next Monday I decided to research booking an appointment at a local after-hours medical clinic. Looking at the government website, it listed nine locations in the province. In checking the hours of each, I discovered that only ONE (1!) had hours listed for the day, but it was an evening clinic from 5-9pm, located over an hour away, AND you had to pre-book an appointment. A pharmacist-led walk-in clinic no doubt would have resulted in a referral, so I decided to hit the nearby hospital emergency department.

I’m very fortunate to not have been in need of any medical intervention during these past few years. As such, navigating the current system as a patient was foreign to me. With all of the changes introduced throughout the pandemic, and a severe shortage of family practitioners, I was unsure of whether my situation warranted a spot on the emergency department triage list.

I rolled the dice and parked in the 4-hour parking lot, hoping it’d be enough time to at least get through the preliminary assessment. Hearing horror stories of 9-hour waits meant I’d be moving my car at some point. There were three steps: 1) Triage, 2) Registration, and 3) Wait for your name to be called. The first two were fairly quick, within 45 minutes, and I settled in for a lengthier stay. At this point of the morning, the monitor hanging above the department conveyed there were 25 others sharing the waiting room, with an additional 73 patients already within the unit. There were plenty of people in and out of the doors, but my perception was that there were very few in visible distress. It did appear that like me, many were orphan patients that needed attention or follow-up for chronic conditions, and had very few options other than wait their turn.

I received an ECG (requiring a wee bit of shaving) and chest x-ray before receiving a diagnosis of atypical pneumonia and a couple of prescriptions. The whole process took about 3 hours and 45 minutes. When I got back to the car my thought was that I made out like a bandit. I may have been classified as a 3 – Urgent on the Canadian Triage and Acuity Scale but to be in and out under four hours? I had plenty of time to drop off my orders at the pharmacy for filling and be home in time for supper.

Then it occurred to me…

Why don’t pharmacy practitioners enjoy a similar grace? Why is the on-demand nature of pharmacy services becoming such a flashpoint for patients and practitioners alike? With burnout reaching a fever pitch, methods for protecting pharmacy staff should include mechanisms that give a similar control over triage and capacity to address patient needs. Inevitably, this has led to sombre reflection on one of the singular tenets of pharmacy practice for as long as I can remember: accessibility.

The pharmacy profession has long touted accessibility as a calling card. For decades it was understood that pharmacists were relatively underutilized; as drug experts, there was significant education provided towards pathophysiology, medicinal chemistry, pharmacology, and evidence-based disease state management. Although diagnostics were not a focus, inter-professional collaborative practice allowed for plenty of exposure to assessment and documentation. Pharmacists achieved a degree of comfort with many common self-limiting ailments and the savvy to make strong referrals for medical interventions beyond their scope. The public were initially wary, and advocates really pushed for pharmacy to shoulder more of a primary healthcare burden.

When the pandemic hit and services became increasingly scarce, once again pharmacy professionals did their best to position themselves as a trusted point of contact for patients in need. Whether it be a long-time patient needing renewals on their diabetes medications, or an orphan patient with uncontrolled hypertension needing an adjustment in therapy, pharmacy staff did their absolute best to intervene and monitor those conditions.

In fact, they were so successful in delivering that care, the public quickly recognized the value and convenience, which began to affect conventional dispensary workflow. Investing and dedicating staff to provide these clinical services has come with a new suite of challenges, with two of the major ones being 1) the transition from a ‘walk-in’ to an appointment-based practice, and 2) inconsistent / confounding funding models for service provision. Yes, pharmacists are legally permitted to perform a range of prescribing activities, however many are subject to conditions or restricted to specific scenarios to be eligible for coverage. Depending on your province or jurisdiction, the management of clinical problems may differ somewhat.

A current example is the recent statement from the Government of Canada regarding the shortage of combination pain-relievers containing codeine and oxycodone. Due to a manufacturing disruption, these products are in short supply for the next few months. As acute pain relievers, these medications are used as part of recovery regimens for minor dental and surgical procedures, as well as critical options for breakthrough relief for many patients with chronic pain syndromes. On the front lines, pharmacists are feeling the brunt of this problem; patients are upset and nervous that their therapies will be disrupted. Potential solutions could include therapeutic substitutions and prescription adaptations within a pharmacist’s scope, and in many cases those services are now expected. At issue is the underfunded time spent to provide these services, which make it exceedingly difficult to plan ahead and increase capacity within existing pharmacy practices without taking substantive risks.

So the question remains: how does the profession stay accessible whilst controlling that same accessibility? Although I am apprehensive of the idea of using a weapon to illustrate a concept, it stands to reason that there is inherent danger in how the issue is handled. If this accessibility ‘sword’ isn’t properly balanced, it could risk bringing harm to the patients (less access to timely services) or to the practitioners seeking to provide quality care (more access but without proper supports). It’s delicate, but we’re well on the way to finding the new sweet spot.

It will take practice and discipline, but we are more than up to the challenge. Of course, changing behaviors and perceptions is a huge undertaking, however the pharmacy community has proven itself to be incredibly resourceful and resilient. We will continue to lean on each other as we grow as clinicians. I strongly believe the solutions we need are all here within the community. In a future post we shall endeavour to review some strategies and generate even more discussion.

Make no mistake, in a short time, we will become proficient in wielding this accessibility sword and achieve that proper balance. The healthcare system will benefit, the pharmacy teams will benefit, and the public will benefit most of all.

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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Chased By The Dinosaur – Part 2

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.

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Staying Current

“I give you three years.”

During my internship in 2001, life seemed to be just beginning: I was engaged the previous fall, and after completing our clinical rotations, my fiancee and I set off for New Brunswick in search of budding careers. In our brand new black mica Mazda Protege and brains bursting with the latest clinical evidence, it was an open road and the world would be changing because of our passion for pharmacy.

My preceptor was quite the jokester, with a quick wit and impeccable comedic timing. He enjoyed needling me on my ability to recite DINs and got a kick out of how I would make recommendations featuring obscure molecules from my lesson notes (“No, benazepril would not be the first ACEI I’d go with in this case.”) Sensing my eagerness, he did his best to remove the training wheels that guided me through 4 years of schooling. Part of that education was preparing me for the realities of retail pharmacy. He would opine on the relationships built with fellow pharmacists in other settings of work. He implored me not to be discouraged when upset customers took out their frustrations on me even when I was trying my best to help. Most importantly, he stressed that with so much ready information available everywhere, I should not be expected to know every detail or answer, but rather I needed to be an expert on how to find that answer.

His theory is that there is a three year window to transition from a purely academic approach to that of a practical, patient-focused clinician. During this time, the environment where someone works will influence the breadth of knowledge being applied. Pearls you use regularly are cemented, and those that are less frequently seen tend to get blurry. For example, a clinical pharmacist in a specialized hospital department may be much more equipped to handle questions in their field than someone with community experience. Be it paediatrics, transplantation, HIV treatments, cancer therapies, or infectious diseases, immersion in those areas will bring confidence that decisions are being made with the best and most current available evidence. Alternatively, community pharmacists may have more general knowledge of prescribing habits in their service area, new molecules or brands on the market, and comfort in assessing minor ailments for their patients. Pharmacists in advocacy and regulatory positions would presumably be more in tune with government relations and challenges facing other healthcare professions. The point is that it’s called a practice for a reason; to stay current, one needs to have access to the best information and the opportunity to apply that information consistently.

So here I find myself, just passing my third year anniversary in my current position. My last full-time exposure to dispensing was during a stint managing a long-term care pharmacy. At that time, I felt I could hold my own in the world of geriatrics. I was comfortable with eschewing guidelines that had little applicability to institutional settings, and really challenged my thinking when it came to weighing benefit vs risk in the frail elderly population. At the same time, many of those patients had pharmacare, or were admitted from hospital with restrictive formularies. This meant that many designer drugs, even new therapeutic classes, came to market well before I became aware. Other than in hypothetical case-based discussions, I have not had to face clinical questions from patients about the management of contraceptives, or most minor ailments for that matter, for extended stretches of time. If I’ve fallen behind, then it’s on me to correct any deficiencies.

The only way to improve is to recognize these gaps and work to address them. I’ve recently re-introduced myself to the wonderful website hosted by the University of Saskatchewan College of Pharmacy and Nutrition. It features a plethora of guidelines and algorithms to help support minor ailment prescribing. The next step will be to explore real patient cases to shake off some rust. As for where to start, I have always enjoyed studying renal and infectious diseases, so it’s time for me to get back to the basics and hunt some new pearls.

In order to stay current, I guess you have to go with the flow.

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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New Year’s Inspiration: Greener Grass from the Canadian Pharmer

One of the original pages posted to this site, on March 3, 2014 was a revelation for me. A simple introduction to the global online community would serve as a starting point for everything I had hoped PharmAspire could be: a place that always looks for the silver lining; a forum to celebrate the profession that has provided so much satisfaction in my personal life as well as my career.

In reading that piece again, I am reminded of my inspirations for starting the blog in the first place: circa 2012, the profession was in the midst of changing in radical ways. Practitioners everywhere were skeptical and calculating what modifications they would need to make to keep current. As a leader, I was often sought out for guidance when there were feelings of uncertainty, or for some, full-blown anxiety. When I realized that the lack of confidence in my own abilities was preventing me from having good answers to clinical questions, or otherwise leading others to jump into the deep end of the pool, I needed to make some major changes in my career path. Joining my peers back on the front line was refreshing and extremely engaging. We worked through those clinical questions, we pushed to the established boundaries of our scope, we redefined dispensary layouts and roles. I learned so much every day from those who had previously viewed me as the subject matter expert and that experience was liberating. The blog was a byproduct of my personal journey, and a celebration of those who continue to inspire me inside and outside of my chosen profession.

“Pharmacists thrive in many sectors of the healthcare system. When significant changes come about, there are almost always negative aspects associated with the transition. The old cliche, ‘the grass is always greener on the other side’ starts to resonate and folks look for new pastures, and new challenges. However, many of us have roots in the sector in which we work, and if our experience can influence how the changes are implemented, it can only help to sand down the rough patches. My goal with the blog is to inspire and motivate pharmacists. Wherever you may be, grab a bag of fertilizer and make your own grass greener. Strengthen those roots and get excited about sharing new experiences.”

I believe these words to be just as significant now as they were back then. When we face significant hurdles borne from the economic realities of the pharmacy industry, we lean on each other to vent, to comfort, to overcome the negative emotions we hold in that moment. I am honoured and blessed to have met and developed deep, long-lasting relationships with patients and practitioners alike, all of whom keep pushing me to be the best pharmacist I can be.

Today, I would like to introduce you to Michelle Stewart, a community pharmacist in New Glasgow who has found her platform to effectively communicate with her peers. The Canadian Pharmer is a weekly podcast that tackles cutting edge changes in the profession, notably in our home province of Nova Scotia. In 2020, Nova Scotian pharmacists have seen their scope expanded to offer assessments on contraception, herpes zoster, and uncomplicated UTIs. In addition, a number of services are now publicly funded for all residents, and not just registered beneficiaries of the public drug plan.

Michelle has been outspoken and tenacious with her vision for pharmacy. Where I have spent time trying to draw a service distinction between a clinical assessment versus the act of prescribing, her only response was to bring it back to the bigger picture; ‘It’s all about care.’

She’s absolutely, 100% right.

Patient-centred care is taking a holistic approach to patient outcomes. The patient is the one affected by disease. The patient is the one who changes drug therapy, or changes eating habits, or exercise routines. The patient is the one who perceives the benefits and risks of such changes. We are a resource to aid decision-making. Our assessments are an opportunity for us to use our expertise to inform a patient of potential options, which may or may not include prescribing. Our ability to communicate effectively the menu of options allow for the best informed patient decisions, and in turn, the best chance of a positive patient outcome.

Michelle is a master at demystifying the idea that we need to be special in some way to properly wield the new powers granted by this new expanded scope. What actually makes us special is our individual nature, and the resulting relationship we have with our patients and colleagues. The expanding scope of pharmacists is not intended to dump healthcare work on our plate as a series of rote tasks or administrative liability. Rather it is a clear recognition that we are best-positioned to perform these tasks. We are trusted. Our hesitant, exacting nature is one of the main reasons that we are entrusted with these ever-expanding roles. The Canadian Pharmer is helping us learn to trust ourselves.

Give the podcast a listen. You won’t be disappointed! In fact, I’ll let Michelle kick things off by introducing herself…

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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Musical Replay

Back in the summer, I had written a post regarding my experience in musical theatre https://pharmaspire.wordpress.com/2019/06/11/i-am-fyedka/ and comparing that to how we introduce a narrative to the public with which they may not previously have been familiar. We are relied upon to guide those looking for our assistance, and to do so at their own pace.

Just as the pacing of movements and line delivery is important to the flow of a theatre production, it’s also crucial that body language and counseling are carefully practiced to be effective. I can recognize my own failings in both personal and professional settings. When explaining healthcare concepts to the public, my comfort in pharmacy has sometimes caused me to use medical terms at inappropriate times, or moved through topics too quickly for others to fully grasp.

My reasons for revisiting this topic is actually a combination of my last two posts: the reprisal of my role in Fiddler over a weekend in early November, and the inspiration of Behind the Post where we were orienting a number of new pharmacy team members to our company. Since my personal journey directly contributes to how I carry myself as a professional, my working life is influenced heavily by the relationships I’ve forged inside and outside the pharmacy world.

I was honoured to be recast as Fyedka in another run of Fiddler on the Roof, produced by the Stage Prophets, a theatre company affiliated by the St. Joseph’s Roman Catholic Church. During the initial run in Wolfville, a town about 45 minutes from where I live, we asked a Jewish Rabbi from Halifax to bless a production steeped with strong religious undertones. In doing so, it brought many people together of different faiths, to learn traditions and help understand love as a shared, underlying value. A partnership ensued with the Beth Israel Synagogue and the show was relaunched in Halifax with the help of a volunteer team of over 100 people. It was a marathon to prepare, but was worth every moment.

After almost 4 months, the cast was brought back together. We knew the show, but the stage had a totally different shape (proscenium vs thrust), meaning we had to rethink every entry, exit, body position and the direction of our actions when delivering dialogue. Some things worked well, maybe even better than the original venue, and some things didn’t. They needed to be modified or removed altogether. Putting some thought into many of these aspects, I attempted to apply some of what I’ve learned into improving our experience behind the pharmacy counter. For instance, if you are a relief pharmacist at a new location, there are plenty of similarities:

  1. You know your professional responsibilities and the rules you are required to follow. There needs to be structure to ensure a consistent performance.
  2. The layout of your work environment may seem familiar in some ways but require adjustment to your routine. Think pick-up and drop-off. Is there an island workstation? How is the staff positioning within the space?
  3. Costumes and uniforms are the same, but some roles are modified, or those playing the roles have changed. For instance, some pharmacy sites have technicians, others have cashiers depending on staffing needs.
  4. Using available props that have been tailored for the workspace. In theatre, the size and shape of canopies, background set pieces, doorways, etc. need to be customized for the best viewing experience. In pharmacy, this is akin to having different counters, balances, or various automation to perform the work. Some sites have basket systems for their clinic rooms, others have mounted drawers.
  5. Expecting the unexpected – even with the best laid plans, in live theatre, or live pharmacy, there is always a chance of a mishap. Whether the sound system goes on the fritz, the timing of a musical cue is off, the third party communications go down, or the drug delivery is late, we need to have strategies in place to regroup and refocus for the next interaction and the next user experience.

At the end of the day, you are still expected to perform at a high level. After all, the audience member, or potential patient, may not know anything about what they will see prior to passing through the doorway.

The impressions we leave are the difference between a simple transaction and the start of a life-long relationship.

 

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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Behind the Post

Sometimes inspiration comes from the unlikeliest of places. A few of my teammates were holding an orientation for new pharmacists recently. The audience was a mix of those graduating that previous spring along with pharmacists with multiple years of experience. Some had been assistants, students and interns with us prior to their degree and were comfortable with much of the policy / procedure discussion foist upon them. Others were new to our organization and unfamiliar with the structure.

We took our turns hosting half-hour blocks in our office training room. This space has a quirk of sorts; there is a 2-foot square pillar not quite in the middle of the room, but close enough that when seating employees it needs to be taken into consideration. On quite a few occasions, we had to remind each other to ‘come out from behind the post’ because we could hear the message clear as day, but the view was obstructed to some members of our group. This was usually rectified with a comical slide-shuffle step about 3 feet to the left followed by a chuckle break.

It did get me thinking about pharmacy in a different way. For the longest time, pharmacists were known as being good soldiers, practicing patient-centered care and asserting themselves in their comfort zones. We were (and still are) among the most trusted health professionals but admittedly not very aggressive when creating awareness and parlaying our value into enhanced services. I do see a shift happening with every step into government relations and other benefit partners; the rhetoric is more disciplined, pharmacists across the country are more emboldened, and we are realizing that it’s okay to attach monetary value to the healthcare gaps we are more than capable to fill.

So now that our message is stronger, and it’s being heard in different forums. Under-serviced rural communities, affiliated walk-in clinics that are challenged due to physician staffing, and provincial government regulators are urging pharmacists to provide accessible and timely care to their residents. As the recent valsartan and ranitidine recalls can attest, the current system of contacting primary physicians for recommendations has become overwhelming and potentially leads to patient uncertainty and inevitable care gaps.

Pharmacists more than ever need to step out from behind our posts and put that face on those services we can provide. Provinces are expanding scope in the realm of prescribing, including more minor conditions to diagnose and treat, initiating therapies based on diagnostic criteria, and allowing better access to lab testing results. College programs are converting to entry-level PharmD programs which further remove the pharmacist training from the actual technical dispensing process.

We also can’t do this alone.

The role of the regulated technician is also expanding. They are now able to witness OAMT cases, and chatter about their capability to learn injection technique is growing louder. More and more dispensary operations are realizing the immense value of the role to proactively problem-solve. Their technical accuracy is on par (and in some cases may even be superior) to that of a pharmacist. Our assistants are owning dispensary processes like compounding and batching compliance packaging. They tend to be a main point of customer contact and are practicing patient-centered care like never before.

Helping people is why we do what we do. Being more visible will command the attention we deserve, but we may not even realize we’re being obstructed. Have a look around your practice environment; can your audience truly see you?

 

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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Driving In The Rearview Mirror

Full disclosure: I am a NASCAR fan. Watching ‘stock’ cars from multiple manufacturers that are designed to look identical, driving counter-clockwise on an oval track for three hours has burned many a Sunday afternoon in the shed. My dad and uncle have been fans for decades, watching Dale Sr. go from a villain to the most beloved driver the sport had ever seen. When their father, my grandfather, passed in 2000, all we did to grieve was talk about racing. That connection has stayed to this day.

Among the jargon thrown about during a telecast about tire pressures, wedge, stagger, downforce, etc. there is a lot of attention paid to driver mentality. How fit they are to withstand the heat, and how level-headed they stay driving an ill-handling race car. Near the end of a race, when the stakes are high, drivers usually get more aggressive and bump into one another. The leader is taught to ‘hit their marks’ on the track, meaning they have reference points on the track to keep them in the right lane, or where to brake and speed up in and out of the turns. If the car had been fastest up to that point, it’s often due to some luck added to a whole lot of consistency in racing the track conditions versus the other competitors.

Of course, if you’re trying to go for a win and someone is making gains on you, that’s virtually impossible to ignore. The attention starts getting divided between those marks, and defending against the competitor behind you. The closer they are, the more attention is spent on the road in the rearview than up ahead. This is called ‘rattling the cage’ whereby the driver chasing is waiting for the leader to miss their mark and make a mistake. They may drive into a corner too quickly and lose control, or pick another lane that blocks the chaser even though their car doesn’t work as well.

We are not immune to this in the pharmacy world. When the pressure is on, we have the tendency to start looking over our shoulders at what others are doing and how they are reacting. Nobody wants to repeat mistakes and we take great pains to learn from the past experiences of ourselves and others. We need to be mindful that if we stop leading or innovating, and are consumed entirely with what others are doing, we risk losing the identity and the drive that put us out front in the first place. Healthcare is challenging across Canada. Every profession is expected to step up in ways that were not possible a decade ago: pharmacists gaining access to lab values and making prescribing decisions, Nurse Practitioners are sought after for under-serviced rural outposts, technicians are being recruited at unprecedented levels, and ancillary staff members are being recognized as the core of many medical and pharmacy operations.

I’m proud to be part of a profession that is so progressive, and willing to change to enhance patient care. The road ahead means more opportunity and better collaboration. We know that every mile traveled may be met with obstacles, or criticism, but we would rather hit our marks than be turned into the wall because we’re not paying enough attention to where we want to be.

 

 

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 Next You

“I want to be the next you.”

Having a student say that they want to be like you is a simultaneously shocking and humbling thing. My summer student saying this to me made me realize we often go through our careers unaware of the impact we have on our colleagues.  I’d like to take a look at what makes a good mentor and why.

Demonstrate a positive attitude and be a positive role model.

I remember working as a 4th year pharmacy student in 2010 with a relief pharmacist and thinking “wow!  I’ve never seen anyone do that before” and “that’s how I want to practice.” I watched him first introduce himself to the patient, then tell the patient how nice it was to meet them before proceeding with the medication counsel.  As mentors we need to model the behaviors we want to see.

Exhibit enthusiasm for the profession 

Are you still enthusiastic about your career? Do your co-workers look up to you?  If you love what you do, it will be contagious. Not only can we have positive impacts on our customers, we have a strong influence on those with whom we work daily. We can make a difference!  I sat in a training room this week and listened as a pharmacist recounted stories about her practice.  It was evident that she loves her work and her enthusiasm was contagious!

Value ongoing learning and growth in the field

As mentors we must not become stagnant in our career. Staying up to date with changes in the profession and with new information will be noticed by the upcoming generation.

When I graduated from pharmacy school pharmacists were not immunizing or prescribing.  Both of these came shortly afterwards and while there was some hesitation at first, I completed the necessary training and sought out resources to prepare for this new opportunity.

Celebrate your career successes and milestones

Have you shared with your mentee how you started your career? This is often done by outlining the steps to take to become successful in a given field.  I started off as a pharmacy assistant and had a great mentor who encouraged me to follow my dream to pharmacy school. After graduation I worked as a relief pharmacist and in interim store pharmacy manager positions.  I set goals for myself and achieved them. You can too!

Be a good teacher / communicator

Effective teachers inspire rather than inform.

Great mentors push your thinking and help you grow in new ways.  I remember asking my preceptors specific questions and being told “to look it up”.  These words caused frustration at the time but I quickly realized it was a beneficial process.

Are you excited to share your knowledge with new people entering the field?  I challenge you to take your role seriously in teaching your knowledge to others.

As mentors we need to model the behaviors we’re looking for in our co-workers.  Don’t expect your team to comply with policies/procedures if you are not willing to comply with them yourself.  Be a leader in the profession.

Is it always easy? No, of course not. But these are some of the attributes a young student is looking for in a mentor and I can promise you it is a fabulous feeling when a young person chooses you as their mentor.

 

 

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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Good Samaritans

There are some amazing people in this world, but they may not be famous or heralded in any way. Every day we wake up to our home and work routines, shuffle off to refill our coffees and catch up on the local morning news (or if you’re in the mood to get fired up, American morning news). There are life stresses to deal with: in naming a few, there may be kids getting bullied at school, finding ways to pay for home improvements, work deadlines that seem impossible to meet, and medical concerns to address. Our orbit often only extends as far as we can practically see, and we rely on others to keep us looped in when our lives may be impacted in some way.

I am certainly, and in some ways shamefully, guilty of taking things for granted and tunneling through life with a large set of blinders. After a surreal week, I am starting to notice little things a bit more. That lady that stops to help a senior pick up a bag of groceries that spilled all over the parking lot. A jogger that helps untangle a child that snagged themselves on a playground gate. A nurse that stops on the side of the road to offer support to an accident victim.

In pharmacy, our jobs are to help people when they’re frightened, or lost, or unaware of resources available. Most of us have a strong desire to apply our knowledge in ways that directly contribute to positive outcomes for our patients and their families. I’m comfortable in a pharmacy setting, and convicted in my approach to problems and their solutions. If you remove my lab coat and lead me out of the dispensary, I still want to help, but may be unsure how.  I would like to help that gentleman broken down in an intersection, but I know next to nothing about car mechanics. I want to aid a friend with financial hardships, but I have limited knowledge about debt consolidation. I want to be a shoulder for someone experiencing tragedy, but I’m not a trained counselor.

What I’ve learned that in the moment, a skill set doesn’t matter. Just knowing that someone is willing to give any part of themselves, even if it’s a reassuring word or simply making themselves available, is a huge help. Perhaps it’s the feeling that you’re not alone allows for a little extra boost of hope. A true empathetic response can really get someone through a dark time. To illustrate this, I’ve included below a brief talk from Dr. Brené Brown, a research professor at the University of Houston.

 

I’d never really thought about the stark difference between the two terms, where one explains the acknowledgement of a hardship, and the other describes what it’s like to personally relate to another’s struggles. To be in the healthcare profession, it can be tricky to be empathetic and remain objective in your decision-making. I feel that balance is what makes pharmacists one of the most trusted professions in the world.

The genuine desire to help can not be faked. Even those days that we’re not feeling at our best, when confronted with a patient-care issue, we always stand up to meet the challenge. Good deeds often go uncelebrated but rest assured, the person needing assistance will remember. If you put the good out into the world, it will come back to you when you need it the most.

 

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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Ascension

ascend

[uh–send]
verb (used without object)
  1. to move, climb, or go upward; mount; rise:The airplane ascended into the clouds.
  2. to slant upward.
  3. to rise to a higher point, rank, or degree; proceed from an inferior to a superior degree or level:to ascend to the presidency.
  1. to go toward the source or beginning; go back in time.
  2. Music. to rise in pitch; pass from any tone to a higher one.
verb (used with object)
  1. to go or move upward upon or along; climb; mount:to ascend a lookout tower; to ascend stairs.
  2. to gain or succeed to; acquire:to ascend the throne.

 

Death and taxes may be the two absolutes in life, but I’m going add a third: learning. Every day we spend on this Earth is another day of life experience. Some of it in the form of the international news, some of it a horrible emotional or physical trauma, and lots of it intentional self-improvement.

As I age, this body of mine doesn’t always seem to rebound as I remember. Mentally? Well some would tell me my brain also does not rebound as it should. In some ways that is true, but it makes for a rich experience and a good story. There have been personal interactions, both loving and in conflict, and professional situations that have played out in the hundreds. There has been travel to take in culture abroad, and DIY projects of which I could be proud (through trial and error and lots of YouTube videos). I do feel that I’ve grown an enormous amount, and happy to share what I’ve learned with anyone who seeks advice. I also crave advice from my own mentors.

In fact, one of my favourite parts of reaching middle age is enjoying the confidence and credibility to mentor others, but also recognizing how much I don’t have figured out. I find being both a mentor and mentee very rewarding. Every situation, every piece of knowledge, every resulting emotional reaction pushes me further up the mountain and is potentially useful to someone else.

A feeling of pride to discover a high-risk drug-related problem and potentially save a catastrophic health event? That lesson may be helpful for a colleague. Up we both go.

Warning signs that go unheeded in a broken relationship? That lesson may be helpful to a close friend or family member. Up we both go.

The anxiety of preparing for PEBCs and the expectations of your first day as a newly licensed pharmacist or technician? That lesson is certainly helpful for those experiencing for the first time. Once again, an opportunity for us both to improve ourselves.

Speaking of first times, those will continue to happen whether you like it or not.

As professionals, we experience many firsts in the course of our careers. Things like our first counsel, the first time a patient asks for us specifically to address their concerns, our first medication incident and how destroyed we all felt at the time.

Even after nearly 20 years in the profession, firsts are still happening every week. Recently, an individual arrived at the counter to request a naloxone kit. I was not dispensing, but was onsite for an unrelated administrative matter. I was asked to perform the counsel. Having undergone the training, I had not yet had the opportunity to put that knowledge in practice. A younger me may have hesitated, but the whole time I had Laura, PharmAspire editor, on my shoulder. She is very passionate about mental health issues and the ongoing opioid crisis. She would NOT let me have this individual walk away without a naloxone kit, so I needed to step up. I reviewed the material once more, took my time to slow a slightly elevated heart-rate, and proceeded to have a positive patient interaction. It brightened my day and boosted me just a little bit higher.

At the risk of sounding smarmy, every day can offer a gift if we choose to accept it. A good friend of mine close to retirement told me the other day that even after 41 years, he still loves pharmacy and is amazed at the constant change. Every day, he wakes up and finds some way to add on to the amazing career he has built. It may be a clinical nugget about NOACs, or a new way to phrase a difficult conversation about a cancer diagnosis. He will miss the chance to use those pearls in a structured setting, and the smiles of all of the people he has helped through the years. Many have become life-long friends.

That is a career I can only hope to emulate. As for now, I can’t quite see his current plateau just yet, but I’m making decent progress of my own.

Another foothold on the mountain.

 

 

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.