Well don’t mind if I do 🙂

Advocacy for the pharmacy profession as a whole is like your favorite cheesecake recipe: there are many ingredients in differing amounts, but you can’t leave one out and expect it to taste right. Unfortunately It often feels like we’re trying to make this cake using only the cream cheese and hoping we can add the rest of the stuff when it’s half-cooked.

There are many segments in the pharmacy profession: community, institutional, academia, research, insurance/benefit providers, government, and consulting (to name a few) and all are required to advocate for the profession. All of these segments are impacted by reimbursement models and changes to legislation, either directly or indirectly. I strongly believe that pharmacists in all sectors want to thrive in the new environment but, as Laura’s recent post on ‘Comfort’ can attest, clinicians need time to evolve as practitioners. One day we were not prescribing, the next day the regulations passed and our whole way of practicing changed. Due to this short transition period, we find ourselves trying to convey confidence to the public while at the same time fending off doubters from other health professionals that feel we’re overstepping.

So polish up your soapbox. I’m sure you have one laying around somewhere. It doesn’t have to be large, or new, or fancy in any way. It just needs to support your weight so that you can stand above the rabble and be heard. It’s up to all of us to support our livelihoods as caregivers in a healthcare system that preys on those who lack vision. Should you have a rewarding interaction with anyone (patient, colleague, peer, another healthcare professional, etc.), share it so that others can begin recognizing their own.

With the flu-shot blitz fast approaching, we will once again be in the public eye. Get yourself ready to look the public square in the eye and show them how effective we can be with our new responsibilities. AND If they want to know a bit more about what we can do, Make sure your soapbox is in the corner…just in case 🙂

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.

This blog is about inspiration and the many forms in which it presents itself. We lost an important colleague from the pharmacy world last week. She inspired many of her students as well as her peers.

She had been a fixture in the south end for well over 20 years and well-known in the community. Her proximity to the university meant that pharmacy students were never in short supply and she pushed them to be strong contributors to the profession. Her passion for teaching extended to the more recent influx of international pharmacists. She was patient and nurturing, allowing them to adapt their styles and lessons from their home countries. The college never hesitated to lean on her to evaluate new entrants and approve their structured time service.

I guess I should explain the title. Before you get the idea that this will devolve into a religious ramble, a few things I should point out as background. Firstly, I was raised Roman Catholic but have not been practicing (and I use the term loosely) for the past 20 years. I may debate and challenge many things about the faith chosen for me, but one thing I DO believe in is the human spirit. Everyone has a driving force that ultimately steers them in the life path they choose. For some, it may be material things. For others, power and control. When someone is known for helping others, it’s never because they are forced to. I had the pleasure of working alongside this individual since 2006 though her name was well-known to me when I started out as a student in 1998. I had lost contact over the past year so when the news hit, memories (as they have a habit of doing) come flooding back. Our last conversation was brief and unremarkable; It was October 2012, and as I recall we both just rehashed our summer vacations before being interrupted by the conference proceedings. So today I found myself looking up and getting lost in thought for a few minutes. If her spirit was floating about somewhere in the ether, I hope she heard my well-wishes.

Karen, may you rest in peace.

http://obits.dignitymemorial.com/dignity-memorial/obituary.aspx?n=Karen-Zed&lc=3758&pid=167056856&mid=5673497

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.

I’ve been asked on more than one occasion what actually goes on in this neurotic, high-strung, circus of a mind I have. If only it was a Cirque de Soleil installment as opposed to a low-rent, 2-ring version.

Today, I’ve been contemplating the role of the community pharmacist and working with the public in general. We say “the customer is always right” in business time and time again. But at what point do we delineate between a fast-food joint and a professional environment, a product-driven service and a cognitive one?

It shouldn’t come as a surprise that most of us at one time or another have had a disagreement with a member of the public. These arguments can be about pricing, product selection, or communication in general. We try to take the high road as much as possible because it’s in our nature to be helpful. It is also our duty to help patients navigate our corner of the healthcare system. But what if you’ve tried to explain a situation as best you can and there is still no satisfaction? What if all the applicable rules have been followed, the proper folks were contacted, and employees carried out their tasks as prescribed, but still the customer remains unhappy? This is the hard pill to swallow. Once it gets beyond the point of no return and the customer has lost patience and faith that the situation will ultimately be resolved, there are no winners:

Scenario #1) You end up being ‘right’:

Although true, it’s bologna (or baloney depending on the mood). The consumer can now feel ashamed that they made a mistake, and possibly a spectacle in your store. You can puff your chest out and confirm that you are rightful ruler of the pharmacy domain. So what? This individual may no longer feel comfortable seeking you out in the future because that baggage is now part of their experience in your pharmacy.

Scenario #2) They end up being ‘right’ (which is always…see above).

Congratulations, you’ve given them the ammo they need to hold you over the barrel. You may have unwittingly validated their mistrust in your operation and the story will pass on to all of their friends, extended family, and complete strangers they meet on the waterfront. You slice up the humble pie to share with your fellow staff and take any lumps dispensed from the verbal frying pan.

Scenario #3) Reconciliation

Both parties agree that there may have been a possible miscommunication or regret how the situation was handled from their end. Even though this is the ‘best-case’ scenario, the onus is on the pharmacy provider to make any compromise as palatable as can be, since the consumer drives the business. The goal is to avoid them deciding to go somewhere else for a fresh start.

Oh, I forgot the last one:

Scenario #4) You’re both wrong

The line is drawn in the sand at the centre of town, you walk ten paces and turn around quickly only to find the ammo is behind the bar at the saloon. Everyone has a great laugh and reminisce about the happier times when all third parties were billed manually and we had typewriters that never jammed. All joking aside, this does happen occasionally and unfortunately, we lose this one too by virtue of the fact that the consumer has every right not to know better. Whereas we, the experts, have more tools at our disposal to figure things out.

That last phrase is probably the most important of this whole post. Admittedly, I don’t know much about cars, heat pumps, or hanging drywall. I rely heavily on trade experts who deal with these things every day and trust their advice is sound  (ideally while avoiding being ripped off). When the public does seek our services, it’s important to remember that we need to be that trusted expert that offers support no matter the customers’ education level or familiarity with our line of work. It can be frustrating when someone doesn’t know the name of the pill they need refilled, or don’t understand drug plan formularies. In many of these cases, they don’t need a lecture, they often just need someone to work through the issue with them.

I guess when it comes to ‘No-Win’ situations, we can’t be looking to win, only to help. If we help, everybody wins. Pure, unadulterated circus-brain logic right there.

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.

Apparently this is my M.O. Title an article with one word then expand on the word using 500 other words. Whatever, I’m comfortable with that. (See what I did there?)

Anyway, as pharmacists, we are in the business of providing comfort. We have to do so within our own comfort zones. It’s all very “Inception-esque.” How to help our patients to the best of our ability while being comfortable in the act and with the results. It’s a balancing act, a thin line, a dance with heavy consequences if we have a misstep.

Recently, my comfort zone has been stretched with our new found ability to prescribe. Before the new regulations, I always took solace in the following sentence: “let me call your doctor to double check this.” That sentence holds comfort. Call the doctor, have her tell you everything is fine or she’d rather change to drug X. Then document all over town and everything is good. I’ve helped the patient and provided care, all very much within my comfort zone.  Now, we have many other ways that situations can be resolved. We can adapt a prescription. We can substitute one drug for another. We can prescribe for a situation where we would normally have to refer (hello, hemorrhoids).  So, we are now faced with a decision. Do we refer? Do we call the doctor? Do we offer one of these new services? If we are all being honest, we would all love to stay in our previous comfort zone. Call the doctor, refer, whatever. Problem solved, patient happy, move on. However, this would not allow for progress in our profession, nor is it in the best interest of the patient.  So, we expand our comfort zone.

The first time I offered one of these new services, I was extremely nervous. I broke out in a cold sweat, my hands were shaking and it took me 45 minutes to assess my patient and decide that yes, it was appropriate to substitute Fucidin H for Hyderm and Fucidin creams to allow the prescription to be covered by MSI. I was decidedly not comfortable. Like, lost sleep that night, called the patient for the next three days to make sure she was ok kind of not comfortable.

The patient was fine. Her wound healed up nicely. She was thrilled that I was involved in her care and able to get her prescription covered without having to wait to hear back from her notoriously hard to contact doctor. Everything was A-OK.

Since that first shaky experience outside my comfort zone, I’ve had lots of experiences with prescribing and I find myself shaking and sweating less each time. This is a classic sign of an expanding comfort zone.

The moral of the story? Dive in, my friends. Dive in. It will suck the first time. It will be hard. You may not be able to eat your lunch due to nausea. But you will do it. You will provide the patient with comfort even though you distinctly lack comfort at the time. Then, you will look back at the experience and realize it didn’t suck as much as you thought. The patient is happy and healthy and you lived to tell the tale. What you’re left with is a new definition of personal and professional comfort and a happy patient. What’s wrong with that? Absolutely nothing.

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.

Even writing the title made me squirm a little bit.

My guess is many of the readership will associate the term suicide with an event or an individual that evoke deep-rooted emotions. If you’re like me, you’re used to seeing people at their worst: in severe pain after day surgery, coughing up one of those pesky ‘lungs’ due to pneumonia, or being hit with a head-spinning diagnosis along the lines of diabetes or cancer. Unfortunately, suicide is a whole other monster to have nightmares about.

At some point in our professional careers, we will face a situation that none of us want to see happen: a person, -not a patient per se- , but a person is exposing their emotional core and saying in some way that they are giving up. If you already have a relationship with this person, the impact is devastating, if you don’t, I almost find it surreal to think that there’s a real threat that your interaction may make the difference between holding on and following through.

Let’s be fair and say we’re waaaay too hard on ourselves.

Although the threat is serious and real, it’s very doubtful that this person woke up that morning and suddenly began plotting. There is almost always a progression, either initiated by a single traumatic event, or perhaps a caustic home environment that has been chipping the layers away for years. I’ve found myself doing lots of listening, and not able to say very much due to my fear of saying ‘the wrong thing’. Is there really a wrong thing to say? I repeat often that I’m concerned and want to help. I try to determine if this episode is fleeting or intermittent. Have there been previous attempts? How much planning has been done? Have preparations been made? Do they know what kind of support they need? I also make sure they know that my expertise is limited and at this stage, having crisis numbers available to call is often the best  way to connect them to experienced professional help.

My solace, regardless of outcome is that I made myself available to this person in their time of need. Working in community, we pride ourselves on being accessible. When this kind of thing happens, everything else takes a back seat. Working with the ‘More Than Meds’ project http://morethanmeds.com , I find that I am much more composed and realistic with my ability to be a positive light in such black pitch. Even a soft candle may be enough to illuminate the way out of the dungeon; whether I am the right one to make them move in that direction is out of my control, but I’m learning to be okay with that.

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.

http://morethanmeds.com

This is more than just another website with links and resources. It’s more than one or two folks with a really good idea to share. It’s also asking pharmacists to do more than they’ve ever been asked to do before.

It’s a paradigm change in the approach to mental health.

As pharmacists, when we tackle our studies in school, CNS is either loads of fun in 3rd year, or frustrating as hell. Diagnoses that don’t fit patterns, therapies that aren’t well-understood, and a general absence of neat black-and-white boundaries to confine decision-making. It would be great if we could measure objective targets for mental health: ‘You’ve been on citalopram for 6 weeks now and this blood test says your libido level is up to eleventeen mmol/L from a low of forty-threeve”. Alas, all cases are subjective and unique, requiring discussion, education, and support for the journey to improved mental-health. Medications that were once seen as ‘the answer’ are now better recognized for what they are: complements to a patient-centred approach.

A good friend of mine offers a counter-point that deserves mentioning. On the topic of objective metrics, he says:

“Of course I’d argue that for other areas of medicine people look to the surrogates too quickly, being fooled by them as being accurate indicators of “clear sailing” (a good blood test) or doom (a bad blood test). With medications for mental illness it is what the patient experiences that matters. We can get feedback from the suitability of treatment pretty quickly, from symptom management, progress toward personal goals and recovery, treatment tolerance and side effects, etc. You can’t get that from a statin or diabetes medication. You can only hope that you are the one to see the measurable benefit vs. all the others who took it and didn’t need to, or took it and still had the thing they were trying to avoid.”

Having said that, pharmacists are often the first point of contact when patients are seeking help with their experiences and may provide opportunity for early intervention. A recent article in the Capital Beat – June 2013 (http://www.cdha.nshealth.ca/media-centre/news/more-meds-pharmacists-and-communities-partner-better-mental-health) outlined the MoreThanMeds project. Dr. Andrea Murphy, one of the co-founders of the project, captures the opportunity by stating, “Pharmacists are often underused or are not working to their full scope of their practice when providing services for individuals living with mental illness. (They) are well positioned to help individuals with lived experience of mental illness, and especially those who often have difficulty getting the right care at the right time.”

<…the right care at the right time…> This phrase really makes you think. Those with longstanding mental illness will report feeling ostracized, or judged, or helpless. Depending on the day, there may be a brief window of opportunity for an individual to be receptive to conversation. Many days this may not be the case, however knowing the pharmacist is available can help build up that trust.

I’m only beginning this journey, but so far it’s been extremely rewarding to scope out community mental health resources from a consumer point of view. I can’t wait to share my experiences with other pharmacists; we can be much bigger part of the collaborative mental health team in the communities we serve.

I aspire to be More Than…a conventional community pharmacist when it comes to mental health support for patients and families…much more.

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.

Having graduated pharmacy school 12 years ago, once in awhile I like to reflect on the education I received and how that had prepared me for my career.

Problem-Based Learning (PBL) was a novel concept at Dalhousie in 1997. Revamping an entire program from a didactic, lecture-based format, to peer-group learning was radical at the time. Our accreditation was at risk, which meant that if the new program was not approved, we would face the prospect of having a pharmacy degree without being able to qualify for licensing with the Pharmacy Examining Board of Canada. There were frustrations from the student body that ranged from abject fear to unbridled rage. I was pessimistic about it at the time so I placed myself in the ‘quiet observer’ category, ready to latch on to the group that gained the most steam. Thankfully, the crisis was averted and everyone was able to strap in and enjoy the ride.

As someone who primarily learns through audio/visual means, for the first time I found myself relying heavily on others to teach me. At the beginning of 2nd year, there were plenty of times that weaker members of the tutorial group would miss major points or interpret their learning issues to focus on items that weren’t going to be tested (as a chem major, I was repeatedly guilty of this). This method of learning was completely foreign and paired with a nasty procrastination bug picked up around that time, I was woefully unprepared for any examination questions on material that I had not personally read. The good thing about pharmacy content is that units tend to build and expand on each other. The details of a given disease or drug may change, but the theory doesn’t. As examples, once you’re familiar with organ systems or receptor theory, that foundation is used repeatedly for increasingly complicated disease states. Thankfully, after the 2nd year wake-up call, my process began to work its way out and the rest is history.

At this point you’re probably thinking I have no point. Recounting one’s difficulties which change is pretty boring for the most part but that’s the benefit of reflection: to see qualities in yourself or your peers that really started to flourish during those formative years (although they were unrecognizable at the time).

So what did MY school provide for me?

1) Community – A group of 64 budding professionals from all academic and cultural backgrounds. All of us swimming in the deep end trying to keep each other above the water. I’m proud to say that some of my closest friends, some of whom are supporting these writings, are from that Class of 2001.

2) Independence – Personal responsibility to take care of your own learning needs regardless of what others are doing.

3) Team-work – Rotating teams of 8 were required to work through cases. Some groups had good chemistry and some were quite dysfunctional. All required give and take.

4) Public-Speaking – Teaching others and articulating difficult points doesn’t come naturally to many people. The PBL format forces you to  practice your style in front of your peers, and that confidence shines through in day-to-day patient counseling or hosting clinic events.

5) Evaluation Skills – Whether it be the latest glossy study on anti-hypertensives or determining which members of your peer group provide credible information, PBL helped me to ask questions and be decisive in solving problems.

As the program evolves, I am continually impressed by the calibre of students that Dalhousie continues to graduate each year. They are articulate, personable, and don’t fluster easily. Most are well-prepared to absorb and put into practice any feedback they receive on rotations. Most of all, they seem to genuinely value the patient interactions they have.

I’ve made it a pledge to be more involved with the college in this coming year. I hope to be a lab demonstrator for 4th years in the fall, and recently I’ve been appointed to be the Secretary/Treasurer for the Dalhousie University College of Pharmacy Alumni Division (DUCPAD).

The fact of the matter is, the College and the education it provided has given me my career and, by extension, has contributed greatly to the life I lead. It’s time for me to give back and allow future students to share this pride in our school. This pride will foster continuing improvement in the programs Dalhousie College of Pharmacy is able to provide its students.

http://pharmacy.dal.ca/index.php

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.

It’s true. Try as I may, my efforts to find a gripping title meant to lure the reader into literary utopia have been for naught. There you have it, ‘Smoking Cessation’. Full stop.

Today I co-hosted a smoking cessation presentation at work for my fellow employees. There were two people in attendance, so I met the minimum requirement to pluralize ’employee’. Close one there.

Out of approximately 70 employees, half of which are full-time, I was able to interest two individuals into an hour of describing stages of change, discussing coping strategies and re-iterating all the wonderful health benefits of quitting smoking. Four people actually signed up; one bailed at the last minute and another was sick. We had a low-fat meat and cheese tray (har har) and another with assorted veggies that proved to be ever so slightly less popular. It was like an oxymoronic ‘group one-on-one’ session that descended into rambling whenever an awkward pause threatened to become pregnant.

You know what?

It was awesome.

I believe we left an impression on those two individuals. At the end of the session, they had a few more items to think about and some formal perspective on their smoking situation. The presentation was smooth and as always, the discussion generated among the group was invaluable to us as practitioners; we tend to incorporate key comments about successes / challenges of those living the experience into future presentations.

The end realization is that I scheduled and coordinated this event because I wanted to. I wasn’t asked, and I didn’t get any budget breaks or bonuses for its completion.  The fact of the matter is I show up for work every day and see smokers lining the plaza at all hours. Many of these folks have no intention of quitting nor are they interested in exploring the possible options. I certainly don’t begrudge them for that at all. But maybe, just maybe, a few of those folks have really struggled with their attempts to quit and lack any confidence to push through. If I make myself available, and convey that I want to help, perhaps that contact can make a difference.

Here’s hoping the next one, – and yes, there will be a next one 🙂 – , will build off of this and bring the discussion to two more people. If I’m lucky, maybe word of mouth will help the turnout. If I have to do 10 more sessions to help 10 more people, I’ll gladly sign up. As an added bonus, I may even be able to prescribe something for those that ask for help.

I have to say, I’m really enjoying being a pharmacist right now. I hope the ride lasts for awhile yet…

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.