Tag Archives: health professionals

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Hip For a Night

How often do you feel part of something too big to explain in words alone? It’s a sensation; a point in time where everyone casts an eye, bends an ear, and opens a mind to an emotional spectacle only experienced a handful of times a generation.

The Tragically Hip bid farewell to the masses in their home town of Kingston, Ontario and an estimated 11.7M viewers across Canada via an uncut CBC live feed on August 20. I certainly won’t find the right words, but I’ll gladly take a lunge at it.

Lead singer Gord Downie was recently diagnosed with glioblastoma, a terminal brain cancer that grows aggressively and offers minimal chance at long-term survival. He decided to do the opposite of what you might expect; instead of becoming reclusive, accepting what remaining quality-of-life measures were available, and letting us mourn in advance of the inevitable, he organized a final tour to share himself with the fans one last time.

 

“Courage…It couldn’t come at a worse time.” – Gord Downie, Courage

However ravaged his body appeared after a craniotomy and six weeks of chemo and radiation, the energy from all pockets of the country seemed to fuel his voice after every introductory riff. Each of the three encore sets reached a fever pitch, and without interruption, we could hang on every solo, every iconic lyric, each instance of a certain signature, tumbling cadence to cap the vocal line.

That night I wasn’t a pharmacist. I was a Canadian…and a damned proud one at that.

The next morning, Laura and I were chatting about the significance of the concert. This exchange captured what many of the articles and pundits had been reporting:

Me: Any way I can tie in the Hip concert into a pharmacy blog post?

Laura: Oh God, I cried through the whole concert last night. Their bravery and COURAGE was unbelievable.

Me: I know. Read an article about Gord burning out onstage for everyone. Pretty amazing stuff.

Laura: They played for three hours.

Me: After the first few songs, I felt he was straining hard, but he kept going.

Laura: Yeah, and a lot of classics later on he sounded amazing. Imagine spending that much time and energy with four other guys for thirty years. They know exactly what they’re all going to do. Remarkable really.

Me: Can’t imagine. They deserve the adulation. If you’re going to hero-worship anything, this feels right.

Laura: Canadian pride and caring less about what others think is a surefire way to a happier life. Tonight the ENTIRE COUNTRY stopped to watch a concert. Would that happen anywhere else in the world? 

The CAPS are unedited, and proper emphasis is where it belonged 🙂

 

“No one’s interested in something you didn’t do.” – Gord Downie, Wheat Kings

I could take a fatalistic approach in saying that many cases of malpractice litigation definitely hinge on things that weren’t done, but I digress…

In all seriousness, wiser words have not been spoken as a mantra to living all phases of life. As pharmacists, how many minor ailments have we failed to offer? How many open-ended questions have we failed to ask? How many turf wars do we concede to other health professions? How many courses have we failed to take? How many trips have we failed to plan? How many opportunities have we failed to grasp? None of these examples are malicious or vindictive, just oftentimes we remain passive because of the emotional investment and unknown consequences.

Laura really drove the point home for me:

“So let’s remember what Gord and the Hip did on Aug 20. They gave everything they had left to their fans in one last hurrah. Every Canadian, healthcare professional or not, can stand to give a little more to others, care a little less what people think and get on with living their best life.”

 

“No dress-rehearsal…this is our life.” – Gord Downie, Ahead By  a Century

Everyone’s watching. Work, play, practice..LIVE on your own terms. 

#InGordWeTrust

 

 

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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Time is Relative

After vacation, you could say we encountered some rather bad luck. I say we, but the sympathy should be reserved for my wife, who after two days back at work, suffered a nasty fall and shattered her olecranon. My diagnostic skills are weak in this area, but my hack medical description of this injury would place it as a Type IIIB, replete with instability of the forearm and multiple fragments. Lest we say that it wasn’t funny at all (cue collective groan).

Having never had a catastrophic injury before, when I received her phone call that something was wrong, her voice was a bit higher-pitched, but the timbre and inflection didn’t suggest anything worthy of alarm. In fact, she seemed more concerned about a set of keys that dropped through a sewer grate during the tumble. Assuming shock was playing a part, we arrived at the emergency with the arm immobilized, and she proceeded to sit and read her book for 4 hours in the waiting room. She felt some discomfort when she tried to move, but no agonizing pain. We were both aghast when the doctor returned with the x-ray results; her ‘bad sprain’ would require immediate surgery. In hindsight, the fact she could no longer locate the knob of her elbow probably should’ve been a giveaway.

So the ER doc forwarded paperwork to the main hospital, but it was one in the morning and the services were closed. So he applied a cast, asked she refrain from eating or drinking, and head to the hospital at 9 in the morning (basically cast, fast, and last). The morning comes, they take x-rays, perform a work-up triage, and….send her home…on a Friday. The new instructions were to start fasting at midnight, and wait by the phone for a possible call in the morning. Saturday morning rolls in and no call. Now I might add, she is not taking anything for pain, just frequent icing and sleeping uncomfortably in a chair with a cushion supporting her thankfully non-dominant arm. By 3pm, I’m calling the hospital myself as she now hasn’t eaten in over 15 hours. Lo and behold, the nurse had thought someone already called. No surgery today due a multiple trauma situation. Repeat the midnight fast. Two MORE days go by until she gets in on the Monday morning. With a little hardware insertion, she is now partially bionic and taking on any arm-wrestling challengers (kidding).

Through the ordeal, we realized that as pharmacists entrenched in the healthcare system, we are providing care to patients, and don’t often ponder the role of the consumer. To find ourselves on the flip side dealing with the uncertainly of a foreign process, we honestly had a frustrating few days. Healthcare is often measured in units of length, not quality. How long will it take to fill my prescription? How long is the wait in the emergency room? How long is the wait list for my carpal-tunnel surgery?

As a provider, we understand all the moving parts and systems that help us deliver quality healthcare. The time we take to ensure we’re being prudent, thorough and safe can not be understated. To us, 30 minutes for a prescription may be completely realistic so that everyone in line for a medication service will receive the same experience, regardless of whether it’s an injection, a medication review and/or a simple refill. In order to maintain consistency and sustainability, that block of time is necessary for very good reasons.

As a consumer on the other hand, we lacked the understanding, and every missed phone call, or being ‘bumped’ was hard to comprehend. My wife is unable to function for 3 1/2 days; no real sleep, fasting cycles, trouble performing any regular tasks we may take for granted (laundry, cooking, dressing, showering, etc). We’ve since determined that an ‘eternity’ is now defined as 3 1/2 days. Just at the point of feeling helpless and distraught, it dawns on us that we need to trust the professionals to provide us with the best care under the system that binds them. How can we, as pharmacists, expect patients to trust us when we say that their prescription will take the time we quote them, when we’re not willing to give that same latitude to those trying to help us?

So I propose we attempt to measure the time in a different way. Specifically, let’s look at duration of relationships. How long have you had the same family doctor? Did he/she treat your parents or kids? How long has your pharmacist been following up on that pesky diabetes? How long is the history you’ve had with a dental clinic? Usually, the strong bonds you form in primary care are a testament to the quality you receive, and yes, most people will feel it’s worth the wait.

Time is relative. A service may seem to take too long, but merely a speck in what could become a rewarding long-term 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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Welcome to Canada

By now, everyone has heard of the Syrian refugee crisis. The Syrian people, having witnessed unspeakable tragedy and horror, are fleeing their home country in the hopes of finding a new, safer, more prosperous life elsewhere.

The Government of Canada has committed to resettling 25,000 Syrians here in Canada. It may have been naive of me but I didn’t think many of them would be coming to our humble little province. I assumed they would be heading west, to Ontario, or Quebec or even further west. How very wrong I was.

I should have known that Nova Scotians would step up to the need. Mosques, church groups and government agencies have sponsored families. They are supporting them as they enter their new lives and helping them with things we all take for granted. As of February 5 of this year, over 500 refugees have arrived in our wonderful little province and I have had the pleasure of meeting a few of them in my capacity as their new pharmacist.

My first meeting came when a gentleman and his interpreter arrived at our store asking for help with itchy skin. He didn’t have his paper that would allow him to go to the doctor, and as myself, my manager and my student all worked to find out how to get him his paper and if he could see a doctor, his interpreter kept telling us that he was saying over and over “Canada is the best country in the world.” At the end of our interaction, we all welcomed him to Nova Scotia and wished him well. We felt we did very little for him – a Google search, a phone call. But to both men, it seemed this little act of kindness was huge and brightened their day. It certainly brightened ours.

The next time I met a refugee was when a gentleman and his son arrived at the pharmacy with the proper papers in tow but not a single syllable of English. Through mime and drawings, we were able to convey to him that his son was to take his amoxicillin three times daily until they were finished. Once they finally understood, they smiled and said thank you. Apparently, in a super Canadian fashion, thank you was the one phrase they had learned.

After both of these scenarios, I was able to go home to my warm house, snuggle my fluffy cat and make a nice meal for myself. I was able to call my friends and family and ask how their days were, read a good book have a cup of tea and go to bed. As I went through the motions of my day, I was struck by how brave these people truly are. I tried to imagine myself in a country in which I didn’t understand the language. I imagined trying to navigate a doctor’s visit, a trip to the grocery store, a walk down the street. I couldn’t imagine what it would be like to have to do all of those things that I take for granted in a totally new country after having fled a war zone. And these folks are doing it with a smile on their faces! They’re so glad to be out of the war zone and starting fresh. They will have lots of healing to do, and lots of learning to do. And so will we. We have to learn how to help these people. How do we communicate effectively? How can we make them feel welcome? How can we tell them where the nearest grocery store is? These are all things that we will learn as they learn to adjust to this new, snowy place.

Despite the fact that their English was broken at best, at the end of both of my interactions with the above mentioned folks, I left them with a sentence they understood right away. As soon as I said it, either alone or through an interpreter, their faces split into some of the brightest smiles I’ve ever seen- Welcome to Canada!

For more information on refugees and what we as health professionals can do, visit www.isans.ca or your pharmacy college website!

 

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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Palliation – A Needed Discussion

This post is a tough one for me. The topic of palliation is deeply felt by most healthcare professionals, either via direct care or through personal experience. Although preventative medicine is the over-arching goal, we still tend to see the majority of people during periods of acute illness or marked progression of chronic disease.

My family is no different than many. Our family history is riddled with various cancer scares with at least one related death, significant heart disease, and diabetes. I have been very fortunate to date that the vast majority of my relatives are in good health; they all live in their own homes and can look after their own affairs. However, the time is approaching when end-of-life measures will become a significant topic that none of us are truly ready to accept, myself included.

Most folks are familiar of the concept of a will. The stipulations for funeral arrangements and the dividing of assets is rife with legalese to ensure nothing is left in a grey area. Lesser known is the idea of advanced health care directives, or more commonly, a living will. With Canada’s aging population, widespread education of the public will be needed to facilitate conversations with healthcare teams. Borrowing from an infographic published by the Canadian Hospice Palliative Care Association (CHCPA), one statistic referenced on the Wikipedia link (above) stands out:

Polling indicates that 96% of Canadians think that having a conversation with a loved one about planning for the end of life is important. However, the same polls show that only about 13% have actually done so, or have created an advance care plan for themselves.

Incredible. I encourage readers to have a look at the complete document for some additional eye-popping nuggets: http://hpcintegration.ca/media/56049/TWF%20double%20survey%20infographic%201pg.pdf

The timing of this topic may seem a bit strange so close to the holidays, but I’ve decided to share from my personal experience and also my experience as a pharmacist. The personal side first:

My wife and I were slow to the game. A will was something we had talked about completing but never had the interest, or urgency to follow-through. Now that we have kids, a house, a car, and even a blog (ha!), it was time to make sure we were prepared in the event of catastrophe. We recently sat with a lawyer and were so far out of our depth, it felt like standing on the bottom of the ocean. The questions being asked about asset shares, and custodial rights of the kids were met with knee-jerk responses that we honestly hadn’t thought all the way through. That bit of guidance really made a difference to our peace of mind. I’m writing this on a Thursday, and our first discussion about advanced health care directives literally just happened. Peering over dueling laptops, we agree that if an objective healthcare team determines that the line in the sand has been crossed, we are comfortable with stopping all oral treatments, blood tests, imaging, etc and focusing solely on symptom management. Just verbalizing it now and working through the what ifs (e.g., whether there is dementia or mobility issues) will allow for a degree of clarity during a stressful, highly emotional time.

As a professional, my current role is managing a pharmacy dedicated to nursing home facilities. Nursing homes have palliative care order templates with the various options for pain, dyspnea, secretions, mucosal dryness, delirium, and anxiety. When these are enacted, the expectation is that the philosophy has moved from active treatment to comfort measures. That said, the waters can get muddy when there is disagreement. If the resident is lucid and can still swallow daily medications, will changing daily routines make things easier or more stressful? If diabetes is no longer treated and blood sugars are allowed to soar, will that ultimately add to discomfort? We’ve had occasions where some oral meds were stopped but not others, or specific medications are lifted from the palliative care orders and written separately in order to have select measures in place without continuing down a chosen road. No doubt it’s complicated, and pharmacies only tend to see the medication side of things. Other support functions are invaluable during the decision-making process; chaplains, grief counselors, and social workers can all play a role to ease transitions, particularly if items have been decided ahead of time.

So this appeal goes out to as many as it can reach: the young, old, sick, healthy, families large and small. Please share your end-of-life wishes with your loved ones to avoid any uncertainty as to your wishes for yourself and for them. How do _you_ want to be cared for when you’re no longer able to process options or articulate decisions? Even though they won’t be needed for a lifetime, choices made today will mold the end of one.

http://www.cdha.nshealth.ca/palliative-care

 

 

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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Dispensing Pride

The terms ‘pharmacy’ and ‘dispensing’ go hand-in-hand. Prescribers diagnose disease and approve treatment. We fill the treatment orders and dispense the therapy, along with any important educational points, to patients and their families. This has been our role for generations. We are known as some of the most trusted and most accessible health professionals in the world.

I admit to being a proud dispenser, but my priorities are beginning to shift. Medication has always held a fascination for me: the clever brand names (remember Desyrel? I still have ‘DEpressive SYmptom RELief’ bouncing in my skull somewhere), the odd shapes of certain tablets and the splashy marketing campaigns. Sometimes missing however, was the proper transfer of information to others. My counseling skills took time to develop, and early on I felt robotic and scripted when interacting with patients.

As a student, I recall basic functions such as writing up manual credits to Blue Cross or the now defunct Maritime Medical. We made funky compounds with Anthralin powder that stained everything a heinous shade of yellow ochre that would make Bob Ross proud. We were the gatekeepers of all things pharmaceutical and sometimes a cursory counseling session was all that a patient received. Sure, in classes and labs we were coached on communication styles and higher standards but the reality was a bit disheartening; dispensing was the main focus and any clinical intervention seemed like an exciting ‘Eureka’ moment for the team to share instead of the norm.

Doing pharmacy relief immediately after graduation had it’s advantages and disadvantages. Although leaving work at work when a shift was over was nice, ensuring patient follow-up and continuity of care was extremely inconsistent from one site to the next. Every interaction was a point-in-time and documentation was rather erratic from one pharmacist to the next. We were however excellent at monitoring days supply of benzos and narcs. I may not have had the relevant history or familiarity with the tools to best determine your pain control but I could certainly attest that those sixty OxyContin 40mg were triple-counted by three different people.

My, how times have changed…

So, there is less of a focus on pack sizes and pricing (still important, but more of a management focus as opposed to pharmacist); better prescription software has lessened the need to manually update every drug file or pricing strategy. Now it’s more empowering to take a deeper look at interactions and latest research guidelines. The volume of calls to the third-party plan to correct date of birth issues are tasks that now may be delegated. We are becoming more intimately involved with special authorization criteria and therapeutic substitutions. Cognitively, we have more opportunity to apply ourselves; with prescribing rights, we can now identify certain DRPs and be able to solve them for a patient. Things like INR and renal adjustments may now feature a pharmacist’s name on the order as we get other health professionals to recognize our new-found decision-making abilities. In fact, just the other day, I was able to halve a sulfamethoxazole dose for an elderly resident with a compromised creatinine-clearance.

The paradigm shift started long before my degree, but the visionaries who foresaw such radical changes had their work cut out for them. The baby-boomers were heading into retirement, and the aging population needed more medications to combat heart disease, diabetes and high cholesterol. In lockstep with that, they were also going to need more clinical care, and more than what general practitioners would be able to handle, especially in rural areas. I look forward to plugging some gaps through medication reconciliation, minor ailment prescribing, and lab requisitions.

To sum up: I am proud of my dispensing hat, I am proud of my expanded clinical duties now, and trust that I will enjoy however the role evolves from here. I guess I’m just proud to be a pharmacist.

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.