Abstract
Health care reform is a high national priority for the public, policy makers, payers, and health professionals. This reform (in whatever form it takes) will be driven by several factors including patient and caregiver demand for higher quality, safer care at lower costs, and demographic and social change. Reform in how we deliver health care will inevitability lead to escalating pressure to adopt best practices and improve operational efficiency in all facets of patient care, including the medication-use process. Overall, there is growing pressure “to do more” without an increase in resources. Therefore, hospital and health-system pharmacists need to develop a practice model that is responsive to this health care reform and the health system of the future. But before we do that, before we change what we do, it seems to me that we need to change how we practice the profession of pharmacy.
What I want to do is give you what I think are 3 (although I think there are more) major characteristics that make you a successful direct patient care, floor-based practitioner: we gotta know it, we gotta be able to say it, and we gotta know we know it.
In another words, the competence, the communication, and the confidence (ie, the 3 characteristics) needed to become that successful pharmacy practitioner.
Competence (aka “we gotta know it”)
Miriam-Webster’s dictionary defines competence as “having sufficient skill, knowledge, ability, or qualifications” or “having jurisdiction or authority over a particular issue or question.”
According the National Center for Educational Statistics (see note 1), over 3 million college degrees were conferred to adults in the United States in 2009 to 2010. Are all of these individuals competent? That question will probably never be fully answered. But what I can tell you are that competency is not obtained or measured on a piece of paper or with a pharmacy license—it is accumulated over time with continuing education, self-evaluation, and experience. It starts in pharmacy school and goes from there. Furthermore, the recipient of the information or service will assess a pharmacist’s competency, whether it is through a lecture, a conversation during interdisciplinary rounds, or a manuscript. In another words, how information is being delivered or how it is communicated to the patient, provider, or student can determine a pharmacist’s competency. That is where good communication skills come in.
Communication (aka “we gotta be able to say it”)
It is been said that continuous attention span, or the amount of time a human can focus on an object without any lapse at all, is very brief and may be as short as 8 seconds. Overall, the average attention span of an adult is approximately 20 minutes. What about the written word? It is not much better. Consider subjects participating in clinical research. The average informed consent document is around 14 pages long and written at what many consider a 12th grade to college reading level. This is despite the fact that the average American reads at an eighth grade reading level. You have to wonder how much anyone is actually comprehending what you say or understanding what you write. Unfortunately, it is probably not as much as you think.
So what is the lesson here? Know and read your audience. They will communicate back to you both verbally and nonverbally. Remember, your audience could be tuning you out about 20 minutes into your lecture or conversation. And that drug information brochure you handed to your patient just as they were discharged from the hospital? Review it with them. In all likelihood, they got lost after the first few paragraphs. As Robert Frost said:
Half the world is composed of people who have
something to say and can't, and the other half who
have nothing to say and keep on saying it.
Robert Frost, American Poet (1875-1963)
Lastly, do not forget the other half of communicating: listening. It is a skill many of us tend to underestimate and overlook.
Confidence (aka “we gotta know we know it”)
The 1952 Code of Ethics of the American Pharmaceutical Association specified that the “pharmacist does not discuss the therapeutic effect or composition of the prescription with the patient. When such questions are asked, he suggests that the qualified practitioner is the proper person with whom such matters should be discussed.” This was our profession’s code of ethics in 1952.
Our profession has come a long, long way in building confidence in 60 years . . . or has it? I would argue with you that some pharmacists still think this way. For example, have you ever heard some of our colleagues refer to themselves as “just a pharmacist”? I also find it uncommon to hear recent graduates from pharmacy school refer to themselves as a “doctor of pharmacy.” Why is that? Is it a lack of confidence? I cannot answer that question. However, I am convinced that if you do not believe in what you do, in who you are, and that a pharmacist knows more about medications than any other health care provider, then all the competence and communication skills you have are for naught, because people would not have confidence in you. Restated,
Are you a Clinical Pharmacy Practitioner?
I have always wondered how one can ever know what you are capable of unless you give it a shot. Let me give you 2 examples: My friends Louis and Ella. Both these guys have the life. They do not have to work, get 3 squares a day, and frankly are spoiled rotten. It was clear to my wife Merrette and I how different these 2 were from the moment we met them: Ella is adventurous and inquisitive and Louis, well, he is just Louie, content with what is for dinner. You see, Louie and Ella are our cats. If I were to open the front door to our house and keep it open, Louie would probably stare at it, peek outside, and then return to whatever he was doing. Ella, on the other hand, would bolt out and come back a few days later with a dead bird, proud as can be.
So who are you? Ella, with her apparent confidence, willing to challenge the unknown or Louie, content with what just is and let Ella do the work? Just like Louie, some of us just do not take the chance and bolt out of the door of change and possibility even though it is wide, wide open. Think about it.
“You have to be comfortable being uncomfortable”
A leader is one who finds that therapeutic dilemma about pharmacotherapy and challenges it. As the medication expert, a pharmacist maximizes pharmacotherapy for the betterment of their patients. Effective leadership is the ability to get others to perform as you intended them to. So live your life as a confident optimist. Think of the cup is always half full and you are filling it up.
The truth is there is no option. Your future is right now and it is yours for the taking. If you love pharmacy (and I love this profession of ours), go and grab it. Remember, we do not want others to tell us what our profession is or what we can do. If we believe in what we do, that we are the medication experts in health care, if you believe in progress and possibilities, we can tell them.