Adverse Life Reactions

I heard something yesterday that I thought was a great way of framing the need to take control of yourself in situations rather than get caught up in the moment.

If a doctor (or other suitably skilled healthcare professional) tells you that you have responded to a medicine you would probably perceive that as a positive thing. Progress toward your goal. Would you still feel that way if they told you you have reacted to a medicine? Unlikely.

We have a choice to respond to situations and circumstances or react. Reacting is natural and emotional and may even feel good in the moment, but does it serve your underlying purpose? Responding can be a challenge and can feel uncomfortable, but it’s likely that it will serve you much better in the long run.

Mind Control

One of the recurring themes of my learning this week (quite accidentally) has been about focusing your energy on what you have control of. You can put in effort to be the best at something and still never be considered number one, because there are other things that influence that beyond talent/skill/effort etc. Maybe politics, maybe poor taste, maybe just pure luck and good timing. You can choose to get bitter and angry about this, or you can acknowledge it, move on and focus on the things within your sphere of influence. But you can’t change it.

The key learning for me is that you put your effort into bettering yourself, not competing with others. Someone whose primary focus is creating a version of themselves that will enable them to achieve extrinsic affirmation of their value doesn’t end the day feeling fulfilled and grateful about their life. Rather, they’re always looking for something else. What they don’t have yet, where they need to get to. That doesn’t sound like the way to live to me. That sounds like anxiety, or a heart attack waiting to happen.

Saul Bellow wrote “Death is the dark backing that a mirror needs if we are to see anything”. Working in PICU and palliative care taught me in a very real and confronting way that life is for living now. Fulfilment isn’t something to put off until you’ve obtained a certain job title or retired. It’s something to work on today. Fulfilment comes from gratitude and continued growth/learning. That can happen now. It takes practice and effort, sure. But it’s worth the mental discipline.

Control your mind or let others control it for you.

Re-scoping scope

I’ve written before about how the phrase ‘practice to full scope’ confuses me. It still does a bit, but I’ve evolved in my thinking. I’ve had a few conversations in the past few weeks that have made me see it from a slightly different angle and challenged my thinking.

When I thought about it previously, I was pretty caught up in my own world. I heard people using these phrases about the profession and I assumed they were applying it to the profession as a whole (I am still not sure if they were or not?). Because I didn’t fit with what they were describing, I didn’t buy into what they were saying and assumed it was all bullshit. But I think that’s where I was wrong.

If we think about how much the profession has evolved over the years, we must keep in mind that the education provided to pharmacy undergraduates has also evolved. True, a graduate from 1995 might need extra training to conduct HMRs, but a graduate from 2019 has already been armed with the skills required. Similarly, other aspects of the curriculum have evolved and will continue to evolve to stay relevant to the times. I might need training to administer a vaccine, but there’s no reason why this couldn’t be addressed at an undergraduate level from now on. Scope of practice isn’t a generalised term.

Defining your individual scope of practice is the core component of what makes you a professional. It’s not about what everyone else can do, it’s about you. Setting your professional boundaries. Because you are an ethical professional you are expected to be able to self identify this. It’s what the whole CPD process is based upon and part of what you’re declaring when you renew your registration each year. I’m kind of a bit embarrassed that I forgot about this to be honest.

So for me sure, vaccinating isn’t within my current scope of practice. But neither is dispensing. I haven’t dispensed since 2011, and I was never very good at it. I am not a stickler for details, I am not meticulous enough and I make too many mistakes if I dispense over a long period. If I was to take on a role that had either of these as core duties I would request some sort of period of supervised practice for dispensing (from a liability perspective) and undertake training on giving vaccines so that I’d feel confident in my ability to perform those roles safely. But undertaking medication reviews, working in a GP practice or RACF? I’m confident they are well within my existing scope and that I have maintained my learning sufficiently to support this.

I think part of why this gets confused is because pharmacy is so obsessed with telling people what they can and can’t do. Certifying everything. Credentials for this that and the other. It’s become a business in itself. I’ve written before about my feelings toward the advanced practice credentialing, I’ve circled around a bit, and I’m back to the original question of what exactly is the point? Where is the public interest? Doesn’t the practice of CPD and being a registered professional mean that all pharmacists should be advancing their practice? Doesn’t telling people exactly what they should do diminish their professional autonomy?

If I apply for a job, I want the panel to assess my merit based upon the evidence supplied in my CV, the quality of my application and whatever interview or presentation they ask me to do. The idea of being judged by the superficiality of my post-nominals doesn’t do it for me. And I’m saying that acknowledging that I am working toward completing a PhD, possibly one example of a post-nominal that has the most variability in quality, other than maybe an MBA. If I provide a service to you, judge me on whether or not I met your needs sufficiently, not on whether I have a certificate showing I’ve completed a workshop. Registration matters, of course. Maintaining CPD matters, of course. Lifelong learning matters. To me, the other bits are either vanity metrics of ways of ensuring you get paid. A humble (or not so humble) brag. Get registered, define your scope of practice, do the work well, and continue to work to do it better. Lets stop over complicating it.

Creative Rehab

As I’ve written before, I’ve been drawing a lot of inspiration from the creative fields these past months. This morning I was listening to the recent Chase Jarvis episode of the James Altucher Show. One of the things they talked about that resonated with me, was how creativity is like a muscle – use it or it will atrophy.

As humans, we are all inherently creative beings. Go into a year one class and see the students work and you will be quickly reminded of that. But sadly for a lot of us, we lose that as we get older. We start thinking of how others may judge what we’re doing rather than focusing on the fulfilment we get from making stuff.

The good news is, just like atrophied muscles, things can be improved with some purposeful rehab. It doesn’t have to be something big. And it doesn’t have to be artistic.

Research is by definition a creative field. It is literally about creating new contributions to fields of knowledge. The same goes with writing – asserting your position, saying something in a thoughtfully structured way, an extremely creative process regardless of the topic area.

I can attest to seeing improvements through practice regularly. Since I’ve been writing this blog my academic writing has significantly improved. My measure of this is the feedback from two of my supervisors regarding my most recent literature review. Over the years I have learned that they are not an easy audience. Whenever I send out a draft for review it’s with some level trepidation and fear. Not bad fear, more like healthy discomfort knowing that it’s going to be uncomfortable but will ultimately lead to a better outcome (still sucks for the moment though). I still felt that way with this paper, but it needed much less surgery to get it ready for publication than previous ones. Part of that is because I now know that writing is a creative process for me, and there is a huge gap between my shitty first draft and one that is ready for review by others. I’m better at judging when to put it out for feedback. The other is that I’m getting to be more confident and concise with my writing.

You don’t have to write regularly, you don’t have to construct a research project. You can do whatever fits with your life to start exercising your creativity. Cook dinner a bit differently than usual. Think about a problem from a different perspective. The what doesn’t matter, it’s the doing it that counts.

Falling short

Today’s post follows on quite nicely from last week’s. This morning my daughter’s class was hosting assembly for the first time. She had a passage to read out and they had a song to sing and dance along to (I will save you the annoyance of getting it stick in your head because I am kind). It was one of those things that wasn’t exactly exciting but was obviously important to her.

The thing was, today was also the day of the final practical exam for a class I’d been working with at uni. Assembly started at 9, uni at 945. So I had to catch the 925 bus to make it on time. She was reading 8th, so I figured I should be able to at least see that bit.

Turns out I forgot how long and drawn out (and boring) school assemblies are. I had to leave without seeing any of her parts and I felt a bit sad about it.

Now I am pretty lucky as far as work goes, I hardly ever have to miss out on stuff. Even if it’s infrequent it still doesn’t feel great. But I need to get over it.

Because the reality is, even though some people tell you it’s possible to have it all in perfect balance if you work hard enough, a lot of the time you just can’t. You have to make a choice one way or the other which may mean fallng short in the other.

It’s ok to fall short every now and then. It’s part of being human. Kids understand that, I don’t think there’s a need to fake it. I think the more honest we are about the struggles we face, the stronger they will be. They’re the only critic that counts in this domain, afterall.

Keeping it Real

Last Friday I learned that there was to be a Halloween disco at my daughter’s school this week. She wanted to be a unicorn and had grand ideas of a costume that she could create. These plans conflicted with my plans of a restful weekend getting the house clean and tidyish.

You see, I don’t always respond to the creative calling as I did during the book week situation I shared in an earlier post. But I wasn’t about to go and spend money on a once off costume either. I chose a half way point. I found some cheap rainbow fishnet gloves at Big W, she had her unicorn headband, we found three different coloured skirts she could wear on top of each other, fabric scraps for a tail and purple T-shirt. A rainbow punk unicorn. She looked pretty ridiculous, but she wasn’t in school uniform and she had fun.

I think it’s so easy to get caught up in what we think we should be doing these days that occasionally you find yourself being sucked into believing the bullshit. But the reality is sometimes that’s just bloody hard work and it’s not really worth it. Sometimes you’re just in survival mode keeping things ticking over as steadily as you can.

I used to really struggle with this concept. Think that it was insufficient to use family life as an excuse, even if I’d spent the previous 24 hours cleaning up vomit and didn’t have a single clean towels left in the house anymore, let alone get any sleep. I’d try and battle on regardless in case people would think poorly of me. Or else feel really ashamed.

I felt like I couldn’t use it as a reason for not achieving what I’d intended because there were times when it felt like there was always something that came up, and I would feel really bad about it and then it feel really anxious.

Nowadays I don’t fake it. I accept that part and parcel of having little kids is that they rely on me, making them my absolute first priority. Things do always come up, so I plan for that as best I can. I make deadlines longer. I try not to overcommit. If it’s a work commitment that’s not flexible then I make sure my husband doesn’t book any work trips over that time. And sometimes that means I have to say no to work opportunities.

I don’t accept this means I’m an underperformer though. When my time is available to me I can more productive than ever before. Because I value that work time and I know I have to take advantage of it.

Everyone has redundancy in their working week. Motherhood just means you can’t hide it so well. That’s not something to feel bad about. Having 5 coffee breaks, doing endless “research” and 15 toilet breaks a day, that’s the sort of redundancy that may be worthy of some guilt. Not parenting.

We Are All in Sales

I’ve always been a bit anti-corporatism. One of the things I’ve always associated with that was sales, advertising and marketing.

As far as pharmacy is concerned, I suppose I used to think that sales was only relevant to community pharmacy. But even then, they might market their brand but they’ve never really been that strong at marketing their services. If you ask most people on the street what a pharmacist does chances are they’ll say something about putting labels on boxes. If there had ever been an effective marketing campaign this wouldn’t be the case. Because I don’t think the need to win over the customer has ever really mattered all that much. A regulated industry has pretty much guaranteed a baseline level of business. But that is not so guaranteed anymore, so marketing and consumer loyalty becomes more important.

It’s a different scenario again for pharmacists working in non-dispensing roles. If you are in a non-dispensing role in primary care you need to get the work (either contracts or referrals) or you don’t get paid. You might get the initial referral from being available, but you get the repeat referrals from engaged clinicians by demonstrating your value and building a relationship. I suppose if you’re a hospital pharmacist then you are guaranteed to get the busy work, but a lot of the meaningful work of clinical pharmacy comes from the referrals from other members of the team. You get those referrals through your relationships and you reputation. I.e. if you are effective at selling yourself.

Being in sales doesn’t have to be seen as a bad thing. It doesn’t have to be manipulative, cajoling someone into an action they wouldn’t have otherwise taken. It can be about telling a story that demonstrates you empathise with their position and you are there to help.

This is what we need to do better. We need to stop bashing people over the head with numbers about medication mishaps, and data on unplanned hospital admissions and start figuring out how to sell our service to those who will benefit from them. I’m not saying this is a straightforward exercise, but I am saying it’s an essential one.

One of the things that makes this particularly tricky is that for most of our consults we effectively have two customers – the patient and their care provider, often a GP. Yeah yeah, I know about patient centred care. I’m not suggesting you compromise clinical recommendations because you’re trying to please the GP over the patient. When it comes to clinical work the patient is king. But there are processes surrounding that clinical work that influence it’s effectiveness and these processes need to be tailored to the needs of the customer you are dealing with.

Let’s think about HMRs as an example. As it stands currently the messaging around HMRs is pretty much the same for patients and GPs. Reduce the risk of medication misadventure. But talking about risk doesn’t really do it for most people. If it did you wouldn’t have a whole lot of people without insurance living in flood prone areas. People generally can’t be bothered dealing with risk. They also generally think they are doing a decent job, which means they don’t usually think they need any help. Hence the other type of messaging is also unlikely effective – that an HMR can help support their medication management.

How do GPs really feel about the HMR process? What is the value for them? Do they really see any tangible improvements in patient care or do they just see extra paperwork for minimal gain? Have they had a bad experience in the past and are now distrusting of the process? How could we present the service to them in a way that would make their work easier? And not just in terms of patient care, is there a way we could help them do their work more effectively and get home on time? Is there a way we could present the report that would be more useful to them? Communicate better? What works for them?

And what about the patients? Patients are often hesitant about the HMR at the start and grateful at the end. What can we learn from this? What causes this shift? How can we use that understanding to communicate the value of that service to other people in similar positions?

If we really valued the service we provide we would care about asking these questions. We would take the time to deeply understand the perspective of the GPs and the patients and make an effort to communicate a story that resonates with them rather than broadcasts our values and beliefs.

This is marketing. And if we want to grow as a profession and remain relevant we have to get better at it.

Perspective

This morning I finished listening to what I would probably classify as one of my favourite podcast episodes of all time. The recommendation came from what might be considered an unlikely source who I encountered through the Akimbo workshop I’m doing. Superficially, we have very little in common. But what I am continually being reminded of is that it’s our shared values and principles that help us form meaningful connections, not the superficial stuff.

The episode was from a podcast called The Futur, a business and design education venture, Contagious Selling with Errol Gerson. So not exactly something you would think would immediately resonate with a Pharmacist. I’ve said it before and I’ll say it again, the more that I am exposed to design thinking and marketing as a concept, the more I am intrigued. So many applications that we could benefit from applying to our industry.

I’m not going to get in to that today, because I have papers to write and I need to be disciplined. Instead, I’m going to end with a quote from Errol Gerson that has pretty much infiltrated my life at the moment (in a good way)…

If you change the way you look at things,
the things you look at will change.

 

 

 

Quiet Disruptors

I was introduced to the term Quiet Disruptors recently and I kind of fell in love with it.

I’ve been revisiting Breaking Bad since watching El Camino. There’s a great scene in season one, episode 4 when Walt comes up against an obnoxious guy he cowers to earlier in the episode. You can tell by the look in his eye that an internal switch has flipped and he’s not going to take this guy’s shit this time around. You expect him to confront him in a typical macho way. But instead, while the guy is in paying for his petrol Walt pulls some crazy manoeuvre with a wet squeegee and some spark plugs, walks back to his car as the obnoxious guys car exploding in the background. Chaos ensues, but noone looks twice at Walt. It’s a great scene.

I’m not advocating to go round blowing things up, but I do love that notion of quietly going about your business while firmly challenging the status quo. You don’t have to move fast and break things. You can be purposeful and still have great impact.

Purpose, not passion

I think I have probably written about this before, and could probably put in the effort of searching through my posts, but I’m not going to because I feel like writing about this today regardless. (Side note, I can’t believe I’ve actually accumulated enough posts that I can no longer keep track of them. This is the first time I’ve ever stuck to anything like this so consistently. I might have to go through and tag them or something so I remember what I’ve written. My concern with this is that then I’ll remember what I’ve written and feel shy about it and psych myself out about writing more.)

I want to revisit the idea that purpose is more important than passion. It’s something I’ve been thinking about for a while as it relates pretty closely to my feelings on what I consider to be the whole traditional career path and head start fallacy. It’s also been very relevant to me since hayfever season has begun and all of my inspiration and enthusiasm has completely disintegrated. Every day has been a mental struggle lately (and yes, I have taken an antihistamine).

There are two books that I’ve read that cover this really well (Ego is the Enemy and Range) and I’m sure there are many more. Seth Godin did a little riff on it on Instagram this morning, although he refers to it as work before passion. He wrote:

offer me a chance to contribute, and I’ll work hard on it, with focus, and once I begin to make progress, I’ll become passionate about it.

This pretty much describes my approach to work. I would never describe myself as being passionate about pharmacy, but I am drawn to the work because, if you do it ethically, it’s making a positive contribution to society at some level. It’s not like working for a tobacco company. It has a purpose that I value.

It’s ok if you don’t feel passionate about your work. It’s ok if there are days when you have to drag yourself along and push yourself to get going while others are all peppy and excited about the day ahead. But it doesn’t mean you have to get stuck feeling that way. It’s a bit like the whole discipline/motivation thing. If you feel that you are doing work that matters, that is serving a need for someone, then that is a purpose for doing it. This purpose doesn’t have to be high level, it could be helping someone understand how to use their medicines properly, or being helpful when a nurse asks you a question rather than grumpy and rude. It’s not your passion for doing the work that matters. What matters is that you show up and you optimise your contribution. That’s where fulfillment comes from.