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.

Fingers and Thumbs

This morning I listened to an episode of the James Altrucher podcast where he talked to his producer Steven Cohen about why people fail. One quote that stuck out at me, as corny as it may sound, was that “we need to point thumbs, not fingers”. That is, we need to stop being so concerned about what other people are doing and start looking at ourselves.

It’s something that I’ve been thinking  about a lot over the past few months. And it’s something that I find I need to constantly remind myself about. Because it’s so easy to get caught up in where other people fall short, especially when it relates to something we care about.

When I think about it in a pharmacy context, the classic example that I think everyone is guilty of is the topic of warehouse style pharmacies. I was engaged in such a conversation yesterday in fact. And I must be honest, I’ve never really stopped to think about how little there is to gain from this approach of complaining about them until this morning. Or even any gain at all? It doesn’t influence their practice in any positive way. In fact, it has the potential to further disengage them and polarise the conversation. And it doesn’t make me feel good or inspired in anyway. If anything it makes me feel kind of sad and deflated. So what’s the point other than branding yourself as not being one of them?

I don’t know what the correct approach is, but I’ll tell you what I’m going to try and start doing from now on. I’m going to try and stop myself from getting sucked into conversations about how bad things are (this is really hard for me sometimes often) and I’m going to try my best to empathise. I’m going to try and focus less on generalisations and avoid making assumptions based on individual’s career decisions.

It’s an important thing for me to get my head around, because I think it’s things like this that can flip a situation from positive to negative exclusivity, particularly in a group setting. What do I mean by positive exclusivity? Good question, I’m trying to get my head around that too.

Here’s what I think I mean by positive exclusivity. I really value the idea of being generous in your work. Of offering service to others without expecting something in return. I have the firm belief that we all benefit from each others success and that’s how I want to live my life. But I’m not a martyr. I have boundaries and I think it’s important to maintain them. I consider positive exclusivity to be circumstances when I hold those boundaries based upon shared values and principles. Negative exclusivity would be when I put those boundaries in place because of something like a personality clash, or personal judgement.

If we take pharmacy work as an example, I’m very open to having a discussion with a Pharmacist who is writing up an HMR report if it will help them get their head around the situation and understand what’s going on. They’re trying to do better work in service of the patient and the GP. I am not open to an HMR pharmacist asking me questions because they are expediting the process of looking something up for themselves in a core reference. I read this as being lazy in an attempt to be more profitable. The outcome might be the same, in that they are both producing an HMR report, but I interpret the actions and the reasons underpinning them are different. One is based upon self-improvement, the other maximising personal gain.

 

The question is, how do we recognise these values in others without being super judgemental? I have no idea, it’s all based on judgement in one way or the other. I think it’s probably about being open. Being open to sharing more of ourselves, so that others know where we’re coming from. And being open to being wrong and changing your point of view. In a group setting I think this means being transparent, even if it looks a bit wanky. Clearly articulating and defining shared values and principles and using them as the basis of decision-making. I feel like that would be a good start, anyway.

 

Student Mentality

This morning as I was mid-plank in the middle of my workout, the voice of a seven year old girl came into my head. “The secret to a good handstand or cartwheel is to really push through your hands, like you’re pushing the floor away”. I followed her instructions and my form improved. The voice was that of a girl we met at the park last week who gave my daughter an impromptu cartwheel lesson.

One of the things that I’ve learned in more recent years is that there’s a difference between learning and education. This is my interpretation of it. Education is focused on outcome, on knowing some sort of ‘truth’, achieving an objective. Learning on the other hand is about the experience and process of change, of evolving your position according to your individual needs.

Obviously there are some circumstances where it has to be about education. I don’t want a pharmacist who doesn’t know how a beta blocker works, or what pharmacokinetics means. Domain knowledge is very important. I tend to want the teachers of those types of education activities to be experts in the area they’re teaching. Or at the very least be a few steps ahead of me and not just be reciting a text book.

But learning is very different. Learning can be triggered by any source. It doesn’t have to be an expert, it could be a random seven year old girl. Because learning is about a mindset, an openness to the world around you. Having a student mentality.

I’ve read two solid thought provoking pieces on this recently. In his book Ego is the Enemy, Ryan Holiday illustrates it with the example of Metallica’s lead guitarist. As the band got their first big opportunity, he sought out guitar lessons which is probably the opposite of what most people would do. Most would just revel in their success and ride the wave for as long as it lasts. But he wasn’t satisfied with good, he wanted to be better. He kept bringing riffs to work on with his teacher for years, continually striving to improve even after the band got really successful. Because he knew there was always something he could do better.

Being comfortable about not knowing everything is what shifts education activities into an opportunity for evolution of the self. Its also what allows us to be open to all of the learning opportunities around us. Holiday writes

The pretense of knowledge is our most dangerous vice, because it prevents us from getting any better. Studious self-assessment is the antidote.

it is not enough only to be a student at the beginning. It is a position that one has to assume for life. Learn from everyone and everything. From the people you beat, and the people who beat you, from the people you dislike, even from your supposed enemies. At every step and every juncture in life, there is the opportunity to learn – and even if the lesson is purely remedial, we must not let ego block us from hearing it again.

The other thought-provoking source was this blog post by Ramit Sethi about why it’s so hard to find a great mentor or coach. He argues that its because we’re often not very good clients…i.e. we need to have a student mentality. Sethi lists three signs of a great student: that you can afford it (time and/or money), you’re mentally ready to learn, and you welcome the struggle. Learning isn’t about making yourself feel good, it’s about pushing yourself into new areas. That should feel a bit uncomfortable.

You can look for the perfect program. But until YOU’RE the right student, it won’t work.

I think of how many times I’ve taken good learning opportunities for granted because I’ve been a poor student. For me, this particularly relates to educational activities. I can think of many examples of when I’ve completely dismissed an educational activity and disengaged from it because I didn’t think it was up to standard. But I suppose there’s something to learn even in sitting through a boring, un-engaging talk, a poorly facilitated workshop or reading a badly written article. For one thing, it’s good to know how not to do it. But critiquing is easy. I think the more challenging activity would be to try and find the decent content despite the poor delivery. Maybe I’ll set myself that challenge the next time I’m at a conference trying not to switch off after a string of dry presentations.

Learning is everywhere if you’re open to it. Be open. Set yourself a challenge to learn something new every day and see what happens. Consciously seek it out every day. I bet it will lead to something good.

 

 

Human = Creative

I was watching a show on Netflix the other day called The Creative Brain. It was ok, not one of my top recommendations. But it did have Nick Cave in it which I consider a positive, and it did remind me of something that I think people often forget: what differentiates humans as a species is our creativity. The good old prefrontal cortex.

For a long time I’ve thought of myself as somewhat artistic, but not all that creative. The main reason for this has been that I am terrible when it comes to making something from nothing. Give me a blank canvas and an open mind and it will likely stay blank unless I have something to use as a reference. If I’m given the task of producing a creative piece of writing is going to be full of cliches and completely derivative, even if you give me a prompt. I think it’s the main reason I thought that I was bad at English throughout high school, because I bombed so badly in that section of every exam.

Creativity isn’t about creating something from nothing, it’s about making something out of what you’ve got. And it’s not something that sits within the realm of the ‘creative industries’. Any time you are looking at something and bringing it into the new, you are creating. That could be coming up with a research question. It could be asking a pertinent question after a lecture. It could be making medicines information relevant for the patient in front of you.

We are all inherently creative in our own ways. It’s what makes us human. Unfortunately, the other part of what makes us human is our amygdala and avoidance of anything that makes us feel uncomfortable. That’s the bit that often gets in the way of us unleashing our creativity…but that’s a topic for another day.

Mis-shapes, Mistakes, Misfits

I have always been a little bit of a misfit. Just a little bit. At school, I suppose you would say that I fit in with the popular crowd, but I did academic-type subjects and was in the school musicals so I was actually a bit of a nomad friends-wise. On casual days when most people were wearing adidas snap-pants, I would choose to wear corduroy. My pencil case was covered with the names of indie and brit-pop bands, not the Spice Girls or Pearl Jam.

Once I’d left school I realised that even though I didn’t really want to be like everyone else, being fully immersed in some sort of sub-culture didn’t really do it for me either. I don’t know if it’s a positive attribute or not, but individuality has always been something that I’ve really valued. The result has been that I’ve always kind of fit everywhere, but kind of nowhere at the same time.

Most of the time I find it’s a perfectly fine way to be. Of little consequence. But it’s been much more difficult for me to embrace in my professional world than anywhere else. At times, it’s created a barrier to my communicating and working with others and been the source of immense frustration. I think it’s why I left working in a hospital pharmacy. I felt as though my desire to push boundaries and find new ways of working created friction with certain people that we just couldn’t get past. I decided that it wasn’t doing me much good feeling so frustrated all the time. If I stayed I was destined to become a worse version of myself. So I left.

Thankfully I went to a different team environment that proved to me that I was capable of working with a wide variety of people. I don’t know if it was because the team was so diverse or because I’d matured (probably both) but I realised that there were plenty of avenues where I could contribute to quality care and not have the same level of frustration. Where I could make stuff. I also learned that its possible care deeply about the work while maintaining a level of disdain for the professional culture in which you work. Some may call that cynical. I call it realistic.

I’ve often thought about retraining and moving into another area of healthcare, or another industry entirely. I enrolled in a uni that didn’t have a Pharmacy school for this very purpose. I didn’t really care about Pharmacy, I cared about doing work that could contribute to better outcomes. Kind of ironic that my whole thesis is ending up being about the value that primary care pharmacists could contribute to cancer care, because that definitely wasn’t how it started out.

Here’s the thing. I still don’t care about Pharmacy. I don’t care about engaging in the pharmacist vs GP turf war about pharmacist prescribing. I don’t care about other people valuing what we do. I don’t care about securing our future or pay rates. I don’t care about calling myself a ‘clinical’ pharmacist, or my post nominals or credentialing status. Some might call me a cynic, disengaged, whatever they want I don’t care because they are judging me by a different set of values to which I apply to my life.

I care very deeply about doing work that matters. For me, the work that matters is contributing to changing things for the better in a way that I am proud of, whatever mode that takes. It might be writing a paper, interacting with a student, coming up with a strategy for a project, researching something, talking with someone about their medicines. That’s the stuff that I care about. And learning every day about how I can do it better. Caring about the details.

I read an article today that perfectly articulates all of these things that I’ve been thinking about not discounting the misfits. It shares the story of pixar, and uniting a team of disgruntled animators together on a project that gave rise to The Incredibles. Because dissatisfaction doesn’t always have to give rise to fight or flight; if given the appropriate outlet it can also lead to invention.

It wasn’t about getting angry animators in a room to complain about the system. It was about finding the people who felt like their skills weren’t being utilised, their creativity stifled by the environment.

“I want people who are disgruntled because they have a better way of doing things and they are having trouble finding an avenue,”

Pixar found the race cars that were spinning their wheels, took them out of the garage and let them race.

I think there are a lot of people who have experienced similar struggles to me. They kind of fit in, but kind of don’t, and each have their own personal reasons why this is true. But I don’t buy into the idea that they’re all cynical, disengaged and non-contributors. I think a decent proportion are frustrated by a system that doesn’t know how to utilise them. A profession that doesn’t push hard enough for quality or foster creativity and innovation. I think it’s time to remind these people they have the keys to their respective garages. Go get your race car off the blocks, bring it to the open road and let’s race.

Courage Over Confidence

One of the things I’ve found challenging over the years relates to being confident. It’s kind of weird, because in some ways I feel like I’ve been supremely confident in what I can do. But like many, it’s often coupled with a bad case of imposter syndrome.

I heard something today that made me feel slightly more comfortable with this. I was listening to an interview with Debbie Millman who hosts a podcast called Design Matters. She talked about confidence being less important than courage.

True confidence comes from experience. You’ve been in that situation multiple times before and you know you can handle it. You’ve got a track record.

It takes a lot of time to develop a track record or build a body of work. If you’re starting out in a new area, trying a different approach, or innovating in any way you won’t have prior experience in it. You might have an inherent belief that you’re capable of it, you might have experience of demonstrating those skills, but you haven’t proven yourself in the past. This means there’s a chance that it might not go as intended. You could fail. This is where the courage comes in. Taking something on even though you’re not quite sure if it will work out as intended.

I will take courage over confidence every time, and for one important reason. Confidence might make me feel safe and assured, but courage takes me new places. It allows me to test my boundaries and find the edges of my capabilities. To have courage provides you with the opportunity to get out of the rut and get moving from somewhere you happen to be, toward a place you want to be.