Knowing When to Quit

How do you know when it’s the right time to quit something instead of just relentlessly pushing through? I’m not sure. But it’s something I’ve had to face up to this week.

I’ve written before about my frustration with receiving anonymous feedback. I’ve had some pretty bad experiences. Well actually, when I think about it, the bad experiences have all been anonymous reviews conducted by pharmacists. I think it’s because most pharmacists like to distil the world down to black and white. They like to be right. And that’s just not the way I see things, so it creates some pretty strong dissonance.

A while ago I decided that if I was going to be studying and writing about the HMR process then I should really get accredited by the AACP. I figured it would help me in understanding the position of the accredited pharmacists. Improve my capacity to empathise. Get to know the community of practitioners.

It’s not so much that I want to actually pursue a career of providing HMRs. In fact, I used to be accredited with the SHPA and never did a single one so I let it lapse. Back then, I was doing medication reviews for the community palliative care team. I thought if I was going to do them I should at least make sure I met the standard, so I sat the CGP exam, filled out my paperwork and paid my fee. Easy.

If only I could say the same ease existed with the AACP process. I can’t. I definitely can’t. In fact, I’ve found it so anxiety-provoking that I have just sent an email saying that I’m not going to pursue accreditation. Yes, I am quitting.

It’s not because I got negative feedback. I got negative feedback the first submission, I had my little rant, then I sat down and revised it and did it properly. Dare I say that I actually quite enjoyed it and learned a few things. I was almost looking forward to the next case. But then I got the feedback telling me I was still not yet competent. That they could see I’d improved so I was lucky enough to get to submit to the same reviewer for a third time. And I could pay another $70 for that privilege.

I let it sit for a while. I told myself that it’s just one of those things to endure. That I just have to play the game. Don’t take it personally. I thought I would approach it like any other peer review and go through the comments one by one. In peer review you’re not expected to blindly accept all the comments, so surely this was the same.

As I sat down and went through each of the 33 comments, a new reality revealed itself to me. The reality where you either produce work that you think is valid, or you produce work that appeases the reviewer – they are mutually exclusive outcomes. And this reality stressed me out.

I’m not really what I would describe as an anxious person. I can take on multiple responsibilities and manage them pretty well without them keeping me up at night. But this was keeping me awake. Multiple nights, there in my head. And it was making me anxious, and angry, and generally not feeling very good.

So, rightly or wrongly, I decided that paying more money and spending more time on this process for learning sake simply wasn’t worth it. I decided that I shouldn’t let sunk costs influence my future decision making. I decided that there was no way in hell I was amending my report to address some of these ridiculous recommendations. Three of the 33 were kind of reasonable, but the other 30 could not be entertained. I ran it by some colleagues first. I’m not stupid, I needed to know I wasn’t being sensitive. They validated my frustrations.

So I quit. I’m a quitter. And I don’t feel anxious anymore.

Going Analogue

There’s just something about tactile, old school methods that just feels better. Like scribbling notes in a notebook. Or moving post it notes across a board from the ‘to be done’ section over to the ‘in progress’ bit. It brings an element of satisfaction. Its made me feel like I’ve accomplished something today, even if it was just a bit.

The Path Less Pooped

Routine was re-established today. Well, somewhat. It’s the first day back at school and I’m excited. I’m excited because I do much better when there is a routine in place.

So this morning was back to walking to school and exercising. I went on a long-ish walk along the river and it was blissful. As I was walking along one section of the path I noticed a lot of fresh bird poo. Not a pile, it was scattered.

As I dodged the fresh grenades, hoping that one wasn’t going to land on me, I started to question my approach. Is it better to avoid the pooped on areas of the path, or seek them out? Aside from not wanting to get your shoes dirty of course, which approach is going to offer the lowest odds of getting through unscathed?

I suppose it depends on the nature of the high frequency poopage. Does it relate to a comfortable perch? If so, definitely avoid. But, if it relates to a general flock of birds feeding in a large tree and moving around, will the previously pooped on areas be less attractive for further perching/pooping? Are you more likely to get pooped on in the open areas?

You can see I tackle the big issues in my mind as I exercise. You’ll be pleased to know that I made it through cleanly, embracing my initial instinct to avoid the pooped on sections of path. I feel like there’s a lesson in there somewhere, but it’s not coming to me right now. Right now, it’s just a silly anecdote that I felt like writing down. Now onto a productive day!

Playground Justice

One of the best things about having kids is the permission to witness playground justice in action up close.

Yesterday we were at the playground with some friends. One of the girls befriended another little girl and her brother, and a new little gang was formed.

There was another child playing with their sibling at the other end of the playground. This kid was being a bit of a menace, racing around on his balance bike. But he was much younger than the other kids, maybe three years old. Five and six year olds should be able to cope with a three year old, even if he was a menace.

He’d race toward them and they’d all scatter. Then he got off the bike and the foot chase began. “Alexander is coming” one would call out, and they’d all start running away. Then he’d run back to the other end of the playground with at least one kid running after him giving chase. A few moments later that kid would be back, fake crying “that mean kid hit me with his water bottle”. Shortly after, another “Alexander is coming” would start and so the cycle continued.

After a while there was a bunch of five and six year olds cowering behind the swings, claiming to be scared because the “mean” kid would get them.

I spoke to my daughter. It was time for intervention. “He’s not a mean kid, he thinks you’re playing a game. If you want to stop, you have to stop encouraging him. Try telling him to stop and that you don’t like it, or ask him if he’d like to play another game. But you have to stop running after him. You guys are keeping this going as much as him”

She went and played the monkey bars. Game over. Alexander started playing (nicely) with my son. Yes, you can call me the fun ruiner if you want to. But that game wasn’t a good one, so I’m ok with that.

Looking for someone or something to blame is almost an inbuilt response. So often we get caught up in cyclical patterns of behaviours and its natural to feel like life is happening to us. Like someone else is the villain. But oftentimes, if we take a step back, things look very different.

With perspective you can start to see the feedback loops that are perpetuating the problem. You can notice your role within the system. You can start to empathise with the so called villain and consider how they may in fact be being victimised.  You can start to see that the only way to change the system is to take action on the one thing you have control over – your action and your behaviour.

When we move to thinking about the system we shift from reacting to responding. Response allows progress and evolution, reacting keeps us stuck in the status quo. I know which one I prefer.

Enough “blah blah blah” and “ra ra ra”

Look at the medication chart of a resident in any aged care facility and its likely you’ll find something that could be improved. Finding issues isn’t difficult, it’s resolving them that’s hard.

It’s not just in aged care, its pretty much universal. Unless it’s an issue that can be resolved directly with the patient, our impact as a pharmacist is very much dependent on a third party decision maker; the prescriber. And that suuuucks.

Sure, there are some who seem happy to blindly accept this. I mean let’s be honest, the whole HMR/RMMR model is built around a process where the pharmacist’s job is complete upon the writing of recommendations in the written report. It doesn’t matter if it results in any actual change in care or not, you still get paid the same.  But for the rest of us, this is the source of an immense amount of professional frustration. You can see evidence of it everywhere. And it kicks in very quickly after entering the workforce.

Perhaps one of the most obvious signs of frustration (other than the steady stream of pharmacists retaining to become doctors) is the hot topic of pharmacist prescribing. I am neither against pharmacist prescribing nor a campaigner for it, I am firmly in the middle. I am in the place where I think it’s inevitable and might make pharmacists feel puffed up and important for a short while, but the identity confusion and frustration will persist. Because pharmacist prescribing does nothing to address the underlying system issues at play.

Effectively, I think pharmacist prescribing presents us with a very attractive workaround. In some circumstances we won’t have to wait for someone else to action something. We can make changes to the medication ourselves. Yay.

But we are still just one member of the patient’s overall healthcare team. The last thing any patient needs is yet another care provider that doesn’t know how to work collaboratively with the rest of the healthcare team. There’s enough of that already. So yeah, pharmacist prescribing might make our professional lives easier and produce short term gains for the patient, but if the collaboration isn’t there it has the potential to further fragment and already fractured health care system. If the collaboration isn’t there it’s not really adding much net value to the system.

So if we’re going to go down that path (and let’s face it, we are) we need to start addressing some of the fundamental issues that get in the way of collaborative practice. We need to equip pharmacists with the skills and attitudes to be team players, and we need the tools and infrastructure to make collaboration easier.

If we want pharmacists who are team players, we need to start with some honest self examination. Like knowing our place in the team and what our teammates think of us.

This brings us back to the whole professional identity thing. Our lack of professional identity doesn’t reflect our worth, it reflects our perceived value. They are very different things. Worth is intrinsically defined, value is externally ascribed. Telling others how worthy we are of being valued does not make them value us more. Its a sales pitch. A “blah blah blah” and some “ra ra ra”. We need to focus demonstrating our value instead. Show, don’t tell.

What that ultimately comes down to is delivering services that people really want. I don’t think we’re ever going to get to a place where the general public are knowledgeable of the role the pharmacist plays in their care, because the fact is that a large proportion of our value is delivered behind the scenes. Its like police officers – do we really want to be knowledgeable about the intricacies of their work? Would we be able to sleep at night if we did? Well honestly, do we really want people to know just how much risk is involved in managing their health?  How would that impact their broader healthcare and therapeutic relationships?  By no means am I saying we shouldn’t capitalise on every opportunity we have with patient interactions to offer them value; just don’t expect to be recognised.

What I think we can (and should) focus our efforts on is getting to a place where our medical, nursing and allied health colleagues recognise our value and act as evangelists about our services. I acknowledge many individual pharmacists do this inherently as part of their work, but I don’t think we do this collectively in an effective strategic way. If anything, I think we self sabotage. Far too often I see pharmacy organisations trying to demonstrate their worth at the expense of another. This is bad strategy.

We need to acknowledge that our medical, nursing and allied health colleagues act as influencers and decision makers in patients lives. They are our key partners in delivering value to patients. We need to build these relationships and leverage them.

Maybe, if we stop with the pharmacist-centric blah and ra, we can start working as a broader team to build the infrastructure and tools we desperately need to deliver more effective care. Enough with the work arounds, let’s start facing up to the stuff that sitting in the too hard basket. It’s not going to get any easier by continually ignoring it.

Six legged learning

I don’t often visit pharmacies, I only go there if I have to. And this week I had to, because our household was facing a problem that only pharmacy strength solutions can tackle. Head lice. Our first encounter with them, and no doubt not our last.

Now I have what I would confidently say is a better than average theoretical knowledge of how to treat head lice. When I worked on the drug information line at the Women’s and Children’s hospital we would regularly get calls asking for advice. I can still recall the go to lines about using any conditioner to wet comb, and the eggs make a popping sound if your squeeze them. I have sat through countless mock scenarios with students and pre-registrant pharmacists, listing their signs and symptoms and counselling pretend patients on appropriate treatments. And yet I still found myself standing in the head lice aisle of the pharmacy, staring at the wall of available treatments in front of me, feeling perplexed.

I didn’t even try to hide my confusion. I quietly stood there studying the labels of the different treatment options to make sure I didn’t accidentally pick one that only contained eucalyptus oil (which, incidentally, were the most prominently displayed). I checked out the different formulations available to see which one would be easiest to apply on children that have hair that always seems to make its way into their eyes. I checked out the different volumes available so that I wouldn’t have to return to the pharmacy to buy more to complete the follow up treatment (or forget the follow up treatment). I stood there for an uncomfortably long time. And nobody offered me any assistance. Nothing. At all.

The selection of treatment wasn’t the only thing I found more challenging than I anticipated regarding the overall head lice management strategy. What I didn’t say earlier was that while this was our first encounter with head lice, it wasn’t actually our first treatment. Our battle with head lice began at the beginning of the school holidays.

First came a delay in the identification phase. Despite my theoretical understanding of how to check for head lice and identify them, I had never actually done it. In my mind, an infestation would be pretty obvious to identify. I didn’t realise that it might only be 3 tiny little lice hiding in a head full of hair. I didn’t realise how hard tiny light brown creatures and their off white eggs are to identify in a head full of dark blonde hair. I didn’t realise that the head isn’t necessarily all that itchy. Not beyond the normal itches and scratches of a primary school aged child who gets hot and sweaty from playing all day. So when I heard that kids in my daughter’s class had head lice I did check my her head and do the ‘right things’…I just didn’t see anything. I was unconsciously incompetent in terms of head lice identification.

Once I did eventually identify them (using the wet combing method BTW – in future I’m just going to do this periodically if it’s going around) I got my husband to go to the pharmacy near his work to get some treatment. He came home with a small bottle of an appropriate treatment which we applied straight away. In order to repeat the treatment we needed to make another trip to the pharmacy, a job which quickly fell off of my to do list. Until I noticed the itching again. Oh shit. I totally forgot to do the repeat treatment. Which brings us back to the present day, and me standing in the aisle of the pharmacy.

As much of a nuisance as this whole experience has been, it’s taught me some pretty valuable lessons. It’s so easy as a pharmacist to get caught up in the theory and forget about the practicalities, but it’s the practical stuff that can really interfere with effectiveness. People need help with the practical stuff, even the people who should know better. And not just with head lice, with most things. We have opportunity to add real value here. To contextualise treatments for people; understand their world and influence their behaviour to give the treatment the best possible chance of being effective. Stop them from throwing money down the drain and perpetuating the problem.

This experience also reminded me of the importance of practical experience. In terms of pharmacy practice, I haven’t been practising clinically over the past few years. That’s been counteracted somewhat because I’ve still been talking with patients and have been somewhat obsessed with understanding their world view. But even so, there’s something about maintaining an element of practice involving direct patient care that I believe is of great value. And unless you’re the world’s greatest empathiser (I’m pretty sure if you’re a pharmacist that immediately rules you out of that category) then I think everyone can benefit from it, regardless of what your role is. There’s a big gap between work as imagined and work as done. We need to start reducing it.

 

The Juiciest Berries

I think there are few things in life more satisfying than going out in the backyard and picking food that you’ve grown. This morning it was satisfying because I didn’t go to the shops to resupply my berries yesterday. Usually this would result in a sub- standard breakfast. But not today. Thanks to Waldo, our magnificent thornless blackberry bush.

Today may have been about the eating, but other days the satisfaction lies in the berry picking process itself. It feels like a treasure hunt. Searching for the ones that are perfectly ripe. Thinking you’ve got them all and then looking from a different angle and hitting the jackpot. Here’s the thing about that jackpot find though; those berries are always the most perfect, but they’re also always the most difficult to reach.

Two days ago I found myself in bare feet, balancing precariously over a neglected compost bin and reaching through a climbing rose to reach those jackpot berries. The result? Satisfaction reigned supreme despite minor injuries.

I don’t even know if I ate them to be honest. My kids took their handfuls of the harvest and I was left with the sad looking ones. But as their chins become stained with the burgundy juice and they started resembling vampires, my satisfaction remained. Because the harvesting process was mine. And it was a challenge. And it was fun.

Steal Like an Artist

I’m a strong believer in teaching kids the classics. Pop culture classics that is. Music. Movies. Books. This morning when I was driving my daughter to vacation care presented the perfect opportunity for such an exposure to occur. The familiar do do do do do do intro of the Pixies Here Comes Your Man came on the radio. I turned the volume up to ensure she was fully immersed in the experience. I don’t think she enjoyed it as much as I did, but it started my day well.

When I got back to the car the radio presenters were talking about someone doing a cover of this modern day classic for Like a Version. I know people have mixed feelings about covers. Me personally, I typically enjoy them. I enjoy hearing someone’s interpretation of something familiar to me, whether I like that interpretation or not. Covers that are direct replicas though (or wanna be replicas) that are just cashing in on a new audience…those I don’t like so much.

This got me thinking about Steal Like an Artist, a great little book I read recently by Austin Kleon. In this book, and in others he talks about how there isn’t much (if anything) that is completely original these days. Thought, expression, all of it is usually built on bits of things that came before us. And that’s not just ok, it should be celebrated. We need to give ourselves permission to take bits from your influences and work them into something new. That’s the creative part. That’s where the originality lies. Do that and have fun with it. And do it often.

 

2020 vision

I know the new year is always a bit confronting, but I’m finding this one especially so. I’ve always considered 2020 a landmark year, primarily because it was my original thesis submission date back when I enrolled in 2013. It always felt so far away, and now it’s here. Geez.

I took a leave of absence when I had my son, so that required submission date has been extended to 2022 now. But I would still like to finish this PhD in 2020. It’s been long enough. I would really like to get a proper job again one day. Well, sort of.

Now, being the New Year there’s a lot of talk about goal setting. I’ve set goals in the past and I have even achieved them, yet I don’t find them particularly useful. I think there are two main reasons for this.

The first is that I am very much a pressure prompted performer. If I set a goal with a specific timeframe and I’m tracking along to achieve it, I will often ease off and get disinterested from actually completing it. I get lazy. Or I achieve said goal efficiently, go full on toward achieving it, but then once I’ve achieved it I revert back to whatever I was doing before. It doesn’t result in a sustained change.

The other problem I’ve found with goal setting relates to me feeling like I’ve already achieved something just by setting the goal. I’m very much a “figure shit out” person by nature, rather than a “get shit done” type. I can plan with the best of them, draw up something that looks amazing on paper. I am capable of implementing the plan, but it’s not my natural preference. I avoid the doing. I struggle a bit with long term goal setting because I get caught up in making elaborate plans.

So I’m going to try something different. One of the things that I learned from Atomic Habits last year was about thinking about the type of identity you want to become. Then focus on the processes you need to put in place to become that. Valuing process over outcomes means your more likely to create a new habit.

Last year I did this in three areas, all of which are very cliche. But for the first time I actually translated intentions into ongoing sustained action. Comparing this year to last, I am now a regular reader, runner (jogger) and writer (as in, I write regularly, not that I would be at a party and introduce myself like that!).

So this year I absolutely do want to complete my thesis. This is obviously a specific outcome related goal rather than an identity based one. But I  think I can still benefit from focusing on process over putcome. I’ve been thinking about what processes I can put in place to steadily track toward this. NOT a strict schedule that I either get ahead of and get lazy, or procrastinate until the deadline. An ongoing sustainable process to grind through the work with discipline.

Here’s the plan. I’m going to draw up an overall outline of all the chapters and the order in which I am going to write them. At the start of writing each chapter I’ll make a detailed task list of all the sections that need to be written. At the beginning of each week I’ll review where I’m up to overall and prepare my goals for the week ahead. Each workday I’ll to stick to the same routine – exercise, write new content, lunch, revise existing content, revisit task list. I think if I do this consistently I will get through the work and achieve the desired outcome.

I do have other thoughts on identity related goals, but they can be for another day. That’s not what’s making me feel anxious, the thesis is. And now, with my plan in place that anxiety has reduced. Nothing to it but to do it now!

 

Reset

Like many people, I’ve taken a break from my usual routine over the past few weeks. Honestly, I can’t exactly say that I feel better for it. Because as boring as it may be, I love routine. I do better on routine. The kids do better on routine. We are a happier household on routine.

It’s something that I find really hard about holidays. I mean, it’s great having extra family time and doing fun stuff like going to stay at the beach. But after the fun stuff I just feel so incredibly blah. Physically, mentally, emotionally, all of it. Far from feeling recharged and re-energised. I feel more like the Sunday after a big Saturday night (if my memory serves me correctly…this hasn’t happened for a while!).

Thankfully, I’m gradually getting better at dealing with it. Years gone by a disruption like this might have sent me on a prolonged period of feeling crappy. Or avoiding exercise. Or avoiding work. But one of the things I’ve become more at ease with over the past year or so, is that it’s normal to lose your routine and feel shitty every now and then. I don’t beat myself up about it, it’s not that important. What’s important is my ability to reset. So that’s what I’m doing. Today. Starting now.