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.