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.

Being Heard

“Don’t you people have an office you can use? This is our space”, a spritely resident goaded us.

My colleague and I were sitting in one of the communal areas of a residential aged care facility taking with someone from head office about a project we’re working on. Being contractors we are used to being mobile
and working wherever we can find space.

Before having a chance to respond with anything more than a smile, she continued. “I’m sick of head office sending people down here and coming into our space and not treating it like our home”. She proceeded to tell us about how ridiculous it was that they’d changed the toothpaste to smaller sized tubes that ran out quickly and resulted in more waste. She spoke of her disappointment that the window cleaning contractors had changed. The friendly family team had been replaced by disrespectful buffoons. She berated us, maintaining a wry smile throughout.

Eventually we got the opportunity to tell her we weren’t actually from head office, we were pharmacists. And we would happily find somewhere else to sit. The woman who was from head office responded with a sympathetic ear and connected her with someone local to register her complaints officially. I asked of her name and suggested we come find her at some stage to talk to her about medicines. She was clearly a systems thinker and sure to have an ideas about what could be improved. She seemed delighted by this. “I used to be a nurse” she said as she walked away with a smile.

We passed her again later that day. This time we were doing the walking and she was sitting in the communal area preparing to listen to a performance of Christmas carols. She nudged the woman sitting next to her. “I told these guys off before. They’re alright”, she said with a smirk.

She gave us a good reminder that day. We are in their home and we should be respectful of that. We still use communal areas to work, but we make sure we ask the residents for permission now.

Dishes

There are some ads that just speak to you. For me, it’s the Finish ad that has a montage of images of dirty dishes that monotonously says dishes…dishes…DISHES. It speaks to my dread and long standing hatred of this daily chore. The challenge for me is that I equally can’t stand dirty dishes accumulating next to the sink, so it’s a chore that fits in the non-negotiable list.

When I met my partner, this issue seemed to resolve itself. I cooked, he cleaned up. He even kind of enjoyed it. This was something I found bizarre, but I was more than happy to leverage. Then kids happened.

Kids bring with them evening rituals, one of which is bath time after dinner. The supervision of this seemed to fit neatly in the Dad category, leaving me with the dishes. Urgh.

For a good few years I loathed this time. It was like it triggered the memory of my Dad insisting that the cleaning up occur immediately after dinner and that no, I could not let it wait until the ad breaks so I didn’t miss Neighbours. Clearly I have some unresolved issues.

Then one day I woke up in the present and discovered podcasts and audiobooks. To say it changed my life may be overstated, but it certainly had a positive impact. I started to look forward to cleaning up after dinner. Dare I say it, I even started to stretch it out to try and make it last longer.

Reflecting on this, I can see what James Clear was talking about in his book Atomic Habits was true (which incidentally, I listened to while doing the dishes). One of the ways to make an unpleasant habit stick is to link it to something that you want to do. Something that contributes to you becoming the identity you want to create for yourself. It worked. I now have a cleaner kitchen and a broader mind.

The Right Stuff

This morning at school drop off one of the kids mum’s told me how she had to get her son to rewrite his Christmas card to my daughter because he couldn’t decide if he was saying ‘to’ or ‘dear’. I laughed and responded, ‘well I don’t have a clue what my daughter wrote in the card because she wouldn’t let me look at it’. Later my overthinking brain kicked in and I wondered if I came across as being a disinterested parent, leaving my daughter to her own devices like this.

I’m not really in to writing Christmas cards, but for my daughter they still have novelty. She’s almost six and nearing the end of her first year of school, so writing in itself has still got novelty. Our Elf on the shelf isn’t a spy for Santa, he helps us do the jobs to get ready for Christmas. So when he arrived this year he came via Big W with a packet of Christmas cards and a note to my daughter advising her to be generous to her friends. (There were also some Christmassy erasers but they seem to have mysteriously gone missing).

On the weekend she set herself up on the kitchen table and got to work. She got out her class photo to spell the names correctly and she was off. I wasn’t allowed to read them, only to double check that she hadn’t missed anybody. And to find her a suitable Christmas themed bag to carry them in.

Yesterday she excitedly delivered them to all her classmates (still sans Christmassy erasers). I was with one of the other mum’s when her son got his, so I was able to sneak a look at one of the messages. “Dear Zac C. You must call me a name and it must start with a C”.

I don’t care if people judge me as being a disinterested parent for not overseeing the Christmas card messages. I don’t think there’s a right or a wrong way to write a Christmas card. Scratch that, I do think there’s a right way – to write a message that means something to you, with the recipient in mind.

Participation Award

This year my daughter participated in her first ever school sports day. The final event was the sprint. All the kids lined up in their age groups and (most of them) ran their little hearts out.  The top three got the blue, green and yellow ribbons as they crossed the finish line and everyone else got a red one that said ‘competitor’.

Situations like this almost always spark discussions amongst parents and grandparents (or more accurately, broadcast of opinions) like “kids these days need to learn how to lose!” and “what’s the point of playing if no one wins?”

You see evidence of this attitude everywhere. Reducing everything is a zero sum game – designed for one person to win, and another to lose. Supposing that your individual worth is determined by bettering an opponent. Maybe in some circumstances, perhaps this is valid. But I kind of doubt it. I’m not really one to use sporting anecdotes, but I’m pretty sure there are plenty of AFL footballers who had very fulfilling careers and never won a premiership. I would even dare to say that some of their most memorable and satisfying games were ones that they may have ended up losing, but were a well fought out match.

A guy named James Carse refers to these as finite games. These are games where there is a winner and a loser, the rules are defined, and there are a specified number of players. The game usually goes for a specified amount of time and it’s based upon a model of scarcity. But he also talks about another type of game – infinite games. In an infinite game the aim isn’t to win, it’s to keep the game going. To enjoy the experience. You are reliant on other players to keep the game going. You want the people you are playing with to be capable players, otherwise the game will end prematurely or it will all fall in a heap.

This is the subject of Simon Sinek’s latest book The Infinite Game. It’s still on my ever growing to read list, but I’ve listened to him talk about it and I like what he has to say. He places this game theory in the context of businesses, and suggests that it’s the business who have an infinite approach that will lead us into the future. And I tend to agree with him.

If we take Pharmacy as an example, I think its fair to say that the reason we are in this position a profession is because for so many years we have been positioned within a scarcity model protecting community pharmacy. And it has failed us. It has not led to a profession striving for quality standards, it has led us to a race to the bottom. I don’t think it’s too late to turn it around, but it going to require some pretty strong leadership. And by leadership, I’m talking about the genuine type of leadership demonstrated by individuals taking action. Not the other kind.

My daughter got a red ribbon and she couldn’t have cared less where she finished in the race. Well, that’s not entirely true. There were a few super slow runners and I’m pretty sure she would have felt disappointed if she finished behind them! What mattered to her was that she went out there, ran as hard as she could and there was a crowd cheering her (and everybody else) on. It was fun! With the school’s encouragement, she was able to have the mindset of an infinite game, and felt much happier for it. And she went to bed that night with her tokenistic red ribbon pinned to her PJs and a big smile on her face.