Pocket Wisdom

I was rifling through a box of papers from the days of my first few years of practice in the small town of Chemainus (1994-1998).    The beginning of learning how to care for patients and fit into the medical system.   I came across a folded up piece of paper that I recognized as one I had carried in my lab coat pocket for many of those early years…

Ode to Patient Care

If we speak with the tongues of specialists and consultants,

and have not love, we will have nothing more than the noise

of our own voices and the clanging of pet ideas.

If we develop new methods, write new curriculum,

and learn new techniques,

and if we understand all about the five stages of dying

so that we are not surprised when a patient is angry or depressed:

and yet we have not love, we are useless.

If we give up our old anxieties about talking with patients

concerning their true feeling,

but we have not love, we gain nothing.

Love never ends.

As for tumour conferences,

they will pass away;

As for workshops,

they will cease;

As for inservice training,

it will change.

For our methods are always imperfect

and our plans often don’t work out.

When I first became a helper, I thought like an idealist

and talked like an expert.

As I began to mature, I realized that I too was afraid

and the patient often taught me.

For now we see only reflections of sickness and death,

but someday we will see them face to face.

And the time will come when we will know for sure what it is like,

and we will be sorry we ever judged.

So methods, techniques, case conferences, care plans,

seminars, small group experiences, counselling-

There is all this and much more we would suggest for

gaining insight and increasing effectiveness:

But greater than all of these is love.

Dan McEver

Now posted once again where I practice daily so I can be reminded of what really matters….

Worth It

ccFlickr shared by Eduardo Llanquileo

It’s been awhile since I’ve been here…. I’ve gone from regular posts to a lapse in writing of over two months!  Even worse for my professional site which has been three months!  I sat down today and thought about what had changed and why I haven’t been writing.

I guess I have just been tired… It has been an overwhelming couple of months with many changes.   Changes that have taken the pharmacy practice I love into the scary place of perhaps not being sustainable.  Government decisions, which have been short sighted and without consultation with the front line health professionals who are affected, have been devastating.  Even as the government back pedals on some of their inane decrees in an attempt at damage control, the changes will continue and have a vast impact on the health of Albertans’ and the sustainability of pharmacy.

The emotional roller-coaster of connecting with hundreds of other pharmacists across Alberta who are in the same position has been both inspiring and enhausting.  I have met so many professionals who are utterly committed to their patients; but it is heartbreaking to hear of some colleagues, near retirement, who may lose the value of their practices they spent years building.

I am many years from retirement and am hopeful this will not be the case for me, but there have been days I have walked into the place I love and found it difficult.  Wondering if decisions, which are in government’s hands, would take away what I have been building.

Then yesterday I received a letter from the College of Pharmacists that I have been anxiously waiting for.  For over a year I’ve been putting together my case to apply for prescribing rights.  I finally completed the process and sent it off.

While I have had limited prescribing rights for years, there have been many times when caring for patients that I have felt like I had my hands tied when I couldn’t prescribe what I knew they needed.

My son handed me the letter from the College, and when I opened it he asked me why I was grinning like crazy!

I had received my prescribing authority; and it was more than the expanded ability to serve my patients that had me grinning.  It was hope.  I could see that I had been losing my joy…the reason I was building my practice in the first place.  This affirmation caused me to take a step back and realized that I am exactly where I always wanted to be.  I practice with colleagues whom I highly value and continue to learn from and I am in my own pharmacy able to care for my patient’s exactly as I want.  Definitely worth it.

IMG_0878

“What have I done?”

A few weeks ago a colleague warned me that in the first year of owning and running a new pharmacy I would conclude that I had made a huge mistake.

Yup….that happened well before turning the sign to “open”!

The two weeks leading up to my opening day were chaos.  I’ve never slept so minimally, had my “to do”list grow so fast, nor seen my children so little.  As I heard repeatedly, “Mom, are you coming home late again today?” I figured I had made a mistake.  I am a clinician; I love the “care” part of health care, and here I was, steeped in putting a business together. Spending hours on end away from my family, and even when with them my mind was racing with all the things I needed to handle.

So when I walked into my brand new pharmacy on day one and flipped the sign to open, I wondered whether I had jumped into something I would resent, or at the very least not enjoy.

Then came patients through my door.  Just a few at first, and a few more each day, and I found myself in a place of privilege.  As I provided health care, I heard their stories.  Stories about caring for terminally ill spouses, stories of how difficult it is to live with chronic pain, journeys through chemo and disappointment with the system.  Even stories of past jobs and places they had visited in their life time.  As I immunized many against the flu I also shared a lot of my own story.  How I came to be in this new pharmacy, growing up in Saskatchewan, how I had started a pharmacy in Chemainus when I was very young.

It struck me once again that the connection made and the care given are what brings me joy.  Having my own pharmacy means I can structure and set up to practice the way I want.  I have control over how I care for the people who walk through my door.  There is no one to tell me I must meet a certain quota or promote sketchy treatments or unproven products.  In the end, it is worth all the headaches that I am sure will come.  So it is to the people who came through my door this week that I am grateful to, for reminding me what it’s all about.

Tidal Wave Changes

cc licensed Flickr shared by Chris-Håvard Berge

For the first time in 8 years I am not homeschooling any of my children, and after 18 years of practicing pharmacy in someone else’s dispensary, I will practice in my own.  I’ve made a huge leap, with the support of my family, into what I hope will be a rewarding new phase in my personal and professional life.

Those who have read my blog, or visited my professional site, know that I have complained a little (and sometimes a lot) about the struggles of wanting to practice pharmacy in line with my philosophy of patient engagement and focus on learning.  So I’ve made the leap to “putting my money where my mouth is” so to speak and, along with some great partners, am opening a pharmacy in Stony Plain.

As I embark on an exciting new phase of my career, my children have also had to adapt and grow.  They have taken on full time school (here’s Noah’s remarks on that), more chores, my babysitting,  and a different way of learning at home (less time with Mom to explore cool stuff together.)  My spouse has moved his office home to be more available to them and they have embraced the changes with more enthusiasm than I had hoped.

I’ve experienced, over the past year, small ripples of growth and change and had no idea where they would lead.  As the ripples converged into a wave, I’ve received much support and encouragement from family, friends and global connections.  I have much to be grateful for. And yes, even though I’m sending them all to school, on their first day they still got cake for breakfast.

5 “Must Ask” Questions about Your Prescription

When you are handed a prescription by your physician or your pharmacist there are many questions you should know the answer to before walking out the door. Below I highlight my top five.

CC Flickr Shared by Rob!

  1. What is this medication for?

This may seem obvious, but countless times when I ask a patient if they know what their prescription is for they tell me they have no idea.  When someone doesn’t know what a medication is for, there is little motivation to take it correctly or even at all.  Most drugs have more than one indicated use.  Know what yours are being used for.

2. What will happen if I don’t take this medication?

This may seem a strange question, but the reality is that over 50% of medication prescribed is either taken incorrectly or not at all.  (Health professionals are a little vain- we tend to think if we prescribe it, you will take it.) If you don’t take your high blood pressure medication, you have a higher chance of having a heart attack or damaging your kidneys.  If you don’t take an antibiotic for a nasty cold…well, really nothing is going to happen because antibiotics do not work for colds.  There are many prescriptions that are unnecessary or could be avoided with “watchful waiting” and there are some prescriptions that can be deadly if you do not take them exactly as prescribed.

3.  When can I expect this medication to work for me?

An important piece of information.  Will it treat my problem/condition in an hour or in 2 months?  Knowing what to expect is essential.  Someone being treated for clinical depression needs to know that the medication they are getting may not start to work for 2 to 6 weeks.  That’s a long time if you are expecting to feel better tomorrow.  Equally important is a person in acute pain to know that the pain medication should start working in an hour or so.  If not, it may need to be adjusted.  And if after 3 days of antibiotics your skin infection is spreading, don’t wait for the ten days of pills to be over.  You need to be reassessed right away. Know what to expect and always ask questions if you are unsure.

4.  What do I do if I have a problem with this medication?

Not all problems or side effects require another appointment.  Many issues can be solved by tweaking the dose, timing, formulation or way of taking the medication.  Sometimes a change of medication is necessary.  Find out what some of the common problems or side effects of your medication are and what you can do about them if they happen.

5.  Can I take this medication with all my other medications?

I find that most patients will ask me about this.  What is often missed though are the non-prescription medications, vitamins or herbal products they are taking.  Patients tend not to mention these as they are often viewed as “safe” and not harmful.  But in fact, there are many vitamins and “natural” products that can interact with prescription medications.  It is important to mention them all.

We all know it is impossible to remember everything your doctor or pharmacist tells you.  And that is where follow-up and communication comes in.  When I see a patient I advise them of any follow-up that is needed or how to reach me for questions. Typically by phone or email, but for more complicated learning I’ll see the patient in the office. Whether your nurse, pharmacist or physician provides you with your prescription, ensure you receive proper follow-up and educate yourself.  You are the person with the most vested interest in your own health.

E=

cc licensed flickr photo shared by chrisinplymouth

E = EXACT

Health Care is not an exact science.  That’s right.  We want it to be…and I see much frustration, disappointment and even desperation because of this fact, but it’s the truth.  Despite all the medical advances and advertising of drugs that seem to point to the opposite, there really isn’t a “pill” for every illness or a test to diagnose every medical condition.  Sometimes there is no clear cut answer to a health problem, nor a solution.

Medicine and Pharmacy are applied science which means we take science and apply it to people.  We take everything we know about anatomy, microbiology, pharmacology, biochemistry, therapeutics, etc., and apply it to individuals who have their own unique physical, biological and genetic differences (not to mention the social, cultural, and psychological aspects).  From this application of knowledge to each individual situation, diagnosis is made and treatments are decided upon.

cc Flickr shared by chrisinplymouth

E = ERRORS

This applying of science also means that medical care is not perfect.  Combine that with the speed at which this knowledge needs to be applied to patients and situations, errors are inevitable.  Here’s a quote from Dr. Brian Goldman that had me thinking this week.

What I’ve learned is that errors are absolutely ubiquitous. We work in a system where errors happen every day.  Where 1 in 10 medications are either the wrong medication given in hospital or the wrong dosage…  In this country as many as 24,000 Canadians die  [every year] from preventable medical errors. [which is a gross underestimate]

We all know someone who has had sub-optimal medical care or errors made in their care.  Often there is anger towards the professionals that made the mistake.  I’ve been on both ends of that situation.

There is an expectation of perfection in health care.  As patients we expect our health professionals to be competent, and so we should.  But as a health professional I know we are all human and lack perfection.  We all fall short and can make mistakes.

I’ve made mistakes in my career and will most likely make a few more before I am done.  Fortunately I have never made a mistake that has seriously harmed someone or caused a death.  But I know each time I put my lab coat on it is a real possibility.

cc licensed flickr photo shared by chrisinplymouth

E= e-PATIENT

The possibility for error is why I continually encourage people to be engaged in their health care.   Not because you shouldn’t trust your health providers.  Quite the opposite.  You need to be an active partner so a trust relationship is essential. Working as a team is the best way to ensure optimum health care.  How can you do this?  Get to know your own body, your medical conditions, your medications.  Ask questions. We need you to be as educated as possible.

More and more patients are getting health information over the internet.  (Interestingly, Health Professionals are often divided over this.  Some thinking this is great and others not so much).  I think the more knowledge you acquire about your own health the better.  And this is where the trust relationship comes into play.  Yes, there can be some bad information out there.  So you check it out with your doctor or pharmacist.

Last week I had a patient in tears because she had read on the internet that her diabetes medication could give her seizures and she didn’t know what to do.  Was that good information?  No.  It wasn’t true.  But I didn’t advise her to stay away from internet health information.  I provided her with some reputable sites and encouraged her to learn more about her disease and contact me in a week to go over what she had learned.   As one e-patient says in this video, “When push comes to shove you check with your [health professional]. They’re there for a reason”

Here’s an example of the growing movement of “e-patients.”  As you’ll see, the “e” stands for many great attributes that can lead to a safer, more participatory, less paternalistic model of health care.

Uninvited Gift

cc Flickr shared by by atlebra

It’s been five years since she was told she was “cancer free”. Today she was told it was back, and the future was quite grim.

My job was to make sure she understood how to properly take the medication that would reduce the swelling around the tumour so radiation could start as soon as possible.

That was my job. Clinically speaking it wasn’t the most challenging or difficult issue of the day as I scanned her file. Then I went to speak with her.

It took mere minutes to make sure she understood how the new medication worked, how to fit it into her day with her other medications, how she might feel taking it. We reviewed her other drugs and medical conditions and I assessed her level of understanding to be high. Job done.

But what about the other part of my job? When she told me about the cancer returning, I looked into her eyes and could see the shock… and the fear. What she needed in that moment was human connection; a hand on hers and someone to listen to her.

When I looked around for the time I needed all I saw was the impossibility. At least a dozen patients waiting for me to sign off on their medications, one waiting to learn how to use their new inhaler, and two patients nervously waiting for me to administer their injections. At the same moment I heard one of my technicians say I was wanted on the phone by a physician.

Time…..I didn’t have it. I couldn’t take her into my office and be that presence for her.  So I spoke medication, touched briefly on the agony of the diagnosis, and resisted going too deep.  I know too well the fragility of emotion, and without the privacy to truly be present to her situation, she needed to keep from falling apart and make her way home.

But somehow I feel I have failed. There have been times when I have taken patients into the office who have been grief stricken, going through withdrawal, requiring in-depth discussion of an issue…. But today, I was stretched too thin.

And so…I take it home with me.

I have had colleagues tell me to leave the job at the door. Walk away to my family and rest assured there will be more patients and problems tomorrow. I have learned that at times I can and must do it, and at other times I simply can’t. But perhaps it’s the “can’t” moments that make me a better professional…..a better person. There are times when I experience humanity laid bare….a rawness of emotion, a fragility to life. These experiences become a part of me whether I invite them in or not. In the end they are an univited gift.