Musings at 7.30 am

Today feels like it could be a good day.

With a light cooling rain in the morning coupled with the miracle of free-flowing traffic through the heart of KL, today can hardly feel any more promising.

Perhaps it also has something to do with my present frame of mind.

Weeks of being annoyed and frustrated has now produced in me an amazing feeling that I recognize as a sense of detachment.

Simply put, I have stopped caring.

It's no wonder that Buddhist scripture places so much emphasis on nonattachment and detachment to all things material and emotional.

It is simply liberating and I like it.

So for now, I aim to no longer contemplate on whether my cup of 'teh tarik' is half full or half empty.

I shall simply enjoy it.

Coming Back...

It's amazing how failure can really show you what you're made of and it's equally amazing how much failure can teach you compared to success.

I'll admit right off the bat that my reason for having stopped blogging for some time was due to an inordinate amount of disappointment in the system, in pharmacy and ultimately, in myself.

While I have no wish to recount the incident especially on a public domain, I believe that I can safely share what I felt during the entire episode.

I felt disappointed and cheated in a system that did nothing to defend its own pharmacists. Instead, the system chose to run down their pharmacists and was intent on choking its pharmacists with valueless work while burdening them with limitless liabilities. In that period of time, I could see no future for the profession. Embittered by the entire episode, I lost all desire to care.

In a nutshell, I had lost hope.

However, I recognized that failures and disappointments such as this often serve as tests of our resolve and they too are often gateways to future success.

I could not let a single setback destroy the spirit and passion that I had previously held for our profession. I recognized that if I were to continue as a pharmacist and champion the cause of the profession, setbacks such as these would be common and I should treat them merely as speed bumps rather than roadblocks. I would have no choice but to move on strongly and learn from my previous mistakes rather than to let them hamper me.

With that firmly in mind, I resolved to emerge from the despondent mood that I had been in for the past few weeks and to make a new beginning.

Today was that beginning.

And it was all good again.

Stay tuned for more updates.

p.s. that was a rather pompous sounding post, don't you think? ;-)

Reply From Charles Ponte

For the lack of a better post, I took my time machine and dug up one of my favourite previous posts. Charles Ponte is the Professor of Clinical Pharmacy and Family Medicine at the West Virginia University School of Pharmacy. The following is his reply to one of my emails:

Hello Mark,

I am still somewhat puzzled regarding how you came to find me among the more than 100,000 pharmacists in the US. Nonetheless, I am happy to share some of my thoughts that may help you and your colleagues. I would assume that you have a BS degree in pharmacy. I don't think that you have to have an advanced degree and/or specialty training to be a successful practicing pharmacist. In fact, most pharmacists in the US have been trained at the BS level.

The pharmacist has to place himself in the position "where the action is". What I mean is position yourself to counsel patients and be available to answer their questions. Do not hide behind the prescription counter. Be proactive with your physician colleagues. Tell them what services you can provide that are unique to pharmacy (e.g., drug histories, medication counseling, medication review, etc.). Develop a newsletter and mail it to physicians
outlining the services you can offer and/or provide clinical drug pearls or other drug information services.

There is no magic way to stay current in your field. You have to ascribe to the philosophy of life-ling learning and take advantage of conferences, symposia, podcasts, live presentations, regional, national and international meetings. There is literally hundreds or more CE offerings on the internet. Be careful and choose these sites carefully. Get involved in presenting lectures. This is a great way to learn new information or to stay current in your chosen specialty area(s). Give talks to physicians and other providers. This is a great way to showcase your knowledge and expertise. Never stop learning and be therapeutically inquisitive.

In the eyes of your physician colleagues, you may be nothing more than a provider of a commodity, namely a drug or device. However, if you want to make an impact and increase your credibility, tell them what you know! Show them that you are more than just a "pair of hands" and a counting tray. I think that you have to be diplomatic and know when to intercede on behalf of the patient. Don't come across as a "know it all". I like to offer the physician options regarding management strategies and let them pick (make sure that you are comfortable with all the options). I never question the physician's intelligence or contributions to patient care. You need access to the patient record if you are to make sound decisions.

Never rest on your laurels. You have to constantly maintain your credibility with physicians and other providers. If you want to make a difference in the acute care setting, maintain your visibility and accessibility in the patient care areas. Don't hide in your office. Let them know that you can be contacted with any questions via pager etc. Go the extra mile. If they have questions for you, response ASAP. Provide them with references or other literature to substantiate your recommendations or answers. A professional demeanor along with good communication skills (verbal and non-verbal) will go a long way to foster good relationships with colleagues. To begin the journey, you have to be willing to take the first step!

I hope that these "pearls" will assist you and your colleagues in becoming more proactive in the provision of pharmaceutical care. Keep me informed and stay in touch. Best wishes as you begin the journey.

Take care,
Charlie Ponte

We Touch Lives

He calls me almost every week.

He and his wife both.

Sometimes it's because they've lost some of the medication and are now short. At other times, the doctor has changed something and they're not sure if it's okay. Once, they even had problems with melting tablets. They've also called when their daughter vomited up all her medications and were unsure as to whether they should rush her to the hospital.

I'd be lying if I said I didn't feel just the slightest twinge of annoyance at their constant neediness. Their insistence on attention often borders on rudeness and they have shown little regard for the time of others.

It's all completely understandable though.

A daughter suffering from the scars of meningitis is no burden to be scoffed at.

Viewed in that light, if a few comforting words of advice and some of my time is all that it takes to lighten their burden, I'm willing to offer my services....

....and I silently thank them for the opportunity to make their lives easier.

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She just wouldn't take her medicines.

The family tried to force her to take them.

The nurses threatened to force them down her gullet.

The doctors threatened her with death and disability if she did not comply.

All they succeeded in doing was to make a little old lady hide all her medications in her diapers.

What a sight it was when they finally changed her diaper!

She distrusted the medications. She had no idea what they were for and why she had to take them. She didn't like that it made her dizzy and sleepy all the time. She especially hated the fact that everyone was telling her what to do without explaining to her what was going on. Being a sick 80-year old patient made her paranoid when everyone around her spoke in front of her as if she wasn't there.

As a result, it took weeks for me to get through to her.

It took daily visits, greeting her and enquiring after her health every morning, taking note of her complaints regarding the medications seriously and not dismissing them as attention-seeking antics. It was particularly difficult to explain to her what her condition was, how we were trying to treat it and what our medications were supposed to do. The language barrier and the difference in education levels only made it harder but it was important not to give up. As the days went by, I could see that she could finally understand what it was that was happening to her. She was forewarned about the side effects of the medications so that when they occured, she knew it was part of her treatment and she started putting up with it. She could also understand her disease better and knew what to expect.

In the end, she learnt enough to manage her disease, her medications on a daily basis and even started giving her opinions on how she wanted her disease to be treated by her doctors.

No mean feat for someone with advanced Parkinson's Disease.

I'm just glad that I could help out in whatever little way possible.

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I write this post not to brag or to highlight my contributions to the lives of my patients.

Rather, I wish to send a message to those of us who are angry, disappointed and disillusioned over our role in healthcare as pharmacists.

We may not have exclusive dispensing rights and we may not be allowed to prescribe at all. Our suggestions are often dismissed and our warnings are often disregarded. Our contributions are often scoffed at and we are viewed as no more than organic medication vending machines.

None of that should be allowed to stop us from helping the needy.

A kind word, a bit of your time and a serious commitment to helping those who have come before you for help and relief is often all it takes to improve their lives.

The take home message is simple:

Despite our limitations we can still touch lives....

....and in touching theirs, we brighten our own.

For Vanessa

To the dear blogger who commented on the previous post,

I got into my little time machine and I dug up the following blog post for your perusal.

Hope it makes your day. :-)

Needs and Need Nots

Let me start this post with a statement:

I have not had so many doubts about my profession nor have I hated my job so much like I have in the past few weeks.

But how can that be?

After struggling so hard to get out of Pissant Hospital, I am finally in one of the country's premier hospitals, working clinically in an intense medical discipline, discussing cases with expert consultants and specialists and slowly becoming someone who others can actually refer to when cases concerning my discipline arise.

So what is the problem?

The problem unfortunately lies in the way Pharmacy is run and practiced in this beautiful country.

I make no attempt whatsoever to censor myself when I say this:

I despair that I am a pharmacist.

To be a pharmacist means that you are constantly subjected to reminders that you are merely a purveyor of drugs. It also means that from the very beginning of your internship, you have been reminded again and again how inferior you are to the masters of medicine. Make no mistake; often these reminders come from senior pharmacists themselves, not doctors. To be a pharmacist means that most people will never see the value of the work you do. Your superiors see no reason to invest in your education. These people also believe that there is no need for a pharmacist to particularly specialize in one field and instead treat all of us as rotatable, constantly adaptable resources. They claim that this results in professionals who are well-rounded and adaptable; I claim this results in half-skilled workers that aren't particularly good at anything with the exception of being able to obediently follow instructions.

When pharmacists trained in the said manner go on to become senior pharmacists, they in turn corrupt the younger generation. 'Do not challenge the doctors, for it is a fight not worth fighting' and 'Remember, we are ONLY pharmacists' are phrases often used to turn bright, enthusiastic, willing interns into slow, dull and perpetually uncertain clods. Additionally, the lack of proper training and guidance during intern years results in pharmacists who are poor in writing, poor in communication skills and exceptionally poor in seeing the big picture. Such pharmacists are also often poor team players which results in the rocky relationships that are always seen between pharmacists and doctors as well as pharmacists and nurses.

What we need are bosses who can see that now is the time for change. Bosses who constantly clamour for new ideas but never provide the right environment for such ideas to flourish are hypocrites of the highest order. We also need bosses who can see that their support and their backing of junior pharmacists are vital in order to instill a sense of confidence and pride and subsequently, generate new ideas and innovations.

We also need colleagues who can rise from their pettiness and shortsightedness in order to labour together for the greater good. We do not need wet blankets and we do not need 'No'-men. We do not need the cowards and the spineless, the depressed and the depressors. What we need are people who live and breathe in the idea that our profession can expand into new grounds and greater heights; people who dream of being able to provide much more than drugs to the people. We need people who believe that through their profession and through their actions, they can bring about change.

We need to strive to expand past our known professional boundaries. We need to achieve a future where the only way to do what we can do is to be one of us. We need to establish the image, nay, the identity of a pharmacist as a highly skilled medical professional practicing a craft that requires great expertise. We need to instill pride in our profession. We need to fight for a day where schoolchildren will stand up and say, 'I want to be a pharmacist when I grow up.'

I believe strongly that the future of pharmacy and its practitioners in this country is at a turning point. We can continue to wallow in mediocrity and our petty squabbles and eventually watch as pharmacy assistants chase us out of labs, nurses chase us out of wards and doctors chase us out of sight or we can push forward strongly and reinvent this profession into one that is strong, dynamic, innovative and highly respected.

Spring Cleaning

Ah, yes...why have all the blog posts disappeared?

For a simple fact that every now and then, I have an overwhelming urge to dump everything and move to a new blog. This time however, I have elected to just trash everything that was previously here and maintain the site.

For the time being, this blog is considered 'Under Construction' while I attempt to figure out for myself what this blog should really talk about as working in a department with no house-officers and barely any nutty medical officers really tends to suck the 'Stupid Doctor' pool dry.

So until then, keep on coming back to stare at this blog post!

Cheers!