On becoming a new pharmacist

Last issue, I introduced you to 3 recent pharmacy graduates who we’ll be following through the ups and downs of becoming new pharmacists. As you’ll recall, all 3 were hired specifically to provide patient-centred care rather than the traditional product-focused (distribution) role. Let’s check in with them a few months into their new jobs. Reid McDonald and Anita Cumbleton have settled into their positions at Fyfe’s Friendly Pharmacy in Barrhead, Alberta. They report that things have been going well. They’ve been busy performing 3 to 5 medication reviews every day. Relationships with the local physicians have been very good, although not all support what they are doing. Their main challenge has been that patients seem unaware of what their pharmacists can do for them. Sometimes patients say “my physician can do that” and dismiss their offer of a medication review. Anita and Reid have changed their approach to patients by making the medication reviews less formal, starting to engage patients more casually by asking them a few questions about their medications. When patients realize how little they know about their medications, it seems to lead them to want to talk more. Another thing that seems to work is to start engaging them while they are waiting for their prescription (rather than after it’s ready). Bryan Gray has been aggressively pursuing MedsCheck reviews for his patients as well at Shoppers Drug Mart in Thunder Bay, Ontario. Early on he had a disturbing experience. He conducted a review for a 75-year-old patient who had been receiving hormone replacement therapy for 20 years. She had not had any menopausal symptoms in over 10 years, and they discussed breast cancer risk. Bryan wrote a letter to her gynecologist, citing the evidence for increased risk of breast cancer. The physician sent back his letter with the following comments: “Please mind your own business” and “PS, You are also poorly informed. There [have been] follow-up studies since the WHI [Women’s Health Initiative].” Bryan was alerted to this response by his boss, who expressed concern that he had “pissed off Dr. X” and that they’d better talk. Not surprisingly, Bryan’s first reaction was that of anger at the unprofessionalism of the physician. He thought of going to his office and confronting him. He also had second thoughts about his decision to intervene in this case. In the end, he explains, “If this was my mother or grandmother, I wouldn’t let this slide, therefore I can’t let it slide for my patients.” Indeed, patient care trumps all. Bryan has changed his approach. He is no longer “cold faxing” but rather phoning the physician first. He reports that this tactic has worked well. Some physicians are very appreciative, while others seem taken aback that he is calling, but are still okay. As you might expect, our new pharmacists have received a good “loading dose” of reality. What impresses me is that despite some barriers, they have shown us that persistence towards the goal of advocating for their patients is more important than their own pride or feelings. Rather than recoiling from the challenges, they are sharpening their resolve. They are learning new tactics to apply their care, and we shall continue to follow along, learning from them (and cheering them on). ■

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