Y’know, after the Ontario Pharmacists Association Conference this year, and after spending time learning new things, meeting new and studying pharmacists, renewing acquaintances with the more “experienced” crowd, and generally being re-invigorated about the prospects of my profession while maintaining a pharmacist-appropriate dose of pessimism, I took a few deep breaths. It is what they recommend when there is a whole lot going on.Others have noted it, including journalists Karen Welds and Vicki Wood (two of the people primarily responsible to blame for my long relationship with Rogers Publishing). It is the wind of change in health care that started in the industrial revolution… or maybe it was the Renaissance.The change I am referring to is the growing sophistication of our patients and how it has changed their healthcare priorities, expectations and demands. It is recognizing the unique wants and needs of patients, and our professional pharmacist role in fulfilling them.The baby boomers are probably the first generation where a whole lot of them, when told something by their wise pharmacist or other health provider, asked the question, “Why?” And, “Because I said so” is no longer reason enough.What is also intriguing is this is a time where the wants and needs of patients actually align with what our healthcare system needs to do—customize care.So what we are seeing right now is symptomatic of the different elements that need to come together. They are all components of the change that needs to happen to bring pharmacy forward, and they are the shared responsibility of all involved. Think of each one of the pieces of the puzzle, and where you are, and how ready you are to change.The first one is desire. Pharmacists must want to be able to provide individualized care to patients. It is why everyone from the pharmacy industry to educators is recognizing that too many pharmacists are reluctant to take on responsibility. It has led to questions about the kinds of people our profession attracts, or admits to pharmacy school. Educators are asking how we find the kinds of professionals who are willing to apply what they have learned, and take some professional responsibility for taking that to the next level. It includes time, effort, financial risk and a willingness to lead (not follow) a process. A profession that refuses to accept it has a responsibility to change is a dead one. So let’s talk about that and figure it out.The second one is ability. Pharmacists need to understand how to do this. The biggest skills gap is that pharmacists, not unlike most health professionals, are fairly lousy communicators. At least they are compared to insurance folks, investment people, social workers and any kind of effective salesperson. We don’t, as a rule, ask about the wants and needs of patients—we just tell them what they are based on what we read on a prescription and a few pre-conceived notions. Methods of interacting with patients that have plenty of evidence of effectiveness at improving outcomes and patient satisfaction, including communication skills, motivational interviewing, goal-setting and health coaching, were rarely taught in school. Even though they are taught now, it is after the fact, instead of an integrated manner where the skill is practised in every clinical interaction the pharmacist has. It isn’t something nice to add, it is how we should do our job. Always. Let’s fix that, too.The third one is control. Pharmacists need to be able to shape the environment and their practice to match what the patient needs. It is one of the reasons why billing numbers are a good option for gaining that autonomy. It is also something that must be with the pharmacist, because a business or corporation cannot adapt at the speed or efficiency necessary for this to work. Indeed, companies have enough trouble understanding that the one-to-one relationship is critical for success and that you can’t apply any solutions or services universally or based on quotas or other things people like to manage and control. It is particularly critical because even attempts to structure and automate clinical services—notably, guidelines and other best practices—are still limited, and require a clinician to match the principles of good care with the wants and needs and abilities and support and beliefs and priorities that patients have. If scientific guidelines cannot find a one-size-fits-all solution, how can quotas and metrics be designed to do so? No one can predict that, so the pharmacist has to be able to control the service offering to provide the best care possible for each patient. So we need to fix this problem as well.The fourth one is compensation. Public payers are way behind on this, although it is catching up in high cost patient areas—for example, complex diabetes, cancer care and heart failure. This is because the payback time is short enough to appreciate. Private payers or patients themselves are another story. Pharmacists will complain that patients are not willing to pay for any services that will ultimately make them healthier, live longer and do so with a better quality of life. To be fair to patients, though, we have never been good at, or offered, the above three things consistently, so we have no experience with marketing that product. If we look at analogous products that people pay for, though, it gives us an idea. They will pay a lot to look good—do you look better if you are healthier? They pay a lot for fitness—as important as exercise might be, fixing your vascular problems will save you a lot more life and misery. They will pay a lot for comfort—do they see you as a provider of that for them. They also pay a lot for security—do they think that as well. Do patients know we save their lives every day, and help improve their quality of life even more, and more importantly do they realize that using us to the best of our ability will multiply that benefit? That perception of value worth paying for really needs to be fixed as well.The fifth is measurement and outcomes. We have to prove that we are worth it, and that means measurement and tracking and documentation. These are all things we are marginally familiar with and usually not too enthusiastic about. They are the things that will capture the momentum and allow us to advance further. The data we have seen so far keep pointing us in this direction. We are slow to uptake because of the previous four issues, but they are not going to go away. So why don’t we spend some time talking and thinking about these things, and wrapping our minds around how this is a big part of the solution for the future of pharmacy, and how pharmacists may be better positioned to provide this if the reins are taken off. It is not surprising that everyone involved, from corporate head to individual pharmacist, is involved in some part of the problem, and each should begin doing their part. We need to prove ourselves, and you can’t prove something is better until you actually do it and measure it and apply it and promote it. Everybody in pharmacy can help fix this.It isn’t a complicated problem. It just means letting go of your biases, your selfish interests, and your general discomfort with change. It means it for everyone involved in the practice of pharmacy. And as I have said before, if you don’t want to be part of the solution, at least don’t get in the way. You owe that to your profession, and to the patients we serve. Ultimately, we all will be the better for it.So let’s start talking about these problems with the goal of fixing them. Fixing things is what pharmacists do.Ken Burns is a pharmacist at the Diabetes Care Centre at Sudbury Regional Hospital.
