SEPTEMBER, Edition # 34 , 2001

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Rollo Manning has spat the dummy!
He thinks no one cares.
No one is prepared to get off their butt and DO something, to bring about this change which will drive us into the New Age Pharmacy.
I agree with him, that change must happen for the survival of the profession.
Rollo and all of us "on" Computachem have ideas on what needs to be done, and suggestions for the model to which we should aspire. The Guild/PSA/AACP/etc are pushing us down the road, with a range of initiatives, and incentives.
I tried to go down the CMI road 7 years ago.
I also produced a series of information leaflets for my patients. I printed little cards to persuade the patients to work with my systems. I tried to make Pharmacist advice work for 4/5 years.
I refitted.
I watched.
I adapted.
I threw $$$ into technology.
I handed out free written and vebral advice.
I had no life.
I was no SuperMan, but I thought I was doing my best.
Eventually, I stopped one day, and looked over my shoulder. There was nobody behind me. I was a leader without followers!
Everybody else seemed to be making money, but I wasn't - I was ploughing too much back in, replacing 2yo computers, printers and fittings, and investing time, energy and dollars in preparing materials for patients.
Then the Big Push started - the QCPP - the CMI - the DMMR.
Money was being thrown at us as incentives to participate.
At least pharmacy was now being paid the setup costs.
Everyone now realises that there is not much left out of the QCPP $10,000 on Accreditation Day. There will not be anything left out of the $3000 CMI printer incentive either.
Credit is due to the Guild for negotiating both deals - well done fellas.
I should have been glad to see that Pharmacy was at last being given financial incentives to improve.
HOWEVER !!!!! - there always was another factor or three!
I couldn't see any way of beating them - I decided that the life of the Pharmacist is set to get worse - much worse!
So I sold out!
I sold while I still could.
The biggest "other" factor is the PATIENTS - Joe Public has very little idea of what we do, or where we fit.
People actually ask "what takes you so long anyway?" and we must thrash out scripts faster than the guy down the road, to keep them happy.
I started questioning years ago, how we could possibly get through the workload, and all the other responsibilities and "initiatives" which were/are being heaped on us. In the early days of CPI/CMI, our local Pharmacists Association worked out, that the issue of CPI would take (on average) - CPI counselling only on original scripts - an average of 2.06 minutes per item.
This was a well constructed study - not just a number plucked out of thin air. Repeats needed zero counselling. A new script for a continuing medication took less time than counselling for a new medication. CMI counselling for an antidepressant medication took longer than a Panamax script. Etc etc etc - an average of 2.06 minutes per item.
So…. even if the processing and assembly operation is done for you by the techo, the average 150 items takes 5 solid hours - just to deliver CMI on new scripts only.
Of course you have to check the scripts etc etc, so, allow 1 minute for that, and eight hours of your day has gone!
The one pharmacist + one techo cannot (repeat CANNOT!) do more than 150 items per day. CMI cannot be handed over by anyone other than the Pharmacist. Only the Pharmacist can check scripts. Only the Pharmacist can hand over S3s. Only the Pharmacist can dispense Methadone.
The Pharmacist must be available for OTC counselling.
ABSOLUTELY IMPOSSIBLE!!!
Another problem arising out of this, is that a pharmacy doing 150 items a day in the New Age Pharmacy would need to increase staffing to support the operation, and would probably be unviable, anyway "Employ another Pharmacist" "Take on a partner"??? - do I HAVE to address that option???
The chronic shortage of pharmacists will always defeat any new, or expanded pharmacist-only duties.
This is not being negative - it is a fact.
I have bounced these numbers off the movers and shakers for many years now. Not one has told me I am wrong, or tried to dispute the numbers.
Remember - CMI delivery is an ADDITIONAL pharmacist-only duty … can YOU find that extra 5 hours per 150 items, or are you going to find ways to just throw the paper at the patient?
OK .. we have a choice - participate or not - our call - but are we not being herded down the same dead-end we have confronted before?
We all know that we are the ONLY profession which practices the way we do - always available, without an appointment, expected to give written and verbal advice (for nothing, at the moment), at a pace which is dictated by the customer.
So Rollo Manning is right … IS ANYONE LISTENING? … have I missed something? … Have I calculated something wrongly? … how are YOU going to handle CMI delivery?
We have a forum for replies to the Krusty Ravings…. Hop on and take me down!
If YOU have a plan to handle CMI issue, tell us all.
Also, how is the single pharmacist going to get out of the Pharmacy to do DMMRs?
Maybe somone from the Guild could hop on and tell us how the movers and shakers have worked out that we CAN do all this?
OR … what changes the single pharmacist pharmacy will have to make in the near future to make it work?
We cannot deliver these initiatives, and become a more valuable member of the health care team, unless the workflow and public expectations are dramatically changed. The single handed pharmacist might have to just walk away from the pharmacy - because no one will want to buy it.
I was going to close by suggesting that we make more use of super dispensary techos, but then I looked at the front page of Aust Pharmacy Trade (6th Sept) and I see that Pharmacy Board of Vic has beaten me to it!
There really is not much talent needed to repeat the Mersyndol story, or demo a Turbuhaler, or recommend a cough mixture, etc - provided that paramenters are set.
In that same article the existance of high levels of stress among pharmacists was canvassed. The term "burn out" was used.
As one who has experienced burn out, I can recognise the symptoms in a lot of my colleagues. I know now that this is not a new phenomenon.
Many of these burned out pharmacists are not going to take up locum duties - because they are burned out!
They will be a loss to the profession, so the stresses on those left in the profession will increase.
I have said many many times, we all need to be honest about what is achievable, and what is impossible.
It is simply not good enough to say "adapt or perish" - maybe we will perish anyway!

Time to lighten up.....

Three guys die together in an accident and go to heaven.
When they get there, St. Peter says, "We only have one rule here in heaven...don't step on the ducks."
So they enter heaven, and sure enough, there are ducks all over the place.
It is almost impossible not to step on a duck, and although they try their best to avoid them, the first guy accidentally steps on one.
Along comes St. Peter with the ugliest woman he ever saw.
St. Peter chains them together and says "Your punishment for stepping on a duck is to spend eternity chained to this ugly woman!"
The next day, the second guy steps accidentally on a duck, and along comes St. Peter, who doesn't miss a thing, and with him is another extremely ugly woman. He chains them together with the same admonishment as for the first guy.
The third guy has observed all this and not wanting to be chained for all eternity to an ugly woman, is very, VERY careful where he steps.
He manages to go months without stepping on any ducks, but one day St. Peter comes up to him with the most gorgeous woman he has ever laid eyes on... a very tall, tan, curvaceous, sexy blonde.
St. Peter chains them together without saying a word.
The guy remarks, "I wonder what I did to deserve being chained to you for all of eternity?"
She says, "I don't know about you, but I stepped on a duck."

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Editor's Note:
With a unique brand of humour, a capacity for expecting the unexpected and a high degree of professionalism, it is obvious that Roy is providing a first class service as a locum.
I am sure there are a number of prospective employers who would like to meet him. He now has a website located at: http://www.computachem.com.au/locums/RoyStevenson.html
You can arrange more information, and a locum booking, from this site.

Roy S.Stevenson Ph.C. M.P.S.,
Locum Pharmacist
40 Northminster Way
RATHMINES 2283.
Tel 4975 5548 Mob. 0402 406 691 Fax 0249 75 2334
ABN 11 585 465 385

Also, check out the human resource and employment sections located in the Computachem site.

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