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I am an aged pharmacist who trained as an apprentice in the olden
days.
Worse than that - I was a country apprentice for two years before
venturing to Melbourne for the final two years.
My career started in community pharmacy in the days before decimal
currency and computers! Even before the Pharmaceutical Benefits
Scheme!
Community
work was interrupted by several years in Papua New Guinea (before
Independence). Five children later we returned from PNG.
It
was then the years of the Whitlam Government, and many small hospitals
were opening pharmacy departments.
The Echuca Hospital in Victoria was one of these.
I applied for the position to establish a pharmacy department
there.
The young upwardly mobile CEO wasn't interested in the services
of a married pharmacist with five children.
Then, as now, pharmacists were scarce commodities.
He finally offered me the position (after he had exhausted all
other avenues).
To
keep one step ahead of the CEO I enrolled in the Society of Hospital
Pharmacists Fellowship course - beginning with the management
segment.
That was a brilliant move, and meant that the department was set
up in line with current practice as I was doing the course.
Pharmacy
at the cross roads.
It has been happening regularly all the years I have been involved
in pharmacy.
In retrospect, I don't think we have been at the cross roads at
all.
My feelings are that every few years there are a few extra potholes
in the road - the introduction of the Pharmaceutical Benefits
Scheme, computerisation, pharmacy ownership, nurse dispensing,
Medicare numbers, clinical/ward pharmacy, medication reviews,DMMRs,on-line
pharmacy.
We
have never reached the cross roads because of the "four wall
syndrome".
Community pharmacy has evolved from the pharmacist dispensing
mixtures and ointments Esc in the small back section of the shop.
It had to be - extemporaneous products and customers didn't mix.
The pharmacist couldn't leave the premises unattended at any time.
These two facts still affect community pharmacy today.
Sure,
we have forward pharmacy and move the pharmacist to the front
of the pharmacy.
But this is just filling in the pothole.
The second problem was sometimes fixed by merging pharmacies or
trying to get extra pharmacists on staff.
Another filling in of a pothole.
In
hospital pharmacy I also discovered the "four wall syndrome".
Pharmacy departments initially concentrated on supply of medications
to the ward cupboards.
To justify their employment pharmacists kept statistics on the
numbers of items supplied to the wards, and dutifully put these
in monthly reports to show how hard they worked, and how busy
the department was.
Yes, I can be cynical.
Ward pharmacy was established to fill in another pothole.
I
believe that the "four wall syndrome" is a very REAL
medical problem.
Similar to depression.
The patient (pharmacist) is unable to function fully.
Loses him/herself in dispensing more and more scripts in community,
or counting tablets and workload statistics in hospitals.
No "social" work contact with other pharmacists, with
other health workers or other well adult people.
I
believe the "four wall syndrome" is an insidious disease.
I feel that it has even spread to our pharmaceutical organisations.
It is easier to hide behind the regulations and current practice
than to face the prospect of working with doctors or nurses.
Even when brilliant advances are made, such as accreditation procedures
for medication reviews and DMMRs the disease causes narrowness
and restrictiveness of the process, and this prevents many pharmacists
embracing the program.
I
know that new graduates are frightened of catching the disease,
and many are looking for other avenues of employment.
I
was scared,too, at Echuca.
Especially after I visited the pharmacy department of an extremely
large Melbourne Hospital where I saw a pharmacist repackaging
tablets from the manufacturers bottle into the hospital bottle
with a hospital label. What an inherited waste of time, resources
and energy.
Not to mention safety or liability.
I am sure that doesn't happen now, but it made me realise how
lucky I was to be starting in a pharmacy department without inherited
work practices.
I
did not collect work statistics.
I spent most of my time in the wards - making myself indispensable
to the nurses.
I didn't ever have to justify the need for a pharmacist - the
nurses did it for me.
This was very hard for the traditional hospital pharmacists to
understand.
Again,in my experience the large city and regional hospital pharmacy
departments tended to reinforce the "four wall syndrome"
even during meals breaks by congregating in the department.
In all my hospital experience I have expected pharmacy staff to
leave the department and to mix with other hospital staff.
The department was just the place where the medications were legally
stored.
The pharmacy was where the pharmacist was - out in the wards working
with the doctors, nurses and patients.
DMMRs are just one area where pharmacists must quickly make themselves
an indispensable part of the healthcare team.
Pharmacy
at the cross roads.
If pharmacy is at the cross roads, then I believe we will see
pharmacy actively moving in different directions from the cross
roads.
I also believe that many other health professionals will be traveling
on those roads.
If we can make ourselves useful and a vital part of those journeys
then we have a future.
If we just keep busy filling in the potholes we will find that
we are well and truly trampled on and left behind.
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