Don’t Worry be Happy

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Over the past year I have asked my staff to pay particular attention to the reasons patients give for wanting to transfer their prescriptions over to our pharmacy.  Despite being a small, independent pharmacy and being surrounded by competitors offering incentives and points programs, patients regularly transfer their prescription files over to us from neighbouring pharmacies.  I consider these patient comments to be priceless information to guide the direction of our practice.

 

Here is what we hear most often about the pharmacies patients are leaving:

“When I go in there, I feel like I’m bothering them.”

“They said they couldn’t help me.”

“They don’t explain things to me.”

“They don’t seem to have time for me.”

“They didn’t seem to be listening when I was talking to them.”

 

There are many variations of the above sentiments, but what it points to is patients who feel a lack of care or empathy from the pharmacy staff.  While there can be many contributors to a patient’s poor experience in their previous pharmacy, I have looked as well to the reasons patient’s give for choosing our pharmacy.  Most often I hear from patients that my staff seem to really care about them, they go above and beyond to help them, they take time to really hear what is important to them.

Now, I’m no hiring wizard, and by no means am I able to always hire people who simply excel naturally at great customer service.  However, what I do think has been a key to our success is that, for the most part, my employees are happy.  They take pride in their work and genuinely care about the people we serve.

Let’s face it, your staff are the face of your business.  If your employees are not happy, your patients will know it!  Why are patients often treated poorly or made to feel like they are a bother?  Most often it is from interacting with employees who are unhappy in their jobs and would rather be elsewhere.

Your employees really are your best advertisers.  No matter what the message is on your website or your bag stuffers, your logos or slogans, a patient’s experience of your business all comes down to the staff they interact with.

Here are three key areas to increase staff positivity and retention:

  1. Allow staff to work to their full potential. Working to their fullest potential is empowering for pharmacists as well as technicians.  Move your professionals away from tasks best suited to support staff and provide the structure required for them to work at the top of their license.
  2. Provide vision and leadership. Team members are happier if they have purpose and meaning in their work.   Be sure to voice your vision and encourage your team to see the bigger picture in their daily tasks.
  3. Involve your staff in decision making. Having a say in some operational decisions creates a sense of ownership for team members.  Ultimately, they will be more satisfied with their position and more likely to stay with your business.

 

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Lessons Learned

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When I left pharmacy school over 20 years ago, I thought I had attained all the knowledge I needed in order to care for patients.  The one thing that all those years of studying didn’t teach me was that my patients were going to become my greatest teachers.

Here are the five most important lessons I have learned from my patients.

 

  1. Listen first. In school we are often taught the importance of “telling” a patient what they need to know about a drug or a medical condition. We practice over and over imparting the top five or so points about a medication, from how to take it to the myriad of possible side effects.  How many times have I spit out the knowledge in my head, then after listening to the patient I realize that it was either too much information, not applicable to their daily life or they just didn’t understand.  Over the years I have become a much better listener.  My patients have taught me that each person and situation is unique and to truly care for them means to simply listen.

 

  1. Trust requires work. When a patient comes to me for advice, they are trusting my assessment of their current condition and medical history. They trust I am not simply giving them random advice; that what I advise is backed by science, is evidence based and supported by my education, training and experience. Upholding this trust requires work. As much as possible I need to keep up with recent guidelines, studies and lines of inquiry in evidence based medicine.

 

  1. Many patients over the years have demonstrated amazing perseverance throughout incredible pain, suffering and loss. They have taught me to keep finding the positive and most especially, to endeavor to live with a posture of gratitude.

 

  1. Look beyond the surface.  As health professionals we often don’t see beyond the immediate presentation of the person in front of us. A patient’s short temper, harsh words or impatience is often directed at us or our staff. Over the years I have learned that the root of behavior is far different from what I see. Patients have taught me that behind the behavior is often a myriad of other issues such as pain, inability to cope, grief, and other emotions or life circumstances that have nothing to do with me, so I don’t take it personally.

 

  1. Empathy goes a long way. Even if I cannot directly relate to being held captive by addiction or have unrelenting pain, I can still express empathy for the human suffering of my patients.  Even in tough situations such as a person going through narcotic withdrawal, the care I provide is much more effective and meaningful when patients feel that first, I am on their side, even when I have to say no or make a tough call.

 

Ultimately, the human side of patient care cannot be taught in school, it can only be taught to us by those we care for, and I look forward to my continued learning.

 

 

Worth It

ccFlickr shared by Eduardo Llanquileo

It’s been awhile since I’ve been here…..I sat down today and thought about what had changed and why I haven’t been writing.

I guess I have just been tired… It has been an overwhelming couple of months with many changes.   Changes that have taken the pharmacy practice I love into the scary place of perhaps not being sustainable.  Government decisions, which have been short sighted and without consultation with the front line health professionals who are affected, have been devastating.  Even as the government back pedals in an attempt at damage control, the changes will continue and have a vast impact on the health of Albertans’ and the sustainability of pharmacy.

The emotional roller-coaster of connecting with hundreds of other pharmacists across Alberta who are in the same position has been both inspiring and enhausting.  I have met so many professionals who are utterly committed to their patients; but it is heartbreaking to hear of some colleagues, near retirement, who may lose the value of their practices they spent years building.

I am many years from retirement and am hopeful this will not be the case for me, but there have been days I have walked into the place I love and found it difficult.  Wondering if decisions, which are in government’s hands, would take away what I have been building.

Then yesterday I received a letter from the College of Pharmacists that I have been anxiously waiting for.  For over a year I’ve been putting together my case to apply for prescribing rights.  I finally completed the process and sent it off.

While I have had limited prescribing rights for years, there have been many times when caring for patients that I have felt like I had my hands tied when I couldn’t prescribe what I knew they needed.

My son handed me the letter from the College, and when I opened it he asked me why I was grinning.

I had received my prescribing authority; and it was more than the expanded ability to serve my patients that had me grinning.  It was hope.  I could see that I had been losing my joy…the reason I was building my practice in the first place.  This affirmation caused me to take a step back and realized that I am exactly where I always wanted to be.  I practice with colleagues whom I highly value and continue to learn from and I am in my own pharmacy able to care for my patient’s exactly as I want.  Definitely worth it.

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Worthy Praise

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Some of us are better at recognizing our own gifts and talents more than others.  Most people, if pressed, could list two or three of their own talents.  Usually they are obvious ones; personal skills or expertise that has contributed to our career, or positive personality traits we have developed.

What might not be obvious are the gifts you have that impact other’s lives.  Just like those around us may not be aware of the gifts we feel they have.  Humans can be slow to praise and general in our thanks.

The people we work alongside, those we run into day-to-day, probably have no idea that we appreciate them or recognize their contribution and hard work.  I was involved in a virtual chat with health leaders/practitioners across the globe (although mostly North American) and we were tossing around what the essential qualities were for showing appreciation and thankfulness.  Some of the prevailing thoughts were that praise should be:

  • Genuine:  Praise that is not genuine feels contrived.  If you don’t actually recognize the value of and appreciate the person, don’t say it.  This involves some reflection on our part, as everyone has value and talents.
  • Specific:  One of the most meaningful compliments I ever received was being told that I put people at ease, help them feel  comfortable.  That’s specific, and something I didn’t know. Referencing a specific incident or particular skill is valuable when offering praise.  It shows you recognize specific qualities and often encourages personal growth for the person being praised.
  • Generous Praise to colleagues, staff and friends should come with no strings attached, no “to-do” list at the end.  It should just be what it is, an acknowledgment of hard work, contribution, or talent.
  • Personal  What came up over and again is that praise which is personal means more.  Praising colleagues or staff publicly in newsletters, staff meetings, in posts online, all are important.  But so is the handwritten note, or the phone call or the one-on-one thanks.

We all need to feel acknowledged and appreciated.  Remembering to show gratitude or praising our colleagues and staff is an important part of team and community building.

Patient Gratitude

A few weeks ago a colleague warned me that in the first year of owning and running a new pharmacy I would conclude that I had made a huge mistake.

Yup….that happened well before turning the sign to “open”!

The two weeks leading up to my opening day were chaos.  I’ve never slept so minimally, had my “to do”list grow so fast, nor seen my children so little.  As I heard repeatedly, “Mom, are you coming home late again today?” I figured I had made a mistake.  I am a clinician; I love the “care” part of health care, and here I was, steeped in putting a business together. Spending hours on end away from my family, and even when with them my mind was racing with all the things I needed to handle.

So when I walked into my brand new pharmacy on day one and flipped the sign to open, I wondered whether I had jumped into something I would resent, or at the very least not enjoy.

Then came patients through my door.  Just a few at first, and a few more each day, and I found myself in a place of privilege.  As I provided health care, I heard their stories.  Stories about caring for terminally ill spouses, stories of how difficult it is to live with chronic pain, journeys through chemo and disappointment with the system.  Even stories of past jobs and places they had visited in their life time.  As I immunized many against the flu I also shared a lot of my own story.  How I came to be in this new pharmacy, growing up in Saskatchewan, how I had started a pharmacy in Chemainus when I was very young.

It struck me once again that the connection made and the care given are what brings me joy.  Having my own pharmacy means I can structure and set up to practice the way I want.  I have control over how I care for the people who walk through my door.  There is no one to tell me I must meet a certain quota or promote sketchy treatments or unproven products.  In the end, it is worth all the headaches that I am sure will come.  So it is to the people who came through my door this week that I am grateful to, for reminding me what it’s all about.

Care of the Patient

cc Flickr shared by By Pulpolux !!!

This post has stuck with me for weeks, and while I blogged about it on my personal site, I feel it has a lot to say to me as a health professional.  So often, as we concentrate on our patient’s heath issues, solving drug related problems and working to optimize their therapy, we can overlook the big picture.  We forget that what is simple to us can often be overwhelming or beyond understanding for our patient.

A Reason To Celebrate

–posted by Dodo on Jul 7, 2012

Numbly, I left my husband, Marty, at the hospital where I had been visiting two of my children and headed for the grocery store. Since it was eleven p.m., I drove to the only store I knew was open twenty-four hours a day. I turned my car motor off and rested my head against the seat.

What a day, I thought to myself. With two of my young children in the hospital, and a third waiting at Grandma’s, I was truly spread thin. Today I had actually passed the infant CPR exam required before I could take eight-week-old Joel home from the hospital. Would I remember how to perform CPR in a moment of crisis? A cold chill ran down my spine as I debated my answer.

Exhausted, I reached for my grocery list that resembled more of a scientific equation than the food for the week. For the past several days, I’d been learning the facts about juvenile diabetes and trying to accept Jenna, my six-year-old daughter’s, diagnosis.  In addition to the CPR exam I’d spent the day reviewing how to test Jenna’s blood and give her insulin shots. Now I was buying the needed food to balance the insulin that would sustain Jenna’s life.

“Let’s go, Janet,” I mumbled to myself while sliding out of the car. “Tomorrow is the big day! Both kids are coming home from the hospital. … It didn’t take long before my mumbling turned into a prayer.

“God, I am soooo scared! What if I make a mistake and give Jenna too much insulin, or what if I measure her food wrong, or what if she does the unmentionable—and sneaks a treat? And what about Joel’s apnea monitor? What if it goes off? What if he turns blue and I panic? What if? Oh, the consequences are certain to be great!”

With a shiver, my own thoughts startled me. Quickly, I tried to redirect my mind away from the what ifs.

Like a child doing an errand she wasn’t up for, I grabbed my purse, locked the car, and found my way inside the store. The layout of the store was different than what I was used to. Uncertain where to find what I needed, I decided to walk up and down each aisle.

Soon I was holding a box of cereal, reading the label, trying to figure out the carbohydrate count and sugar content. “Would three-fourths a cup of cereal fill Jenna up?” Not finding any “sugar free” cereal, I grabbed a box of Kellogg’s Corn Flakes and continued shopping. Pausing, I turned back. Do I still buy Fruit Loops for Jason? I hadn’t even thought how Jenna’s diagnosis might affect Jason, my typical four-year-old.  Is it okay if he has a box of Fruit Loops while Jenna eats Kellogg’s Corn Flakes?”

Eventually I walked down the canned fruit and juice aisle. Yes, I need apple juice, but, how much? Just how often will Jenna’s sugar “go low” so she will need this lifesaving can of juice? Will a six-year-old actually know when her blood sugar is dropping? What if…? I began to ask myself again.

I held the can of apple juice and began to read the label. Jenna will need fifteen carbohydrates of juice when her sugar drops. But this can has thirty-two.  Immediately I could see my hand begin to tremble. I tried to steady the can and reread the label when I felt tears leave my eyes and make their way down the sides of my face. Not knowing what to do, I grabbed a couple six-packs of apple juice and placed them in my cart. Frustrated by feelings of total inadequacy, I crumpled up my grocery list, covered my face in my hands and cried.

“Honey, are you all right?”  I heard a gentle voice ask.  I had been so engrossed in my own thoughts that I hadn’t even noticed the woman who was shopping along side of me. Suddenly I felt her hand as she reached towards me and rested it upon my shoulder. “Are you all right? Honey, are you a little short of cash? Why don’t you just let me…?”

I slowly dropped my hands from my face and looked into the eyes of the silvery haired woman who waited for my answer. “Oh, no, thank you ma’am.” I said while wiping my tears, trying to gather my composure. “I have enough money.”

“Well, Honey, what is it then?” she persisted.

“It’s just that I’m kind of overwhelmed. I’m here shopping for groceries so that I can bring my children home from the hospital tomorrow.”

“Home from the hospital! What a celebration that shall be. Why, you should have a party!”

Within minutes this stranger had befriended me. She took my crumpled up grocery list, smoothed it out, and became my personal shopper. She stayed by my side until each item on my list was checked off. She even walked me to my car helping me as I placed the groceries in my trunk. Then with a hug and a smile, she sent me on my way.

It was shortly after midnight, while lugging the groceries into my house, that I realized the lesson this woman had taught me. “My kids are coming home from the hospital!” I shouted with joy. “Joel is off life support and functioning on a monitor. Jenna and I can learn how to manage her diabetes and give her shots properly. What a reason to celebrate.” I giggled to myself. “I have a reason to celebrate!” I shouted to my empty house.

“Why you should have a party,” the woman had exclaimed.

And a party there will be!

The human side of patient care cannot be learned in school.  It can only be taught to us by those we care for… our patients. 

Dr. Oz and the Ruby Slippers

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I really wish Dr Oz would just put on his ruby slippers and go home. Just click those heels three times and retire.

That may sound harsh, and I usually don’t make such blanket statements, but honestly, he’s starting to do some real damage.

Like Oprah, when Dr. Oz speaks, millions of people listen. His level of influence in the average North American household has become almost iconic. Millions turn to him for advice. That would be a good thing if he was a health professional with integrity and his advice was backed by science. The reality is quite the opposite. Here’s my beef with Oz.

Dr. Oz puts profit before people.

When Dr. Oz first started out on Oprah, his information and health recommendations were fairly standard, typical of your family doctor with some Hollywood spin. Over the years, however, he has become more “Hollywood”and less “doctor”. He sensationalizes medicine, often offering quick fixes with unproven therapy. It makes for great sound bites (like the un-workout workout) and it sells, but it’s not based on science. In fact, coming soon is his own product line of unproven supplements. It doesn’t matter that he lacks the science to back up his claims. His name sells and so will his unproven products.

His advice can be dangerous

Diabetes can be prevented with vinegar and coffee. Really? If that were true, I know many of my patients would be reaching for more pie; just add a cup of coffee and it’s all good. Instead, what is proven by science is that weight management and good nutrition can delay Type 2 Diabetes.
If a person needs to lose weight to reduce their risk of having a heart attack or stroke and Dr. Oz says all they have to do is take white kidney bean pills and they can eat all the cake they want…that’s dangerous.
How about having a doctor on his show that believes cancer can be cured with baking soda? Not kidding.

Dr. Oz presents “Pseudo-Science” as fact

Pseudo-science is presenting a claim or belief as scientifically valid without having the scientific supporting evidence. Here’s what we mean by science:

What we mean by “science” is simply rigorous methods of observation. Good science looks at all the evidence (rather than cherry picking only favorable evidence), controls for variables so we can identify what is actually working, uses blinded observations so as to minimize the effects of bias, and uses internally consistent logic. Steven Novella, MD

Are there some studies showing coffee has an effect on diabetes risk? Yes. Can we use these studies to make sweeping statements that affect people’s health? No. That would be irresponsible. All that is proven by a few small studies is that more studies in that area need to be done.

Dr.Oz takes “bad science” or limited science and presents it as fact. That’s irresponsible.

I’ve been in health care long enough to see really good studies point to facts that we incorporate into our practices as health care professionals. But 10 years later (after more studies with larger numbers of people, going on for a longer time), the original studies are proven to be misleading or even point to the opposite conclusion. Studies need to be examined with the eye of a sceptic and there is a science in itself to evaluating the strength and validity of scientific studies.

When people come to me with health concerns looking for advice, they are in essence sharing a trust. Patients expect me to be honest and to have their best interest at heart. They expect that my advice will be based on scientific evidence, not on anecdotes, popularity or profit. Patients should expect that from all their health providers.

Dr. Oz fails on all fronts. So, Dr. Oz, if the ruby slippers don’t fit, perhaps you can take the job of the original Oz behind the curtain. After all, he was a charlatan too.