(The below is adopted from my elective "medical management of vulnerable and underserved" blog. Please visit the blog if you wish to directly interact with me, my co-faculty member and our students http://vulnerableandunderservedpatients.weebly.com/ )
Today we discussed chapters 6 and 7 (Effective interventions; Promoting behavior change). We started the conversation with a case from the book, a 67 y.o. female with multiple health issues. She received the optimal medical regimen to treat her conditions but she remains sick and requires multiple hospital admissions.
The question we posed to the class is "what is going on with this patient"
As expected, the initial thoughts revolved around her medication regimen.
"What is her medical history?", "Is she compliant?" , "Comorbidities?"...etc.
We dug a little deeper, "What else is going on?"
"Is her PCP and specialist talking to each other?"..."Is she getting the best regimen?"
We dug a little deeper......."What else is going on?"
"How is her emotional health?"..."What else is going on with her?", "what other contributing factors might there be?"
EXCELLENT! let's go on these latter thoughts and dig a little deeper.
Pharmacists are trained, and rightfully so I may add, to identify medication related issues. We ask the question of "is this the right medication for this person" and build upon their medical history, medication history, individual pharmacokinetic properties ....etc. Seldom do we ask however about all the other factors that may positively or negatively impact a patient's treatment. Questions such as "Can this patient afford the medication?", "Does the patient understand why they need to be adherent with the medication?" (A whole discussion about adherence vs compliance ensued, but that's for a later post), "Does this patient trust me as a healthcare professional to realize that his/her best interest is what I have in mind?"
These questions are essential in understanding the patient's FULL story and help us identify vulnerabilities and strengths of the person we are trying to help. This is how we, as healthcare providers, establish that therapeutic alliance where the patient-provider relationship is healthy and the patient's optimal therapeutic outcomes are achieved.
But.....but.....but....."How Can I do this?", "In what setting can I accomplish this as a pharmacist?", "If I work retail and I have all these prescriptions to fill, I do not have time to understand what other factors the patient has?"
And that is when I got on my soapbox (accompanied by Dr. Hanson).
It really upsets me to see students succumb to the status quo of our healthcare system. They get so overwhelmed by the "production" driven healthcare system that they start seeing these concepts of caring for their patient, beyond medication related issues, as luxuries. My line to this class, and certainly a line repeated by our faculty, is that we do not want you to graduate and become pharmacists like us. We want you to graduate to be better, to keep moving our profession and healthcare system forward. To keep the focus on the patient.
Pharmacists are the most easily accessible healthcare professionals. You can walk into a pharmacy any time and walk straight to the pharmacist and ask questions. This trust that the public has with us is something that we must build on. Spending a few extra minutes with your patient to understand what might be preventing them from achieving optimal care will not only improve their health but will also have a tremendous overall financial impact by reducing potential of adverse events and hospital readmissions.
Think back to the patient we started our discussions with. If I, as a pharmacist, see multiple hospital admissions despite her receiving the best medication regimen, I should stop and ponder "what else is going on?" If I have a trusting relationship with my patient then I will know that maybe she cannot afford her medication. She may be going through some emotional problems, family problems or maybe she just does not understand why she must take all these medications. Understanding my patient's full story allows me to help them best. And yes, we must be realistic; it's not like I am going to solve all their problems but I will, at the very least, be able to direct them to someone who can.
I asked my students "How many of the pharmacies you have worked in have a folder full of menus of all the restaurants that are near by?" (To those who don't work in pharmacies, almost every pharmacy has such a folder)
All raised their hands.
Then I asked, "how many of the pharmacies you worked at have a folder of free clinics, shelters, counselors or local resources?" only one raised his hand (to which I was ecstatic because seldom do you hear about this)
The point I was trying to make with my above question is knowing the available resources in the community you work in will help maximize your impact as a healthcare provider. When you have that trusting relationship with your patient and get to know them beyond the prescription you are dispensing to them, you will solidify the therapeutic alliance you establish with them and have the ability to provide them with the best outcomes.
This understanding of the patient's complete story is of paramount importance in the vulnerable and underserved patient population we are focused on in this class. But as Dr. Hanson emphasized in class, we must understand and appreciate their vulnerabilities but we must also realize and build upon their strengths. These patients don't need our pity, they need us to appreciate their circumstances and help them in whatever capacity we can so they can get back on their feet. And who is better suited to do this than the most accessible healthcare professionals out there.
Great, passionate discussion today. I look forward to walking besides my students on their journey.
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