The Art of Pharmacy

"Can you please see Mrs B, she needs a medicines reconciliation," said the EHR task from the doctor.

I was glad that Mrs B was promptly available to see me. The state of her understanding of her medications was sobering.

"Were there no pharmacists left on the planet?" I thought to myself after seeing her.

It was like she had never had an interaction with a pharmacist.

Here goes the situation...

Mrs B, a 79-year-old, indigenous patient, was prescribed a number of medications for diabetes, gout, and hypertension.

Without getting into the detail of her medical history, which is irrelevant to the purpose of this article, her medication adherence needed the urgent attention of a medicines expert.

She was prescribed Jardiamet, Atorvastatin, Ezetimibe, Candesartan, Allopurinol and Glipizide.

"Mrs B, thank you for sharing your experiences with me, I would like to know a little bit more about how you take your medicines. Can we talk about this in more detail, especially any challenges you have with your medicines?"

I will not get into the details of every response I made, but here are her statements:

• "So, I take the Jardiamet once a day every day, but I don't understand why I need to, the doctor said it was for high blood sugars, but I don't eat a lot of sugar."

• "I also take this bottle (referring to Atorvastatin) sometimes when I remember, because I forget to take it at night after dinner.

When asked about the rest of her medications, she went to a medicine cupboard in her kitchen and brought out another tray of medications:

• "I have so many boxes of this medicine (referring to Ezetimibe), sometimes I take it with the statin medicine when I remember."

• "I didn't feel my blood pressure was high, so I wasn’t taking this (Candesartan). The doctor never told me I had high blood pressure."

• "I don't get gout anymore, I haven't had gout for a year, so I stopped taking this (Allopurinol), why did they put me on it if I only had one gout attack?"

• "No one explained to me about this medicine (Glipizide), so I never took it, I find it in my medicine parcel sometimes, and I have boxes of it, but they keep giving it to me."

When asked if she had ever told her doctor that she wasn't taking some of these medications. She responded, "I always felt rushed, there was no time to tell him, and I didn't want to upset the doctor."

It was only because the environment I was talking to her in, was conducive to communicating her concerns out loud that she felt safe to do so.

You can imagine how I felt for this patient throughout this...

The consultation not only identified severe medication non-adherence but also:

• Time barriers in healthcare

• Lack of patient empowerment

• Health inequities and disparities

• Disconnect between the health system and the patient

• Poor communication, on our part, as health professionals

Eliciting a medication history was very challenging, and it took a few minutes of random conversation to understand more about her, her living situation, and her health concerns, before we got talking about her medications and her understanding of them.

This brings me to the point of this article...

Being a pharmacist is an "art".

I had to overcome several challenges to get this patient to open up:

• Putting her at ease by greeting her in her native language and developing a connection that sets the scene

• Talking about her culture and the role it plays in healthcare, whether she has family supports

• Addressing past negative health experiences, where she felt, due to her culture, she received inequitable health care

• Letting her do most of the talking, rather than dominating the conversation with what I know

• Filling in the knowledge gaps, without undermining her existing knowledge

• Using MI techniques to explore her motivation to take this medication, and why it matters to her

• Asking her what support she feels she needs from me and her doctor to ensure she has better health outcomes.

In short, making her in charge of her health, makes her feel empowered.

And that took a lot of energy, but this is also why it made me feel that practicing pharmacy is an art.

The Art of Pharmacy

If we draw on the similarities between an artist and a pharmacist, we will understand why being a pharmacist, is more than just being an ordinary health professional.

Sandwiched between the doctor and the patient, we are health advocates for the patient. This is evident in the scenario above.

Mrs B had not been taking these medications properly for over a year. She fell through the cracks for so long, before someone with the required skills, gave her the time to explore these challenges...

Someone with the required art.

Pharmacy is an Art because:

1. Pharmacists require extensive knowledge, skill, and expertise before they can reach a level of proficiency that fosters trust with patients. Just like an artist knows how the colours blend together to produce a painting, a pharmacist elicits all the information needed to understand what factors affect a patient's medication regimen.

2. Pharmacists build up their art in crafting communication techniques that enable them to elicit the most accurate medication history, while also creating a safe environment that allows the patient to talk about the barriers they have in taking their medications. They must convey complex medical information in a clear and understandable manner to ensure optimal patient care, and there is an art to achieving that, especially under time constraints.

3. Pharmacists pay meticulous attention to detail. Just like an artist focuses on every stroke, colour and texture to bring their vision to life, pharmacists have to ensure medication accuracy and safety. As the gatekeepers of medicines, a small oversight can have significant consequences, just like the wrong stroke, ruins the whole painting.

4. Artists often encounter challenges during the creative process and find innovative solutions to achieve their desired artistic outcome. Pharmacists face similar challenges when addressing patients' health issues, such as identifying appropriate medications, managing drug interactions, or resolving medication-related problems.

5. Just like an artist has a profound effect on society with their art, pharmacists, with their skilled art in medicine, directly impact patients' health outcomes and contribute to the overall well-being of communities.

6. Just like an artist explores new techniques, experiments with different mediums, and stays informed about artistic trends, pharmacists constantly update their knowledge about new medications, treatment guidelines, and emerging research to provide the best care for their patients.

Why does understanding this concept matter?

In last week's edition, I talked about the concept of 'Flow'.

The concept of flow was first introduced by psychologist Mihaly Csikszentmihalyi in the 1970s. Csikszentmihalyi was studying happiness and creativity and noticed that people who were deeply engaged in their work or hobbies often experienced a state of flow.

He went on to develop a theory of flow and described it as a state of optimal experience where people are fully immersed in an activity and feel a sense of enjoyment and fulfillment.

And I argue, that if we as pharmacists do not understand that the practice of pharmacy is an 'art', like a skilled artist, who finds the 'state of flow' that allows his painting to only get better with time, we will:

• struggle to find the real purpose and meaning in what we do and immerse ourselves in the tasks at hand.

• we will struggle to find enjoyment, and will eventually be stressed and burnt out

• we will not seek to make our 'paintings' better to contribute to health innovation in society

• we will struggle to connect with the patient, develop a relationship that fosters trust, and work together as partners in healthcare.

Yes, it is harder to enter a state of flow when it's a two-way patient conversation, but it is not until you get into the depth of the conversation, and find meaning in what you are trying to achieve, that you unearth the information that matters most from the patient, and find what is really standing in the way of them, owning their health.

If you quit, early on, if you lose your motivation, you will not reach this outcome, you will have a half-finished, ugly painting!

While being an artist and a pharmacist are distinct professions, they share commonalities in skill, creativity, attention to detail, problem-solving, communication, impact on society, and the pursuit of lifelong learning. Both professions require passion, dedication, and a commitment to excellence.

Here is to the next generation of pharmacist artists,

-Katrina

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