You can see more of his musings on Twitter – @TheCynicalRPH

TCP makes some great points in his comment, and in my opinion his thoughts reflects the sentiment of many pharmacists practicing in the real world. I was going to refer you to the comment, but felt it would be better to post the meat of it below:

…………

Here’s my opinions -

I agree with you that pharmacy is on a precipice of massive change, and like everything else in this world, it’s all about money and power.

Subtle clues convinced me that it was headed this way long ago. If one reads the various medical, nursing, and pharmacy journal articles, it’s easy to notice. The medical and nursing journal articles NEVER have authors telling them what their roles should be, or how they should practice their profession. Almost every other pharmacy journal article has the phrase “the role of the pharmacist” somewhere in it’s description. It seems to me that we’ve always been desperately looking to find and describe a role for us since 3rd parties came into the picture. Now, it’s supposedly MMT.

These articles also point out a reason why pharmacy is so fragmented and why we haven’t fully been able to communicate with each other and work together. These same authors are often “telling” pharmacists “how” they need to practice their profession, as if we are beneath them instead of being their equals, or like we aren’t capable of doing it right. It sends a negative subconscious message to other pharmacists.

In my experiences, pharmacists also waste inordinate amounts of time competing with each other contemptuously in order to prove to themselves that they are smarter, richer, or somehow “better” than the “other” pharmacists. It seems that way since I’ve been a pharmacist, and I first experienced it in school. While we were foolishly fighting with each other about what pharmacists should be doing, how to do it, and who’s better, the profession’s enemies did away with us.

Like they say.. divide and conquer.

Also, while we were bullshitted by our leaders years ago that technology will “help” the pharmacist, I believe it will eventually replace us. If you ever visit or work for a PBM, you’ll see that robotics has already replaced pharmacists, and the BOPs give them special preferences because of their robotics are more accurate. Think about this too – how many hospital pharmacists do you know whom carry smart phones or other hand-held devices that they automatically pull out when asked a question by a doctor or nurse? Everyone, right? So, what’s to stop those other healthcare providers from doing the same thing? Why try to find, and consult with, the pharmacist, especially one they don’t like, when they can use the same devices the pharmacist does, but quicker and with less effort?

The same goes with community pharmacy. It’s “been” a given that third parties, and some of our chain “colleagues” have already, and will finally, make it so that no individual pharmacist can make a living through “legally” operating an independent pharmacy. Even the chains are finding it difficult now.

In chain pharmacy, everything has become automated and computerized, with improving capabilities being discovered daily. Corporate powers concerned with the bottom line, again with help from some of our “colleagues”, have enabled technicians to take over our traditional roles altogether, and have almost fully pushed us out of the pharmacy. So, where are we to go?

Of course, our “colleagues” in higher education, probably fearful of losing their jobs, or of having to work front line positions that they may consider “beneath them”, try to find ways where the system can use pharmacists. Again, we don’t have a defined role anymore. It’s always changed throughout the years, and like I said before, now it’s MTM.. or what I like to call “babysitting”.

But, of course, we are not “smart enough” or “capable enough” to handle that job. In order to teach us to be almost as equal to our journal colleagues, we must pay higher tuition rates, enlist in residencies and become certified. Instead of 6-years of college education we have, we’re now “unofficially” required to have 8-years or more of education in order to considered “good enough” to provide the same services we’ve been already providing for years.

So, now that would give us the same amount of education required to becoming a physician – someone considered a “provider” by Medicare, someone who can bill insurances for their services, a decision-maker, someone who is able to make their own treatment decisions and prescribe, or even someone who can command an equally-educated pharmacist to be his/her handmaiden.

If you ask me, why spend the time and money becoming a pharmacist instead of a physician, or why not even spend less time and money becoming a nurse, whose roles are already defined, and who seemingly have the ability to bring their profession together as a whole?

I recommended that we use the pharmacy specific lingo, but I was told no because it wasn’t the industry standard. I found that quite interesting because we build products for pharmacy, i.e. that is the industry we’re in. However, the terminology used for this particular process is different outside the pharmacy world. Still with me? Good.

So, the question becomes does one conform to the terminology in the market segment you’re in, i.e. pharmacy, or do you ignore the pharmacy terminology and go with the “standard”? My gut reaction would be to go with the standard – after all I preach standardization all the time – however, if one does that you end up talking to pharmacy people that have no idea what you mean. You know, everyone has that deer in the headlights look with everyone standing around wondering what the heck is going on. And to top it off, no one asks for clarification because they’re afraid it might make them look stupid. We’ve all been there. I know I have.

So, based on what I just said above I think you have to conform to the industry you’re in. In other words, use the pharmacy terminology, standard or not.

One thing is for certain, if you’re waiting for the right moment, the moment will never come. Decisions don’t need to be right or wrong, they simply need to be made. Heaven forbid you make a bad call on something. I seriously doubt anyone has gone through life mistake free. If you never make a mistake you’re not trying hard enough in my opinion. Heck, I’d go as far as to say that some of the most valuable lessons I’ve learned have been from my failures. Sure, the failures sting a little, but that’s what helps one learn from the process.

I believe fear is the cornerstone of indecisiveness; fear of making the wrong decision. Choosing to not make a decision is, in itself, a decision. Unfortunately it’s a decision that people repeat time and time again without learning from the mistake of not choosing. The only way to learn to make good decisions is through the experience gained from making bad decisions. Kind of a circular argument, I know. Go figure.

According to Albert  Camus “life is the sum of all your choices.” So what does that say about your life if you don’t make any decisions? Not much.

As Staff Sergeant Nantz so eloquently put it in the movie Battle Los Angeles, “You can go right. You can go left. I don’t give a damn. Just make a decision”.

This is where pharmacy is with robotics. We should conduct a little research into their cost-effectiveness versus accuracy and speed. Know what I mean?

The articles below come from Current Opinion in Urology, Jan 2012; 22(1)

Article 1 Pages 61-65

Is robotic surgery cost-effective: yes.

PURPOSE OF REVIEW: With the expanding use of new technology in the treatment of clinically localized prostate cancer (PCa), the financial burden on the healthcare system and the individual has been important. Robotics offer many potential advantages to the surgeon and the patient. We assessed the potential cost-effectiveness of robotics in urological surgery and performed a comparative cost analysis with respect to other potential treatment modalities.

RECENT FINDINGS: The direct and indirect costs of purchasing, maintaining, and operating the robot must be compared to alternatives in treatment of localized PCa. Some expanding technologies including intensity-modulated radiation therapy are significantly more expensive than robotic surgery. Furthermore, the benefits of robotics including decreased length of stay and return to work are considerable and must be measured when evaluating its cost-effectiveness.

SUMMARY: Robot-assisted laparoscopic surgery comes at a high cost but can become cost-effective in mostly high-volume centers with high-volume surgeons. The device when utilized to its maximum potential and with eventual market-driven competition can become affordable.

Article 2 Pages 66-69

Is robotic surgery cost-effective: no.

PURPOSE OF REVIEW: Utilization of robotic surgery has increased dramatically in recent years, but there are significant cost implications to acquisition and utilization of robots. This review will evaluate the cost-effectiveness of using robotics in urologic surgery.

RECENT FINDINGS: This study will evaluate studies comparing outcomes for open, laparoscopic and robotic procedures as well as costs associated with these procedures.

SUMMARY: Current studies have not found the robotic approaches to be cost-effective. In order for the robot to be cost-effective, there needs to be an improvement in efficacy over alternative approaches and a decrease in costs of the robot or instrumentation.

The ASHP Midyear 2011 Conference basically concluded for me today. I’d like to evaluate the meeting, but honestly have very little to say. This was my first year working in the role of Product Manager for a vendor, and not acting as an “attendee”, i.e I was here for work. The conference took on an entirely different feel this year as I wasn’t able to attend any of the sessions. For the most part I was stuck in the company booth playing the role of demo jockey. It was a strange feeling to say the least. I tried to follow the Twitter stream (#ashpmidyear) a bit, but finally relented and gave up.

I ran into a few old friends that came by the booth to mock me. It was good to talk pharmacy for a while here and there, but it was far and few between. I would have liked to seen and talked with more colleagues and friends, but it wasn’t meant to be. I wonder why I didn’t see more familiar faces in the exhibit area? Hmm.

Anyway, I found a few minutes here and there to wonder the exhibitor area and check things out, but nothing like previous years. The exhibitor area used to be one of my favorite places to be as it’s typically full of all kinds of cool automation, technology and new ideas.

Some vendors were worth visiting such as Omnicell, CareFusion, Baxa and Healthcare Logistics (HCL). Those were really the only booths I took time to peak at in any detail. Both Omnicell and Carefusion are doing some cool new stuff. Looks like both companies see a change in the future and are making moves to get ahead of the curve. Baxa had some great IV room stuff. Simply put, they’re kicking the crap out of everyone else. And HCL always has a great booth with a cool design. This year was no exception; Scottish theme complete with castle, kilts and Loch Ness Monster. Sorry, but I didn’t think to snap a picture.

I was thrown out of a vendor booth for the first time ever. That was pretty exciting. Apparently they didn’t think another vendor should be snooping around. The most interesting thing about the whole ordeal is that this particular vendor and my company aren’t doing any of the same things. Weird.

One of the most innovative things I’ve seen in a long time had to be IV Check by SEA Medical Systems. I’ll blog more about that later. Needless to say, I was impressed.

On the upside, New Orleans was an interesting place to visit. The city certainly has its share of night life activity and there’s no shortage of good food. The highlight of my entire visit, however, had to be my trip to the Superdome to watch the Saints take on the Lions on Sunday Night Football. What a great experience.

So, was the move worth it? Simply put, yes.

I can tell you that my eyes have been opened. My world as a pharmacist was small. My ability to impact change was non existent. As a pharmacist, my thought process was limited by my own lack of experience in the real world. As a pharmacist I thought I’d reached the pinnacle of success. I mean, I had a good job, making good money. I was respected by my peers. I was pretty good at what I did. That’s what we all strive for, right? Like many pharmacists I figured I’d work for 40 years, retire and enjoy some time at home. After all, that’s how it’s done.

I was naïve. I lived a sheltered life as a pharmacist and now that I’m out in the real world things are a bit more interesting. People outside my once sheltered reality are brutal. They don’t really care about the credentials after my name; I’m just another schmuck. The really smart people don’t all work in a hospital (I have a theory about that, but won’t share it for several reasons). As a pharmacist I was allowed to make decisions on my own, now it’s decision by committee.

Overall the past year has been eye opening for me. I’ve been humbled on several occasions and had my ego bruised a few times. On the other hand I’ve had some minor victories and grown a bit in the process. I’ve just now started to learn my boundaries and what I can and can’t do. For the past 15 years I’ve learned how to hold my temper, play well with others, hold my tongue and live off favors. Basically I’ve been learning how to be “a nice guy”. Turns out that this is the equivalent of an anchor around my neck in the world outside of healthcare. I no longer have to be a nice guy. I need to learn to be direct, to the point and straightforward regardless of peoples feelings. Interesting change in philosophy don’t you think? And guess what, as long as you’re getting your job done that’s ok.

Someone once told me I was too old to be an effective Product Manger (I’m in my 40’s), and now I know why. At my age I have certain beliefs that have been cemented in place by years and years of exposure to the world around me. And to put it in simple terms, the world around me has changed. With that said, I don’t think age has anything to do with being a good Product Manger. My mind is still sharp, and I have experiences that the 20 something crowd lack. Getting older, yes. Toothless, no. I can hold my own.

With all that said, it may seem to you that my move was a bad thing. Nothing could be further from the truth. For the first time in many years I’ve been challenged. Challenged to compete with people who are smarter than me. People that work harder than me. And people who have more experience and know more about the job than me. Being a Product Manger is a good job, and I like it.

Thoughts on being a Product Manger. I can’t say whether these are unique to the company I work for or can be applied across the board because, hey, I’ve never been a Product Manager anywhere else.

The Good

The company – Salary and benefits? It’s all about the same, but the company treats me well; very well. From the little things like free snacks and drinks at the corporate office, to letting me run around the country on the corporate dime. It’s all good. Hands down the best company I’ve ever worked for.

The job – Seriously, can you believe people pay me to think up new things to build? I can’t. I love pharmacy automation and technology, and the fact that I get to do this for a living is still hard to believe.

Autonomy – I suppose this goes along with the job, but people pretty much leave me to my work. Pharmacy was never like this.

The people I work with – The people I work with are all intelligent, hardworking people. They have the same goal in mind that I do: build a successful product. I haven’t met anyone yet that I’d like to punch in the face or drive out in the middle of nowhere and leave for dead. I can’t say the same for any of my previous jobs.

The people I visit, i.e. “the customer” – As a Product Manger I spend a fair amount of time talking to “customers”. It just so happens that those people are pharmacists. Seriously, someone pays me to run around the country and talk to other pharmacists. I’ve learned a great many things by speaking with pharmacists from different parts of the country, and the one thing that sticks out the most is that the profession is completely fragmented. Every pharmacy has the same set of problems and they all approach them with a different strategy. Some good. Some bad. They could all learn from one another, but they don’t have the luxury of spending time with each other. Too bad really because there are some really great pharmacies out there. Perhaps I’ll write a book someday on all the different things I’ve seen.

Education – As I said above, I was naïve. I’ve been schooled on more than one occasion. My business knowledge sucks and I’m struggling to understand it now. I’ve learned things that I would have never learned as a pharmacists.

Never bored – I was pretty bored as a pharmacists. I don’t have to worry about that now. I get to do a lot of things that I’ve never done before.

Authority/Power – I’m just now starting to probe the limits of my authority as a Product Manger. Apparently they have a lot of power inside a company. However, I haven’t figured out how to wield it yet. As I said above, I need to learn how to be a more direct and to the point. No fluff needed. 

The travel – This has been a blessing and a curse. I’ve seen places that I would have never seen in my lifetime. I used to fear getting on a plane. Yep, I was scarred of flying. Well, nothing’s changed. I’m still afraid of flying, but now I take it like a man. No more crying during takeoff and landing ;-)

Conferences – I’ve been to more conferences in the past 12 months than the previous 3 years combined. I believe conferences are a necessary part of one’s development as a pharmacists and I’ve been fortunate enough to enjoy several this year. What an awesome bonus to being a Product Manager in a company that deals in pharmacy automation and technology.

The Bad

The job – I used to scour the internet looking for pharmacy automation and technology to escape from my real job. Now it is my real job which makes it less appealing. Now I look for ways to escape from it.

I used to love to blog, but some of the luster has been tarnished now that it’s part of “my job”. Not to say that I find things less interesting, I just don’t feel compelled to write them down. I used to look forward to getting off work so I could get home and blog about something interesting. Not anymore. Now I read about something interesting, make a note about it and truck on.

Definition – No one can really tell me what a Product Manager does. I’ve had multiple people, from top to bottom, give me different opinions on what I’m supposed to be doing. So, what’s a Product Manger do? Crud, I don’t know.

The travel – A blessing and a curse., remember? I feel like I travel quite a bit, but I’ve been told that it’s not really that bad. I’m away from home about two, sometimes three weeks a month. Not bad I suppose, but compare that to my previous 15 years on the job; gone zero. For the first time ever as a dad I’ve missed both my girls birthdays (the actual date, not the celebration),  I’ve missed sporting events and school functions. Fortunately my girls are 14 and 17, and they not only understand, but are so busy that I’m not sure they even notice when I’m not in the house. I couldn’t have done this job 10 years ago.

On wearing a suit and tie – Not my style.

The people – I work with some pretty strong personalities. I haven’t really learned how to deal with that part of the job yet, but I’m working on it. Some people think they’re always right. Sometimes it feels like I’m working with physicians again. 

Opinions – I just can’t get used to having people tell me my opinion is wrong. Yep, my opinion. Someone will ask me my opinion and then spend a half hour lecturing me on why opinion is wrong. I took that at face value for a while, but not anymore. My opinion is my opinion, and they aren’t wrong. You want to know why? Because they’re my opinion, nimrod. If you don’t want my opinion, don’t ask. And just for the record, who’s to say your opinion isn’t wrong and mine right? Chew on that.

More opinions – The other nasty thing I’ve run into on several occasions is someone telling me I don’t know what pharmacists want. Really? Last time I checked I was a pharmacist long before I was a Product Manger. I’d argue that I still know pharmacy a heck of a lot better than I know being a Product Manger. I’m not saying I’m always right, but I find that some “business” people don’t have a clue how a pharmacy operates.

Paperwork – These people like their documentation: battle card, ROI, business case, concept document, MRD, technical specs, spec sheets, etc. One could get lost in the mountain of paperwork. “Did you write up an MRD?” “Did you fill out a battle card?” “What’s the business case?” “I didn’t see a spec sheet on that?” Half my time is spent creating some type of documentation. And I thought healthcare was full of red tape and an over abundance of documentation.

The Ugly

It’s a business, bro – Ah, the heart of the matter. Never forget, this is a business. It doesn’t matter how great the idea, if you can’t prove it will make money then you can forget about it. This is a frustrating concept for me because I personally believe there are some ideas that can’t be proven before they’re done. How can you prove something will make money if it’s never been done? It’s a problem to be sure. Nature of the beast boys and girls.

Some ideas that I thought were quite brilliant were conceived years ago by the company I work for, but shelved because they were perceived as low profit potential. Every once in a while I’ll trot out something I think is totally awesome only to have one of my colleagues show me documentation on the same idea they had four years earlier.

Final Thoughts

I’m enjoying my time as a product manager. In fact I don’t see myself going back to being a practicing pharmacist any time soon. Pharmacy as a profession is a dead end, and I’m just not ready to sit in the proverbial professional rocking chair.

I’m still a rookie as a product manager, and I have a lot to learn, but that’s okay. I’m looking forward to the challenge. For now I’m just along for the ride.

Fluting filter paper is common practice in high school and college chemistry labs across the country. The process is done to increase the speed of the filtration process and give one a larger surface area onto which to collect the sample. Pretty low tech, but cool nonetheless. 

MedVantx, Inc., has announced the deployment of its patent pending Patient Profile™ patient medication and adherence reporting engine across its network of 3,600 high prescribing primary care providers participating in the Company’s integrated program of initial free medication therapy, adherence management and home delivery program. This new program utilizes the Company’s proprietary automated ATM like sample management system (“MedStart™“) and an integrated secure web reporting portal to provide physicians visibility to their patients’ adherence to chronic medication therapy…

The MedStart™ system automates the traditional sampling process for the physician; captures physician sampling data for inclusion in the patients’ claims history medical record and provides consumers access to highly relevant drug and disease state educational materials. Since patients don’t always get prescriptions filled, physicians can enhance adherence by providing their patients with initial therapy and better informational tools to manage their conditions right from the office…

 

Now with the availability of the MedVantx Patient Profile™, physicians are able to view data about how patients, on an individual basis, are complying with their prescribed medication treatments.  By showing exactly when a patient fills prescriptions, physicians can detect late refills, gaps in medication fulfillment, discontinued treatments and more to accurately access and improve patient compliance.

Interesting concept. I often wonder if simply getting rid of chain and grocery store pharmacies, and going back to neighborhood community practices would be the best way to improve patient medication compliance. I’ve worked in chain, grocery store and community pharmacies and have always felt that the small community practice knows their patients best and provides the best patient care when it comes to medication management. Something to think about anyway.

More on the system mentioned above can be found at the MedVantx website.

Would you rather have a five pound paper volume sitting at home on your shelf or an electronic version with you at all time taking up nothing more than a little space on your smartphone or tablet? That’s a rhetorical question really, because it’s a no-brainer.

Dear USBMIS Software User:

Taber’s Cyclopedic Medical Dictionary, 21st Edition is now available for iPad! Taber’s is also avilable for iPhone, Android phones, and Android tablets.

iPad and iPhone Users
View in iTunes

Note: If you already own the iPhone version and use the same iTunes account on your iPad, then the iPad version is free.

Android Phone and Tablet Users
View in Android Market

The Taber’s Cyclopedic Medical Dictionary app includes:

• Cyclopedic entries that offer more than just definitions.
• 60,000 reader-friendly definitions.
• 3,000 brand-new terms and 7,000 revised terms.
• Over 1,000 full-color illustrations.
• More than 600 Patient Care Statements.
• Caution Statements with easy-to-find icons.
• Dozens of Allied Health and Nursing Appendices.

Sincerely,
USBMIS Development Team

Some simple things that could have prevented this error include some type of CPOE system, a healthy dose of clinical decision support software and pharmacy access to laboratory data. Any one of these could have made the difference.

One other thing worth mentioning. Orders for oral KCL greater that 40 mEq per dose are typically accompanied by instructions for a set number of doses, i.e. 80 mEq po daily x2 doses for hypokalemia. It’s a simple thing, but could be the difference between electrolyte correction and death. In this particular instance the patient received the dose for 8 days before succumbing to hyperkalemia. 

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image taken from ISMP Medication Safety Alert, Nov. 3, 2011, Vol 16, Issue 22