It may amaze (or amuse) those who know me to think of me as a Bible scholar, but I actually have had some training in that line. The quote above is from the King James Version and is a serious mistranslation of the Hebrew (the actual translation is "Where there is no preaching, the people cast off restraint").
Nonetheless, I really like the notion in this translation of the text. It speaks to me of the need for a group of people (perhaps we pharmacists) to be moving toward something grander than what we currently experience. It speaks to the need for real leadership that can focus on getting through the day without losing sight of actually moving down the road. It speaks to the essential difference between leadership and management, which appears to be, after all, founded in the presence (or absence) of vision.
When I think of this in the context of PPMI, I am reminded of how essential it is for our leadership to continue to paint the picture for the brighter future envisioned by that initiative, and to keep us moving toward that new practice, even if the steps periodically falter, or some of the pathways seem a bit dark and murky.
Strangely, I have found myself referring to this verse in a number of conversations, recently, because those conversations involved either the appearance of motion without a clear vision (e.g., the yearning for bygone days), or because those involved could not see the path forward.
In a blog some time back I described an experience where I was granted a vision of pharmacy as it might be if we stubbornly stick to our current notion of the practice. That, too, is a sort of vision. There is a real danger that we could be left behind. Those visions cannot compel us forward, they can only leave us fearful of the future.
So while we must realize that the healthcare system is moving in directions that will no longer sustain the practice as we (especially people of my age!) have known it, it must not be the fear of losing our entitlement that moves us. It must be the grander vision that permits us to see a new practice where we are more influential in, more essential to, and more involved in the larger healthcare team (with the accountability that that involvement implies) than we are today with the result that we actually move the needle on the national gauge of healthcare quality.
Is it scary? Yes! Will our practice change? Undoubtedly, whether we want it to or not! The question is not whether our practice will change, but whether or not we will be able to guide the course of that change.
Is the path clear? No, it is not! Part of having the vision is being able to recognize an opportunity to move it forward, and to grab the opportunity when it presents itself. Part of leading to a vision must be believing that forward motion toward that vision must be possible, and recognizing the opportunities required to maintain that motion when they occur.
So how does this affect you? Part of it involves recognizing that waiting for someone else to set the direction does not move us forward. Part of it means embracing, even facilitating change in practice, even if it is scary! Part of it means advancing yourself and your credentials, even if the rewards for that advancement aren't immediate or obvious; in doing so you incrementally advance the profession. In that sense, each of us is a leader; and each of us has opportunities to advance another step toward the vision.
So don't wait for someone to bring the PPMI to you; make it happen where you are and in the context of what you do. And when it succeeds, write about it and talk about it. Encourage others to go where you have gone. In so doing, you articulate the vision, and move us down the path.
Dennis A. Tribble, Pharm. D., FASHP
Daytona Beach, FL
DATdoc@aol.com
(386) 871-6940
The opinions expressed above are my own, and do not necessarily reflect either those of my employer or those of ASHP.
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