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keeping what's important

By Dennis Tribble posted 04-28-2017 09:48

  

I recently attended the European Association of Hospital Pharmacists meeting in Cannes, and my wife and I took the opportunity to visit family in Europe and the UK and get a little sight-seeing in. London is one of our favorite cities to go sight-seeing.

This time we visited a place called the Royal Mews, behind Buckingham Palace, which is the location of horse stables and a series of carriages (“coaches”) used by the Royal Family for State activities.  The coach collection is impressive, spanning centuries of the monarchy and generations of individuals dedicated to building, maintaining and operating the coaches.

One of the oldest coaches is the Gold State Coach which is used to carry every monarch to their coronation, which is easily the “crown jewel” in the coach collection. It weighs in at 4 tons, requires two days just to get it out of storage, requires a staff of 23 and a team of 8 horses to run it at a walking pace (its fastest speed), and is suspended from the frame by four very large leather belts which makes for an extremely uncomfortable ride. King William IV (a former naval officer) described being driven in the Gold State Coach as the only ride that ever made him seasick, and King George VI described is as “.. one of the most uncomfortable rides I have ever had in my life…”

Other coaches are smaller but similarly grand. While it was made clear during the tour that many of the techniques and processes used to manage and operate the coaches were fundamentally unchanged over the centuries, as the coaches got younger, features had been added to them to make them more comfortable, up to and including the Diamond Jubilee State Coach which has electric windows, heating and hydraulic stabilizers for a comfortable ride.

What struck me was that over the centuries this collection of coaches had managed to preserve what was important and timeless for state coaches (the sense of history, pageantry and symbolism that British State Coaches are supposed to provide), while adopting modern technology to improve what was problematic, the quality of the ride.

This made me think about the evolution of our practice, and wonder whether or not we were preserving that about ourselves that should be important and timeless as we move ourselves to advancing our practice.

Don’t get me wrong; I believe firmly that our clinical role will permit us to move the needle in advancing the general quality of healthcare in ways that our distributive role could not. I do worry that the journey toward that goal may have minimized that which makes us unique (and therefore valuable) to the healthcare system.

I observe that there is fundamental training about drugs as chemical and pharmacological entities that has been displaced in pharmacy curricula by more clinical pursuits. My experience has been that such fundamental training provides a basis upon which we can act when there is no peer reviewed literature upon which to call, provides a backdrop of science against which we can and should critically evaluate that literature, and a bedrock of science that should drive our dosing and other clinical decision-making.

I see that being lost when I talk to pharmacists who are swayed by the presence of statistically significant population differences when those differences are practically immeasurable, who lack the understanding of the limits of our ability to accurately measure a dose, or who lack the fundamental pharmaceutical chemistry to understand why one must mix the ingredients of a TPN in a certain order.

Without those fundamental skills, what differentiates us from the variety of other clinical practitioners out there with whom we must compete? Why should someone pay a pharmacist when they might get a nurse practitioner for less money if clinical skill is all that is important?

I realize that I am setting up a straw man here, but I do that because I believe we may have lost track of what is important. I am not suggesting that we return to the days of hiding in the basement, nor am I suggesting that we need to be teaching new pharmacists how to whip up an emulsion, mold suppositories, or fill powder papers (I was going to put in a link for those who don’t know what a powder paper is and I can’t even find reference to it on line!). What I am suggesting is that perhaps we need to take stock of what it is that we uniquely bring to the health system table, and preserve that at all costs. And maybe… just maybe… some of that includes things we have minimized in our pharmacy curricula, or stopped teaching altogether.

What do you think?

Dennis A. Tribble, Pharm. D., FASHP

Ormond Beach, FL

DATdoc@aol.com

 

The opinions expressed herein are my own, and not necessarily those of my employer or of ASHP

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