Author: emr15006

The Community Pharmacist on the Healthcare Team

Crystal Shaw

By Crystal Shaw, PharmD

Like all healthcare providers working in the field, I feel like I am working non-stop to provide the best care to patients that I can. Our current health care system stresses ever-increasing speed and efficiency while minimizing costs; these emphases compel health care providers across disciplines to push themselves to their limits, and make their time all the more valuable. Under these conditions, it becomes even more important for professionals to recognize when other types of providers can make their jobs easier and their patient care more effective.

Although pharmacists have long been core members of healthcare teams, community pharmacists in particular are frequently underutilized in many practice settings. To illustrate this, I conducted an experiment: over the span of seven days at the community pharmacy where I work, I tracked the number of times I interacted with other health professionals. During that week, I received a total of eight medication- or patient-related phone calls from other health professionals. For scale, I answer on average 150-200 phone calls per week, the majority of them routine calls from patients or doctors calling in new prescriptions. Should medical practitioners more frequently turn to community pharmacists, they will find valuable sources of both technical and community knowledge.

Community pharmacists have extensive knowledge of medication, acquired from years of schooling and study. While filling prescriptions keeps us very busy, at the end of the day we are still pharmacists, experts on medication. Whether there is a question about treating a patient in the hospital or a drug interaction for a new medication prescribed to a patient by their primary care provider, we are trained to answer any and all medication questions. And, if we do not easily have the answer our fellow professionals are seeking, we can draw upon a plethora of resources to find the answer.

Alongside this technical knowledge, our practice location gives pharmacists a unique perspective on patients’ lives; we have the rare opportunity to get to know patients on a deeply personal level. For many, the pharmacy is the health care facility they visit most often: multiple maintenance medications necessitate frequent trips out to the pharmacy for patients or their caregivers. We build relationships with these patients, and we gain insights into their lives that can become important should they become hospitalized and in another provider’s care. We can tell, for example, if they’ve been taking blood pressure medication, or if they recently started purchasing an over-the-counter product indicative of an underlying health issue. And, we can often see earlier signs of health deterioration, at which time we refer them to doctors, dentists, or sometimes even the hospital.

Next time you are working in your medical team and you have a question about a medication or you need medication-related insight on a patient, give your local community pharmacist a call. It may make all the difference for your patient.

To leave a response to this post, please email Ellen Ravens-Seger.

Be Who You “Wanted” When You Were New

Rubby Koomson

By Rubby Koomson, RN

Mentoring is a central tenet and hallmark of the Urban Service Track/AHEC Scholars (UST/AS) program. A mentor is a non-judgmental individual who is trustworthy, listens, gives constructive criticism, and acts as an overall role model for the student or novice professional. Mentorship is integral to students’ experiences with the UST/AS program from the day they are accepted.

As a first-year student in UST, I looked up to the second-year students as coaches and mentors. These coaches were instrumental in teaching me how to maneuver through the program. From these early days in UST to my professional career today, my notions about what mentoring entails have evolved. I used to think mentoring could only be done when one is at the peak of their profession; I have come to realize the right time to begin mentoring is fluid. After just six months of working as a nurse, I found myself mentoring less-seasoned colleagues and student nurses. That was the moment I learned that I did not have to know everything about the job in order to be a mentor, but rather that I had to be aware of the resources at my disposal and be able to direct others to those resources when needed. This criterion is undoubtedly applicable in both nursing as well as other professions.

One of the key components of mentoring is providing mentees with constructive feedback. Good mentoring requires clear, effective communication between mentor and mentee. Such communication and well-intentioned, constructive criticism are especially important early in the mentoring relationship, as the parties adjust to each other’s teaching and learning styles. It can be quite difficult to gracefully give constructive criticism, and it can be equally difficult to gracefully receive constructive criticism. If mishandled in the delivery or intent, criticism can be one of the factors that sabotages the mentoring relationship. But, once clear, open, effective communication is established, constructive criticism will find its place and value in a mentoring relationship.

Mentoring is an exciting learning opportunity for all parties involved. Mentors have the opportunity to learn new ways of practicing and communicating from their mentees, to gain a deeper sense of self-awareness, and to frequently test their knowledge base. The mentee learns alternate ways of practicing medicine as well, and how to avoid some of the mistakes the mentor may have made as a student or new professional. My advice to you is to be prepared for and open to mentorship opportunities and relationships and aspire to be the type of mentor you needed and wanted as a new professional.

To leave a response to this post, please email Ellen Ravens-Seger.

Work-Life Balance, or Something Else?

Owen Kahn

By Owen Kahn, MD

Now that I am a resident physician, the difficulty of achieving a work-life balance has been pushed to the extreme, as many of you in health care fields have experienced or will. In dark times, during stretches when my schedule keeps me at the hospital every day for long hours, I fantasize about a future time when I won’t be as busy:

“When I’m an attending, things will be better and I’ll be happy.”

Then, I recall similar thoughts I had as a student in medical school. We were either studying, endlessly it seemed, or rotating from site to site, where we were always the least-experienced team member around. Stress, frustration and burnout were commonplace. We often fantasized about a future time when we wouldn’t be as busy:

“I can’t wait to graduate and be a resident. Maybe I’ll be happy then.”

I find myself in a familiar spot, with the same feelings, once again with unrealistic expectations of the future.

Granted, some things already are or will be better. As we medical professionals become more experienced and confident in our positions, the work itself becomes easier and each day stresses us less. Completing our training also allows us to reach our financial potential. However, attendings, supervisors, practitioners, all those who have reached the peaks of their careers, are usually no less busy than we are. Once training concludes, the safeguards put in place to protect trainees from overwork and burnout disappear. Unprotected, we acquire new professional roles and responsibilities as well as new personal roles and responsibilities as we start families.

At this time, I am still a resident-in-training, so I cannot speak from experience. But I hypothesize that my life will never necessarily get easier. Instead, it will likely become harder and more complicated. And that is okay. Accepting that life is and will be complicated permits us to prepare for it effectively. To best prepare, we need to be capable of successfully uniting work and life–now; we need to be able to find happiness in and outside of work–now. Because, just as our lives will become more complicated, the linkage between personal and professional lives will become more tenuous. Its maintenance is a skill and an art, rather than a science. We must learn and practice it as trainees so that we may be consummate professionals when we graduate, just as we learn and practice our individual disciplines of medicine, nursing, or pharmacy, among others.

I dislike the phrase work-life balance. Balance implies that two elements are at odds, opposing each other from different ends of a spectrum. Instead, our professional and personal lives must co-exist in a healthy relationship. Thus, I consider work-life union to be a more appropriate phrase. And we all need to be better at it.

To leave a response to this post, please email Ellen Ravens-Seger.

Clarifying the Role of the Social Worker on the Medical Team

Lisa Vallee

By Lisa Vallee, LCSW

Misunderstandings abound among medical professionals regarding the role of social workers, even among professionals who pride themselves on their involvement with and knowledge of interdisciplinarity. Many professionals believe they understand the function of social workers on their team, but do not fully grasp the technical knowledge and training that social workers possess. By explicating social workers’ knowledge and capacities, I hope to open up new opportunities for interdisciplinary engagement between social workers and their medical teams.

On a medical team, the social worker is typically seen as a resource guru, the professional who knows important phone numbers and works with local organizations capable of supplying basic needs and transportation. Medical social workers are often known to be responsible for discharge planning and coordinating aftercare. But social workers pick up this logistical knowledge over the course of their careers; their education and training prepare them to be more than logisticians.

The social worker possesses an understanding of human behavior and development within a broader social context, and of cultural differences among social groups. The topics social workers are educated on to this end include physical and mental illness, substance abuse, violence, grief and loss, homelessness, poverty, discrimination, aging, and spirituality. One of the central principles instilled in social workers is to pursue social change, particularly for vulnerable or oppressed individuals and groups.

For social workers operating at a systems level, the client may be a larger group, a community of people, or an organization; clinical social workers more typically work with individual patients or smaller groups, and these latter social workers are the ones found on medical teams. In their practice, social workers begin by assessing the level of fit between the client and the client’s environment. Social workers begin their assessment by collecting information about their client, organizing this information, and analyzing it. They carefully listen to the client and help them identify any problems or issues with their situations. They identify their client’s strengths and mobilize those strengths towards dealing with stressors having an adverse effect on their client’s life.

Following their assessments, social workers plan and carry out their interventions. Providing resources and coordinating care is essential to most interventions. However, social workers perform a number of other, crucial functions: they can diagnose and treat mental illnesses and substance use disorders; conduct psychotherapy with individuals, groups, families, and couples using a variety of evidence-based approaches; and work with community groups to build coalitions that work to promote or advance a social cause. In the political sphere, social workers engage in lobbying, testifying, or grassroots organizing to support legislation that advances the needs and rights of vulnerable groups.

Social workers can help clients change dysfunctional patterns of behavior and can improve communication between people. Their knowledge and understanding of human behavior uniquely position them to solve particular medical problems and to provide insight that other providers might lack on critical medical questions. The social worker is a critical player in the health care field and a vital member of any interdisciplinary team.

To leave a response to this post, please email Ellen Ravens-Seger.

Life after Training: Exploring the Work Field

Elizabeth Chasse

By Elizabeth Chasse, MD, MPH

For young physicians, completing their residency and entering the work force can be exciting but daunting. Years of training lead to this pivotal time and finding the perfect job may be stressful: many physicians end up leaving their first position within a couple of years. Rather than seeking out the perfect job, I advise medical professionals not to limit themselves. If you cannot find everything you are looking for in one job, it may be advantageous to explore working two jobs. This approach can also further your interdisciplinary and interprofessional training, one of the central tenets of the Urban Service Track’s educational program.

Speaking from personal experience, I liked that working in the Emergency Department was shift work and did not require being on call. I also liked outpatient pediatric medicine, which provided the joyful opportunity to watch children grow over the years. Instead of choosing one job over the other, I decided to do both. Working both jobs provides a nice balance between both the outpatient and emergency room settings.

In the pediatric office, I get to develop and grow ongoing relationships with my patients and their families. This continuity provides one kind of great learning environment: through follow-up visits, I am able to assess the success and effectiveness of my plans and treatments. It is also a priceless experience to see children at their newborn visit and then see their growth and development at subsequent visits. The Emergency Department (ED) is a different work environment, one with a more urban patient population. With the ED’s quicker pace, I have the benefit of promptly knowing lab and radiology results, allowing me to reassure patients with rapid answers.  I am able to hone skills and practice procedures that I would not have the opportunity to do in outpatient pediatrics. The ED is also a variegated and stimulating academic environment. I work with scribes, many of whom are interested in going into the medical field themselves, am shadowed by undergraduates, and supervise medical and PA students. I advise PAs and NPs when they have clinical questions, and also seek advice on patients from them, as well as from ED physicians and fellows. Working in the ED and in outpatient pediatrics makes me a more well-rounded physician. I can apply what I learn in each work environment to the other, and I can better relate to patients in both settings.

It is neither feasible nor sustainable to work two jobs both full-time, and working two jobs in two different work environments is not for everyone. This column is simply meant to raise awareness of the option as a workaround for strictures which may manifest early in medical professionals’ careers. Scheduling difficulties can be obviated: jobs can be worked full-time, part-time, or even per diem. Some subspecialty physicians work both in their subspecialty and in general outpatient pediatrics, and some pediatricians work both as hospitalists and in outpatient pediatrics. Although this column is focused on pediatrics, it equally applies to other specialties, providers and disciplines. It is worthwhile to explore your options, no matter your field, and to not settle. You will have to find out what works best for you and what will give you the most balance in your life.

To leave a response to this post, please email Ellen Ravens-Seger.

Continuing Education Challenges and Opportunities

By Hannah Hughes, DMD

Hannah HughesI still remember the powerful relief of graduation day. I was ready to shelve my books, put on scrubs, and start working with patients; the continuing education (CE) Connecticut required of me to renew my license was the last thing on my mind. But, as my first year of work progressed, I began to ask some questions. How was I going to motivate myself to go back to the classroom? How do I find and then pick CE courses? Can I justify spending money on CE courses while I still have student loans looming? Since that first year, I have arrived at some preliminary answers.

My work itself provided both the motivation to return to the classroom, and the topics to be prioritized. After residency, I relished my newfound freedom from the classroom, until gaps in my knowledge began to become apparent. Whether a coworker brought up a topic I needed to know more about, or a patient had a question that I could not answer, there arose a need to broaden my knowledge. I started to make a list of these incidents, and this list became an inventory of subjects to be addressed through CE.

I next took on locating and choosing CE courses, and eventually discovered three sources for relevant CE. I began with an exhaustive search of local schools' websites to see if any offered CE in dentistry; many did. Outside academia, I found many town and state dental associations offered CE. Finally, one of my colleagues recommended looking at social media groups. I turned to Facebook, and was surprised by how many profession-specific groups there were. Even the less helpful groups were filled with other health professionals looking for advice, not only helping me find CE, but also helping me feel like a part of a broader medical community.

Even after solving these problems, I still thought I should wait before spending more on education. Then, I remembered that during my third year of medical school, I had met a dentist who was four years out of school. He told me he had made a promise to spend 10% of his yearly income on CE while working. I admired his plan at the time, but only after beginning work did I realize the importance of his commitment to staying focused and bettering his education. I resolved to set goals and make plans for my CE. Since Connecticut's CE requirements are counted in hours for dentists and many professionals, I tracked and planned my CE in hours rather than dollars. Setting a goal for my CE, and visualizing this goal by tracking my hours on a spreadsheet, helped me think about CE productively rather than with fear for my finances.

I’m still experimenting with CE to find what works for me. I still ask for advice from colleagues and check internet forums. With so many CE classes offered, finding effective ones still requires research. And, sometimes, I still need a break from the classroom for a few months. I just make sure to keep my goals in mind and to remember that my patients are counting on me!

To leave a response to this post, please email Ellen Ravens-Seger.

On Delivering Bad News

By Kate Schiff, MHS, PA-C

Kate SchiffOne challenge all medical practitioners face is how to deliver bad news to their patients. During my five years as a PA, I have been the beneficiary of excellent advice on how to do this. But, from time to time, I have wondered whether there may be something I could do to better comfort and communicate with patients during these difficult moments.

For guidance, I turned to Dr. Gerard Fumo, medical oncologist and hematolgist at Midstate Medical Center. “Sit down, sit close, don’t rush, remove distractions and don’t allow interruptions. Watch your patient closely as you talk. Make sure you are not losing them,” Fumo advises. “Pause if necessary, let them absorb what you are saying. Frequently people stop processing when they get bad news…don’t be uncomfortable with a little silence. This is where you can ‘read’ the situation – is your patient coping well or decompensating? You will proceed differently based on how you read the situation.” The ability to read the situation is critical, and patients will notice when their provider fails to do so even if the patient appears distracted by their diagnosis. When labor and delivery nurse Amy Murlowski received news that she had a progressive, degenerative spinal disorder, she explains she wished her spine specialist had “simply acknowledge[d] the shock and discomfort” Amy was in due to both the diagnosis and her level of pain at the time.

Patients watch their medical providers closely, and read their demeanor for clues to the diagnosis. Breast cancer survivor Kimberly Jones* describes her first doctor's visit after a breast biopsy: “When the initial biopsy came in, she checked [the biopsy site] and never looked at me. We have a history of friendly banter usually with each other…I already knew it was bad.” She recalls feeling alarmed and offended by the sudden loss of friendliness and withdrawal. Later, when pathology revealed her cancer to be worse than what she had initially understood it to be, Kimberly resisted returning to the office to discuss her treatment and prognosis. “I said call me, I can read your body language so not looking at me doesn’t work for me. She said ‘well I don’t like to give bad news’…in my heart I want to say I’m glad she has not been desensitized, but in my head I’m like my God it's your job to inform me of everything…”

While tact and body language are extremely important, the greatest nuance lies in knowing the right amount of information to give the patient. To gauge the proper amount, Dr. Fumo suggests observing how comfortable the patient is with the conversation. “You don’t always have to give all the bad news in one meeting. Some individuals just can’t cope with it and others don’t do well with bad news that just seems to be getting worse and worse. Many times bad news can be given in stages.” He also cautions health care professionals to be aware of the influence of accompanying friends and family. “It’s great to make sure that family and friends are getting what they need from the conversation, but your first obligation is to your patient. Even as you address family’s questions, always keep an eye on your patient and make certain your patient is comfortable with how things are going. Stay at the pace of your patient, not the family or friends.”

My hope is that this essay will provide some useful tools, insight, and reassurance for a distressing medical moment. In conclusion, I offer one last pearl from Dr Fumo: “Be sincere and empathetic. Patients sense whether you are just giving them standard recommendations…or whether you’re giving them individual care and guidance based on medical information. Earn their trust and guide them with your heart and instinct; you have the knowledge.”

*Name changed at patient's request.

To leave a response to this post, please email Ellen Ravens-Seger.