Editorial

From the desk of the editor

Welcome to the May 2012 homepage edition of i2P-Information to Pharmacists. Rollo Manning has been having some time out having staples removed from the site of his open heart surgery.He is now at home recuperating in Darwin, having arrived home last Friday, beating a cold and hasty retreat from Canberra.We all wish him a speedy recovery and hopefully, he will be fit enough to contribute by next month.
This month, Pharmedia discusses the toll that is taken when someone complains about you to an authority without good cause. Well, the good news is that you can now take action to protect yourself if such a complaint is made, and that may even include action for defamation. Read about a recent case involving two doctors, with Mark Coleman drawing on personal experience to illustrate.

read more
open full screen

Columns

Recent Comments

Click here to read...

Past Editions

Volume 1 Number 1
Volume 1 Number 2
Volume 1 Number 3
Volume 1 Number 4
Volume 1 Number 5
Volume 1 Number 6
Volume 1 Number 7
Volume 2 Number 1
Volume 2 Number 2
Volume 2 Number 3
Volume 2 Number 4
Volume 2 Number 5
Volume 2 Number 6
Volume 2 Number 7
Volume 2 Number 8
Volume 2 Number 9
Volume 2 Number 10
Volume 2 Number 11
Volume 3 Number 1
Volume 3 Number 2
Volume 3 Number 3
Volume 3 Number 4
Volume 3 Number 5
Volume 3 Number 6
Volume 3 Number 7
Volume 3 Number 8
Volume 3 Number 9
Volume 3 Number 10
Volume 3 Number 11
Volume 4 Number 1
Volume 4 Number 2
Volume 4 Number 3
Volume 4 Number 4

i2P Archives

EPublications

Click here for a list of epublications

I just want them to THINK!

• Printer-friendly version
• Send to friend
• PDF version
• Share

Dr Linda Bryant (PGDipPharm, MPharm, DPharm(Auck), FACPP, FNZCP, FPSNZ, MCAPA) articles by this author...

Linda is a New Zealand Clinical Advisory Pharmacist working as part of a team with GP's and nurses, in a medication advisory role. New Zealand clinical pharmacists get some encouragement to work independently in a variety of settings not necessarily tied to a community pharmacy. Through her company, Comprehensive Pharmaceutical Solutions, she contracts to Primary Health Organisations, lecturing postgraduate students in Clinical Pharmacy and undertaking evaluations of services. Linda's PhD thesis involved investigation into the barriers of implementing Comprehensive Pharmaceutical Care (clinical medication reviews) in primary care.

I was fortunate to hear Edward de Bono talk a year or so ago, the guru of lateral thinking / critical thinking. He was lamenting the lack of thinking of the ’young people’, who appeared to have the view that if the answer wasn’t on the Internet, then there was no answer.

open this article full screen

De Bono seemed to have got to the point where it wasn’t lateral thinking he wanted anymore - “I just want them to THINK!” he proclaimed. It certainly seems like a backwards step from the concept of lateral thinking, yet with so much ‘information’ out there now that is so readily available, have we forsaken our need and therefore our ability to think a problem through – good old problem-solving skills, not based on a ‘gut feeling’ or ‘experience’, but using an understanding of underlying principles to come up with an answer that is evidence-based, but unique to the individual person in front of you – i.e. individualisation of pharmacotherapy.

Asking some new postgraduate students what they used as drug information sources, rightly they came up with the basic textbooks, product data sheets and databases such as Micromedex®, Up-to-Date® or Dynamed® etc. But there it seemed to end. Google and MedLine were used at times, but not particularly systematically or thoroughly. It is very easy to fall into bad habits with MedLine and overuse possible shortcuts, forgetting the underlying principles – such as the use of MESH terms, especially with the PubMed version. Then there is what to do with what is found in the literature search and how to evaluate or appraisal the data found, assimilate it and extract from it the relevant information to be applied to the individual patient.

I hear the comment – “I don’t know the answer, but I know where to find it. That’s what really matters”. Alas, the vast majority of patient’s do not conform to our textbook cases. They do not fit the guidelines. They are complex individuals with multiple co-morbidities, differing life experiences and attitudes, and intricate medicine needs. To apply the information we have, we need an in-depth understanding of the foundations and principles of pharmacotherapy, and the ability to apply these to an individual person with unique problems. If we are simply people who can look up information about medicines and repeat that information, including ‘what the guideline says, so it must be best practice’, we are not applying the knowledge and understanding that we should have as pharmacists. Any layperson can look up the information, but it is whether they understand the implications for the individual.

I’m seeing more guideline-driven prescribing, and while that may be excellent for the population in general, I am unsure about it for all individuals. It is generally a non-thinking process that even the patient could do … (s)he can look up heart failure and tell you what any particular guideline says that they should be on. They can look up the benefits and adverse effects of the medicines. It is readily available on the Internet. Remember, most of these people are the “Baby Boomers’ – a hedonistic, demanding bunch who want to manage their own lives; for themselves, by themselves. How do we help people navigate that vast information source out there – be a Knowledge Navigator as Peter Ellyard (Futurist) described it many years ago at an SHPA conference? Being a knowledge navigator means that we have to understand the principles in order to apply them to the individual, and communicate why the individual may be different.

What I am finding is that it is not only the patients who source information from the Internet, but also our medical practitioners and others – so when I receive a medicines information enquiry, it is no longer about looking up an answer because the doctor is busy or doesn’t have the ‘special’ resources of a medicines information centre. They have ‘Up-to-Date®’ readily accessible, and I find that their favourite websites are minimised at the bottom of their computer screen (also educational to see what their preferred information sites!). The questions are usually patient-specific and are outside the norm – so the response has to be developed specifically for that patient and usually by applying some of that ‘old-fashioned’ understanding of phamacokinetics / pharmacodynamics. It is about managing adverse medicine reactions and interactions, not just stating that they exist.

For me, I find the blind application of guidelines to older people, particularly those over 75 years, most galling. We see research papers lamenting the fact that we are “ageist’ because we are not putting all older people on all the guideline-recommended treatments for their medical conditions, and therefore are not achieving the clinical indicator targets for these people. We stop seeing these people as individuals. We stop thinking about the effects of medicines in older people, and applying our foundation knowledge to the individual.

The move from a pharmacist to a practitioner, in my mind, is the move from using guideline-driven standard recommendations about medicines use, to focusing on the individual and being able to recognise when not to follow a guideline. The advanced practitioner knows how to manage medicine adverse effects and interactions, and is able to justify their recommendations using first principles and by bringing the patient’s input into the decision.

Like De Bono, it would be great if we could all learn to THINK holistically about the individual to solve their unique medicine related problems. Patient care is NOT guideline driven population care.

Clinical Newsfeed

Click here to read more...

Research Reports

Practice Development

Information Technology

Preventive Medicine

i2P Alliance Partners