[The panel continues.]
Q: Now that you're currently practicing, looking back, how did pharm school prepare you?
4 – I was the last class before the pathways. I didn't get to be involved with that. It would have been nice to get the HPM (health policy and management) pathway before jumping into it. In pharm school you get skills to be able to compile large amounts of information. You don't get lost in the details. You can see in grey if that makes any sense. A lot of healthcare practitioners see in black and white. In my line of work, you can't just deny a request for non-FDA approved drugs. You have to look at the literature. We're not called the pharmacy department, we are clinical support. We have to keep up with the latest surgery procedures, and use skills in researching drugs. I have UCSF to thank for that.
3 – I took the HPM pathway, and now I'm doing something completely different. You can choose one pathway, but you don't have to stick with it. You still come out with a PharmD. UCSF really opens a lot of doors. We're forced to be so involved. You don't want to be the only one not in a club. All your classmates are all hardworking, energetic, and nice.
How many clubs are there now? There seems to be a new club every year. You get exposed to a lot of careers. UCSF has allowed that to happen for me. I knew I didn't want to do retail. It's good to know you can be in law, insurance, a physician group, research, or management. The pathways do help a lot. in HPM we studied out of Harvard Business School books. It helps you manage people. I remember we used something called word jujutsu. We role played how to deal with different people, how to negotiate a raise, and dealing with lobbyists. You deal with difficult people, and you have to use that, to calm things down rather than add to the fire. You don't want conversations to blow up. That's what UCSF has really taught me. People mostly are well spoken and get their point across [at work]. But you have to back up all your recommendations to the doctors on a daily basis. At UCSF you have to get up and talk. You do it at least once if not 10 times. You learn how to become a great speaker.
2 – UCSF prepares you for anything you want to do. With that said, you're never prepared for anything. For UCSF students, vs other schools, you have so many opportunities opened up for you. They make you think outside the box so you're not so rigid. you have experience in public speaking, presentations, interacting with colleagues. Those skills are just invaluable. Working on the east coast, comparing students here and Rutgers or USP, we're more prepared to deal with people and changes. Things that don't go your way. If you're in community pharmacy, you don't always get people who want to tell you about their winter vacation. You sometimes get yelled at about things beyond your control. The school teaches you how to deal with people like that. You don't just yell back or make the tech deal with that. That's what's great about a pharm degree. You spent 4 years in your undergrad, and 4 years in pharm school, and now you're the manager. That's your responsibility.
3 – You work a lot in groups at UCSF. You learn to be a team member. Now that I'm a working adult (I don't feel like an adult), you can tell sometimes, "You didn't play sports as a kid, did you?" You can tell. You have to work as a team.
4 – You learn about reflective listening. “I’m sorry you feel that way.”
1 – First thing is that when you're at a professional school, it takes about two quarters getting over the competitive feeling. UCSF does a good job about that. Gets those basics in you. Also you get to work with world class professors. I'm not sure about now, but I got to work with a nobel prize winner. You can't exchange that opportunity for anything. The connections, the dean, the awards, the opportunities, and the door that are available. That puts you in situations _____. They want to see you as a person. You can learn a completely different skill sets than just the science of it all. How to negotiate, those kinds of opportunities are valuable, how to read a patient's body language, how to approach them based off of that. Will they do what you want? Or will it be a negotiation? Or will you have to lay down the law.
3 – I still use those skills.
Q: Talk about how you see pharmacy practice changing in the future.
1 – Back then it was just, how did it go? Count, pour, lick 'n' stick. That’s all we used to be. Pharmacists were only supposed to dispense meds and that’s it. Now we do medical collaborations. In stores, I rarely counted. I didn't care if I had to ring up patients, I wanted to be there to create a bond. I had patients from poison ivy to pancreatic cancer, and I wanted to be there to provide emotional support. It's shifting to being an information specialist [Note: I like that term. "Information specialist."] It's great to be able to think in grey. Not "this is what the book says".
2 – In terms of drug research, right now we're working on hepatitis c, the standard is a pill or shot once a week, with lots of side effects, and only 40% respond and get cured. Now we're developing new drugs, such as a protease inhibitor. Works similar to HIV drugs. We're moving away from a standard of care with lots of side effects and not that effective. Also, personalized healthcare. We're developing drugs that are easy to pick as low hanging fruit. Develping drugs for stuff that doesn't have a treatment, no more Cialysis. Going away from drugs approved for different disease states. Right now Lipitor is being approved for other stuff than just cholesterol. We're looking for drugs for treatments that otherwise wouldn't have it.
3 – It might be a little unethical to say, it's a huge cultural issue, that we shouldn't be prescribing if we're going to be dispensing. If the pharmacist prescribes and dispenses, you'll prescribe the most drugs to make the most money. But I hope in the future, it'll be more about prescribing medications. Because I'm in a hospital setting, I'm not selling the drug, so I can do this. I'm not making a profit out of that so it's ok.
Now, the doctor says this what I want, what do you think? We had a heart disease patient with renal failure. She was struck between two pathways. In that process, I was the one to decide. I wrote it and the doctor signed it. In outpatient, we can't do that. Hopefully there will be clinical pharmacists in inpatient as well as outpatient. Physicians do the diagnosis, they're good at diagnosis, then we prescribe.
4 – I agree. There are few states where pharmacists can prescribe. I did in Seatle, Washington, and I thought it was normal. And then in California you have to have a protocol to do that. I thought that was weird. Going forward, it may become easier to do. As physicians see that we're more specialized now. With healthcare reform, insurance carriers will be looking at more innovative payments. Instead of pay for service, it may be lump sum of money to manage my patients. They may say, here's how much you have to work with, now do what you can do. It will be more challenging. Cardiology, oncology... will be hard. It's very complex. They may give lump sums for different types of cancer. On the flip side, we have to include a clinical component. Intensive to withhold medication. People will get very innovative. Right now we can't sustain the rise in drug costs. We have a patient, her drugs cost $800k a year. It's for an enzyme replacement. It allows him to walk 20 more meters in 6 minutes. Is that efficient? Well, she has the disease, so she has the drugs. Going forward pharmacy will develop new payment methodologies.
[Now that's the end of the pre-set questions, next post will continue with the questions from the audience.]
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