Melting barriers

A trial run of a new pharmacy shift led me to working in cancer care for many years. I truly enjoyed my years in this area of patient care but it certainly wasn’t without its many challenges. Please read on to hear about the barriers I had to overcome, how I dealt with them and how I proved the value of a pharmacist working in the oncology setting. There was one oncologist in our hospital who was extremely busy— covering the inpatient unit as well as holding clinics at least three days a week. Because of this busy schedule, the oncology clinic would start late in the afternoon and patients were still waiting at suppertime to receive their treatments. As a result, the pharmacy managers felt the need to create a new shift such that a pharmacist would be available to fill and process oncology orders. The new schedule was posted as a 10 a.m. to 6 p.m, shift, so I volunteered to give it a trial run. I began to spend more hours at the oncology clinic. This was a first for the pharmacist to work in the clinic on a full-time basis, so it was new to the already present oncology team as well as the oncologist. My first task was to prove myself to the oncology team and convince them that the pharmacist was a valuable part of this team. I had to show that pharmacists could be trusted in providing tips and education to patients and other colleagues. This was not an easy task. The oncologist was very demanding, impatient and always ready to defy the norm. I often found myself checking orders, counselling patients and trying to jump to the doctor’s needs all at the same time. I knew things had to change, but the question was how? It didn’t seem to matter how efficient I tried to be, there was always something that didn’t get done fast enough to please the oncologist. I started to observe their behaviour and came to realize that often the same question was asked to several individuals. The oncologist might have already asked another pharmacist or nurse to retrieve the same information, for example: would a drug be covered under the patient’s health insurance plan, or did the hospital pharmacy stock such an item. To overcome this, we decided to communicate more openly amongst ourselves to see whose role it really was to find these answers in a timely fashion. After a few months we did notice our workload more evenly spaced. This also led to improved communication among all health professionals working in this area. Cancer patients utilize most services a hospital can provide such as nurses, doctors, dietitian, social workers, funding assistants and pharmacists. It was essential that we collaborate effectively to avoid duplication of our efforts. My next discovery about the doctor’s likes and dislikes was that they didn’t like to be bothered about the same thing two or three times, even though they might not have answered the concern properly the first time. They would become impatient and walk away when they felt the discussion was finished, even though it really did not meet my satisfaction. Once again, I learned that if it could wait or it could be answered in an e-mail this might be better. This seemed to work and often the replies were more in depth than spoken communication was providing. I believe this was due to the fact that the messages were read in a quieter environment and the doctor had more time to reply. Overall I tried to change my routine and not theirs’ which seemed favourable for everyone. The theory of working with and not against a team proved worthwhile. Patients can detect when there is tension or different opinions amongst their health providers and it can be embarrassing to the whole team. Often miscommunication or the patient not comprehending what another team member might have said or explained can come back to you with errors. Always check the source before making judgment and ask it to be clarified with the patient. The nurses were very receptive and relieved to have the pharmacist doing the patient counselling. The nurses were also happy to have pharmacy review test results and approach the doctor if dose changes were required due to abnormalities in either kidney or liver function tests or maybe even a significant weight change. Initially the oncologist was somewhat reluctant. I decided to change my approach by doing all the homework, such as, calculations, finding the reference to support my recommendation, anticipate what questions might be asked and go directly to the oncologist with this information. This way, he/she could see why change was being recommended and the majority of the time the oncologist would agree. It was important to document these changes for all staff to see and for follow up. As this method seemed appropriate, the oncologist gradually depended on the pharmacist to catch any of these discrepancies. As more oncologists were hired, the pharmacists and technicians working in the clinic also expanded. Eventually I transferred to the inpatient oncology unit where I had to overcome similar issues. In 2012 I became the first Board Certified Oncology Pharmacist (BCOP) working in the Health Network—the second pharmacist in the province with this designation. On the inpatient unit, I was dealing with more than just oncology issues but the whole patient. I continued to learn from webinars, educational events and listening to my colleagues discuss medical issues. I worked well with the all staff, regardless of what role they played. Being respectful of their role allowed me to communicate openly with them over the years. I learned as much from them as they did from me. When facing a barrier of acceptance, I believe it is important to look at the complete picture. No doubt, both groups will have to make changes in their work style, their methods of communication and/or their degree of collaboration. Don’t be afraid to ask for help or deal with an issue before it gets out of hand. We never know what the other person may be thinking because of miscommunication. Be open, be direct and think before speaking. When I retired, the nurse manager on the unit told me“ Not once did you ever let us down,” and I was so humbled. I felt fortunate in helping these patients and learned from them as well. Cancer is a chronic disease now and no matter how many unfortunate relapses patients might have had over the years, they always seemed to remember me and that made me very proud of our team and our efforts in helping patients live a respectable quality of life. This is Karen’s second entry in our Write to Win reader writing contest and the tenth entry to be published. Thank you to everyone who has submitted stories, blogs and poems. In March, the editorial staff of CanadianHealthcareNetwork.ca will choose three winners for a grand prize of a $500 gift card and two honourable mentions for $250.

Melting barriers

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