because a small town is like a small stage for teenagers and their drama

(Hoopes I did it again–Relient K)

I was thinking about this song, and I think this lyric applies to small schools too…things that really shouldn’t cause such waves, when occurring in such a small environment, become the focus of more attention than they deserve…especially since everyone knows everyone else’s business sometimes…word spreads faster than shots fired…

On the positive side, I ate my very first caramel apple ever on Saturday…which led to an impromptu haircut in the car as I realized some of my hair was caked in caramel…oops…but what was I supposed to do when I realized one hand and my hair was covered in caramel? So yeah…the caramel apple was really good and something that might be fun to try again some day, but in the future I will put my hair up to avoid another impromptu hair cut…I wish first year I hadn’t been so shy and had been able to accept the caramel apple that was offered to me…there is a lot I feel like I have missed out on because of how quiet I used to be…not just caramel apples…

Saturday there was an open house thing. It was okay…but I felt like an imposter/deceiver, because I was telling everyone all the really awesome things about school without warning them about the really big bad things. I wanted to have an open honest conversation, but I also needed to keep with the program which is to tell people how wonderful it is so that they can be crushed later when it isn’t quite so idyllic (okay, that last part isn’t part of the program). Yes, there are some great aspects of school, but there are also some issues, and I think it is more fair and allows people to make a more informed decision if you are actually honest and give them ALL the information, not just the censored version…Did it make me happy to hear when I visited UMKC that there would likely be almost no financial aid for me there and that the limiting factor for how quickly I could get through the program would be getting back and forth from classes if I didn’t have a car? No, but that was important information in order to help me make the choice that was right for me. For some people that might not make a big difference, but for other people that might be a vital deal breaker. Why do you think the atmosphere is so negative at school? In my opinion, it is at least in part because of how everyone is so disillusioned as to what they are choosing when they choose this school. Don’t promise things you can’t give. Don’t omit the less than ideal circumstances. Don’t put on a puppet show about how awesome everything is…I kept with the program and didn’t say anything negative, but it is hard when there is so much dissonance between the picture I am painting with my words and reality.

Can I have another honest moment?…I had another frustration breakthrough Saturday night…It wasn’t an anxiety returning-related breakdown, more of just an I can’t do this type of breakdown because everything that could go wrong felt like it was going wrong…I started screaming and crying that I want my old car back (only to myself). Compared to all the other things I could have had a frustration-breakthrough over, that seems pretty trivial and dumb…but human emotion is a strange beast…I mean, in terms of the car, I had no intention of buying a car until at least sixth year and probably not until I graduated…the idea of being less traceable and a little bit of the fact that I felt bad using people’s time to look at cars when I had no intention of buying pushed me to actually buy sooner…but then I messed the un-traceability thing up last week…and I am frustrated because my car got some boo-boos on last Monday and car problems were supposed to be something I left behind with the old car that I didn’t sell for nearly as much as it was worth because I needed to get rid of it ASAP to get the insurance process started and finished on the new car in a timely manner. Should a young female pharmacy student be routinely driving across the country in a 1999 Chevy Cavalier? Well, no, probably not, but she probably also shouldn’t be jumping off the edge of the bed instead of using the ladder and she does that…

…And then on Saturday I went to get my car fixed for real this time (as opposed to Monday when they didn’t have the part and then called me a jillion times on Tuesday)…except they charged me for throwing away the tire, and didn’t tell me until I had already swiped my card and signed…I’d rather keep it as a souvenir or throw it away myself than pay you to throw away MY tire that I paid for with my car this summer. It’s MINE (Yeah, I know I sound like I have a case of the gimme hands)…and then upon further study of the receipt they also charge me more for the stupid part than the dealership was going to charge me by a pretty significant amount…IDK what the dealership would have charged for the tire, but I think they probably would have given me a matching tire which I would have preferred…I know it is dumb to care much about material things like cars and money…it shouldn’t be a big deal, but sometimes it feels like it is.

…and then on top of that as soon as I got in the car to go back to school to work with my case group the low tire pressure light went on…NOT happy…it doesn’t look like any of the tires are flat, but I am just so frustrated and over it…I just want my old car back…

It is also kind of frustrating when these things happen, because I feel like a lot of the time I bring these breakdowns and other frustrations on myself…I am very much aware that not sleeping enough or not eating regularly enough can bring on wide emotional swings…but on the other side, I can’t live in fear of something happening, and if I want to be a “normal student” as much as possible, sometimes I have to stay up late for Cru and FCA, and sometimes there are things like needing to fix my car, and then the pre-service meeting at church occurring way earlier than usual that decrease the feasibility of getting a meal in on time, and it is not like a 1:1 correlation with a late meal or a lack of sleep and an issue, so I really can’t just shirk my responsibilities or otherwise try to force the world to conform to me…but hindsight is 20/20, so every time I have an issue I look back and really regret not finding a way to magically get enough sleep without leaving behind my responsibilities with FCA, or more realistically not realizing what might happen and excusing myself to shove some food or at least some candy in my pie-hole before joining the service…

Sometimes flexibility means intentionally re-interpreting rules…because sometimes when you are about to cry there is not really time to wait in line and go through the whole ridiculously stupid sign in/sign out process, just time let’s get out of here right now…but don’t worry, I totally didn’t break the rule about signing in and out…I wasn’t a guest or visitor, I was an invitee and friend…totally different. On Friday I was talking to one of my friends about something hard and someone else started listening in and basically telling me I was dumb and didn’t deserve good grades (not in those words by any means, but it was pretty clear that was what she wanted to say) and so I was about to crash if I didn’t quickly get out of the situation and my friend could tell so we left…it’s a ridiculous rule anyway…not that ridiculous rules should be any less pertinent to my behavior, but if there were actually a reason behind the rule I wouldn’t have re-interpreted it…

Oh my! So this summer we were talking about the Target/CVS merge and someone was like someone should write a letter to the board about how dangerous this is (because CVS does not have safe working conditions and prior to the merge, Target was one of the best community pharmacy chains, and as the changes rolled out it was clear that CVS’s practices were going to be predominant in the Target pharmacies (one of the pharmacists I work with has a spouse high enough up in Target to get notice of a lot of things before they even are released to the pharmacy staff, and many of the pharmacists I work with also work on a very part time basis with Target)…so anyway, I could tell that was something that wasn’t going to really happen, but realized that I am someone, so I wrote the letter…and last week I got an email from the Board of Pharmacy announcing new changes to work practices rules. I have no way of knowing whether my letter had any impact or if this was something they were already working on that would have happened anyway, but it is really cool that some of the changes I suggested really were incorporated into the rules or at least taken into consideration.

Here is my letter. It is not perfect, but I think I am proud of how I expressed my/our opinion without sounding bossy or snotty or anything. (Formatting is super screwy on wordpress…it looked a lot better in word…)

Dear Sir or Madam,

quoteI will consider the welfare of humanity and relief of suffering my primary concerns.

I will apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for my patients.

I will respect and protect all personal and health information entrusted to me.

I will accept the lifelong obligation to improve my professional knowledge and competence.

I will hold myself and my colleagues to the highest principles of our profession’s moral, ethical and legal conduct.

I will embrace and advocate changes that improve patient care.

I will utilize my knowledge, skills, experiences, and values to prepare the next generation of pharmacists.”

Every pharmacy student since 2009 has taken this Oath of a Pharmacist, dedicating himself or herself to a lifetime of service in the profession. These principles inform our decisions as practicing pharmacists and as members of the community at large. These guiding principles have been created to guard the status of our profession and to remind us of our duty toward those we serve.

Our Code of Ethics, adopted by the American Pharmacists Association in 1994, requires us to “promote the good of every patient,” to “act with integrity,” to “respect…colleagues and other health professionals,” and to “seek justice.” These are certainly targets we would all like to bulls eye, but how can we help people if we cannot first help ourselves?

With the news abuzz about the Target buyout by CVS, those of us in the pharmacy world should be worried about the future of our profession. CVS pharmacists often work long shifts, without even so much as a break to sit down and eat lunch. These pharmacists are checking hundreds of scripts, urged to counsel more patients, while not even given a minute to themselves all day, much less the mental space they need to ensure the right drug gets to the right patient in the right dosages and right time and route.

When we do the same thing over and over, racing the clock to get more and more done, we are setting ourselves up for mistakes. At the pharmacy at which I work, we rotate tasks throughout the day to ensure we are not creating the recipe for a mistake by having any one person do the same thing all day. Technicians rotate between entering and filling prescriptions, while pharmacists rotate between checking prescriptions as they are filled, and counseling, compounding, and double checks. Everyone takes at least a half hour break to eat every day. By not solely doing any one activity for an extended period, and being required to take time to take care of ourselves, we can better use our abilities to promote better outcomes for our patients.

As our Oath states, we must embrace and advocate changes that improve patient care. We are only human, and as such, are doomed to imperfection, but we can minimize our mistakes and the outcome of those mistakes on our patients if we make some minor modifications to the mandates guiding the practice of our profession.

First, I believe there should be a limit on the number of prescriptions a pharmacy is allowed to fill in a specified period without a second pharmacist present. This ensures that the pharmacist has sufficient time to truly check the prescriptions before sending them out rather than acting primarily as another box to check to comply with standards of practice, meeting the letter of the law while missing the intent. It also allows the pharmacist a backup worker to enable the pharmacist to leave the pharmacy briefly to take care of his or her own physical needs.

This leads to another requirement I believe should be in place: a mandate on taking at least one break in the day; perhaps not simply a suggestion that pharmacists may feel coerced into refusing, but a true requirement. Even if that break is quite short and limited, a pharmacist needs a few minutes over the course of a day to take a break from his or her duties.

Not recognizing and acknowledging pharmacists’ physical needs and limitations, and denying them the decency of a minute to themselves on break serves to perpetuate the notion that pharmacists are not truly health care professionals performing a critical aspect of patient care on the medical team, but rather that the pharmacist is simply a box to check to comply with legal requirements, that all we do is pour, count, lick, and stick. If we continue to work this way, I fear our patient outcomes will begin to reflect this lack of concern towards helping ourselves in order to better help our patients. Surely you would rather our profession be known for medical professionalism and expertise, not menial labor. Please consider how we can work together as a profession to advocate change to protect our patients and advance our profession.

Thank you for your time and consideration.

Sincerely,

“Code of Ethics.” American Pharmacists Association: Improving Medication Use. Enhancing Patient Care. AphA. 2015. Web. Accessed 23 July 2015.

“Oath of a Pharmacist.” American Pharmacists Association: Improving Medication Use. Enhancing Patient Care. AphA. 2015. Web. Accessed 23 July 2015.

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