By Michael Ross, Founding Partner, ROAMcare
I have a sign in my office hung where I can easily see it from my desk. It’s been there for years. It has travelled with me to all my professional stops, always front and center, always within sight. It reads, “Don’t believe everything you think.” It is a gentle reminder that I am not the smartest guy in the room – not even when I am alone! It is advice to myself that has served me quite well for many years. It’s not unusual that I’ll go with my first thought, but not the first time I think of it, just in case it might be wrong. Often it needs some extra thinking, then some re-thinking, a little more research, some refining, one more thought, maybe two. Then it could be ready enough that I can say, “Let’s go with that first thought.”
I wish I could multiply my sign and send it to the oh so many people who should really stop believing what they think. In the last year we have heard people say some incredible things with seeming sincerity, making up their own “alternate facts” to fit a circumstance. The fact that these "facts" are not facts does not stop some from holding onto them as facts perhaps wishing that repeating a fallacy can turn it into a fact.
Fortunately we work in the world of science which has stringent requirements about fact making and everything is black and white. Of course we know that isn't true. Medicine is still a discipline with many grey areas. Why else would we consider "take one or two tablets every 4 or 6 hours if needed" a legitimate order. But it is a discipline and with discipline comes order and we take direction like that and through thoughtful review, evaluation, analysis, and counseling, turn it into order.
Today, more than we may be accustomed, pharmacists are looked to for information. Much of that information may be information we didn't even know a year ago. It might not have even been known that we needed to know it. As if medicine doesn't already change fast enough with new drugs, new indications for old drugs, new delivery systems, and sometimes entire new classes of drugs, 2020, in one single year, brought more changes in therapy than we ordinarily might not have seen in five. By the end of 2020 the FDA had ruled on two Emergency Use Authorizations for treatment modalities, three EUAs for vaccines, and no less than a dozen other medications proposed or used for symptomatic relief of a single disease - CoViD-19.
While that was and continues going on, within the hospital pharmacy you may be considering shifting inventories to make physical and budgetary room for new vaccines and treatments, reintegrating decentralized services into the daily routines, re-adjusting delivery schedules, and reinstituting floor rounds, error prevention, and education services. In extended care pharmacies you are reevaluating delivery frequencies, stocking levels, and long term consequences of the disease in previously infected residents. In community based pharmacies you may be fielding questions regarding comparative effectiveness of CoViD-19 vaccines, reactions to and remedies for reactions to vaccinations, and will CoViD-19 vaccination schedules affect the timing and administration of other vaccines.
You have navigated your way through one set of unknowns only to find new ones surfacing to demand your attention. Pharmacists seem to instinctively know when it is not the time to rely on that "way we always do things" as the best way to approach still shifting priorities. Now is the time to thoughtfully approach each challenge, calling on team members, colleagues, and supporters to brainstorm new solutions to new problems, debate possible solutions and conceptualize probable results, and test your theories in small pilots if necessary. Your ability to temper your thoughts, to ponder, consider, and adjust are part of what makes you greater than just you.
Together with your team and your colleagues now is it time to think and think again, then act as you believe best.
