Early in my career, I spent most of my time distributing medications. I would spend most of my day moving pills from a big bottle to a little bottle and then giving those pills to patients. Today, automation does most of this for me. I also spent a lot of my time educating patients and other healthcare providers on the effects of medications. For example, I would talk about how medications work, “side effects”, and how they interact with other medications. Now people have access to unlimited information at their fingertips, so they don’t ask me as many questions.
I still spend some time making sure the medication is correct and appropriate for the patient and answering some questions, but, for the most part, technology has changed each of these processes. We are now able to distribute medications more accurately in less time.
Serious Problems To Address
Despite all of these technological advances, as well as significantly higher healthcare spending in the country, America’s health outcomes are not any better than those in other developed countries. America performs worse in some metrics such as unmanaged diabetes. (source).
As pharmacists,, we need to realize that in order to answer the call to help make America well again, our role has shifted. We now need to help people change their behaviors so that they can get better. Quite simply, pharmacists are now in the behavior modification business.
I realize that the health problems our nation faces can’t be solved with behavior modification alone. There are issues with our food- from the chemicals in processed food to the horrible conditions in factory farms. Economic and serious social issues such as childhood trauma play big roles in why we’re sick. Nonetheless, we must step up and do what we can to help people see they are valuable and capable of making the changes required to get well.
Just spending money won’t solve the problem. U.S. healthcare spending grew 4.6% in 2019, reaching $3.8 trillion. That averages out to $11,582 per person. As a share of the nation’s Gross Domestic Product, health spending accounted for 17.7 percent.
If money alone won’t solve this complex and multifaceted problem, then what can one healthcare provider possibly do?
How Change Happens
First, we must realize that trying to change the world immediately is not possible. If you say, “I want to change the world!” you won’t even try because it’s impossible for one human being to change the entire world in a day.
Instead, what if you go to work every day with the goal of helping just one person? With that goal in mind, you could help someone see the value in their medication. You could help someone understand that they do have some power when it comes to their wellness. You could help one person know that they are smart enough to understand how their body works.
By helping people connect the dots between the medication, their own behavior, and how they feel, you can inspire them to make changes. When people understand how something works and how things benefit them, they’re more likely to engage and make changes.
I’ve always told my patients, “If you can learn how to use a smartphone, you can learn about how your body works.” There is often a lot of information on the pill bottle: take with food. Avoid sunlight. But there is other information that is relevant at the moment to the patient right in front of you that isn’t on the label. This isn’t generic information, but specific information that can really help your patient.
Let’s say you notice that your patient has been picking up her “only as needed” anti-anxiety medication every 28 days like clockwork. Just a few months ago, she was picking up the prescription every two or three months. Something has changed. You could say something like, “I noticed that you’re needing your Buspar more often than before.” This person may not have even realized that their new circumstances have resulted in feeling more anxious. Just that one simple sentence can help people connect the dots. From there they can discuss the issue with their therapist, counselor, or doctor. They will appreciate that you noticed and cared enough to bring it up.
Maybe you’re dispensing Chantix for smoking cessation. You could say, “I noticed this is the fourth time you’d tried to quit smoking in two years.” You patient may say, “Yeah, nothing seems to work.” You could say, “I applaud your tenacity and persistence. You know what’s interesting about all the therapies for quitting smoking?” Then you could drop a wisdom bomb about how it doesn’t matter as much which method you choose when you’re trying to quit smoking, it matters most that you WANT to. Your mind has as much to say about his as your body. Yes, the drugs help but your mind also contributes. Now you’ve shown this person the connection between their mind and their body and the medication, Chantix, in this example is more of a bridge between smoker and non-smoker.
You Take Care of What You Value
By treating people like they have value and therefore deserving of good care, you will help them see their own value. There are so many quick and easy ways to do this. Over time people begin to see themselves in a different way. They start to care more about their own health. From the caring comes the changes and from there, they get better and it’s a virtuous circle. I’ll give you a list of some of the things I say to help people see their own value. Take some of these insights and try them out:
- When someone calls to ask why their pills look different this month, after you’ve explained that you’re now using a different manufacturer, you can say, “It’s really good you’re paying attention. You must really care about what you put in your body.”
- When someone complains about the cost of their medication after you’ve checked for accuracy, you can say, “You know you’re not paying for little yellow capsules, you’re actually paying for the benefits that these bring you, and only you can decide if those benefits are worth it.”
- When someone calls in their refills early, you can say, “It’s really good that you’re taking your medications on time. This is important for your health. Next time to make it even easier for yourself, you can use our automated system.”
- When you notice an increase in dose for a blood pressure medication and you’re going to counsel anyway to make sure the patient was expecting the increase, you can say, “Upping the dose of this medication means that your blood pressure is less under control. This isn’t the direction we want to go. What’s going on?” Once a patient responded with, “Do you think it’s because I gained fifteen pounds?” I said, “Indeed I do, sir! It’s good you’ve made that connection. Now you can do something about your weight.”
Honesty is Good Medicine
By being honest with our patients about what medications can and cannot do, you help them come to that place where they get to decide what changes to make for themselves. If they continue to buy into the myth that pills do it all, they’ll be less likely to make changes to their diets or how they live.
We all know that, yet we’re afraid to talk about it. For example, I had this patient who didn’t understand that if ate less sugar, he wouldn’t need as much insulin. If he used less insulin, then his copays would be less. It’s easy to say to yourself, “How could he NOT know that?!” Understand that our message has been that the medications are the only source of wellness. And that needs to change. We haven’t spent money and energy on teaching people how their organs work. For example, I think there should be a PSA for the pancreas:
“Do you have type 2 diabetes? Did you know that eating cookies raises the amount of sugar in your blood? Your body is unable to get this sugar in your cells and it can’t hang out in your blood. It will cause all sorts of problems for you if it does! Limiting your intake of processed sweets will help you lower your blood sugar. This has been a public service announcement from the Love Your Pancreas People (the LPP).”
An important part of being a good leader is being flexible and willing to change with the times. See where the needs of the people are and then jump in to help. Our role has changed. Are you still behaving as if that’s your only job to get the pills to the person or have you realized that you are being called to do something more? You are. Many of us in different fields are. All healthcare providers—doctors, nurses, dieticians, physical therapists-—are being asked to make sure our prospective businesses maintain a healthy bottom line by changing the behaviors of our patients.
Getting people well is no longer as simple as putting pills in bottles. People need what you have to give: wisdom, empathy, and strength. You can’t put these in a bottle, but you can make sure they get a dose with each interaction.
One thought on “The Remedy for Modern Healthcare”
I especially enjoyed the play on words of using “virtuous circle” as the opposite of “vicious cycle.” Good on ye!