Difficult conversations

I started my day with a difficult conversation with another parent at school drop off. It came onto my radar yesterday afternoon and was one of those things that I knew I couldn't let slide. It was something that just didn't align with the values we're trying to establish in our family. The annoying good thing about kids is that they bear witness to these types of things meaning you've got a live-in accountability partners. The details don't matter, but the action did. I lost sleep over it last night, felt nervous about it this morning, and felt uncomfortable while I was doing it, but I did it anyway and I'm glad I did.

I followed that up with watching Atul Gawunde's Google talk on being morning during a morning indoor rowing session rather than the run that I was supposed to have. The content wasn't really anything new to me, but it was a good reminder of what got me on the path that I'm currently on.

In October 2011 I attended a lecture given by Eric Cassell. I had just started in a completely new role as a Pharmacist in a regional palliative care team. It may have even been my first week. Definitely during my induction. I had no idea who this old man was, but he spoke with that kind of New York accent that immediately feels more entertaining and worth listening to (at least when you're from Adelaide). His content lived up to my superficial assessment. Surpassed it. It was a life changing moment for me.

It was very similar to what I listened to today. It challenged my perspective on sickness, and forever changed my perception of our roles as health care providers. I checked the notes and reflection I wrote following the session.

  • We need to change our definition of sickness

    • Not disease but something that impairs the patient from achieving their goals and purpose
    • Palliative care helps patients get the most out of what remains of their life
    • People don't wake up in the morning wanting to survive, they want to live, i.e. heartbeat doesn't equal life
  • In terms of Pharmacy, this philosophy could also apply to assessing appropriateness of medicine, side effects etc.
  • Health isn't just about the body, but also mental, social etc.  Therefore sickness and dying also isn't just about the body.  Doctors think of dying as the time from which no cure is possible, but patients and families consider it to be when that person ceased being able to be who they really are
  • How can we as pharmacists assist patients with the dying process?

    • Identifying goals of treatment for that patient that are real to that patient
    • Recognising adverse effects and things that are impairing the patient's life that don't necessarily have to

It also made me think about one of the Pharmacist interviews that I've been analysing and interpreting this week. Pharmacist 14 put it perfectly, I think:

If we’re not brave enough to talk about death, it’s very hard to talk about multimorbidity and co-morbidities in the context of cancer. Because we can’t then say you probably don’t need a statin because you’re unlikely to be alive in 5 years. I think that pharmacists are inherently scared...

...a lot of people are uncomfortable with talking about death and therefore would not be comfortable having those conversations to allow good pharmaceutical care

If your motivation as a pharmacist is to fulfil work duties and feel comfortable and secure, then you won't have these conversations and your impact and value will be limited. If you are a Pharmacist that is driven to do important work for people who care, you will embrace the opportunity to be vulnerable, respectfully engage in difficult conversations, and make people's lives better as a result.