Thursday, March 28, 2013

"Clinical Pharmacist": What's In a Name?


Let us take a trip down memory lane.

The year: 2011
The month: January
The event: Onsite interview for a PGY-1 pharmacy residency program
The place: Swanky office of the residency program director

It was very early in the morning, and I had a full day ahead, with back-to-back meetings with various preceptors and residents of the pharmacy residency program. It was my very first interview of several, and so I was understandably very nervous. For the past few days, I had gone through a comprehensive list of potential questions that I thought the folks interviewing me would ask, and I had all my answers down to a T. I was ready, but still a little anxious for some of the possible curveball questions that I would get asked.

I was asked to sit in the office of the program director, and I waited a few minutes for the program director to come by. My heart was racing, and I placed both of my hands on my lap to try to minimize the sweat being generated from my palms. I looked around and marveled at the size of the office and all the certificates and awards displayed on the walls. "Fancy," I thought to myself. "Maybe I can achieve that one day."

In walked the program director, and I braced myself of the interview. The first question that was asked was the simple yet ever-so-challenging question of "tell me about yourself." I gave my ready-at-the-helm answer, and I was quite pleased with my response.

Here was the next question I was asked:

"What does the term 'clinical pharmacist' mean to you?"

Now, I had done my homework with this question. I had read several articles on the topic, including this article here, which defines the term 'clinical pharmacist' very succinctly. The term was not foreign to me; in fact, throughout my didactic and experiential learning experiences, I heard the term constantly. It encompassed everything that I aspired to be.

But for some reason, when that question was asked, something came over me. All the definitions and descriptions of the term that I had read about regarding the role of the 'clinical pharmacist' literally flew out the window. I just couldn't bring myself to answer the question the way I had originally prepared. I am still not sure as to why it never dawned on me before. Regardless of the reason, the moment of realization conveniently happened to be during the interview at that very moment, and I provided the following response:

"I think that all pharmacists are clinical, regardless of their practice setting."

I still firmly hold to this belief. The sheer number of pharmacists who practice in the profession is much less compared to physicians and nurses. Yet, with our profession as small as it is, why is there a distinction between 'clinical' and 'non-clinical' pharmacists? And where did it originate from?

It all goes back to the early 1960s, when the practice of pharmacy in the hospital setting began to evolve. During this time period, technologies for compounding pharmaceutical formulations as well as the provision of medications advanced. In addition, the number of pharmaceuticals being discovered, developed, and available for the treatment of complex disease states dramatically increased. There was a recognized need for expanding the role of the pharmacist to become more integrated into the healthcare team in managing the safe and effective use of medications for patients to improve health outcomes while minimizing the potential for adverse events. At around the same time, post-graduate residencies began to develop to further educate and train pharmacists and even allow for specialization within specific areas of medicine such as critical care, internal medicine, infectious disease, pediatrics, and emergency medicine.

We have come a long way since then. The profession has continued to evolve and the role of the pharmacist has expanded across all settings to such an extent that nowadays, many healthcare teams have come to rely upon pharmacists to a great extent in managing complex medication regimens. We have witnessed collaborative relationships between pharmacists and other healthcare professionals that was never before imaginable. As part of the curriculum for pharmacy education, there are dedicated courses to educate and train student pharmacists in becoming effective communicators as well, which is essential for providing therapeutic recommendations to healthcare providers on behalf of patients and for providing counseling to patients regarding their medication regimens in order to ensure comprehension and full adherence to therapy. In addition, there have been a number of legal cases that have shown us the importance of screening for drug interactions and contraindications to therapy and intervening on behalf of our patients to ensure patient safety.

Yes, there are those who have had the extra training and certification to practice in a niche area, and I believe that the title of 'specialist' is well-deserved and justified for those pharmacists. The same holds true for physicians as well, as there are 'general practitioners' and 'specialists' in the field of medicine.

Pharmacy happens to be a profession where there exists a vast amount of environments that one can practice in, which include the community, hospital, and managed care settings, just to name a few. The day-to-day duties of the pharmacist across these different settings may vary, but the essential responsibilities of managing medication therapies and providing direct patient care is the tie that binds us all. The pharmacist practicing in the community setting is as every bit responsible for these activities as those who practice in the institutional setting (if not even more so, as there is greater accessibility of the pharmacist to patients in the community setting).

So my response to those people who meet me for the first time when they ask me about my profession: "I am a pharmacist." My practice setting just so happens to be in the emergency department, and I could go on to describe my residency training, my typical workday, and the types of patients that I encounter. But just as it is with any other healthcare professional, the 'clinical' aspect happens to be part of the package that comes with practicing as a pharmacist.