2022 Australian Clinical Pharmacy Award oration
BPharm, GradDipHospPharm, MSHP, FPS, CSHP, AdvPracPharm | Complex Care Clinical Pharmacist, Fiona Stanley Hospital, South Metropolitan Health Service
[Pharmacy GRIT Article No: 20231385]
Oration presented at Medicines Management 2022, 46th National Conference of the Society of Hospital Pharmacists of Australia, 1–3 December 2022, Brisbane, Australia.
I would like to acknowledge the Traditional Owners of the land on which I stand today, the Turrbal people, and pay my respects to Elders past and present, and recognise their enduring contribution to the culture and spirit of the land.
Good health is more than the absence of disease or illness. For Aboriginal and Torres Strait Islander peoples, it is a holistic concept that includes physical, social, emotional, cultural, and spiritual wellbeing, for both the individual and the community. This is ancient wisdom.
There are these two young fish swimming along, and they happen to meet an older fish swimming the other way, who nods at them and says, ‘Morning, boys, how’s the water?’ And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, ‘What the hell is water?’1
David Foster Wallace was an American philosopher, poet, and author who used the fish story to illustrate the point that the most obvious, ubiquitous, important realities are often the ones that are the hardest to see.
The trick, according to Wallace, is keeping the truth up front in daily consciousness. And this is not easy to do — as we are all hard-wired to see and interpret everything through this lens of self.
It is about simple awareness —awareness of what is so real and essential — so hidden in plain sight all around us, that we have to keep reminding ourselves, over and over…
‘This is water, this is water’.
The reason I am channeling this great philosopher today is because I feel so incredibly honoured to be awarded, by you my colleagues, this Clinical Pharmacy Award.
So, through that lens of self — it could be tempting to think that this award is all about me… as Tim Jarvis so aptly put it in his keynote — it is a good time to step back and reflect on the bigger picture.
Transitions of care are danger zones for our patients and while it may seem a stretch to liken pharmacists working in this arena to intrepid explorers, I couldn’t help but think of similarities when Tim described an advertisement “[m]en wanted for hazardous Journey”.
In the words of one of our retiring Specialty Practice Leadership Committee pharmacists, Horst Thiele “Let’s face it Deirdre — working in transitions of care is not exactly a ‘career move’”. So, clearly you have to be up for the challenge, and maybe just a little bit weird. To the Transitions of Care and Primary Care (TCPC) pharmacists who are making transitions of care a safer place for our vulnerable patients, thank you for being that rare breed of pharmacist.
My move into the world of complex care happened after a series of unfortunate events:
- In 2012, after 14 years with the NPS, a restructure of the educational visiting program left me looking for a new challenge.
- But as fortune would have it, a return to Sir Charles Gairdner Hospital (Charles) at the right time saw our Pharmacy Department partner with the University of Western Australia and be awarded $690 000 in project money to implement a pathway aimed at improving medicine management across care transitions.
- It sounded too good to be true… and it was. Six months into our project, we were advised of an error in calculation — the project never saw the light of day.
- Not to worry — I had been accredited for 10 years so felt ready to tackle branching out into my own business with direct referrals from GPs to independent accredited pharmacists becoming available. This time it was the Federal Government who advised of an error in the calculation of “demand” — the capping activity to 20 Home Medicines Reviews per month meant this was no longer a viable career option — an opportunity lost in my opinion for our patients at risk of medication related harm.
And so, it was at a Continuing Education meeting back at Charlies that I heard Bruce Williamson — a much loved and revered Respiratory, Geriatrics, and Mental Health clinical pharmacist — present three incredibly interesting case studies from his new role with CoNeCT (The Complex Needs Coordination team). I was listening to him describe ‘my dream job’. He told us how he had been asked by the Team Lead — who he knew very well — to prepare a series of lectures on managing medicines in complexity for the team of nurses, occupational therapists, physiotherapists, and social workers as they were finding it tricky to navigate high risk medicines or polypharmacy in complex, vulnerable patients.
Bruce tells an entertaining story about how he started working diligently trying to tailor content to this broad range of healthcare professionals. He tells of getting angrier and angrier and he ended up storming into the CoNeCT Team Leaders’ office saying, “You don’t need a lecture series on medicines — you need a pharmacist on your team!” And the rest, as they say, is history.
Bruce passed the mantle to me when he retired and over the past nine years there have been many changes, both in funding mechanisms and acuity and patient loads. The evolution of the Specialty Practice could not have come at a better time for me. Where once I was described as a ‘lone-wolf’ in my Advancing Practice Portfolio feedback in 2015 — I found a whole pack of like-minded visionary, resilient, and oh my god persistent, pharmacists who have just never given up.
The APAC (Australian Pharmaceutical Advisory Council) Guidelines for medication management may be outdated, but these pharmacists were at the frontline, finding a way and making the system work for our most complex, vulnerable patients.
I was so very honoured to lead this team of trailblazers. It gave me a safe space to be with like-minded people — many of whom had faced similar challenges and came armed with a gracious ear, and invaluable wisdoms. Manya Angley was an absolute champion, not just for me, but for all of us. We walked talker and aimed higher because of her enthusiasm, encouragement, wisdom, and grace. It has been a privilege following in her footsteps to progress action across the care continuum with a clear vision to identify that risk and develop the Pathways. Through the great work of the TCPC Specialty Interest Group — hospital-initiated medication reviews are happening now — because someone said ‘[y]es, without the business plan, without the sustainability budget, but because it is such an obvious, important reality that we need to keep our patients safe from medication related harm beyond the hospital walls’.
This is our red thread... This is water...
There is so much to love about pharmacy. I have had more adventures — and more failures —than I can care to count. And it is not about to stop any time soon. Our CoNeCT team in Western Australia has been granted $10 million to extend our program dedicated to navigating patients with complex needs — to include mental health and patients trying to get the right supports through the National Disability Insurance Scheme. Imagine — joined up holistic care! Perhaps we are beginning to understand that good health is more than the absence of disease or illness. And this time, there is a budget for clinical pharmacy. I am super excited to see how the next chapter unfolds — and this time there is not going to be any apologies for a budget error. This project WILL happen. I’m channelling Katie Philips, our Chair of TCPC, who will tell you “[o]ur time is now”.
I have so much to be grateful for, for making my pharmacy life so fulfilling — and there are far too many people for me to name from the many chapters in my pharmacy life. However, I would like to make a few exceptions.
To Jenny Benzie, the Head of Pharmacy at SCGH in 2012, who took me in during my annus horribilis and gave me that all important start back into hospital. I miss you every day.
To Peter Smart and Brenda Shum, our SHPA champions and Leaders in the West. My sincere thanks not only for your kind words in my nomination but for being the change we need to see.
And to family - thank you to my parents – Ron and Thelma Criddle, Geoff and Lesley Davidson. My beautiful children all grown up now — Ben, Max and Millie — for enduring excitable conversations about ‘the PHarmacie-R data’ which apparently gets so much air time, it has its own seat at the family dinner table. Finally, and most importantly, to my amazing, creative, clever, and wise husband Tony Davidson, who has always been there. What can I say to a man with the patience to interpret my wildest ideas and make them into an App that I could show the world? I am so very grateful for you.
This is water...
- Wallace, DF. This is water: Some thoughts, delivered on a significant question, about living a compassionate life. New York: Little; 2009.