Pharmacists may be intellectually bankrupt today – financially bankrupt tomorrow

Pharmacists collectively deserve the derogatory comments proffered regularly by the AMA about providing professional services between the “toilet paper and the toothpaste”.
Not enough has been done by pharmacy leadership organisations or individual pharmacy proprietors in terms of investment in appropriate clinical spaces.

Nothing in terms of spatial identity and patient comfort has evolved anywhere near a critical mass so as to attract the immediate attention of a patient.

Yes, that’s right – that individual that sometimes does a double-take as a customer actually purchasing the “toilet paper and the toothpaste.”

Do you have an actual written process for converting a customer to a patient?
This simple strategy has the power to deliver major dollars in profit if you actually have one.
Do you?

Even if you have an interview room and believe that you are fully equipped to deliver clinical services, have a look from an unblinkered patient perspective.
Where is it? I can’t see it!
Why is there not a sign (the same size as the dispensing sign) that helps direct me to that area?
Where are the clinical staff who can give me immediate help and assistance (not those people who eventually emerge from a dispensary who give me a hurried response to my questions and can’t get rid of me quickly enough!)

It’s you – the same person who complains about being left out of primary health care initiatives and not being recognised by other healthcare professionals.
Doctors are not the only ones who notice!

And 94 percent of you realise that your future (if it ever has the opportunity to arrive) is intimately bound in the delivery of paid professional services.
You complain about your leadership organisations not delivering, but they are immobile because there is no movement at the coalface.
Yes you!
You are the person who does not have the courage to actually research and invest in your own business!
You are the person who does not have the authoritative voice to speak loudly to your leadership organisations!

I know all the excuses you may offer, but I would point out to you that I have been the owner of a number of pharmacies in my early career and I am still trying to help my profession by researching ideas and concepts that you may not have been able to do for yourself.
You have no excuse.
If you do not immediately do something to further clinical services in your own pharmacy NOW, I pronounce you intellectually bankrupt immediately and financially bankrupt within 5-10 years.

Despite the fact that you may feel yourself under pressure at the moment, it will be nothing to the feelings you experience when you are forced to give up your business for liquidation or sold at a “fire sale” loss.

2014 marks the year that governments in all the western economies have begun to realise that the illness systems they have supported at great cost for so long have failedl.
Particularly as people are living longer, but are more ill – especially so in the last seven years of their life.
The illness system has done a great job in support of infectious diseases and trauma surgery in life-saving hospitals.
It has done nothing to prevent the progression of non-communicable lifestyle illnesses because investments in this activity are usually not able to be patented and requires skilled practitioners to deliver results.

We talk about these practitioners as people who practice “patient engagement” from a “patient centred home”.

Many of us “talk the talk” in regard to the above without investing in “walking the walk”.
Pharmacists used to go the hard yards, but their supply-side activities have bound them up and they have lost the art.

In a recent US study involving young people suffering from hypertension they talk about patient counselling.
This was once pharmacist territory – in the old health paradigm, doctors consulted and pharmacists counselled.

Now only one in two young American adults with high blood pressure gets advice from a doctor on lifestyle changes, a new study finds.

Lifestyle changes are critical to helping young adults control their blood pressure, and they cover areas such as exercise, weight loss and healthy eating, the researchers said. This requires patient engagement.

Among Americans aged 18 to 39, an estimated 9 percent of men and 7 percent of women have high blood pressure. Of those, nearly 60 percent are not good at controlling their blood pressure, the study authors added.

In this study, the investigators looked at lifestyle counseling rates among 500 young adults with high blood pressure being treated at a large Midwestern academic practice.

Only 55 percent of the patients received lifestyle education within one year of being diagnosed with high blood pressure, the study found. The most common topic was exercise, followed by advice on quitting smoking. Only 25 percent were counselled on how to lower their blood pressure by changing their diet.

The study was published online Nov. 6 in the Journal of General Internal Medicine.

Those most likely to receive lifestyle counselling included women, patients who made regular visits to the doctor to manage long-term health problems, those previously diagnosed with high cholesterol, and people with a family history of high blood pressure or heart disease.

The findings show that doctors are missing far too many “teachable moments” to advise young adults with high blood pressure about lifestyle changes, study author Heather Johnson, of the University of Wisconsin School of Medicine and Public Health, said in a journal news release.

What she didn’t pick up on was that the more hours that a patient received, the lower the blood pressure and a better managed lifestyle created a permanent cure.

What also was left unsaid is that the style of treatment involved functional medicine.
What I am pointing out to Australian pharmacists is that unless you have appropriate “patient homes” (clinical spaces), coupled with a system of long-term counselling (something that you used to do) then you are not doing your job.
Further, as governments increase investment in functional medicine there will be a massive reduction in the dispensing of mainstream medicines.
In the fiscal year 2014, the US National Institutes of Health announced the award of nearly $31 million in funds to develop new approaches that engage researchers, including those from backgrounds underrepresented in biomedical sciences.
According to the biomedical model, health constitutes the freedom from disease, pain, or defect, thus making the normal human condition “healthy”.

People reading this article should also read in this edition of i2P –  “Functional Medicine – embracing all that is needed in health” where we discuss the fourth largest hospital in the US – the Cleveland Clinic, that has set up a full department of Functional Medicine.
The reason is to halve the intake of patients suffering from chronic ailments from having to be hospitalised.
This dramatic world first will be the marker for health maintenance and illness prevention, picking up patients well before they might have to be hospitalised, as well as being involved in after-hospital care to prevent a rebound as an inpatient.
Rebound patients within a hospital system are usually the most expensive to treat.

Cleveland Clinic will become a resource for recommending protocols for treatments and the evidence-base to back it.
No longer will Functional Medicine have to suffer the snide remarks from the better resourced (but not better evidence) from global Pharma’s.
It is the reason for their expensive disinformation campaigns and are directly the cause of bad health with high cost.

Cleveland Clinic will also impact on pharmacy dispensing volumes because Functional Medicine treatments will not require prescriptions.
So unless pharmacists update their core business and provide matching skills, they will cease to be relevant within a decade.
Once Cleveland Clinic shows the way, governments will invest in the resources to deliver the benefits of Functional Medicine.
This should be pharmacists in pharmacies – but I am not sure Australian pharmacists have the motivation to succeed.

While Functional Medicine offers opportunities for pharmacists, if they do not invest in space and skills, they will be bypassed.
Further, warehouse type pharmacies will enjoy greater market shares of Functional Medicines because of their marketing skills and their pricing structure.
But they may not be necessarily able to match the skill set.
If employment opportunities are not created and individual clinical pharmacists are not valued in traditional pharmacies, they too will be commoditised in the warehouse space.

I have always respected the warehouse pharmacy ability to anticipate trends in pharmacy.
Is this their current strategy by dominating the nutrition market knowing what may be coming?

And while the PGA is currently demonstrating some leadership in the clinical services marketing field, how much of it is backed with community pharmacy substance?
The PGA has long been part of the illness infecting pharmacy, but it has the ability to be part or all of the cure.
Remember that the PGA draws political support and dollars from the supply system.
This type of currency would reduce dramatically as Functional Medicine would have nowhere near the resources that mainstream medicine has initially.
But they will, particularly as government investment begins to take hold.
And it will accelerate if the PGA fails to lead its flock out of the current wilderness.

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