Coming Around, Slowly and Surely

In October 2014, I wrote Logic Applied……nothing new under the sun. in response to Jim Plagakis in Drug Topics. I needed to write the piece as  the once money-making enterprise, being a pharmacist, finally become an issue for reflection – at what price is the salary providing satisfaction in professional and personal spheres of life? As long as the money was good, it seems pharmacists were willing to overlook so much regarding their profession. This does not mean pharmacists do not work hard as I know otherwise. The good pharmacists work long, hard and diligent hours on behalf of their patients.

What the reflection does mean is pharmacists are finally realizing they have  the reasons and power to change their profession in general and healthcare specifically.  Their job is no longer one in which the pharmacist works for one employer for life. People such as Oluwole Williams realized it was not about the legacy, rather it was about thinking what one could do with their experience and knowledge within a specific field. Mr. Williams addressed a number of wonderful and promising ideas in the Dispensed as Written column of which I only could have added Peace Corps Volunteer. And then Kelly Howard wrote 2015: The #YearOfTheRPh, where she explained a very personal situation which changed her for the better.

There is the thinnest glimmer of hope in thinking the pharmacy profession will reach into the 21st Century. More and more pharmacists are seeing the bigger picture and looking at what they can do to create change rather than talking about what should be done. It is inspiring as pharmacy is a field which can change people’s lives. Instead of licking, sticking and filling, pharmacists can provide patients a degree of education and efficacy in the medicinal choices they make. It has been a long time coming and I am thrilled.

Instead of hospitals, insurance companies  and health care institutions defining good patient care, pharmacists now can look at how to use their fulcrum.  Amazingly this benefits ‘patients’ and  students – those who study the sciences. There will be new opportunities and careers allowing people to use knowledge and skills in different ways.

As a pharmacy tech, I am looking forward to being able to work with people who will take an interest in their patients as people and DOP’s who have an interest in more than cost metrics. Clearly Ms. Howard indicated it is time for those in the pharmacy and medical fields to stop being doormats. This is all it takes – one or two people to decide the profession has to change.

As a teacher, I am inspired to see people taking on the corporate mentality. Sharing with others the varied and rich options available through what used to be seen as a stagnated degree is exactly what education needs to see. Teachers, similar to pharmacists, have been licking, sticking,counting and ‘filling’ (in the case of teachers, student brains) far too long.  If the long-standing tradition of pharmacy can change, surely education can progress as well.

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Logic Applied……nothing new under the sun.

I have thumbed through Drug Topics magazine forever. My father was a pharmacist; He read the magazine and left it lying around. It was something we discussed as he thought, when I was in high school, I might wish to try out the profession. My father suggested I join the Air Force (he had been drafted Army). All those years ago I just did not feel compelled to study so much chemistry, although in retrospect I wish I had. Biochemistry/biotechnology is the ‘new-new’ thing of my lifetime.

Despite my father trying to convince me of serving my country and obtaining a stellar education via the Air Force, I took a different path. I kept with the science and medicine type themes, earning a BA in Speech Pathology (after leaving nursing right at the beginning of clinicals). I so wanted and needed to see positive outcomes, I left speech pathology for education. My head and heart told me I could apply what I learned as an undergrad and help many students do well. Neuro, learning, behavioral outcomes and more were what motivated me. Watching people slowly be overtaken by declining health, descending into  the depths of hell with the many types of brain damage nature provides (organic and via car accidents, etc.), I had to leave speech pathology.  I went on to be a Peace Corps Volunteer.

My father pursued an advanced  degree in public administration as he foresaw the Kaiser Permanente model to be the future. My father had worked for Kaiser way, way back. He re-invented himself and did things he loved, including working as a consulting pharmacist. He did chart reviews, he   spoke with community members and educated them on everything from how to read up on the medicines they were taking to understanding the difference between a cure and something which treats a symptom (antibiotics vs. other stuff). My father worked with the Red Cross. He wanted to be part of the re-trenching of pharmacy tech programs (more on this in following paragraphs) so he taught pharmacy tech with the INTENTION of getting students into pharmacy school – which he did accomplish with quite a few students.

Education was a great fit for me. I taught for many years – formally, informally, public, charter/public, private, corporate. Each day I always found one ah-ha and it sustained me. I left the classroom/corporate (formal setting) about eight years ago for tutoring and consulting work in ed-tech. The first four to five years were difficult. I was not willing to compete with the shills who promised all parents they could ‘brain train’, teach their child to read, etc. as it was not true. It took awhile to define myself (I was NOT a snake oil salesperson) and clarify there are times when some students do indeed have deficiencies which can not be overcome with what we know currently. I had to admit failure where failure was due, own it and move forward.   From this time period, I  learned how to write tight, effective IEP’s and 504’s. I learned how to have conversations with parents, teachers and admin which actually matter instead of being vague, noncommittal and wishy-washy. I have many accomplishments of which I am thrilled as I have, and continue to, change lives for students and families.

Simultaneously the Silicon Valley folks taught me something completely different – failure was absolutely necessary. Essentially Silicon Valley reiterated what I knew about scientific method. Failure was indeed the answer. Only through failing could you see what you needed to do differently and better.  In Silicon Valley, you are not worth much if you do not take a calculated risk and fail. Confirmation bias is quickly obliterated if you learn to work in and with people from Silicon Valley. I have, by complete accident, had the pleasure to work with some of the brightest talent in Silicon Valley who do and make things which matter. I take calculated risks regularly.

Along the way I obtained my Pharmacy Technician’s License. I did this as I love traveling and living abroad. It gave me hope to know between being a pharmacy tech and tutoring, I could travel, come back to the states, land on both feet and function. Not so. A pharmacy tech license is the equivalent of Gr 9-10 Algebra and chemistry/bio. Everyone told me to cold cock the test (including my father who stated I could do it with one eye covered and a hand behind my back). I was afraid. I took a course. Holy moly. I began to understand some major problems, the least of which is who takes responsibility for what.

Pharmacists created the pharmacy tech program and  never intended for it to be a pathway to pharmacy, dental, med or nursing school. It was meant to alleviate pharmacists of the non-thinking portion of their job. With this in mind, a pharmacy tech is little more sophisticated than working any other repetitive job as the pharmacist still carries the responsibility for the ‘final product’. I know as much about sanitation as I would working in a restaurant and learned more as a science teacher. Since the threshold to train pharmacy techs was so low and the pay little over minimum wage, it did not encourage the right kind of people to come into the program. More often than not, pharmacy techs are underutilized since the program (aside from how the military trains pharmacy techs) is deficient on so many levels.

It could be said the pharmacy tech program in the U.S. is an abysmal failure of everything from logic to creativity to improving healthcare. It failed at launch and has slid downhill ever since.  It was created by pharmacists and  should be re-configured into something valuable, useful and appropriate.

All of this led me to wonder about the article by Jim Plagakis in Drug Topics from September 2014. He addresses the issue of legacy pharmacists, those who are highly paid with no more room to go upward without a career change or pursuing something different. If pharmacists are worried about losing their prestigious place in the dog pile, they should be doing something more akin to what Dr. Atul Gawande does outside the surgical suite. Even though Dr. Gawande has stated over and over he is near or at the top of his game, he finds something new to pursue with excellence on behalf of patients.

Pharmacists have reached the point in time where they need to drop the stance of having ‘earned their keep’ (the equivalent of tenure for teachers) and actually do something above and beyond. Find out what is happening in Silicon Valley regarding ACA (don’t be afraid – there is this amazing place with a med school called Stanford and another place called UCSF with a pharmacy school in the area). Along the way, it would be great if pharmacists thought about improving the pharmacy tech program so they could actually train responsible people looking to pursue a medical career. Create a step-ladder for people to go to pharmacy, medical, nursing and dental school. I would imagine a pre-med student who  worked as a compounding pharmacy tech and was intellectually engaged by the pharmacists would be a shoe in for an outstanding medical program and/or biotech.  According to everything I hear on NPR, we are desperately short of doctors.

Comparing  ‘legacy’ pharmacists to tenured teachers  not only weakens the argument, it begins a strange comparison which benefits neither teachers nor pharmacists. Using the word legacy does nothing to change the connotation. Very few professions in todays 21st Century stay constant. Stagnation or inertia is when some one chooses not to move.

The legacy my father left was very genuine and real. Education was seen not as a mere accomplishment, rather a continuous expectation. One did not stop learning by being ‘done with school’.  He earned the Governor’s Award for Volunteering in IA while he was cycling through various cancer treatments . He volunteered regularly on an exhibit (Iowa Roots, Global Impact: The Life and Legacy of George Washington Carver) which he felt could re-invigorate scientific thinking. Most of all he helped me embrace change as real, necessary and of the utmost importance for succeeding in life.

And then it happened……people were surprised.

http://www.huffingtonpost.com/2012/12/16/i-am-adam-lanzas-mother-mental-illness-conversation_n_2311009.html

http://drugtopics.modernmedicine.com/drugtopics/Modern+Medicine+Now/A-tragic-lesson-in-risk-management/ArticleStandard/Article/detail/799851

As a teacher, I am allowed much less latitude in my day to day existence then the average person who is not a teacher – (no actual education experience yet has a college degree, may be a parent, after school provider service, baby sitter, etc).  This lack of latitude is not a problem, rather it presents a unique dilemma.  Society expects me (with my nifty CA State Teaching Credential) to act differently and generally better so I have little wiggle room if something goes wrong. As a science teacher, I can tell you, up front and honestly, ‘Things go wrong’ and so I do all I can for reasonable risk assessment in an attempt to avoid the ‘something going wrong’  starting small and becoming HUGE.   Adam Lanza went wrong. Come to think of it, so did NECC (New England Compounding Center).

When I have had to deal with work colleagues, administrators, parents, etc., about avoiding problems,  the  mantra I most often hear is, ‘Well we have been doing it this way for ______ (pick your amount of time) and have not had a problem’.  The second most often heard mantra is, ‘We have a license, degree, certificate…..’.  My favorite mantra: ‘Kids don’t come with operating instructions’.

I want to roll my eyes as mantra one means we can’t/won’t/are afraid to change. Mantra two indicates abdication. My favorite mantra translates into lack of use of common sense and/or asking for help.

When something goes wrong, these mantras never hold up with talking to parents, police, doctors, etc. These mantras do have the capacity to help some one feel better about the lapses and excuse ineptitude, which is why we have lawyers and insurance.  These mantras allow people to feel okay about not being a functioning member of their family, work colleagues,  group of friends and community.

We are a society so separated from reality we expect others to take responsibility for everything from poor parenting to bad grades to bad behavior. When something bad happens, we console ourselves with the concept we ‘did the best we could’ and immediately start looking where to point blame.

I have to ask – did you really do the best you could? Were you afraid in some way and so you chose to take the easier path?

Were you putting some self interest in front of your job/relationship with another person(I can’t deal with lunatic parent B so I will just give the kid a C and call it a day – even though the kid has some serious learning and behavior problems; I have to have enrollment numbers up so I will accept whatever kids come to my program;  I was afraid to address parent Q their child has behavior X consistently and it is not benefitting their age/play mates; Just this once I can let it slide – it will keep everything calm and so on) and did not step it up?

Anything in science ‘lab’ can become dangerous under the wrong circumstances so we practice, practice, practice-we practice how to use particular tools correctly, who gets to pick up broken glass (ME and any other adult only), how to stop, drop and roll (we light candles and peanuts for experiments some times), how to walk around a puddle. We talk about why, at the end of the day, it is quite important I return children to their parents in the same or better (they learn something and maybe grow a gyri on the brain!) condition and I have told them I really never wish to have to call a parent from the ER.

I am strict. My students need to demonstrate they know how to WALK with scissors pointed downward….and this is at all age levels. We learn how to position a butter knife (blunt edge) since with enough force, even a butter knife is dangerous.  I have explained that while I would do anything I could to keep them alive, I don’t feel like doing open heart surgery today so they must walk with scissors AND they must walk and HOLD scissors a particular way.  Knives and tools requiring use of ‘force’ must be pushed away from body for proper use. Fortunately for me I have not had to do heart surgery – I have had to deal with ripped clothing, scissors falling just shy of puncturing a toe as child wore sandals, scissors being used in wrong direction (don’t ask me how the child was able to do this to try and unplug the glue bottle) and kid getting cut on hand, etc.

In the case of Nancy Lanza, the story unfolded all too sadly after the fact. Apparently she practiced my favorite mantra  and the most often heard mantra about having a license (for anything, as if this makes you invisible from harm, most especially  a license for a gun).   Not only did Mrs. Lanza practice one of the mantras, her so called friends aided, abetted and abided in the mantras.  After Friday 14 December 2012 people began to blame the NRA (yet, Mrs. Lanza had a license). People were able to construct a bit of a story about Mrs. Lanza – she was generous with money yet never managed to talk about one son.  Mrs. Lanza does not seem to have any ‘close’ friends or they sure are not talking.  People confused Mrs. Lanza as a teacher.  People knew Adam was different (interestingly, kids can always tell when some one is  different even though they may not have words for the ‘different’) and yet apparently his different was ‘normal’ – AND THEN IT WAS NOT.

Some one was afraid to use the tool of truth and sincerity.

The methodology of CAREFULNESS rules what I do.  I have substantially more to lose for a ‘mistake’, no matter how well intentioned I was in avoiding the mistake.  My choices are public (they occur in a classroom for all to see and hear), my choices are constantly what parents talk about.  My choices supposedly have more impact on a child then anything their parents could/should do…….

The higher standard is sometimes frightening and often frustrating. I can lose my credential in the blink of an eye if a child is hurt  or some stranger abducts a child under my care (even if the child stated they ‘knew’ the person since a child’s knowing is distinctly different from an adult knowing) even if I told two kids to go to the bathroom together, I am expected to have eyes on the back of my head and a third eye at all times. The  same  behavior is  not  required/expected of a parent – something going ‘south’ would be called an accident.   Adam Lanza’s behavior was apparently an accident since no one seemed to see it coming and yet it seems all the signs were there and the signs were pretty blinding neon, most especially having an interest in guns and sharing guns with a child as a demonstration of responsibility.

Since my livelihood depends on how well I can inculcate the use of particular  tools, I am careful to note the following:

Bleach – great for sanitizing. Five drops in a gallon of water is good stuff when there is no clean water. A child drinking bleach left below the kitchen sink is deadly.  Scissors – awesome for arts and crafts. Kitchen scissors can be used to cut chicken bones.  Falling on scissors can cause blindness, puncture wounds, death. Pencil – great for writing on paper and drawing. Flung across the room, can cause blindness. http://www.cnn.com/video/?hpt=hp_c3#/video/us/2013/01/25/dnt-pencil-spears-tot-in-the-eye.whdh   Rubber band – wonderful for making a model airplane propeller turn. Horrific is shot to the face. Minimally painful if it hits a tender part of the body. Needle – great tool for sewing on a button, getting glue stuck in neck of glue bottle, making a tiny hole to demonstrate starlight in a black piece of paper. Completely dangerous on many levels up to and including carrying germs so we should not even use it to pretend we have magnetic skin.  Magnets – wonderful for holding things to refrigerator. Great for an MRI which can help in doing a medical diagnosis. Terribly bad when swallowed by children and the magnets bind in the gut.

The above are just the minimum of issues I deal with as a teacher.  Add on taking students on a field trip where the generally accepted standard is 6-10 children per adult (and many times the adults act like children).  Add on being distracted for one second by a child who does not understand the word NO  is indeed  A COMPLETE SENTENCE when stated by an adult and you start to get a tiny view of my world.

When children act out, I am clear in communicating with parents and administrators regarding what happened as I just watched my life pass before my eyes and that of the children I am in charge of.   I do not have a ‘free pass’ – ever.  I am not unempathetic, I am honest, sincere and don’t let acting out pass for the ‘next time’.  This is known as the practice of behaviorism – catching it when it happens, addressing it and moving forward instead of letting the behavior go and become a routine.

This methodical approach applies to not only  all tools above  but  the speaking tool in human relationships with family and friends.

In the same way I  would state  guns are a tool (air BB pellet guns at summer camp for target practice, hunting, use on big game drives in Africa), and require extraordinary care in use, I would state honesty and telling the truth to parents, friends and family is so important when something is ‘amiss’.

Tools and truth  are a safety issue  – improper use of a tool can have some unintended consequences and outcomes.  Improper use of truth (protecting some one from feeling hurt, their self esteem tapped, etc.)  does not help people seek help/services/support  before something unforeseen happens.  We need to treat our relationships the same way we would demonstrate respect for a tool – practice telling some one something is wrong and share how to get help; report a problem to the police (the converse of this is not ‘snitching’ and we all know how this works in neighborhoods with gangs), follow up and practice again; check things out every now and again to make sure things are in good operating condition – especially your relationships.  Don’t let being politically correct stop you from being ACTUALLY CORRECT.   If you have that ‘feeling’ inside of something being amiss, talk to your friend, their family members, etc. Report what you think is amiss- your internal gut is more accurate then you realize (Gary Zukov, The Seat of The Soul).

I have never seen cops at a shooting range practice without goggles and ear mufflers.  I am not condoning guns although I support the idea that if you have a gun, you should at a minimum know how to use it and store it appropriately.   This is what leads me to state that guns in and of themselves are not inherently dangerous, rather the people using them are dangerous.

People without care or thought or an understanding of risk management have difficulty imagining the horror of  everyday items in the house.  Liza Long noted this in her piece above. People with  problems of mental and behavioral health issues are not inherently dangerous – rather the people who have mental/behavioral  problems tend to have a proclivity to be dangerous for a variety of reasons.  Not saying something to the person or their adult care taker  due to the impoliteness factor is dangerous. You have a tool (your brain) to think through information, analyze the information and share if something is not making sense.

When you get down to it, a teacher should not be different from anyone else.  A teacher should be respected for noting when something is amiss in equal proportion to when they note something is awesome and wonderful. A teacher should be appreciated for honesty when it comes to children.  Generally this is not the case as there is no nice way to tell the truth about something being amiss.  If this were the actual case, some one somewhere in a small place called Newtown, CT would have rung a warning bell about Nancy Lanza, her relationship with guns and her son who was different and perhaps should not (in retrospect) have been shown how to shoot guns.   Some one at the college where Adam attended or a friend of Nancy’s who had kids themselves should have noted something was incongruous and at a minimum, contacted the police as a ‘heads up’ and let the police follow up.  It seems both Nancy and Adam had a unique relationship with schools.

The danger is not the ‘tool’ – the danger is in not knowing how to use a tool – any tool, not practicing enough and expecting a better outcome than if you actually made the  attempt to  thoughtful and careful about all tools, including the SPEAKING UP tool.   Speak up instead of being surprised.