RPhLink.com  A Great Link for the IPhBOs (Independent Pharmacy Business Owners)               Student : University of Arizonia School of Pharmacy    I must reveal that this essay predates a turning point in my life. The death of my mother, my inspiration.  "Dr. Smith" is a compilation of my mentors and everything I believe a great health care provider should be.  The pharmacist I will strive to be.  I have been a pharmacy technician for three years, a pharmacy compounding technician for one year, and a pharmacy intern for two years now, this essay may sound näive.  Perhaps it is näive, but it reveals the truth as to what propels me to succeed in my need to be the best health care provider possible.  When I am asked what made me choose pharmacy school, I smile and say, "that's easy.  A bottle of aspirin and my mom."  My response always warrants the following explanation.  Upon entering college, I was fascinated to learn that the mechanism of action of aspirin was relatively simple in comparison to the many effects it has on the human body.  I continue to marvel at how one small pill can interact with the body to produce many different results.  The fact that two hundred milligrams of a substance can alter the mood, the appetite, the pain, or even end the life of a one hundred eighty pound man seems nothing short of magic to me. Mom was diagnosed with terminal cancer six years ago.  Since that time, my entire family has gathered around her to offer her support and love.  From the very beginning, I noticed the words in which she took the most comfort were not phrases like, "Everything will be okay," or "Your pain can be treated with this pill."  What put Mom most at ease was when her pharmacist, "Dr. Smith" took the time to explain what was happening to her body and how each medication would work to fight her cancer.  Even when these conversations had their necessary downsides, Mom was still put at ease by knowing what exactly was happening to her body.  "Dr. Smith" also made it a point to inform her of the latest drug treatments she or her physician may not have known about.  In doing this, "Dr. Smith" gave Mom a gift for which she, and I, will be eternally grateful: Hope.  I found myself thinking, what an honor and privilege to offer such a gift. "Dr. Smith" gave me a reason to reexamine my views of what the responsibilities of a pharmacist should be.  A pharmacist needs to forever bear in mind that even the most potent pill can not replace the healing power of the human spirit.  A drug should not be administered to regenerate this spirit; rather, the human spirit should be present to alleviate the needs for drugs.  It is only with this motto that the pharmacist can rise above the stigma of "pill-pusher" to truly perform the job for which his/her profession was intended:  Rid suffering to improve quality of life.  It is these particular aspects of the profession which are the most appealing to me because they imply that the pharmacist can still help a patient even when science can not. An excellent pharmacist must posses the communication skills, approachability and compassion to win the trust of his/her patients.  Without these skills a pharmacist can not be entirely competent.  Through my years of customer service experience, I feel I posses these skills and continue to hone them in my present work as a pharmacy intern.  My positive attitude, my patience, and my commitment to people are the characteristics of the pharmacist I will make. Currently in my second year of pharmacy school, my classroom experience has provided me with a solid foundation.  I have chosen to enhance this groundwork through participation in professional organizations.  As President of the University of Arizona's Academy of Students of Pharmacy Chapter, I work hard to maintain the high level of performance that preceded me; as well as, to move our chapter to a place it has never reached before.  My focus is on the success of the chapter.  My dedication has come with personal growth and satisfaction.  I am confident in my abilities to play a role in shaping and modifying the future of healthcare. As an aspiring pharmacist, I am prepared to make a commitment of a lifetime of learning.  A commitment to the patient.  I will fulfill my responsibilities to the patient by taking the time to show them sincere concern and hope, by educating them in their decisions.  I will work as part of the triad:  Patient, doctor and pharmacist.  I am confident that my fascination with the biological influence of chemical substances on the human body, coupled with my unique perspective of the role of the pharmacist, and my academic and organizational accomplishments, will make me a pharmacist that Mom, "Dr. Smith" and the makers of aspirin can be proud of.                                  The #1 Link for Pharmacy Students     As a Pharmacist, how will I make a difference in the profession? By Renee Riddix-Hilliard, Pharm.D. Candidate University of Maryland School of Pharmacy. As a pharmacy student, I have begun to pave my path of how I will make a difference in the profession of pharmacy as a pharmacist. First, I am and will continue to play as active role in increasing the number of students who pursue the profession in a capacity that has never been explored. To begin to fulfill this goal, I have founded a high school tutorial program, A Bridge to Academic Excellence, to which students from the University of Maryland schools of pharmacy, medicine, law, dentistry, and physical therapy participate. On many saturdays during the school year, we tutor approximately eighty high school students in mathematics. in order to inform and encourage students to become pharmacists, I have arranged for mentoring and internship committees to be created through our program. The pharmacy-mentoring program is comprised of a group of pharmacy students that invite the high school students to participate in some of their professional and social activities. The pharmacy internships we are developing involve volunteer or stipend paid work sites where the high school students can learn about pharmacy during the summer months. When I become a pharmacist, I have been asked and intend to remain on the board of the tutorial program as the project coordinator. my faculty advisor for the tutorial program is applying and seeking numerous grants and other funding to support and expand the program. With additional monies, the program can be enlarged to become a model for all pharmacy schools around the country. When the public observes the impact of A Bridge to Academic Excellence Tutorial Program on society, the image of pharmacists as educators who have a fountain of knowledge that they are willing to share will be enhanced. Secondly, as a pharmacy student, I have begun to be an information resource for the minority community and other pharmacists. At present, I give free, mini-lectures on disease state prevention, management, and medication counseling for my faculty preceptors at workshops for health professionals and my local church. As a pharmacist, I intend to expand these lectures to include all churches in Baltimore City and surrounding counties at no cost to the patient. These lectures will continue to make a difference in the knowledge base with which consumers are equipped. Furthermore, they will empower the patient to play an active role in his/her health care. Since I have a particular interest in the disadvantaged and minority communities who tend to avoid seeing a health care provider until a major illness/event occurs, I believe that I will be a valuable asset to these populations. In addition, I believe the response rate of patient's attending their local church as opposed to going to a facility, such as a doctor's office or clinic, is and will continue to be very high because the environment of the church communicates trust and integrity. I am convinced that my operating as a pharmacist in this capacity will improve the image of the pharmacist as an information resource that can be trusted. Moreover, there is sufficient evidence in the literature to support that a pharmacist's interventions have a positive impact on the health of the patient. If I could attract other colleagues within the profession, to help by volunteering one day a year, we could offer multiple disease state management seminars and counseling to patients on an individual basis in different communities. The more pharmacists I can recruit to join in this cause, the greater number of events we can have a various sites within a year. Also, as a pharmacist, I can be an information resource for the physician of the patients to which I give medication counseling. I can serve as the gap between the patient and the physician. For example, I was reviewing a patient's medications when she told me that she was cutting her extended release blood pressure tablet in half because she was experiencing side effects and the strength was twice the amount she normally gets so she thought the doctor made a mistake. When I informed her that she should not be cutting the tablets in half because of how they were made to work and that she should contact her doctor, she requested that I contact him for her because she felt he was too busy for her. After the session, I contacted the patient's physician to make him aware of what she said and had been doing. This small, but significant interaction may have saved the patient from having uncontrolled hypertension, increased her compliance, and facilitated future communications between the patient and the physician. When I become a pharmacist, I think that being a liaison for the patient and doctor in the community will make a difference in the profession of pharmacy. Thirdly, I am convinced that as a pharmacist, I can make a difference in the profession of pharmacy by implementing practical, non-invasive patient monitoring programs in retail pharmacy. Currently, I have begun an osteoarthritis research project that simply requires a questionnaire and a simple monitoring to gain evidence on the value of a little data collection, which doesn't require a large amount of the pharmacist's time. Should the outcome of this project become evidence for the proposed idea, it may be published in a journal. Furthermore, I plan to design, implement and teach other practical disease state management projects to retail and/or consulting pharmacists. Lastly, I will make a difference in the profession of pharmacy by supporting and developing programs that supply medications and medical services to the elderly and financially impoverished. Despite the fact that I have not been able to actively begin working on this goal to date, I have found a resource from which to begin. There is a clinic located in Columbia, Maryland for which I have visited while I was completing a rotation with a pharmaceutical company. The site was in need of a pharmacist who would volunteer one-half day per week to dispense donated samples of medication to patients. Initially, as a pharmacist, I plan on becoming involved with this organization as a dispensing pharmacist. I believe I have to first meet the present need prior to doing anything else. From there, I intend to learn the business, enlarge the scope of its vision, and extend it to other clinic sites. In summary, when I become a pharmacist, I intend to make difference by creating and implementing ideas for disease state management, mentoring high school and pharmacy students, teaching pharmacists and other health care professionals about disease state management, uniting pharmacists to volunteer time to provide services to the disadvantaged, providing medication counseling, and facilitating communication between patients and their physicians. Although I am contemplating of where I will be employed as a pharmacists, whatever I choose must allow me to demonstrate that I am providing a necessary service that is beneficial to the patient as well as give me the opportunity to present ideas to expand and/or enhance what I do. RPhLink.com  The Pharmaceutical Care Network!   A Case Study Illustrating Professional Care Judgement Within an Ethical Framework, by J. Harnitz, PT. Physical Therapy in the long term care setting is a challenging profession. Because the occupation is called physical therapy, most people would assume that decisions about moving and positioning of individuals are the most crucial. However, sometimes even more important professional decisions can result from moral and ethical contemplation about whether to continue treatment or not with a particular patient. Recently at my workplace, a favorite resident of our facility suffered a majorly debilitating cerebral vascular accident. Prior to this episode, the resident was conversive, ambulatory and independent in all activities of daily living. After the event, the resident was virtually non-responsive and dependent for all mobility skills and care. All three disciplines Occupational Therapy, Physical Therapy and Speech Therapy received orders from the resident's physician for evaluation and treatment as indicated. After a three day evaluation of the patient, it became obvious to me, having seen many individuals with similar medical backgrounds, age and cerebral vascular accidents that the prognosis for the patient was very poor. My decision was to set up a comprehensive range of motion and positioning program for the patient and to discharge him from physical therapy services in one week, when all nursing staff had been inserviced on the patient's program. Occupational and speech therapy decided to treat this resident on an on-going basis, seeing more potential in the patient's outcome and possibly not wanting to "give up" on this once vibrant resident of our facility. Part of my decision was that the physical therapy department would continue to communicate with occupational and speech therapy and personally screen this patient every two weeks to see if the condition improved to warrent re-initiation of physical therapy services. The decision to discontinue physical therapy treatment in this individual presented a conflict between my personal moral and professional codes, making it a difficult decision. My personal moral code includes the principle of not depriving any individual of beneficial skilled physical therapy intervention. In this case this belief was intensified by the individual's high level of activity prior to the cerebral vascular accident. Another facet of the dilemma reflected the rights of the individual since my moral code also includes the belief that all people have the right to receive the best care possible. Even though nursing could perform the patient's range of motion and positioning program, a skilled physical therapist would most probably do a superior job. In another way, the principle of nonmaleficence was called upon. By not providing the daily skilled physical therapy service, was this ultimately goig to harm the patient by not allowing him to improve with a more vigorous program? The final moral principle that influenced me was justice. My feeling that all individuals, no matter what age or diagnosis should receive the same degree of healthcare made it difficult to decide whether the individual should continue to receive physical therapy services or not. On the other hand, my professional code of ethics presented some opposing views. Although all of the moral principles apply to my professional code of ethics as well, the professional ethic of beneficence was applicable. Although the patient may benefit from continued physical therapy treatments, would the outcome from these treatments balance the cost? Even fifteen minutes of physical therapy treatment is very costly, and it isn't professionally ethical to keep a patient on a caseload for financial or personal reasons, even if you have the reasonable expectation that the patient will receive some benefit from these treatments. Additional professional direction is provided through the Medicare system in this instance. Medicare states clearly that the rehabilitation services should not be performed unless there is documentable progress in each case. This is an important part of the physical therapy code of ethics as well which implies we must not provide unneeded services just to increase financial gain. One final part of my professional code of ethics played a role in my decision, and this is discernment. It was very important that I was able to problem solve and reach my decision without being unduly influenced by personal attachment to this favorite resident or his rather assertive family which was resistant to the idea of discontinuing the resident's treatment. There was a rather obvious conflict between moral code and principles and professional principles. In summary, morally I was drawn to the ideas of providing skilled service to this patient so that he might receive the best possible treatment, but professionally I knew that the cost versus benefit issue made continued treatment unreasonable. Further conflict arose when occupational and speech therapy decided to continue daily treatment with this individual, both of these disciplines felt my decision was incorrect, even though the resident would continue to be considered for re-initiation of treatment, if any improvement in status was recognized. The conflict was resolved by realizing that part of my motivation for wanting to keep the patient active in occupational and speech therapy felt my decisionwas hasty and was not compassionate enough. There were several antagonistic discussions regarding the reasons and ramifications of my decision. Secondly, the patient did not receive the amount of range of motion exercises that I had deemed minimally necessary from nursing. This resulted in several frustrating attempts to increase carryover of my instructions, knowing had I kept the patient on my caseload the proper instructions would been followed. Thirdly, five weeks later, the patient died. This reaffirmed the fact that my decision was the appropriate one. Occupational therapy continued to see the patient until the end, showing what I perceive as misuse of silled therapeutic intervention. In this instance, after being temporarily caught between apparently equal but conflicting principles, I was able to deliberate about the situation to come to a successful justification of my decision so that the patient received appropriate medical care for this particular situation. However all decisions of this sort are ethically very difficult since moral, emotional and professional factors come into play. Each new situation requires new deliberation.