UC-Merced Pre-Pharmacy 4th Annual Banquet

Congratulations to UC-Merced's pre-pharmacy class - hosting a successful 4th annual banquet this past Saturday.  The event invited current pharmacists and pharmacy technicians to provide their own experience to the club members and create an open Q&A forum for the students to ask questions of the "distinguished guests" (their words, not mine). 

The questions were well-prepared and relevant. Even the potentially unsettling topics like future job forecast were addressed in detail. Students asked about the didactic portion of the curriculum, interview prep, work-life balance, etc. It was a great opportunity for students to take action and surround themselves with others currently in the field.  They hosted a wonderful event. 

Reflecting on the night reminded me of my first exposure to the profession.  I feel it's a story and a message worth sharing. It's about the power of mentorship:  

During the summer following my first professional year of pharmacy school, I applied for an internship opportunity with CVS/Health at the NJ shore.  Six students were accepted into a community-practice internship program and randomly assigned to a shore point.  I was assigned to Cape May County, where I met my preceptor, Dan Ringer. Dan is a Rutgers alumnus who had been managing this pharmacy for several years. I didn't know it at the time, but I met him just a week after his one-week old daughter was released from the ICU following life-threatening birth complications. Despite this he at the store and available for me when I most needed it.  I remember two very distinct thoughts:  "What an incredible example of my school's program" and "I got a loooonng way to go."  

Dan had a presence about it. He was calm but assertive, confident but not arrogant. People liked being around him. I couldn't identify it at the time, but in hindsight I can see that it was the thing I had been seeking my entire life.... steady.  I would watch in amazement as he approached each customer interaction with care and personal attention regardless of the circumstances.  

Not long into the summer, I experienced my first "difficult" customer. [Difficult was a word I used to assign to certain people to later help explain a complaint against me]. A gentleman approached the pharmacy, and it wasn't long before he was verbally attacking and aimlessly firing obscenities at anyone and everyone having the misfortune of being in his line of sight. There was no question his actions were wrong and his behavior way out of line. Surely the police would be notified, he'd soon be in handcuffs, and we'd all have a story to tell to our grandchildren.  But there were no police, no handcuffs and most surprisingly no retaliation.  My preceptor stepped in, and I watched silently as he extinguished the fire.  

Something about the interaction was unusual.  I come from a place where a man defends himself if he is being wrongfully attacked. Never mind the fact that the one identifying 'wrongful' is likely also in fight or flight mode and subject to the distorted cognitive processing that goes along with it. Never mind the fact that this philosophy had never produced any beneficial outcomes that would support its continued use into adulthood. Never mind the fact that I developed this pattern of thinking likely at around age four or five and then pridefully tried my best to uphold it for the next 17 years. Never mind any of that. I knew what was going on - this man had scared my preceptor.  Fear was the explanation for his lack of retaliation - or so I thought.  Being new to the team and wanting to make a good impression, I saw this as an opportunity to win the team's respect.  I broke my silence by stepping forward and ordering the man to leave the store before I called the police.  I felt heroic, but the expressions on my co-workers' faces did not match my feelings.  Rather than extinguishing the fire, my words had more of a gasoline effect. Dan took him to the side, had some quiet words, and within minutes the interaction was over.  The patient left. Not much was said to me, but not much needed to be said.  I got the message, and it has reverberated throughout my career.  

What I couldn't grasp at the time was how his reactions were not dependent on the patient's emotions.  What a concept!  He could speak with the same empathy and compassion to anyone under any circumstance without being hostage to the unpredictable emotions of the general populace.  

His energy crumbled whatever walls the patient had erected between himself and the pharmacy team.  I later realized what I had witnessed - the subconscious response to confidence and compassion.  This patient may have had experiences in the past that conditioned him to enter a pharmacy braced for battle. Or maybe...he was simply having a bad day.   

I've since met, interviewed, worked alongside, and trained hundreds of pharmacists across four states, various demographic settings, and countless pharmacy teams.  I have crossed paths with only a few "Dan Ringers". When Saturday night's discussion turned to the fear of occupational insecurity, I answered the question solely from my own experience, as limited or extensive as that may be perceived:  

"We may have a surplus of pharmacists, but we do not have a surplus of good pharmacists."

To this day I'm not sure if compassion or bed-side manner can be taught.  Some may get lucky to be paired with a Dan Ringer and have something permanently alter their perspective on human interactions and difficult encounters; I certainly take no credit for it. I've heard it said,

"When the pupil is ready, the teacher appears. 

However, there is a corresponding responsibility of the current student. Students must not passively remain surrounded by negative energy or mentorship simply because "that's who I was assigned to."  You might consider consulting with a trusted friend or instructor to confirm the motivation for the request, but it is not inappropriate to request a new experience once the initial committment has been fulfilled. There are many pharmacists who enjoy their professions, and there are many who do not - like with any industry I would imagine.

Next time you're talking with someone suffering from a pessimistic outlook of their profession, don't be afraid to politely question why they feel that way.  Nine times out of ten the answer given will be some variation of the following statement: "The business just ain't what it used to be."  That attitude has absolutely nothing to do with pharmacy.  It is representative of one of the most common roots of depression and restlessness- over-glorification of the past and discontentment with the present. The truth is we're not able to recall with any degree of accuracy the pains and discomforts of even a few weeks ago let alone ten years ago!  In any job, industry or personal relationship, it's the one trying to live one day at a time who will be better protected against bouts of worry or negative thinking. 

You can lead a horse to water, but you can't make it drink.  The professional programs are wonderfully designed to lead the student to the experiences, but personal development is an inside job; it will come when it's honestly desired and sought.  

When this happens to you, you start to see that the Wall-Street Journal's job forecast is nothing more than a boogeyman.  It can be defeated by shining a light on the fear. I recall several seductive articles published in 2008 encouraging investors to purchase real estate at any cost because it was currently the safest and most guaranteed return on investment... I won't touch further on old wounds.   

Since pharmacy education implemented the mandatory doctoral program, students' clinical knowledge and training has greatly improved.  We have, perhaps, one of the strongest advocacy groups in the country.  Our impact to healthcare expenditure by measure of treatment outcomes and overall expense has created a huge expansion to the current and future application of pharmacy practice. Immunization certification, MTM management, provider status... the future is bright!

But what has been lost? We are learning a lot, but are we improving quality of life? It is a difficult question to answer. With certain disease states, absolutely we are, but others are more difficult to assess.

Dan and I went on to become good friends.  He has two beautiful, healthy girls. Several years later I had the opportunity to learn from Dan again during an ambulatory care rotation at a compounding pharmacy.  I will be relocating to the east coast this summer.  Dan, if you're reading this, I expect my spot back during the Annual Ringer-Luau :)

I tell this story for a few reasons.  As a preceptor, mentor, or teacher, we never really know who is watching and how we're being perceived. For this to be my first demonstration of practical pharmacy, I assumed all pharmacists were like this. I have come to learn that is not so. And that's okay.  To this day the majority of my patient interaction style is only a slight adaptation of Dan's. When my own consultation-style is complimented, I give credit to that summer in 2006.  Young students are often nervous and easily intimidated.  I try to never forget the feeling and the impression that a first year pharmacy student had on the southernmost tip of New Jersey.  Secretly I feel that I could never do enough to repay those who guided my path, but I still try to pay-it-forward when requested.

Merced, CA was a 10-hr round trip.  My wife and I left early, put the convertible top down, and shared a relaxing drive breathing in California's fresh northern air.  It felt like no time passed.  I got to see Bob, pre-pharm club president-elect, and had to hold back tears of pride.  Five years prior, I met a 19-yo boy stocking shelves one week removed from a one-way ticket from NY to CA. He didn’t have a friend or family member in the state nor an ounce of experience to speak of.  But he had an undeniable bright light that shined as clearly as it had from my first preceptor seven years prior.  I invited him to lunch one day, explained the pharmacy business, the steps to obtaining a technician license, a national certification, and if interested, the path to a professional degree.  Ten minutes of my life.  He took it from there. A lot can come and go in one’s career – regrets and successes. But relationships like these have the power to move mountains, and they can never be taken away.

If UC-Merced's pre-pharmacy students are an accurate sampling of pharmacy's future, the profession is in good hands :-)