25th Midyear Clinical Meeting
American Society of Health-System Pharmacists
Las Vegas, NV
December 5, 1990
"LEGACY: The Gifts We Receive and the Gifts We Give"
Philip J. Schneider, M.S., FASHP, FFIP, FASPEN
Class of 1975
You sit on the runway waiting to take off. It has been a long week, with visits to three cities, three speeches, installation of officers, late nights, too much to eat (and occasionally to drink!), an occasional cigar (but no cigarettes!) and you are anxious to get home. Sometimes there is a delay in the flight, a missed connection, a student teacher conference missed or days when you wake up not knowing what day it is, or even what city you are in.
The most common question that I am asked is: "what was it like being ASHP President?" These are some of the things that I will not miss. On the other hand I will miss being so informed about health care and how pharmacy relates to the care of patients and how the pharmacy community differs in their perception of our role. I would like to share with you a perspective from 30,000 feet, if you will; a perspective that I have had all to frequently in the last three years. I would also like to thank my family, my colleagues, and the residents without whose support I would not have received this award and with whom I would like to share this recognition.
The title of my address is "Legacy: the gifts we receive and the gifts we give." I have chosen this theme because it represents the essence of what makes our residency program and what makes the hospital pharmacists different and special. Consider the fact that at this meeting 36 papers are being presented by graduates of our program. Consider the fact that over 11,000 people attend the ASHP Midyear Clinical Meeting, making it by a factor of two, the largest meeting of practicing pharmacists in the world. There is no doubt about it, we are a very special group among an already special group of pharmacists.
Like most of you, I have reflected on why this is the case and further, what obligation this places upon us. I believe we have received some things that have made us successful from our mentors, we gather at this meeting to understand our environment, and we struggle each day to create the future. In other words: we honor our past, we understand the present, and we create the future to continue our legacy.
Honoring the Past
The reason we have this function is to honor a mentor who had such a positive influence on many of our careers. There are many others here today and at this meeting who have contributed to the foundation on which each of us build our respective careers. It is through the accepting of these gifts that has enabled each of us to make a contribution to this great profession. Without this headstart on which to build, we would not have had an opportunity to do as much. It is the cornerstone of the careers of all the leaders in our profession to have had one or more mentors from whom the baton has been passed. We should cherish this heritage and continue to recognize the contributions that these leaders make to our profession. "Remembering forward" as Roger Anderson said two years ago.
Understanding Our Present
One of the greatest challenges that we face is understanding the present. Consider the major changes which are having a fundamental impact on the practice of pharmacy. Prospective pricing has required us to think of our mission as focused on cost containment rather than generating revenue. Automation and technology has required us to focus on drug use control rather than drug preparation and distribution. The move toward an entry level Pharm.D. degree has given us the opportunity to reorient our pharmacy service programs in a more clinical direction. There are over 11,000 people at this meeting trying to gain a better understanding of our present. There are 35 graduates of this program that are adding their contribution to this collective effort to understand the environment that shapes our practice. These are the gifts that we receive from our peers and from ourselves. Continuing our legacy requires that we continue to make the extra effort to interact with each other by sharing our successes and failures; our responses to the challenging changes in our environment.
Creating Our Future
Perhaps the most important contribution to the continuation of our legacy is creating our future; giving what we can to the future generation of leaders through innovation, teaching and research. Think back on the fourth level of residency training that Clif described on October 12, 1966 at the Second Special Conference on Hospital Pharmacy Resident Training in Columbus, Ohio. We were challenged to "learn to conceptualize our accumulated experiences and knowledge of practice and to transform these concepts into new and improved types of pharmaceutical services". The collective contributions to hospital pharmacy by graduates of residency training pgorams who achieve this level particularly at the Ohio State program is remarkable. There are unmet challenges remaining as we "move into history" leaving our own mark on the legacy of the Program and on hospital pharmacy. I would like to leave you with several of these challenges.
Residency Training. There are now 230 accredited residency training programs in the country. In 1990, these programs produced about 450 graduates, and have produced only about 6,000 graduates since residency training programs were accredited 27 years ago. This is simply not enough to create a critical mass of pharmacists with the philosophy and tools to advance practice in our changing world. The continuum of legacy; honoring our past, understand our present and creating our future demands an increased effort to develop more residency programs and expanding the number of residents trained at existing sites. The entry level Pharm.D. degree will increase the number of pharmacists seeking such training, both in practice and practice management. There is no better a group than graduates of our own program to renew interest in expanding residency training opportunities for future leaders; a gift to others, creating a better future. If you do not have a program associated with your organization, why not set a goal to begin one with the next three to five years. If you have a program, why not try to double the size of your program within the next three to five years.
Research. There are times that I am reminded of the hamburger advertisement where the lady kept saying: "where's the beef?" Not just in pharmacy, but in all areas of health care and consumer marketing as well. how often do we hear a plea to do something without objective evidence supporting the request? Should we be surprised that our interest often fall on deaf ears in administrative or public policy circles? For example, what objective evidence exists that patients are at increased risk if they receive prescription medications through mail instead of face-to-face from a pharmacist? In fact, what evidence exists that it makes a difference if a pharmacist is involved in the process at all? I am not saying that pharmacists do not add value in the drug treatment process, but rather we have not done a very good job of documenting the value. Henri Manasse has done an excellent job documenting the problems related to drug therapy in his "Medication use in an imperfect world: drug misadventuring as an issue of public policy". If you need a place to start in developing a research agenda, that would be a good place to start. Creating the future requires solving the problems of today and creating new knowledge through research. One of the reasons we have continued the statistics and research methodology courses in the Masters Degree program and required a research project, is to give the residents the tools they need to solve problems and create new knowledge. Contributing to our legacy by creating the future demands that we do this. Why not set a goal for you and your organization to develop a research agenda for the next three to five years?
Reaching Out. I would like to borrow a phrase from my good friend, colleague, amigo, and immediate Past President of the ASHP, Tom Thielke, who titled his presidential address "Reaching Out". The last challenge I would like to leave with you is to increase your awareness of issues outside of our own sphere that have an impact on what we do and can do. There are several "publics" as Tom described them, on whom we could focus more attention. One group that I have become exposed to as ASHP President, are our international colleagues through FIP. I have attended the last three FIP meetings and have found them to be very stimulating professionally. Of particular importance is the contribution that pharmacists from our country can make to those less privileged or less well developed than we are. Our legacy could and should be reflected in the gifts we can give our international colleagues. We have an unusual opportunity to do this at the next FIP meeting which for only the second time in its 50 year history is being held in our country, in Washington, D.C. Why not plan to attend and present some of your work? I can tell you that they will be very appreciative.
A second "public" is medicine. To a certain extent, pharmacy has been the handmaiden to medicine in our recent history. The current changes in health care and advances in knowledge will provide brand new opportunities for pharmacists to work as colleagues with physicians in the interest of the patient. Our continued efforts in advancing the concept of therapeutic interchange is an example of this. ASHP's growing relationship with the American College of Physicians is another. As pressure to focus on economics and cost containment grow, we need to redouble our efforts to establish and maintain a synergistic relationship with our physician colleagues in the interest of the patients.
A final "public" to which increased attention must be directed is nursing. While relationships between pharmacy and nursing have been less than ideal both locally and nationally, both groups represent major contributions to the treatment of patients. It is my impression that the whole has often been equal to less than the sum of the parts when it comes to pharmacy-nursing relationships. In today's environment, this is simply unacceptable. There is often considerable room for overlap and role conflict between nursing and pharmacy. Consider, for example drug administration and patient education programs. We need to extend an olive branch to nursing, without whose cooperation and support we cannot achieve full measure of potential. Consider the number of nurses compared to the number of pharmacists in the health care delivery system. That alone should underscore the importance that nursing has in any health care delivery system. At the national level, ASHP has renewed it dialogue with the American Nursing Association, who is relocating their headquarters from Kansas City to Washington, D.C. Patience and perseverance may be the secret ingredient in the restablishing this relationship, but it is critical to our future.
The warm feelings that this annual get together brings are cherished by us all. I am very grateful to Ron Dechant and Baxter Corporation for their continued and generous support of the event. I am also honored to be the fifth recipient of this award which recognizes achievement among a group who have themselves achieved quite a bit. For this award, I am truly grateful. Let us appreciate, also our legacy: those who have helped us to get where we are, the contributions that each of us make in our daily practice, and the future we are all trying to create. With these gifts, our hard work and the good feelings which come from fellowship like this, the future will be bright indeed!