Can you hear me now?

You can call it selective hearing, being preoccupied or just not interested in listening to somebody when they’re trying to tell you something. In my case, it was also losing my hearing in the frequency range of my wife’s voice. never listenShe would often complain that I never listen to her. She returned one evening from a craft fair or bazaar with a painted block of wood, wrapped with a ribbon, and handed it to me. It had the following inscription:

“My wife says I never listen to her… at least I think that’s what she said.” 

Later I discovered our lack of communication was only partially due to my progressive hearing loss. I say “partially” because I now know I was guilty of not giving her my full attention when she spoke to me. I struggled with my hearing (and listening) until a few years later when I suffered profound loss of hearing in both ears.

Though my total loss of hearing was devastating when it happened, regaining my hearing through the process of receiving a cochlear implant has taught me some very important lessons about the difference between hearing and listening.

Hearing is not the same as listening.

The rehabilitation process of regaining my hearing through the miracle of a cochlear implant was hard work. I would struggle to hear at times, knowing I needed to understand the words being said.

But because I was concentrating so much on hearing the words in a conversation, I found myself lacking in the area of listening to the conversation. My brain was so focused on hearing that I didn’t have time to listen at first. Likewise, if our minds and concentration are focused elsewhere, we’re going to miss most of the conversation.

Using more than just your ears.

Listening is not only hearing what is being said, but what is not being said or only partially being said. There are so many nuances to a conversation that one can’t hear unless they truly engage in listening. Body language, facial expression, verbal and non-verbal messages can only be pick up if one is fully engaged, both hearing and listening.

So now you might be asking yourself “what does this have to do with healthcare?”

Time allotted:  8 minutes per patient.

The New York Times recently published an article referencing a study which confirmed “new doctors are spending less time with patients than ever before.” I’m sure this translates over to many of the physicians who’ve been in practice for a number of years as well. Physicians (and pharmacists for that matter) are being bogged down in paperwork and other tasks not directly associated with patient care.

Pharmacists have been under this pressure for years. Even With OBRA mandating patient counseling on all new prescriptions, most pharmacists find it difficult to  get 30 seconds to counsel a patient at times. And I’m sure that physicians and pharmacists are not the only healthcare professionals who are lacking the time to spend listening to patients.

“The opposite of talking isn’t listening. The opposite of talking is waiting…”
~ Fran Lebowitz

So here’s a few tips that would improve the delivery of healthcare from a listening perspective:

  • Stop talking – let your patients tell their story
  • Get ready to listen – remove distractions (including laptops, etc.)
  • Be patient – put them at ease and let them share their concerns
  • Listen for what’s not being said – listen with your eyes as well
  • Be empathetic – try to understand the patient’s point of view

Unless we put forth the effort to prepare ourselves to listen it probably isn’t going to happen.

No time, no time, no time…

One might argue the case of  this new generation of healthcare practitioners being different than past generations due to time constraints. Circumstances may change over time. But the framework for building good relationships with other people hasn’t changed much, if at all, for centuries.

If we want to improve healthcare we must improve the communication and interaction with patients… many who are more informed and engaged in their health and medical conditions than ever before.

So what happened to the sign?

It still sits on our kitchen windowsill, over 15 years later, as a daily reminder to us all.

Nearly three years ago I wrote a blog post titled ‘OBRA (’90), Where art Thou… and Where art We?’ .  In it I wrote  the following paragraph as I was questioning why many pharmacists are reluctant to be ‘patient pro-active’ and get involved with changing trends in the profession

” I don’t understand why some pharmacists have been reluctant to get involved with the evolution of their profession and provide effective patient counseling. Perhaps those pharmacists are practicing in a workplace not conducive to patient counseling or maybe they are fearfull of patient interaction. Possibly they are just not interested in getting involved, in which case I would suggest they consider a new profession. Regardless of the specific scenario, I think it is time for another call for action. Pharmacists need to get involved in counseling and educating their patients now!”  (Pharmacy 2.0 and 1/2 March 18th, 2009).

Fast forward to the year 2012.  The pharmacy world continues to watch and wait as we follow the WAG vs. ESI saga amidst reducing third party reimbursement, changing pharmacy regulations and many pharmacy Boards extending a ‘blind eye’ towards idiotic (or insane)  ‘15 minutes or it’s free ‘ types of corporate policies that are dangerous for the public and demeaning to the practice of pharmacy.

I’ve heard it for years… pharmacists will be providing counseling and cognitive services to patients and GETTING PAID FOR IT in the near future.   I remember first hearing it before I graduated from pharmacy school in the ’70s.  I always believed it and thought OBRA ’90 legislation might be the beginning of it.  But I was disappointed to see this happening only in a few areas of pharmacy like long term care.  Many pharmacists failed to recognize the potential for patient counseling and most members of the pharmacy corporate world continued to place profits before patients, ignoring the need and disregarding the future of the profession.

But I still believed it to be true.  Pharmacists will be providing comprehensive patient counseling and cognitive services and getting paid for it.  This is a valuable service to provide to our patients and customers that will improve their lives.  This is a service that saves health care dollars in the long run.

Early this century, MTM became the new pharmacy buzz word.   According to my ‘trusted sources’ at Wikipedia, Medication therapy management (MTM) is a partnership between the pharmacist, the patient and their caregiver, and other health professionals that promotes the safe and effective use of medications and helps patients achieve the targeted outcomes from medication therapy.  (see www.pharmacist.com)

I like that definition of MTM.  Unlike the Medication Modernization Act 2003 it specifically states that MTM is a partnership between THE PHARMACIST, the patient and their caregiver.  Not a nurse, not a physician or any other health care professional.  The pharmacist is THE member of the health care team best qualified to provide medication therapy management services.

So who’s ready to get on board with MTM?  Will pharmacists finally step up to the plate and qualify themselves to be actively involved with MTM?  The future is happening right now!  Pharmacists are being paid for MTM and other cognitive services.  This is becoming reality and will become the norm in pharmacy practice.

There is power in numbers.  It will only be through the power of those involved in providing these types services.  It cannot be achieved any other way.  Not by by associations or organizations;  and certainly not through legislation or pharmacy boards.  It will only come from the strength of those providing the MTM services.  Everyone and everything else is only an appendage and supportive in nature.

Together, as a unified group, MTM pharmacists can make that happen.  You might ask “how are we to do this”?  

The Community Clinical Pharmacists MTM Group on LinkedIn is one of the ways to achieve this.  If you have not started a LinkedIn profile you need to consider it now, especially if you want to start an MTM practice.  The ccpMTMgroup is designed primarily for pharmacists who are interested in providing independent MTM consulting services.  This is the first step in setting up a network of MTM pharmacists committed to promoting and providing pharmacy MTM services.  I invite you to join this group and take part in the discussion and be part of this transition towards independent MTM consulting. As a group we can overcome the obstacles in our path and achieve this goal.

Albert Einstein  defined insanity as “doing the same thing over and over and expecting different results”.  Pharmacists cannot expect to continue with a ‘business as usual’ attitude and expect the necessary changes to take place.  We need to create an environment to accommodate these changes.

Now is the time for a new call to action that stimulates pharmacists to take steps to make this change happen. Pharmacists cannot continue (as @empress_penguin ‘s Twitter profile translates) like  “clumsy penguins swimming in the sea of mothers across health and welfare”  and expect this change to happen.  (Google Translate – Japanese to English).  (Since I don’t speak Japanese I don’t fully understand what that means but it seems to be representative and descriptive of the pharmacy profession at times.)

We need to change that now.  Pharmacists need to stop swimming ‘clumsily’ and erratically with the currents.  We need to set our sites on the goal and fight the currents in the river of Lethe we’ve been in for years.  Pharmacists must learn to swim upstream towards those goals that will maximize our efforts to improve patient care and strengthen our position as a health care professionals.

Decide now to commit to action or get out of the way of progress.  If you stood back with a ‘wait and see’ attitude when OBRA ’90 was put in place, we don’t need you now – unless you are ready to step up and make the necessary changes.  “It’s time to get down and dirty and practical, so let’s focus on what might really work to make progress on… change at the grassroots level”.  (see ‘How to Create Change’, sustainablebusiness.com)

To be successful in this endeavor MTM Pharmacists need to:

  • Decide to ‘DO IT’ and incorporate MTM opportunities into their pharmacy practice
  • Commit to a PLAN OF ACTION to facilitate the necessary changes for practicing appropriate MTM principles
  • FOLLOW THROUGH with their plan for implementing MTM within their practice setting
  • Support and encourage their colleagues who are involved with MTM and educate the public to the benefits of MTM services
We cannot continue with the ‘wait and see’ attitude that has constrained the profession of pharmacy in the past.  If we educate ourselves, educate our patients, get involved and follow the course we will gain momentum in the process and our efforts will bring positive results.  But it’s up to us, YOU and I, to work towards this end.