Back to Fundamental

Introduction

We once extracted active ingredient from natural flora and henceforth the development in western medicine started.

• Today, for our clinical decision making, it should always be evidence-based.
• However, the origins of these so called evidence practices, it all just started from off-label use too.

Beyond Technology

I once attended a course, discussing on the use of pharmacometrics, in which we can formulate a mathematical model of biology, pharmacology, disease and physiology to describe and quantify interactions between drugs and patients.

• With the computer software calculation, after inputting the data, we would be able to achieve precision medicine.
• Well, it seems sophisticated and promising in the future.

However, are we on the right track? Again and again, in therapeutic drug monitoring practice, we have been emphasized to treat the patient clinical condition, but not the drug level and estimations that we calculate from the formulas.

• Carbamazepine is 70-80% protein bound and shows a wide variation in the population average apparent Vd (0.8-1.9 L/kg).
• Each patient also has individual clinical history, social history, genetic profile, liver function, renal profile and concurrent medications.

Working As A Team

Subconsciously, at work, hospital pharmacists have divided themselves to inpatient, outpatient, clinical, logistics, clinical pharmacokinetics, total parenteral nutrition and chemotherapy drug reconstitution services pharmacist.

• Back to the root, this so-called specialisation is to allow pharmacists to be more focus on respective tasks and to provide better patient care to patients, but not to differentiate among pharmacists on who to provide the clinical service or who is more important or busier.

Remember, all pharmacists at a facility are a team.

• We, from different departments, should work hand-in-hand to tackle any issues, instead of playing tai-chi.
• Afterall, all the tasks that we do at one department may affect another department workflow.
• Staffs at different departments are facing their own tough fights too, NOT you alone.

Everyone Can Contribute

When I was a provisional registered pharmacist, I once had a silly thought and told a senior pharmacist, you are such a passionate pharmacist, you should go clinical.

• She disagreed and replied, all pharmacy departments require passionate and knowledgeable pharmacist too.

It is only later, after working at outpatient pharmacy for few years, I start to appreciate how important it is to have passionate and knowledgeable pharmacists working here.

• Outpatient work is always at fast pace; Each day, we screen and fill hundreds of prescriptions from different disciplines.
• Whenever we have a doubt on the prescription, we wished to get the answer as soon as possible, if possible, instantly.

It should not be a golden rule that every pharmacist who studied Master in Clinical Pharmacy to be stationed at wards.

• They can actively contribute their knowledge at other pharmacy departments.

Summary

In the face of a shortage, the fundamental roles of pharmacists in both inpatient and outpatient settings should be prioritized before expanding into other services.

• These core responsibilities are the foundation upon which pharmacists build their value and expertise.
• Adequate staffing levels ensure pharmacists can provide optimal care without excessive workloads, which potentially leads to burnout and turnover.