Deanna [00:00:00]  So imagine a Zoom chat with just, like. 20 to 100 of the coolest young pharmacists you can find from every corner of Australia, and that’s what the Communities of Specialty Interest is.

Peter [00:00:22] From the Pharmaceutical Society of Australia, hello and welcome to Pharmacy & Me, the podcast that explores how pharmacists do the extraordinary things they do. I’m Peter Guthrey from PSA and a community pharmacist at a 24/7 pharmacy in Melbourne.

Hannah [00:00:38] And I’m Hannah Knowles, a senior pharmacist at the Royal Brisbane and Women’s Hospital. In each episode of Pharmacy & Me, we speak to an everyday pharmacist doing outstanding work about the highs and lows of their career, and we unpack what they’ve learnt and how you can put their experience into your practice.

Peter [00:00:56] Today, we have Deanna Mill joining us. Deanna is the ECP Community of Special Interest Chair, the PSA Early Career Pharmacist Board Appointed Director and a PhD candidate. Welcome, Deanna.

Deanna [00:01:07] Thank you for having me.

Hannah [00:01:11] It’s lovely to have you here, Deanna. For our listeners who aren’t familiar with your work, can you tell us a little bit about your current role?

Deanna [00:01:18] So, my current full-time job is as a PhD candidate, which means day-to-day I am coordinating research studies. My particular topic of interest is professionalism of pharmacists and professional behaviour. I also teach at UniSA and UWA and I also work as a research assistant for another researcher at UniSA.

Hannah [00:01:39] Quite an impressive list of things that you’ve got on at the moment, can you talk us through an average day in your research role?

Deanna [00:01:46] Yes, I guess no two days are the same. Generally, I start my day with some meetings and they might be with my supervisors who are experienced researchers. We’ll have a chat about the things that I need to do, whether that be recruiting participants for my studies or designing the methods, like a survey, for example.

Once I’ve had some meetings and know what I’m doing that day, then I’ll go and work on whatever’s on top of the list. I also tend to have quite a few meetings with PSA throughout the day, as well for things relating to the Communities of Specialty Interest.

Hannah [00:02:21] I don’t know how you fit it all in, to be honest. And you’ve come a long way, but are you able to describe yourself as a student and what your life is as a pharmacy student?

Deanna [00:02:28] Yes, I think I was a pretty good pharmacy student. But that stemmed from the fact that I never knew how much study I needed to do to get through, so I just did as much as I could, and that paid off in terms of my grades. I was very engaged, which meant that I studied hard but I also sought experience in community pharmacies to make sure I knew what I was getting myself into as a pharmacist at the end of my degree.

Hannah [00:02:52] And did that engagement extend to organisations such as the PSA as a student?

Deanna [00:03:01] No, not as a student. So, I like to explain to people why I wasn’t involved. And usually that’s because when I was at school, I was told that I was very opinionated and that was a bad thing and I wouldn’t win any friends with my opinions. It wasn’t until I was an intern and had a mentor who was encouraging me to get involved in as many things as possible that I started to take those steps and become engaged with our professional organisations.

Peter [00:03:30] How did you overcome this idea that you’re too opinionated to contribute?

Deanna [00:03:34] I decided to do an honours program, which meant I engaged in a research project and my research supervisor, who I happened across because I wasn’t getting replies to emails to anyone else I spoke to, happened to be Jacinta Johnson. When I did eventually speak up about things to her, she’s like, great, you’re the sort of person, they’re the ideas that we need, do you want to come along to this meeting with the PSA Early Career Pharmacists? And I didn’t know what that meant, but there was free dinner. So, Jacinta was hugely influential in shaping me to become confident enough to actually start to contribute my ideas and opinions. And then she’s been around ever since. And I think I’ve gotten better at sharing them to the point I am at today.

Hannah [00:04:20] And after you attended that first meeting, what was your motivation for increasing your involvement within the PSA?

Deanna [00:04:26] Yes, I think after that first meeting, and to give an example of what the meeting was like, there was about 20 or so early career pharmacists there, from community, from hospital, varying levels of early career pharmacists, from students all the way up to those that were at the end of that 10-year period. And we had a planning, brainstorming session about activities we were going to do throughout the year. And because I’d always been so curious about what else was out there, what other career pathways were out there; I just saw it as this really enthusiastic group. They’re quite engaged, they knew a lot, they had all these different experiences to share and they were super supportive. So, it was at the start of intern year, it was pretty stressful, I was realising that I was going to have to work full time, I was going to have to study my intern training program and then I had research projects to do at the hospital. It was overwhelming, and one of the pharmacists said, look, we’ve been there, you will get through it, let me know if you need any help or you want a study buddy. And I just thought, how could I not be part of this group where people are offering free advice and free help, purely because they want to see me be a good pharmacist too? So yes, that’s what kept me going back, and I think that we’ve still got that going on today.

Hannah [00:05:41] Yes, it’s a fantastic group to be a part of. How did that then influence your decision on potentially stepping out of your hospital pharmacy job and into a research position?

Deanna [00:05:52] The network that I was engaged with in my intern year through PSA Early Career Pharmacists, and I was also an observer on the SHPA branch committee at that point too, it really opened my eyes to, I guess, the different pathways that were out there. And some of these people were, in my opinion, quite brave, and they had stepped away from hospital or community practice to start to try and get more work in a GP clinic, or in aged care. And I guess the fact that they were exploring something new, they weren’t afraid to do it and they were really willing to offer advice, gave me the confidence to step away from my hospital position for a period of time. So, the entire time I was at uni, I was fixated on getting a hospital internship. I figured that was the best career pathway for me, I didn’t see myself as anything else. So, to decide to leave that for a few years, not knowing what would happen at the end, was scary. But I’d met all these people that had stepped out of their comfort zone and they couldn’t have been happier and they felt challenged, they felt fulfilled and they were willing to share that. So, they sort of empowered me to do the same thing because I’d seen that it was possible.

Peter [00:07:03] Is it fair to say that even in your intern year, though, you’d already found a bit of a passion for research?

Deanna [00:07:09] Yes, the thing that sparked my passion for research was my honours project with Dr Jacinta Johnson, and at that point in time, I was a fourth-year pharmacy student. Codeine-containing analgesics were still Schedule 3 medicines, and if anyone remembers that, it was quite the event having people come in everyday dependent on codeine. So, that particular project, we looked at the costs related to the hospital admissions of people who had misused or overused combination codeine-containing analgesics. And that particular piece of work was cited by the Therapeutic Goods Agency in their decision to upschedule codeine-containing products to Schedule 4.

So, I was fortunate I was somewhat in the right place at the right time, researching the right thing. I know Jacinta knew what she was doing, but I had no idea, I just jumped on board. But to see us actually actively be able to contribute to practice and improving patient care and helping pharmacists as well to be able to have those conversations about codine because of the scheduling change. And we weren’t the only reason it happened, but we were cited in that. It just inspired me that we can have a very big impact if we’re researching the right area, if we’re putting the right supports in place. And then in intern year I was lucky enough that the hospital was quite pro-research and I got to work on looking at those Parkinson’s medication-related errors, working on the Antimicrobial Stewardship National Survey, educating nurses and graduate nurses and seeing the impact education had on them. So, it started a little bit earlier than intern year, but I really was empowered throughout that year to keep exploring that research as an option and how it could directly influence or indirectly influence practice for the better.

Peter [00:09:03] So, you got to, I guess, you’ve moved into a research role and at some point, you’ve made a decision to commence doing a PhD on professionalism in pharmacy. Starting your PhD is always a big decision, it’s a big commitment. What was the motivation that said, I want to do a PhD and I want this to be about the professionalism, the ethics and the values of pharmacists?

Deanna [00:09:24] Yes. So, there were two things that, well, fed into my decision to do a PhD, but also fed into my choice of topic. So, throughout my first 12 months of practice, I really, really missed being allowed the time to work on research. I was working as a clinical rotational pharmacist. I barely had enough time in the day to see the patients that really needed me, let alone do anything else. Whereas in my intern year, you were given a few hours each week to work on research or various other things for professional development. So, I really missed that component, and I started to see throughout that 12 month plus of practice that there’s lots of things that happened in the hospital system or the way that we did things that actually prevented good patient care. And I didn’t understand, I guess, what the issues were, and I wanted to have the skillset to be able to influence those various systems and processes.

So, for example, we would have 30 patients on our list. We’d have to prioritise them and depending how clinically complex they were, we might get to council five and organise their discharge medicines and then do a medication history for another three, and then the next day they would have shifted wards and teams, so you won’t see half of them again. And it just seems like a really ineffective way to provide care, but I didn’t understand why it was that way other than being short of time and staff. So, I figured that if I could upskill in research and understanding systems, then I would be able to work out a way of improving things like that.

Secondly, I was, I guess, inspired by my earlier research to pick something that was relevant to practice. I love being a pharmacist, so if I could connect it directly to being a pharmacist, rather than clinical care or drug design or something like that, I was going to choose that. I scoped out different researchers in the practice area and came across the team at UWA, who had, for quite a number of years, been wanting to look at professional, legal and ethical practice because of the observed, I guess, inconsistencies in practice that they’ve seen when they’d done previous mystery shopper studies.

Hannah [00:11:42] And Deanna, when you say scoping out different research teams, what does that process involve?

Deanna [00:11:49] Literally just cold calling people. So, I started with the list of academics that I knew at UniSA that researched various things and sent them an email and said, I’m looking to do a PhD, I’m interested in something practice related, do you have anything, and received various emails back. So, generally those lecturers or research academics would have particular topics they wanted to look at that they would offer. They might refer me on to someone else. Again, I asked Jacinta, who she knew in the area and contacted people that she recommended and spoke to anyone and everyone I knew around me that had done a PhD or had contact with researchers that looked at practice-type topics and had a chat to them to see what was, what they were interested in.

Hannah [00:12:45] And cold calling people can be very daunting. Do you have any techniques or tips to make sure that that process is effective?

Deanna [00:12:51] Yes, I guess, and I’ve seen this on Twitter rather than be told it, but I find that it works. Obviously, being polite, introducing yourself and where you’re from or why you’re contacting them, so, for me recently it’s been, hello, I’m Deanna, I’m a pharmacist and I’m a PhD candidate, this is the topic I’m looking at. And then moving on to acknowledging why you’re contacting them. So, if you’re contacting them on a recommendation from another pharmacy academic, so if it was one of my supervisors, I would say Jacinta Johnson recommended that I get in touch with you about whatever the topic is. If it’s me cold calling them and we don’t have a prior contact with them, I usually acknowledge some of their work or the reason why I’m contacting them. So, for example, I’ve contacted people after seeing a Tweet about a topic that I’m also interested in and I’ve just said, hey, look, I’m looking into this area is there a way that I can get involved or can we call catch up for a 10-minute chat.

Peter [00:13:53] I’m going to come to some more of your amazing tweets a little bit later in our discussion because Twitter is both a great leveller and a great connector professionally as well. I’m keen to learn a bit more about some of what you’ve learnt about professionalism so far. You described yourself as a promoter of pharmacist professionalism, and you’ve sort of studied that, what have you learnt about professionalism in the practice of pharmacy?

Deanna [00:14:17] Firstly, professionalism is a really interesting term, because it’s something that we put in every single professional guideline and document that we have. We tell all our students they have to display professionalism. We think that we measure it. But people don’t ever actually talk about what does that mean? What actually is professionalism? So, professionalism, by its definition, which is incredibly broad, is the traits, characteristics, values, attitudes and behaviours of a professional. So, obviously, we’re talking about pharmacists. Lots of those things you can’t see. So, I focused in on professional behaviour as a component of professionalism, how we talk to people, our body language, our communication. Those things are the things that other people see, that’s how they measure us, that’s how we build trust, that’s how we build relationships. The biggest thing I’ve learnt, so we’ve done a number of things. We’ve looked at use of professional practice resources in terms of guidelines because they actually articulate how we should be behaving. So, we asked people whether they use them, if they do or don’t, why, why not? We also asked a number of key stakeholders, so in this case, pharmacists from all practice levels, all practice settings, interns included, prescribers, consumers and pharmacy assistants, what professionalism looked like.

Peter [00:15:48] What did you find?

Deanna [00:16:00] Well, it was interesting, because what it really highlighted was that a lot of what a pharmacist does is not visible to people on the other side of the dispensary, for example. So, the key thing that came through was that communication is essential, because that’s the main interaction people have with us, and it’s something that they can measure the quality of. They can’t measure the quality of our attitude towards dispensing because you can’t see my attitude. You can just see how I interact with you when I hand your medicine over.

Peter [00:16:31] Does it speak to the need for communication to really be a bit more transparent in why we ask the questions that we ask and why we make the decisions that we do with our patients and with other prescribers and other health professionals we interact with?

Deanna [00:16:46] Yes, absolutely, so because they are only seeing the end point, which was us essentially handing them or selling them a product and maybe talking to them about it or like with our prescribers, it was mainly them getting a phone call about something going wrong. So, they didn’t understand the processes that we’d undertaken to check that it was safe. They didn’t understand why we’re asking them questions when they just see us put a label on a box and that takes 2 minutes sometimes, and for whatever reason, it’s taking 10 minutes this time. So, we need to be transparent about why we’re doing what we’re doing in a way that they can understand.

Peter [00:17:25] Yes, so if I’m talking to a patient about a prescription and they’re getting agitated about how long it might be taking, how might I change how I talk or what phrases might I be able to use to help change that communication in a more positive way?

Deanna [00:17:38] If you work out any, I’d like to know them too. I guess we didn’t really delve down into specifics, but we did try to get our participants to give us examples, and it started well before you’re handing out the prescriptions. So, their perception and how willing they were to interact started the moment they walked in the store. So, if they came in the store and they weren’t greeted or people didn’t acknowledge them, then they were already put off. So, I think it starts with either introducing yourself or acknowledging they’re there, describing what it is you’re going to do, so, all right, great, you’ve got this prescription here, that’s probably going to take 5 minutes, but I’m going to just double check that it’s the right medicine for you by checking that there’s no drug interactions, and I’ll have a quick look at some information and give you some information about side effects. So, they go, oh yes, this is what you’re doing, that’s why it’s taking 5 minutes. That also gives you leeway to come back out and say, look, while I was going through, I’ve actually noticed you’re on this other medicine, it might interact with it, which might mean you’re more likely to have side effects, so I’d like to talk to the doctor if that’s okay, it’s going to take another 10 minutes, but I want to make sure it’s right for you. So, if you start that interaction in a way that, I’ve got steps that I need to take, but I’m doing them for you, this is probably how long it’s going to take. Then when you come back and you’re adding on to that, hopefully it doesn’t escalate.

Hannah [00:19:11] Yes, and something that we teach our pharmacists and technicians at my work is also resetting those expectations. So that instead of just calling the doctor, actually explaining to the patient, this is the issue you’re going to call the doctor for. So, they’re not sitting there for 10 minutes making up stories of what’s potentially happening behind the counter. They’re actually aware of the process and the fact that we’re doing it to benefit them.

Deanna [00:19:36] Absolutely and they do not like whispering behind counters, and they don’t like talking through assistants. They find that unprofessional, and they can very readily describe what unprofessional behaviour is and what poor communication is. It’s much more difficult to describe those good interactions so that we can model them. So, we’ve got some work to do there, I think, to work out more, delving further into what that looks like. But you’re right, it’s resetting those expectations, so you’re not making them promises at the start that you don’t keep and breaking that trust within one interaction.

Peter [00:20:12] In terms of transparency, certainly, for me, in my practice, I found the medicine safety report, PSA’s medicine safety report series, has really helped me reset conversations. Talking in terms of medicine safety, your safety is my top priority. This will take as long as it takes to do safely.

Hannah [00:20:34] If someone’s a little bit agitated when they’ve been waiting; I like to start a conversation with thank you for your patience. So, immediately identifying the fact that they’ve waited and you disarm them pretty quickly. So, I’ve had a couple of patients when I’m on the ward say, oh, well, I’m sorry, I haven’t actually been very patient, and that actually makes them start to reflect on their behaviour. But then also, you start a conversation with everyone feeling quite relaxed and on the same page, so making sure that you can get that information across about their medications, about the supply and potential side effects to look out for.

Peter [00:21:07] It’s a really good point, Hannah, as well, because I remember being on the phone, on hold for an hour with the phone company once and my agitation disappeared instantly when they uttered those words.

Hannah [00:21:15] Thank you is a very magic word. So, Deanna, we’ve spoken about conversations with both pharmacists and prescribers, how does communication impact on these relationships?

Deanna [00:21:27] I think the big thing to point out is that how we communicate is the other person’s experience of us. So if that communication breaks down, then they start to distrust what we’re saying, and we cannot do our jobs because our main job is communicating with patients, with prescribers or nurses, whoever it is, we’re essentially medication information translators. With prescribers specifically, they were much better at pointing out, I guess, very specifically what they didn’t like, but also giving some possible solutions. So, they notice that pharmacists, particularly in a community setting, are mainly calling them because they have a problem with the prescription. Their only relationship with community pharmacists tended to be quite poor ones for that reason. They also described having worked with pharmacists, accredited pharmacists, so pharmacists providing home medicines reviews or pharmacists in a hospital setting, and they talked about those relationships quite differently. And they talked about them from a perspective that they were collaborating on the patient’s care, that they were asking for medicines information and receiving answers specific to their questions. So, for example, they had a patient, they weren’t sure which anticoagulant was most appropriate for them, so they called this medicines service and they specifically did some research, sent them through the research and the evidence for that patient. So that built trust, and that happened over years. Now they have a pharmacist in the GP clinic. For the community pharmacists, because they didn’t have a good relationship, they suggested that pharmacists should go and introduce themselves to the local GPs in their area so that their relationship starts off as, this is the person on the other side of the phone. So, introduce yourself, establish the best way to communicate and establish that you’re there for a two-way conversation. So, if they’re not sure which PBS code to put in because they’ve forgotten and they’re out doing a home consult, they can give you a quick call and you look it up for them.

Hannah [00:23:36] Once people start to realise you’re happy to answer questions it can really develop the relationships and at the end, improve patient outcomes. We’ve spoken about some of the issues with professionalism, are there any structural barriers that you identified?

Deanna [00:23:51] Yes. So, I’m looking at the professional behaviour of pharmacists. We look at their capability to be able to enact the behaviours, so we look at, do they have the right knowledge, do they have the right skills to be able to do it? We look at opportunities, so is their environmental issues stopping them from acting professionally, is there social influences on the reasons that they’re behaving or practicing how they are, and also look at motivations. So, intrinsically, do they want to do the right thing, are they getting rewarded if they do the right thing, stuff like that. So, when we look at that and we asked pharmacists what’s stopping you from doing, completing, ideal practice, the things we hear over and over in pharmacy in terms of being a barrier are money and time. They gave the impression they wanted to do the right thing so we assume they have the motivation. In terms of capability, do they know how to do the right thing, do they have the skills to do it? Yes, I believe so. You certainly leave university with the basic knowledge and skills to do those things correctly. So, I think we have a huge issue in terms of the environment that we operate within, which often is out of control of the individual pharmacist.

Peter [00:25:04] So, there are some things we can control and some things that we can’t control. And things we can control sometimes are choosing our place of employment; it might be how we choose to handle a particular interaction with a patient. But sometimes saying no can be a really challenging thing. If your professional and legal obligations require you to say no to somebody, what’s a better way of doing that than just having a blank negative response to that patient?

Deanna [00:25:28] Yes. So, I talk about this quite a bit with other friends that are pharmacists, and the conclusion we’ve come to is to not actually say the word ‘no’. So, you might have decided in your head, you’re like this, I can’t do that, that’s illegal. Or I’m not doing that, that’s unethical, unprofessional, whatever it may be, you have your reasons. With everything, and we were previously talking about when we’ve given doctors a call to talk to them because there’s something wrong with the prescription, people like solutions, and if you can provide them with an option or a solution to their problem, they’re going to be much more accepting of you essentially saying no to whatever the request was. Whether it be they’re asking for an owing prescription, happens all the time, you’re probably not going to blanketly be like, no, I can’t do that. You’re going to work out what other options you have for that person to provide them that medicine or to enable them to get a prescription for it. So, the conversation usually goes, you asked for an owing prescription, what we actually can do is X, Y or Z, what would you prefer me to help you do? So, you’re not saying no, you’re not saying I can’t, you’re just saying these are the options that you have. If they then say, no, I want that, you can say, look, it’s not safe or it’s not professional and give your explanation then, but offer them solutions before the problem, if possible.

Peter [00:26:57] Offering options is something that I want to pick up on there. I can think of an emergency supply situation I had. I work in a 24-hour pharmacy, which at 5 in the morning, occasionally, if I’m doing an overnight shift, you will see somebody with some unusual emergency supply and pre some of the expanded COVID supply rules that we, thankfully, have available and hopefully hang around long term, we had someone who was visiting Melbourne for the day. They were on a NOAC, a novel anticoagulant, and they didn’t have their medicines with them. They absolutely knew that they shouldn’t be missing their dose because harm can come from it but they didn’t bring a prescription with them. Being a relatively high-cost medicine, there were a couple of options at 5:00 am you can provide, one is that it’s going to be a relatively high cost for a single dose because you’re breaking a box, or you facilitate fairly early access in the morning through either waiting list at a hospital to an emergency prescriber or try and access a doctor. I am continuously surprised at the number of times patients are quite happy to choose fairly high-cost options to get the best option for them at that time. And it’s taken me a while to get out of the habit of mentally excluding the high-cost options. But I think the health sector does that quite commonly. Is that something that you found in your work?

Deanna [00:28:12] Yes. I haven’t specifically asked about it, but through reading all the research in the area, patients want to be offered options because they want to feel like they’re in control of their own health care, and they should be in control of their own healthcare, right? And if the option is I pay $20 or I go to ED, if they can afford the $20, I’m pretty sure that’s what they’ll pick. But yes, I agree, I’ve done the same thing. You haven’t sort of offered that option because you think that it’s out of what they’re willing to pay. They’re willing to pay for health care that they see a benefit of. We see that when they pay quite a substantial gap to go see a GP of their choice. So, I think that that option should always be offered, acknowledging that for some people, it’s not an option, but for some it is.

Hannah [00:29:05] Absolutely and I don’t think it’s fair for us to be dictating what people can and can’t afford. I’ve seen patients in practise decide that the FreeStyle Libre is worth the $90 a fortnight, and they’ve really rejigged their budget to make sure that they can.

Peter [00:29:21] And even for a delivery fee late at night, I’ve had people who are on health care concession cards but have been willing to pay a fairly hefty delivery fee to arrange a late-night delivery through a courier service because to them, not leaving home and being able to access that medicine from home has been more important to them. So, people make their own decisions and we shouldn’t be the ones making those judgments for them.

Hannah [00:29:45] Another key ethical scenario that comes up in community pharmacy is the provision of emergency contraception as an S3. We still find that some people in community pharmacies are running with the, fill in the paperwork, document, questionnaire and sit in the naughty corner, then the pharmacist will see you. How do we ensure that pharmacists are staying up to date with current guidance?

Deanna [00:30:12] Yes, this was an issue that was brought up by the participants in my research. So, we did quite a large survey to find out which of PSA’s Professional Practice Guidelines they used in the last 12 months. And also, part of the focus groups that we did, we asked what the barriers and enablers were to essentially using these guidelines and resources. It’s interesting that you pick up on the emergency contraception supply issue because that guideline was, I think, the second or third most accessed in the previous 12-month period.

Hannah [00:30:51] Wow.

Peter [00:30:51] Wow.

Deanna [00:30:54] As told by our respondents. So, I think the first two were the Professional Practice Standards and Code of Ethics. And we did have students in there, but the Schedule 3 guideline for emergency contraceptive supply was next. So, 40% of 600 respondents had accessed that in the last 12 months.

Hannah [00:31:12] Wow.

Peter [00:31:16] But the use of that form has not been recommended for a large number of years, and yet it’s still something we see quite commonly used in the profession. It’s cited by women around the country, including on social media, and in communication with their pharmacists, as potentially being a barrier to care, for many, whether that’s for language or because people don’t want those details recorded. How do we change that practice?

Deanna [00:31:38] I think the problem here is that people obviously aren’t confident to have that conversation with the woman herself. I personally have never used the checklist. I have always, when I’ve been asked for that particular product, said no worries, I’m happy to give it to you, are you happy to have a chat? I just want to make sure that you’re going to get the best out of this medicine or that you know about things to look out for just in case. And most of them are like, oh, great, thanks. And then I’ve had the conversation with them, and it’s ended up that the emergency contraceptive pill that they’re asking for isn’t the most appropriate one for them, or that they are 99% sure they can’t possibly get pregnant, so I need to tell them about other options. In terms of getting people to change their practice, I think there are a number of things that need to be looked at. I think it’s the pharmacists themselves. Firstly, do they have the awareness that the checklist is no longer the best option? And we’ve found that women actually do not respond well to it and that they’re not providing the best possible care if they’re just asking a checklist of questions without a conversation. So once that awareness is addressed, we actually need to look at the workflows of the pharmacy. I think, sometimes, unfortunately, it’s used to sort of bypass the pharmacist’s involvement in that particular sale or conversation, which does not meet the guidelines or legal standards at all. So, I think once we can be sure that everyone is aware that that’s not the best way to go, and part of that might be removing it from wherever we can find it too, we need a little re-education campaign about your responsibilities and workflows. And that might be educating our pharmacy assistant staff, too. So, the pharmacist might know that that’s not the best way forward, but the assistant might not be comfortable with receiving those requests on the front line and referring them on, so some upskilling there might be needed too.

Hannah [00:33:36] How important is it that we support both pharmacists and pharmacy assistants to upskill continuously and building these skills of having difficult conversations and dealing with ethical dilemmas?

Deanna [00:33:48] Yes, I think it’s become increasingly important and I think, hopefully, there’s been a bit of a spotlight shone on it because of COVID, that our assistants are just as vulnerable to having these conversations almost as much as we are. We have the legal responsibility, but their job is to support us and most of the time they really want to be there and to help us out, they don’t know how. So, we have to bring them along for every step of the ride. Every time we upskill or expand our scope of practice, we should be looking behind us to see how can our assistants support us and what kind of training do they need? The pharmacy assistants and technicians in my research were very, very clear that their job was to help the pharmacist, but they could only do that if they were appropriately skilled and also recognised for their contribution, which I think often unfortunately doesn’t happen as much as it should. We are under-recognised and then we under-recognise those that are supporting us.

Peter [00:34:54] Something, as we sort of come towards the end of the podcast, and something we’re keen to work through, is your recent appointment to PSA’s Board as the ECP representative. I guess we’ll start by looking at what made you want to become involved with the PSA Board in that ECP role.

Deanna [00:35:13] Yes. So, throughout my research, I’ve obviously worked out there’s a lot of, sort of systematic barriers in place stopping us as pharmacists from practicing to the top of our scope and providing the best possible care that we can. And like I explained earlier, my motivation for research was because of these barriers and working out what they are, being on the board means that I can see the inner workings of Pharmaceutical Society of Australia as an organisation and see how they’re actively working towards addressing those barriers in terms of their interactions with state and federal government, in terms of the way they construct continuing professional development and training programmes and advocate on a grassroots level for us, but also right up at the top. So, I wanted to be able to understand how the organisation works so that I could understand how I can best contribute to that and also communicate that back to our early career pharmacists that are so removed from it. They probably don’t see that and know that there’s people working on the inside to improve things for them. And I also have quite a curiosity, a little nerd bit is that I like governance, I like structures, I like policy, I like seeing how we go from these sorts of big, big ideas or big statements that are very broad all the way down into how that results in action for the pharmacist that’s working in the pharmacy 50 hours a week. So, it was to be able to see and then actively contribute to that, of course.

Hannah [00:36:47] And it’s really important for ECP’s to have a voice on the board via that position. We know it’s still a relatively new position, having only been filled by Taryn, Lauren and then yourself. What do you bring to the room where the decisions are made?

Deanna [00:37:01] I’m quite candid about the early career pharmacists’ perspective when we are making decisions or discussing how things would impact members. And obviously incredibly passionate about making sure that that process is transparent so that others can see how we’re making those decisions on their behalf. But also just making sure that we never forget the pharmacists at the coalface. They’re very high-level discussions at times, but they’re going to affect our pharmacists working and providing vaccines and things like that.

Peter [00:37:39] So, what are the biggest issues currently affecting the pharmacists at the coalface?

Deanna [00:37:40] So, we’re talking about things like our stance on vaccinations, our stance on nicotine vaping products. So, the board approved the position statement that PSA puts out. That position statement directs our communications with media and with government about what pharmacists need and what they need to actively supply those products in a safe way. And then in terms of vaccinations, PSA were the ones that were advocating to all the governments to get legislation changed and to get us involved in the rollout. Didn’t happen as quickly as any of us would have liked, but without the PSA staff and management constantly advocating for that, we probably wouldn’t have got anywhere. And then I guess long term goals is different ways of being remunerated and continuing to explore role expansion for us and how we can make those things sustainable long term.

Hannah [00:33:38] If we continue those themes of big goals and looking forward, how will you know if your time as an ECP Board Director is a success?

Deanna [00:38:48] That’s a big question. So for me, it’ll be if I can connect up as many ECP’s as possible so that our conversations that we have about problems we’re experiencing in our workplace are being shared across states, nationally, and if someone feels a little bit less alone because they were able to have that conversation with someone in Victoria because of something we facilitated in the Communities of Specialty Interest, I’ll feel like my job is done for ECP’s.

Peter [00:39:23] And you’ve created a segue for me there by mentioning the Communities of Specialty Interest. For those that aren’t familiar with what it is, how would you describe it to them?

Deanna [00:39:35] It’s like, we’re calling it early career pharmacists without borders now, so imagine a Zoom chat with just like 20 to 100 of the coolest young pharmacists you can find from every corner of Australia, and that’s what the Communities of Specialty Interest is. And we’ve got a discussion forum to talk to each other. So it’s like a Facebook group with early career pharmacists, except for this time, there’s no non early career pharmacists in it. That’s a terrible explanation.

Peter [00:40:00] No, I liked that, talking about Zoom. We’ve all become very familiar with Zoom through the pandemic.

Hannah [00:40:13] And the forum is an excellent way to engage with other like-minded early career pharmacists, so it’s great to be involved in. You mentioned the wonderful Jacinta just earlier in this conversation, what role have mentors played in your career thus far?

Deanna [00:40:28] I can’t quantify the impact that mentors, and I didn’t call them that at the time, have had on my career. Like I said, it definitely, most definitely started with Jacinta encouraging me just to look at other things, get involved. Being someone to read over my resume when I was applying for an internship, and I think she’s read over most of my CV applications every chance since. I draw my inspiration and passion from other people. If I’m having a low day and I talk to a pharmacist that’s enthusiastic about whatever it is they’re doing, I feel better. So, mentors and peers are the reason why I’m researching what I’m researching, the reason why I’m in the positions at PSA I’m in, because I want to be able to help them and their practice. My mentors in particular are just the people that provide me with the confidence, I guess, to pursue the things that I didn’t think I could do. So, yes, I definitely wouldn’t be on this podcast, Pharmacy & Me, without them.

Peter [00:41:41] And you do rattle off on a tweet late last year, I’m going to point to now, some of the amazing mentors that you had, Jacinta Johnson, Amy Page, Kenny Lee and Rhonda Clifford, but to name a few. It was really powerful. You wrote that I’m somebody that always looks forward to the next thing. I rarely celebrate my achievements along the way, and lately I’ve been rather focused on how much work I have left to do and how little of what I have done I have published. This needs to change. But then you go on to talk about this concept of writing a done list as well as a to-do list.

Hannah [00:42:11] Love it.

Peter [00:42:15] This list that you wrote back at the end of last year focused on some fantastic achievements, whether that was some of the work you’ve done within your PhD, and the work you’ve done with PSA and returning to work in the community pharmacy and hospital pharmacy settings and great work with FIP. What would be on your 2021 done list? And is this something you would encourage other pharmacists to do?

Deanna [00:42:33] You’ve just reminded me that what would probably have gotten me out of my bad mood last week was writing another done list. So, I’m going to go and do that again. I guess I’m most proud this year of continuing to survive the pandemic life. I’ve taken up more teaching roles at UniSA, which I’m really proud of. I did some teaching for UWA. I was on Zoom, they were all in a room, so it was this weird hybrid teaching and I managed to do that. I’ve done a number of courses to upskill in things, but I’m most proud of just still getting up each day and continuing to do it because it’s been a long, COVID has been a long five years or whatever it’s been. So, yes, I need to write a new done list. I think I have some different activities to add to it this time, but that reflection is so important for me because I tend to always look forward, which means that I always do a lot. There’s more to do and stopping to reflect on how far I’ve actually come helps to recentre me. And yes, I would encourage other pharmacists to do it because it is so easy to focus on all the negative things or all the things you think you did wrong or you’re not being paid what you think you should, or whatever it is. Reflecting on what you’ve actually achieved will help you to move forward, too.

Hannah [00:44:00] There are a couple of questions we like to end on with all our guests. The first one is what’s the best piece of advice you’ve been given?

Deanna [00:44:03] Be the change that you want to see.

Peter [00:44:09] And what are your top three tips for early career pharmacists who want to improve?

Deanna [00:44:12] Be reflective, think about the conversation that you had or the piece that you wrote and think about how you could improve that next time. If you do this once each day for a short period of time, then you’re always going to improve. Get a hype girl, or man, or friend. Everyone needs some positivity in their life, so it’s nice when you’ve got someone else to remind you how great you are. If you can’t find them, join the CSI and we will be your hype women and men for you. And I think the third thing is you’ve chosen to contribute to the health care of Australians. So, if you have joined with the best intentions, then you’re always going to be a great pharmacist. So remember your why and you’ll continue to improve.

Peter [00:44:56] What a wonderful place to leave it.

Hannah [00:44:59] Some really great advice Deanna and we’d like to thank you so much for coming on the show today.

Deanna [00:45:03] It’s been great. Thank you.

Hannah [00:45:06] And thanks to everyone for listening. You can check out the show notes for links to everything we’ve spoken about today. And don’t forget to subscribe to get episodes as soon as they’re released.

Peter [00:45:15] And if you’re looking to connect with other early career pharmacists or take an active role in the profession like Deanna, consider joining the ECP Community of Special Interest.