American Journal of Pharmaceutical Education 2013; 77 (5) Article 92.
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`ADDRESSES
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`2013 Rho Chi Lecture: Writing the Headlines of Tomorrow
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`Joseph T. DiPiro, PharmD
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`South Carolina College of Pharmacy, Columbia, South Carolina
`
`Headlines are a reflection of society, what people
`value or find interesting. They indicate sensational events
`as well as trends that affect important aspects of peoples’
`lives. While headlines originated in the print mass me-
`dia, they remain important in our wired and digital world.
`When headlines are about pharmacy, they provide a mir-
`ror to how we are perceived by society. Whether head-
`lines are good or bad, they influence the course of our
`profession. Recently the negative headlines about phar-
`macy unfortunately outnumbered the positive, mostly re-
`ferring to the New England Compounding Center tragedy,
`and that is something the profession will need to work
`through to reestablish credibility and trust that was lost.
`We have seen many positive headlines that reflect
`how pharmacy is changing and moving to a patient-
`centered rather than product-centered profession. On
`August 14, 2010, a headline on the front page of the
`New York Times1 read “Pharmacists do more than count
`pills.” The story begins:
`
`“Eloise Gelinas depends on a personal health coach. At
`Barney’s Pharmacy, her local drugstore in Augusta,
`Ga., the pharmacist outlines all her medications, teach-
`ing her what times of day to take the drugs that will
`help control her diabetes.”
`
`This is a lengthy story about Barney’s Pharmacy
`and the pharmacists who work there. They provide a wide
`range of wellness and clinical services in addition to
`traditional prescription services. Such a story in a promi-
`nent news source is a significant positive impact.
`In the December 15, 2012, edition of the New York
`Times,3 on the editorial page, the headline read “When
`the doctor is not needed” and it goes on to describe the
`potential for pharmacists (and other health professionals)
`to fill the big gap in primary care. It talks about how phar-
`macists are underutilized given their education, training,
`and closeness to the community. Last week, on National
`Public Radio a nationally broadcast story was headlined
`“Why The Hospital Wants the Pharmacist to Be Your
`Coach.” It talked about how hospitals are partnering with
`
`Corresponding Author: Joseph T. DiPiro, PharmD,
`Executive Dean, South Carolina College of Pharmacy.
`E-mail: jdipiro@sccp.sc.edu
`
`1
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`community pharmacies to help keep patients out of the
`hospital by managing their medications.
`What will the headlines be 20 years from now? That
`will be in an era determined by your generation, not
`mine. I can imagine the good headlines: “Pharmacists
`clinical services become a standard in health care” or
`“Retirees demand medication therapy management by
`pharmacists” or “Pharmacists play major role in designing
`drug treatment regimens using genomics.” And even the
`possible negative headlines, such as “Importation and
`automation lead to demise of the pharmacy profession.”
`I am and remain very optimistic about our future as
`pharmacists and the roles that we will play in health care.
`Medications are much more commonly used, particularly
`for chronic diseases, and make up a greater portion of
`the national health care expense compared with 10 years
`ago. Medications are increasing as a portion of the na-
`tional health care budget, the number of prescriptions will
`significantly increase, as will expenditures on prescription
`drugs.
`When I think about the huge changes that the pro-
`fession has gone through from the time I graduated in the
`late 1970s until now, I am confident that we will continue
`to progress as a profession. There is so much that we know
`now about our profession that was not evident a decade
`ago. Years ago we talked about how much we needed the
`evidence for the effectiveness of pharmacists in health
`care. The evidence is in and has been published in well-
`respected journals. Studies by Cab Bond showed that
`clinical pharmacists working in hospitals are associated
`with lower mortality rates.4 Pharmacists effectively manage
`patients with diabetes, as demonstrated in the Asheville
`Project,5 and manage hypertension6 and many other dis-
`eases and conditions. Pharmacists activities result in a
`significant savings in health care costs (approximately
`$5 for each dollar spent on clinical pharmacy services).7
`There are hundreds of other good examples documenting
`the benefits pharmacists contribute in health care.
`So what will prompt the headlines about pharmacy
`in the future? Certainly we have to hope and also actively
`work to assure that there are no more drug-related trage-
`dies. The future headlines will result from what the pro-
`fession does and what we as pharmacists do individually
`to address societal needs related to medications. I hope
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`American Journal of Pharmaceutical Education 2013; 77 (5) Article 92.
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`that you have seen the vision of pharmacy written a few
`years ago by the Joint Commission of Pharmacy Practi-
`tioners. They describe the role of pharmacists as such:
`
`“Pharmacists will be the health care professionals
`responsible for providing patient care that ensures
`optimal medication therapy outcomes” and “Phar-
`macists will have the authority to manage medication
`therapy and will be accountable for patients’ thera-
`peutic outcomes.”
`
`This is a vision well focused on societal needs, and
`the needs related to medications are obvious. There are
`many unresolved problems related to medications, in-
`cluding high expense, medication errors, inappropriate
`drug use, preventable adverse drug effects, poor adher-
`ence to therapy, and counterfeit medications. Pharmacists
`can be assured of an important role in health care as long
`as we are focused on these needs and unresolved prob-
`lems. They are not likely to go away any time soon.
`Some important points that I would like to talk with
`you about today is how you as individuals can be a part
`of writing the headlines of tomorrow. How can you set
`a foundation for a career of influence on health care?
`I know that you are going through a rigorous PharmD
`curriculum, but this is not sufficient to assure your suc-
`cess within our profession. As good as your program may
`be, there is a lot that cannot be well taught in the curricu-
`lum, such as, how to work in a busy, complex health care
`environment, how to effectively supervise people, how to
`make the most effective use of information technology,
`providing care in rapidly changing health care organiza-
`tions and understanding rapidly changing areas in bio-
`medical sciences. And there are aspects about pharmacy
`education that are not the most effective in promoting
`progressive thinking and acting. We well know that, as
`hard as we try, some of what we do in pharmacy colleges
`is not the best. When we teach factual knowledge it quickly
`loses its value and can easily be replaced. Pharmacy itself
`and health care are rapidly changing, requiring new knowl-
`edge and skills all the time. And our traditional lecture
`approach does not instill the desirable attributes needed
`of pharmacists.
`After 35 years as a pharmacist, there are some things
`that have become more clear about what is important in
`how we act as pharmacists, what we do, and how we do it.
`I am talking about 4 important personal characteristics
`that lead to the headlines: working hard, capturing ideas,
`being persistent, and a commitment to quality. The com-
`bination of these characteristics is a sure way to a career
`with significant influence on health care by serving the
`needs of society. One without the others is not likely to
`be effective.
`
`2
`
`Working hard is a necessary foundation for suc-
`cess but not a guarantee. The words can sound trite and
`many of you may be thinking – “Great, I want a life
`outside of pharmacy – life is not all about work.” You
`would be correct and I agree. Hard work has at least
`2 dimensions – quantity and quality. A career objective
`should not be to work 80 hours per week, and I am not
`saying that “the more hours you work the higher your
`chance of success.” Working hard is working smart.
`Learn how to prioritize, put effort into the important
`things. Learn what needs to be done now and what should
`be put off. Remind yourself of your priorities, write them
`down. I have some key words that I think about from
`time to time to make sure I am working on top priority
`areas for my college: usually these are communication,
`organization structure and people, resources, advocacy
`for the college, and fund raising. These words help me
`sort out all that I have to do and keep my work focused.
`What will be your key words that help you stay on the
`right path?
`Efficiency is an important part of working smart. It
`is possible and desirable to be more productive and work
`fewer hours. Identify what distracts you from being pro-
`ductive. It is easier to balance work-home life when you
`are more efficient. Working hard, working smart is some-
`thing you can control early in your career. It sets the foun-
`dation for a successful career.
`So if you work hard, where does that get you?
`Competence—you become reliable and dependable,
`someone with integrity. These are all good things, but
`real progress or advancement of the profession takes
`ideas. Ideas jump start progress. Ideas come from insight
`and perspective about problems and needs. Develop a
`mindset to search for ideas about ways to solve prob-
`lems in health care. Identify the gaps in knowledge and
`understanding. Any time you hear complaints, problems,
`or unmet expectations, there are opportunities for new
`ideas. I believe that ideas come to most people any time
`of day or night, and most are forgotten. Find ways to cap-
`ture ideas, write them down, enter them into your iPhone,
`to save them for later when they can be put into action. A
`great objective for attending a meeting like this is to
`come home with one new idea.
`I have come to believe that one distinguishing point
`between an average person and one who has high achieve-
`ments is not that one does not get the ideas and the other
`does. It is that the high achiever can carry those ideas for-
`ward, can retain them and act on them. Many of us de-
`velop a rationale for not moving forward with ideas, a
`rationale that sounds like common sense but can be code
`words for inaction and inertia. For example: “it will take
`too long,” “I don’t know how,” “it is already good enough,”
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`American Journal of Pharmaceutical Education 2013; 77 (5) Article 92.
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`or “it would cost too much.” When you hear these words,
`a light should go off in your head to recognize that these
`can be rationales for discarding good ideas.
`Creating headlines and implementing new ideas
`means being an agent of change. I expect that all of you
`will at some time want to be agents of change. One of the
`most difficult things to manage at any level of profes-
`sional services is change. People are naturally resistant
`to it. Change can bring out the negativity in people and
`you can find yourself fighting an uphill battle. So it is
`important to have a plan and a method to successfully
`implement changes. One framework for managing change
`was written by John Kotter, a Harvard faculty member in
`his book titled Leading Change.8 To achieve the kind of
`change that makes a difference in our profession requires
`planning and does not happen by chance or waiting for
`someone else to do it.
`When I started as dean at the South Carolina College
`of Pharmacy, I was faced with a change of major pro-
`portions, merging 2 independent colleges of pharmacy.
`The newly merged college started out with no focused
`mission, divergent cultures, minimal trust among faculty,
`and considerable inertia to resist change. Over the past
`8 years we had to work through this to make our college
`a functioning program of high quality.
`I am confident that at some point in your careers,
`probably sooner than later, you will be faced with imple-
`menting an idea that represents a major change. I have
`found the approach by Kotter extremely helpful and I am
`sure that you will too when you have the need to imple-
`ment change. He describes the steps to effectively lead-
`ing change. It begins by establishing a sense of urgency
`(communicating why change is needed). Effective change
`management requires creating a team, developing a vi-
`sion and strategy, communicating the vision, empowering
`others, demonstrating “wins, and changing the culture for
`long-term. With all the changes going on in health care,
`you will have many opportunities to effectively “manage
`change.”
`The third quality for success is persistence. Persis-
`tence is patience with effort, focus, and commitment to
`a cause. What do you value highly enough that you would
`commit to it with years of effort? I don’t believe in over-
`night success in our field, it takes time. For many goals,
`regularly making incremental advancements over time
`can bring you a long way. I think that is what persis-
`tence is, not being disappointed that you can’t change
`the world over night and having a willingness to hang
`in there with small changes over time. If there is some
`achievement or goal that is important to you, be per-
`sistent about it. I refer to this as having a “marathon
`attitude.”
`
`3
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`The fourth and final characteristic I want to talk
`about is a commitment to quality. Certainly, everyone
`can agree with that. But what does it mean? What is qual-
`ity? You can answer that only by learning about quality.
`How do you know quality when you see it? This char-
`acteristic should really be “A commitment to learn
`about quality.” Think about some of the finer things in
`life – art, ballet, or very good wine – we don’t recognize
`their qualities until we learn what quality is. To recog-
`nize quality we need comparisons—who or what is the
`best? Whether you admit it or not, not committing to
`learn about quality is commitment to mediocrity. One
`of my favorite quotes is from Michelangelo, who said
`“The greatest danger for most of us is not that our aim
`is too high and we miss it, but that it is too low and we
`reach it.” With these 4 characteristics, working hard,
`capturing ideas, being persistent, and committing to qual-
`ity, anyone can set the foundation for a career of influ-
`ence, to write the headlines of tomorrow.
`I remain very optimistic for our profession in the
`years ahead and for your career opportunities. Whether
`you enter community pharmacy practice, practice in a
`health system, or in one of the many dozens of other set-
`tings, you will find many doors open to you. Recognize
`that there are interesting and challenging careers at the
`interface of other professions and disciplines: for exam-
`ple law, public health, business, computer science, and
`information technology. Being a pharmacist gives you
`opportunities in these areas that others don’t have.
`You won’t be able to succeed alone. Almost every-
`one who has been successful can tell you about people
`who were influential in their careers. Sometimes these
`are recognized as mentors. I can see clearly in my career
`how people along the way served as mentors and helped
`me to get to the next step in my career. I still have men-
`tors who I rely on. Who you associate with is one of
`the primary determinants of whether or not you will be
`successful. Successful people create an environment that
`helps others become successful.
`It is important to be observant and identify the suc-
`cessful people around you. The right mentors help you
`in ways that are difficult to put a price on. They tell you
`things you didn’t know; keep you informed. They are
`your advocates. They are your best critics who will tell
`you when you could have done better. They help you
`solve dilemmas and ethical issues. They keep you an-
`chored to reality.
`So, I have talked about the ways that you can put
`yourselves in a position of influence: working hard (and
`working smart), cultivating ideas, being persistent, and
`being committed to learning about quality. Making these
`characteristics part of you and your career will go a long
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`way to positioning yourself as a person of influence, one
`who can write the pharmacy headlines of the future. It is
`entirely appropriate that you would dream about the
`possible headlines in 10 to 20 years from now as moti-
`vation and inspiration for what you will set out to do in
`your career. What will the headlines be for your gener-
`ation of pharmacists?
`
`REFERENCES
`1. Abelson R, Singer N. Pharmacists take larger role on health team.
`New York Times. August 14, 2010:A1.
`2. When the doctor is not needed. New York Times. December 16,
`2012:SR10.
`
`3. Whitney E. Why the hospital wants the pharmacist to be your
`coach. National Public Radio. February 19, 2013.
`4. Bond CA, Raehl CL. Clinical pharmacy services, pharmacy staffing,
`and hospital mortality rates. Pharmacotherapy. 2007;27(4):481-493.
`5. Cranor CW, Bunting BA, Christensen DB. The Asheville Project:
`long-term clinical and economic outcomes of a community pharmacy
`diabetes care program. J Am Pharm Assoc (Wash). 2003;43(2):173-184.
`6. Carter BL, Ardery G, Dawson JD, et al. Physician and pharmacist
`collaboration to improve blood pressure control. Arch Intern Med.
`2009;169(21):1996-2002.
`7. Perez A, Doloresco F, Hoffman JM, et al. Economic evaluations
`of clinical pharmacy services: 2001-2005. Pharmacotherapy. 2008;
`28(1):285e-323e.
`8. Kotter JP. Leading Change. Harvard Business Review Press:
`Boston; 1996.
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