Tom English is the editor-in-chief of Student Pharmacist magazine in Washington, DC.
In the September–October issue of JAPhA, Wendy Mobley-Bukstein, PharmD, BCACP, CDCES, CHWC, FAPhA, detailed the virtues of interprofessional collaboration among health care providers. Mobley-Bukstein, an associate professor of pharmacy practice at the Drake University College of Pharmacy & Health Sciences, has an ambulatory care practice in an internal medicine and family medicine office where she works 3.5 days a week. She believes that “interprofessional collaboration in the current health care system is imperative,” and pharmacy practitioners must foster these relationships.
Always eager to engage with and mentor students, Mobley-Bukstein recently sat down with Student Pharmacist magazine (SPM) to discuss her experiences and share valuable advice.
SPM: Please describe the collaboration and daily interactions you have with other health care providers at the federally qualified health center.
Mobley-Bukstein: My office is located in the internal medicine office. I am literally steps away from certified medical assistants (CMA), medical residents, and physicians. I do not have a collaborative agreement; this is due to being a pharmacist in a federal entity (where the pharmacist is not recognized as a provider). Our work directly impacts quality indicators for our patient-centered medical home designation.
All of my recommendations are sent to the physician for signature. That said, the physician and I have discussions about what is going to be in that note and what changes I would like to make. Nothing is ever sprung on the provider. We make collaborative care plan decisions, and then the documentation of those decisions is sent to the provider to sign off on. We are in constant communication with the attending physicians, resident physicians, and CMAs.
I would say that we have “face value” in that they see us all day, every day, and recognize the utility of our knowledge in the clinic.
SPM: You indicate in your JAPhA article that relationship-building is at the core of interprofessional collaboration. How does a pharmacist go about fostering these relationships and building rapport?
Mobley-Bukstein: With any relationship, there is a give-and-take. It is imperative that the pharmacist have a clearly defined role and responsibility in their position. They should be curious and ask questions. [They should] meet with the physicians whom they are working with on a regular basis. Offer education on different disease states and treatment guidelines. Showcase the value of the pharmacist on the health care team.
SPM: How important is active listening in these interprofessional relationships?
Mobley-Bukstein: Active listening is paramount in interprofessional relationships. It lets you identify areas of knowledge gap—perhaps rhetorical questions or areas in which the provider is an expert and where you can learn something. It affords you the opportunity to become better at your role and allows you to be more effective on the health care team.
SPM: Does interprofessional collaboration increase efficiencies in health care delivery? If so, how can pharmacists help?
Mobley-Bukstein: Interprofessional collaboration increases efficiencies in health care delivery by freeing up the time of other professionals when they have completed the necessary work in which they are the expert and handing off the patient to the next expert on the team to assist in further management of the patient’s health.
The pharmacist can play many roles in this. For example, as an ambulatory care pharmacist who specializes in diabetes, the providers in the office [I work in] complete their review of systems, point-of-care lab testing, and physical examination, then conference with me to discuss their findings and how I can best offer services to a patient who is unsuccessfully managing their diabetes. This allows the physician to describe the areas of concern to me and then move to their next patient knowing that I will take care of the education and treatment plan changes. Occasionally, we assist with medication refills, prior authorization of medications and medical devices, and generally work with the providers and staff to provide the best care to our patients.
SPM: How does a pharmacist new to a team handle and respond to early rejection from other providers?
Mobley-Bukstein: Don’t take it personally! It is important to look at the situation from all perspectives. The provider may be having a difficult day or may have just had a difficult interaction with a patient, and your interaction may have unfortunately come on the tail end of that. Document your recommendation for the provider to review later and move on. Keep calm and pharmacy on.
SPM: What is the most important piece of advice you can provide to student pharmacists who will soon be new practitioners?
Mobley-Bukstein: Enter every encounter with curiosity, an open mind, and the desire to learn and grow with every opportunity. Don’t be discouraged by one “bad” encounter with another health care professional. Be yourself. Don’t oversell yourself or undersell yourself. Be authentic in your interactions. This is truly the only way for you to know whether you are a good fit with the group you are working with and if they feel you are a good fit for them.