My Mom was the oldest daughter of eight kids in her family. She was born in 1922, and was raised through the Great Depression. She learned at an early age how to do household chores, such as cooking, cleaning, and caring for the younger siblings. These skills came in quite handy when she got married and had four kids of her own to raise. Of all of her housekeeping skills, none was more noteworthy than her ability to bake bread.
Mom shared her skills with everyone. Mom would instruct me “Pete, run a loaf over to Grandpa’s house ... run a loaf over to Shirley’s house ... drop one off at Aunt Dell’s, too.” Mom gave away a lot of bread to a lot of people over the years.
My Mom’s sister, Aunt Dell, was the pie baker. She made the most delicious pies, a skill that my Mom didn’t have. On those rare occasions when Mom would bake a pie, she would tell us, “Just eat the filling. You don’t have to eat the crust. I know it tastes like cardboard.” Mom knew her limitations and wasn’t afraid to let us know what she couldn’t do. Let Aunt Dell make the pies, and she’d bake the bread.
Health care could learn a lot from my Mom and Aunt Dell. Mom took relative cheap ingredients, like water, sugar, salt, and flour, etc., and provided a great product that was much appreciated by the recipients. Low cost, great results done with the skill of the producer was how she was able to give away such a great product. Government-run health care seems to be the exact opposite: Expensive ingredients, a very cumbersome way of delivering the product, and a total lack of teamwork seems to be how we provide health care.
One of the local physicians, Zane Gates, MD, is delivering health care with a total teamwork approach. He has two excellent PAs, has a pharmacist in his office who sees the patients before the provider, as well as a dietitian to help with the management of type-2 diabetes. It is amazing when we pharmacists intervene on the very foundation of patient care in the physician’s office, and the positive outcomes we have.
Gates frequently discusses the economic concept of “vertical externality,” where one group’s effect can have a positive or negative effect on the other group even if they are not connected. Drug companies, insurance companies, government payers, pharmacists, physicians, hospitals, and, of course, the patients, all have impact on each other. If a drug company raises costs of a medication, it is fair to assume they impact everyone in a negative way.
In the direct-care family practice model, pharmacists are able to provide consultation on cost-effective prescribing, monitor patient adherence, and eliminate drug interactions. I hope I practice long enough to see this direct-care family practice model become the norm and not the exception.
We cannot know all there is to know about the pharmacotherapeutics, anatomy and physiology, history and presentation, and diagnosis of every disease state. We as pharmacists, when we offer these clinical services, have a positive impact on the other players in the health-care system. As team players, we can use our skills and expertise to help physicians, hospitals, payers, and ultimately our patients. Gates frequently sees himself at the “quarterback” of the team. I prefer to think of him as the head chef, with all of us in his “kitchen” doing things we are most capable of, in providing the very best outcome.
There is too much to know today. I witnessed this as a kid on Thanksgiving at my house, where Mom baked the bread and Aunt Dell baked the pies!