A Story from a Clinical-Pharmacist-to-be

14
478
Is clinical pharmacy the same with pharmacy?

Pharmacist, or Apoteker in Bahasa. Have you ever heard about them?

I am a pharmacist myself, and I have to admit that this profession is not an infamous or sophisticated one. Some of you may think that we are the ones who only sell the medicines in drug-stores, spend most of our time trying to crush tablets with that old-fashioned mortar and stamper.

Well, you are not totally wrong. Historically, in the early years of nineteenth century, pharmacist worked to prepare a relatively small amount of medicine. But when industrialization took its period, medicine making became industrialized as well and it still required the role of pharmacist in ensuring the mass production of medicine would not risk its safety and efficacy. And as the world developed and people aimed for greater quality of life, pharmacist role has expanded to optimize the benefit of medicine itself. This would include a proper selection of drugs for one particular patient as well as ensuring the patient consumes the prescribed medicine as it should be. The branch of pharmacy science, which focuses on looking at those roles is called ‘clinical pharmacy’.

It’s understandable if you don’t think such role of pharmacist exist in Indonesia as it’s not yet developed. Indonesia, as any other countries in the world, is heading towards a better application of pharmacy practice. I am one of the Indonesian pharmacists who have interest in clinical pharmacy area and that is the reason why I decided to pursue a Master degree in this particular field.

After a series of struggling moments with application essay, recommendation letters, IELTS test, scholarship interview, etc., I finally managed to secure a place in the MSc Clinical Pharmacy, International Practice and Policy program in the University College London (UCL). The program provided me the opportunity to regularly visit UK’s hospitals and see the work of clinical pharmacist directly from the hospital.

One word to describe my first day in the hospital was, overwhelmed. It was so amazing to see how the hospital pharmacists played their clinical role! They go to patient’s wards and carefully check the list of prescribed medication for each patient. They will ensure that there is no interaction between the drugs being prescribed (sometimes one drug could interfere the work of another drug, thus lead to reduced efficacy or increased side effects), ensure that the patient, or the nurse, understand the most appropriate way to administer the drugs (some tablets are meant to be chewed instead of ingested as a whole), and most importantly, they will ensure that the patient obtain the drugs they need (there is no point of taking antibiotic if you don’t have any bacterial infection or if you’re going to undergo some infectious-risk procedure, for instance).

St. Mary’s Hospital London, one of my clinical placement site. Trivia: it is the place where Lady Di and Kate Middleton delivered the Royal babies!

That was the ‘passive’ work, and yes, they perform the ‘active’ tasks as well. They will talk to every patient, have interviews about their drug history (medication that is regularly taken, be it a modern medicine or the traditional ones), ask whether or not they experience some undesirable effect of their prescribed drug.

You might ask, why should those activities takes place? What is the importance?

Data shows that errors in prescribing medicine happen to 7 in every 100 patients in the hospital. Its consequences also vary from increased hospital fee (surely additional fee is needed to amend the error) to the risk of putting the patient on some ‘dangers’ because of the inappropriate use of medicines. But the good news is, studies have found that clinical pharmacist’s work could reduce those events!

But the thing is, comprehensive health care provision is not a one-man show. It definitely needs collaboration among healthcare professionals. And that’s what I experienced when I was in my placement hospital. The pharmacist actively communicates with the doctors and nurses and discusses the therapy choices. Both parties are open for suggestions, they work together and learn together. The pharmacists themselves could prove that they are capable of making differences in their service.

I might be wrong, but I rarely see such collaboration takes place in Indonesia’s daily clinical practice. In my very own opinion, it happens because we cannot prove ourselves that we are capable. It’s not only about the knowledge but it’s also about how best we try to offer our services to make better outcome in the whole treatment plan. That’s why it’s a big homework for all Indonesian pharmacists to be more proactive in this effort.

I do have to admit that I did not have such courage. However, I have always been told to actively talk to the patient, the real ones. I was not very confident with my verbal English. Moreover, I have to put all my knowledge about the drugs into real practice. But after some times, I could manage it. Even now, I’m quite addicted to do the ward round and have some chats with the patient. Since most of the patients I met are the elders who lives alone, they found it nice to have someone they could share their story with. I had a very dramatic story-telling session with a kidney-transplant patient who happened to have had done dialysis in an entirely full bus in the Caribbean Islands. I remember he said, “I said to the passengers to hold my dialysis set, it is my kidney!”). I also heard about a patriotic story of a patient who is a veteran and got admitted to the hospital because of his chronic obstructive pulmonary disease. “Cook by yourself miss, you’re the only person who knows what’s best for yourself!”), said the patient who had undergone a knee-replacement surgery.

Hammersmith Hospital London, my another clinical placement site. Trivia: it has one of the biggest renal transplant centre all over UK!

It has been more than four months since I started my master’s program here and I have been gaining new experiences every day that enrich my knowledge and skill on clinical pharmacy practice, which I am grateful for. Hopefully, this is not only for the sake of having a masters title following my name , but it is also for the improvement of Indonesia’s pharmaceutical care. That is my wish.

And to end this story, don’t forget to ask for your pharmacist’s suggestion every time you have queries about medication because we are here to gladly help you!

 

Images in this article are taken from www.primehealth.ae and the author’s personal collection.

 

  • Gung Ari

    halo mbak Yovita Titiesari, let me introduce myself i am Gung ari, i am a pharmachist student now i still on the way of pursuing my Apt. title in Udayana University in Bali, i am in 2nd grade mbak. before i ask you, i am really sorry if my english is bad. Mbak i really want to continue my master degree in clinical pharmacy too like what you are doing now, i am really happy to find this article, this is the first time i find article in indonesia mengglobal about pharmacist. mbak, like what you’ve mentioned in your article that’s what i faced in my practice at hospital, in my 2nd grade i take practice in hospital pharmachist store especially in depo. the pharmacist role is so passive, the nurse just call and order some drugs that prescribed by doctor, then i just prepare it and deliver it to the nurse nothing more that i can do, so i fell so useless as pharmacist that i couldn’t offer something more in pharmacheutical care based on what i’ve been studied before at campus. Sometimes i feel not confidence to talk about drugs and give some explanation to patient or discuss with doctor or nurse. Poor i am, :(. In Indonesia pharmacist’s role doesn’t seen as a collaborative partner of doctor. So i think people just know pharmacist as a drug seller and from what i see in pharmacy store the dominant point is business. After i practice at the pharmachist store i think i am not suitable there. I love to visit patient in the ward, communicate with them…ask their condition. I have experienced when i took practice in the hospital i get task to take patient signature in the drugs bill at the inpatient room. And i advice not to talk so much just get their signature but sometimes i just ask the patient about how their condition, any improvement or not. Sometimes the patients will tell me more. I feel such a hapiness on doing that, mbak. And after i read your article what a beautiful experience you get in england, i want to studying abroad too mbak, so i can give the best to the patient from what i’ve learnt and experienced, be a good pharmacist. Mbak may i ask your email address or the other contacts that i can reach?. I wanna ask about your scholarship. Than you so much mbak, may god bless you,

    Salam hangat dari Bali
    Gung Ari

    • Dear Gung Ari,

      Thanks for reading my story! I’m so glad that there’s another pharmacist who loves clinical things :) Really enjoy your story about your work in hospital, and as I wrote in my post, the role of clinical pharmacist in the hospital is not yet developed, but I believe it’s only the matter of time!! And also it needs a team of people like you, who want to develop the clinical pharmacy itself!
      You can visit my personal blog (hit the ‘website’ button in the end of my post) if you want to know the step I took to get the place in the course, also some stories about my study here.
      Good luck and all the best for your study!

      Cheers,
      Tiesa

  • Denita

    Hi mbak Yovita, my name is Denita and I am also a contributor in Indonesia Mengglobal. I am a medical student and I am currently working as a junior doctor/koas. I am currently in my geriatric medicine rotation in which all patients are above >60 years old. Most of them had history of using more than 5 drugs or were prescribed with more than 5 drugs (polypharmacy), which is very prone to drug interactions. I totally agree with your statement about the idea of collaboration with clinical pharmacist in terms of assessing the patient’s drug history and discussing with doctors and nurses regarding the drugs administered to the patient (especially to geriatric patients).

    In the hospital that I worked for, geriatric patients are managed comprehensively by different specializations (e.g. internist, neurologist, cardiologist, pulmonologist, dietician, etc) but I have never seen a clinical pharmacist or even clinical pharmacologist (sp. Fk) who approached a patient and assess their drug history. I think hospitals in Indonesia should start to implement this kind of system like in UK to prevent drug interactions and misinformation about drug administration or intake. Hopefully there will be more clinical pharmacists from Indonesia who have a same vision as yours and when you go back to Indonesia you can advise this kind of system so we can have a better healthcare system like the UK do. Best of luck for your study! :)

    Regards, Denita

    • Dear Denita,

      Many thanks for reading!
      I found your comment to be very interesting. I agree that polypharmacy is something inevitable, especially for geriatric patients, however drug interaction issue with polypharmacy still can be prevented/minimised. And yes, thus should also be a task of clinical pharmacist, to work together with the doctor on deciding the best medications for the patient.

      As far as I know, some hospitals in Indonesia (e.g. RSCM, RSHS, Soetomo), have been implemented clinical pharmacy in daily practice, though not in every ward. It would be nice if we could do it in every ward, in every hospital as well. We are heading that way, and I am very optimistic that in several years ahead, we could see marked difference :)

      Thank you for your comment about the idea about collaborative work as well, since in daily practice, approaching the other healthcare professional colleagues are one of the challenge pharmacist must face :)

      I hope you’re doing great with your koas as well, let’s together build a better health care provision in Indonesia :)

  • Anggie Wiyani

    Hi mbak Yovita,

    I love your writing, I love your story, and moreover I love your spirit! :)) This is the first time I find an article in Indonesia Mengglobal about pharmacist, thanks to you mbak :) I am doing my pharmacist educational program in UGM, and hopefully I will be a pharmacist this August. I always get encouraged by stories of pharmacist and pharmaceutical care in developed countries, and so I dream of my country getting there. And I believe we will if we have pharmacist like you, mbak :)
    I hope we can share stories and meet up in UK!! Good luck for your study!

    Regards,
    Anggie

    • Hi Anggie!

      Thank you for your kind comment, I’m blushing! Hehe… Oh, lots of best luck for your ujian Apoteker then! Can’t wait to welcome you as teman sejawat :) And later after you graduate, let’s work together to develop Indonesia’s pharmaceutical care :) As I said, it’s not a one man show :)

      Cheers, Tiesa

  • hendra

    Hi Mba Yovita.. Such a great and motivate story. I’m Hendra Herman and i am clinical pharmacist graduated from UGM. Totally agree with you. I hope more pharmacist can play that role. And salute for dr. Denita who open her mind and give the pharmacist a chance to collaborate. Maybe we can take this out to more specific discussion. Please email me at hendrahermanapt@gmail.com. thanks…

    • Hi Mas Hendra, so glad to find fellow clinical pharmacist (well, I’m not yet :p)! Will drop you a message soon, many thanks for your kind comment! -Tiesa

  • Ayu Pratiwi

    Dear Ms.Yovita
    I really am glad when I found and read your story.
    My name is Tiwi and I am a pharmacist myself, a hospital pharmacist actually.
    I love my job (i freakin do duuh~lol) but i gotta agree that our profession doesn’t stand out like another healthcare profession.
    Most of peoples thought that we’re just some extras in medical field since we often go unnoticed aka invisible.
    I can’t blame it tho,since part of it is our fault some of us are just a really “shy” person.
    I don’t say that it such a bad things but like you said before we gotta be more active and played our role in a clinical team properly so that pharmacist won’t knw as personwhoselldrugs-kind of job (I am no drugs dealer  sir~) ever again .

    I would really love to follow your step,keen to learn more about clinical pharmacy.
    I’ve been lookin about clinical pharmacy scholarship overseas but i haven’t met someone with a same interest to talk and ask things about (till i read your story)
    If you don’t mind I would really love to hear more about your story (and also tricks and tips to gt accepted).Please email me at pratiwiasihayu@gmail.com #bowstosuhu

  • Yohanes Lukman

    Dear, Ms Yovita
    maaf koment sy pake bhs indonesia (cause of my toefl point only 505..:> ). perkenalkan nama saya : lukman prayitno, S.Si., Apt. sy apoteker lulusan UBAYA 2003. skrg bekerja sbg apoteker pns di RSK dengan pengalaman baru 5 thn di “RS”. sy merinding membaca artikel mbak yovita..bangga ternyata profesi apoteker di UK lbh dihargai ya. salut jg tuk mba yovita yg sudah bs tembus ke UK tuk belajar clinical pharmacist. ada bbrp hal yang ingin saya diskusikan :
    1. Baru awal bulan desember 2015, RSK dinyatakan lulus sbg RS terakreditasi tipe A versi KARS 2012. pada akreditasi ini, farmasi ada satu pokja tersendiri yaitu MPO (manajemen pengelolaan Obat) di salah satu pointnya apoteker dituntut untuk berperan lebih ke pasien dgn berinteraksi lgsg ke pasien -> mengisi form CPPT & form edukasi pasien (fungsi dan aturan pakai obat, interaksi obat-obat, interaksi obat-makanan). meski sdh dinyatakan “lulus”, implementasi interaksi apoteker dgn pasien baru 1%, sy heran kok bs dinyatakan lulus ya???..:) how lucky RSK..btw, sekedar info sy sempat ditanya ama assesor (dokter senior dari jakarta) mengenai peran farmasi di divisi PICU & saya menjawab hny sekedar prepare obat –> assesor menjawab : hrs ada farmasi khusus yg bertugas di divisi Pediatric! ini diutarakan lgsg didpn direktur keuangan dan direktur Medis (karena mereka kebetulan ada bersama assesor). tp hingga saat ini, implementasi belum ada perubahan. jujur kendalanya di jumlah tenaga farmasi (baik asisten maupun apoteker) –> seperti sengaja tdk ada niat untuk berubah. sejak sy bergabung, sy pernah menyarankan dan berulangkali mengusulkan untuk dibentuk dream team farmasi sbg pilot project pengembangan farmasi klinik tp usul itu tdk dianggap sama sekali baik dari team farmasi apalagi di level direksi. padahal kepala instalasi saat ini merupakan lulusan farmasi klinik dari UNAIR dan ada senior yg juga lulusan farmasi klinik UGM. jd saat ini di RSK sudah ada 2 magister farmasi klinik tp tdk ada niat untuk membentuk sistem farmasi yang berorientasi pada pasien yaitu farmasi klinis.cape deh. malahan salah satu master farmasi klinis mengatakan ilmunya kalah dengan dokter –> kalah sebelum berdiskusi –> cape deh lg..
    2. DI Indonesia, per januari 2015 sudah melaksanakan sistem jaminan kesehatan universal yang dikelola melalui BPJS. Undang-undang BPJS masih belum mengakui eksistensi dari apoteker. saya lupa no undang-undangnya. intinya blm bole ada swamedikasi melalui pelayanan apoteker yang ditanggung oleh BPJS. jd semua obat hrs melalui peresepan dokter.cape deh. sedangkan apoteker di RS dituntut untuk melakukan pengendalian obat yang digunakan oleh dokter. hal ini hny dilakukan melalui membaca peresepan dari dokter saja –> lebih ke arah pengendalian obat secara administratif tanpa melihat keadaan pasien melalui interaksi lgsg. saya ngeri dengan praktek dan tuntutan apoteker yg seperti ini karena apoteker harus mengambil keputusan tanpa melihat dan mengikuti perkembangan keadaan pasien dari hari ke hari.tak jarang kami bersitegang dengan dokter dan pasien karena obat tidak bs diberikan oleh farmasi.ngeri melihat keadaan ini tp sangat bny penghematan dan peningkatan efektifitas terapi yg sebenarnya bisa dilakukan oleh apoteker. (apalagi di divisi chemotherapy)
    3. berdasarkan 2 point diatas, mohon saran dari mbak yovita. btw, bole ya minta SOP pelaksanaan pekerjaan kefarmasian di UK. smua yg berkaitan dengan aktifitas kefarmasian di RS di UK. kl memang bole, tolong kirim ke alamat email : yohaneslukman@gmail.com
    juga website untuk mendapatkan journal2 farmasi yg terkini.
    4. sy sangat setuju dengan pernyataan mba yovita : not one man show. tp melihat point tersebut diatas, mnrt mba yovita, kira-kira pa aja ya yang dibutuhkan farmasis di Indonesia agar lbh eksis???
    maaf mba, panjang yg sy tulis. lg sy minta maaf jk ada sengaja menyinggung institusi tempat saya bekerja dan mengabdi. Yg saya inginkan hnylah perbaikan kinerja farmasi di seluruh Indonesia khususnya di RSK.
    5. maaf jg, mudahan 1 bulan kedepan, sy bs mutasi ke jawa. sementara menunggu SK mutasi. cape sy bekerja di RS skrg karena merasa perkembangan yang lambat dan tidak didukung oleh manajemen melalui pembentukan sistem farmasi klinis yg terpadu. apalagi mendapat tawaran untuk studi lagi di jawa..:)
    6. mohon info alamat email mba yovita ya, sy ingin berinteraksi lebih lg dan menanyakan tip dan trik untuk bs tembus studi di UK.
    semoga Tuhan memberikan kelancaran dan kemudahan studi mba yovita di UK dan smua yg mba yovita cita-citakan..amin

  • Mufidahhairani 8

    Pagi All, teman-teman yang berminat jadi asisten manager sales untuk perusahaan kapsul ternama dari luar yang akan membuka base di indonesia,dengan pengalaman minimal 5tahun. fluent in english untuk pekerjaan secara rinci silahkan hub tlp/wa 081297300592 / Rani. nanti akan disampaikan website,alamat email dan job desc perusahaan kami. trims.

  • Marina Mazumder

    Hello every body my name is Micheal Brown a citizen of Nepal.
    i am here to publish to the world how i became rich after selling my
    kidney to one Doctor Williams, we met on internet and negotiated on buying one of my kidney and i accepted to donate one of my kidney for money which brought him buying one of my kidney for 300,000 dollars
    and even paid me half of this amount before the operation took place here in India and the balance was given to me cash after the operation,now i am bold to say i can never be poor again in life.
    Advice you to meet him on dr.williams07@hotmail.com for your dream come through once more write him via dr.williams07@hotmail.com

  • Winda Dwi Astuti

    Dear, Ms. Yovita Diane Titiesari.
    Let me introduce my self. My name is Winda, i’m a graduated pharmacist from UAD (if you didn’t know my college it’s Ahmad Dahlan University in Yogyakarta). I’m so sorry at first if my english grammar is not totally right, i’m just learn it now.
    Okay, its enough to introduce (hehe).
    I’m so so so glad to find, read, and enjoyed your story and exactly your more knowledge especially in clinical pharmacy. I’m a apothecary clinic student now (insya Allah be a pharmacist with a exit exam named UKAI at 2017). I’m concern at clinical pharmacy and i have plan to take a magister of clinical pharmacy like you (maybe ini Australia aamiin). Because i have a big expectations like you about the pharmacy role in Indonesia.
    I agree with your opinion, it’s “not only a man show” , but we have to collaborate (all of medical practice) to developed clinical pharmacu in hospital or community.
    I have a dream and target, if there is a lot of pharmacist like you, Ms. Tiesa, pharmacy in Indonesia will be developed.
    I’m so glad if we can keep in touch with another branch of communication, because i have a lot of question about your magister, experience, especially in clinical pharmacy. This is my email, windadwia@gmail.com
    I’m waiting for your amazing story more. Let’s developed our country with a good pharmaceutical care in clinical pharmacy :) . -winda

  • Milly Lalmusee

    Hello…
    I’m Milly from Myanmar.
    It’s really interested to read your story here. I’m also gonna hospital pharmacist.Thanks for sharing your experience. And if you mind can I also read more your stories.My email is millynavsweet@gmail.com