The photo was taken at Pharmacy U Toronto. Pharmacists Brandon and Hugh Toner speak with one of the attendees about care for patients with mental health issues.
PharmacyU.ca talked with pharmacist father and son, Hugh and Brandon Toner of Medicine Shoppe Pharmacy in Sydney, Nova Scotia (left), in a wide-ranging conversation about the changing world of pharmacy.
Do you think pharmacists are beginning to wake up to their potential?
Hugh Toner: They’re an untapped resource in some areas. I think pharmacists are very special. I think they’re unique, they’re funny, they’re smart, they jump through a lot of hoops. You have to be very smart to get into any pharmacy school in Canada. They’re intuitive, they’re smart, they have to be well-rounded, they have to have good intention. It’s not about a lack of capacity or willingness. It’s just a very challenging time, and sometimes there are things coming at us from all sides, and they’re things beyond our control that can challenge or derail us. Generally speaking, pharmacists are wonderful people, they’re caring, they’re planted in the middle of a hospital or a community setting and I think that the future looks extremely bright because they’re well positioned for where we’re going to go.
Are pharmacists becoming more aware of their ability to help patients?
Hugh: I think the world’s waking up. You see yoga and meditation on the front page of magazines. The world’s become so stressed out, so busy, we can’t leave our house and leave our cellphone on the counter without driving back to get it. It’s a busy old world out there. Pharmacists are the recipients of prescriptions. We modify prescriptions, there are all sorts of new biologics and biosimilars coming on the market, it’s an unending pipeline, and it’s becoming more complicated all the time. The irony of all that is that we need to demystify pharmacy, let the dust settle, and create a place of presence where we put the patient at the centre of care.
Brandon, did you always plan to go into pharmacy with your father?
Brandon: That was never the master plan, but it just fell into place that way. And that’s given us an opportunity to align the old and the new, from his perspective on patient care from being a pharmacist for 30 years to me, with a modern view of what pharmacy practice could be, and to try and blend those worlds. We’ve spent a lot of time trying to create that sense of alignment and a vision of what we want for the profession and for our practice specifically in Sydney, Nova Scotia.
How have things changed?
Brandon: They have changed and continue to change a lot, and I think it’s wonderful. Where we’re at specifically now, in the last three to five years, the ideas that seem to be surfacing…it seems like an exciting time to me. When I was going through school, the concept of patient care was a little bit like a unicorn, the ideal gold standard of practice, but you knew very well that it was going to be very challenging to incorporate that into your day to day practice when you graduated. Hard to blend that theoretical gold standard magical unicorn land with the realities of the constraints of business and practice. What I’m seeing now is strategies, techniques and tangible initiatives to breed a sense of community for ideas to come together, to bring things to actual fruition. I’m getting a sense of urgency and believability in the profession right now that things can be better and more professional.
Patient-centredness is finally something the government is supporting financially. Is that making a difference for pharmacists?
Brandon: I think so. I think payments models will continue to shift. One thing I find very interesting is that pharmacy seems to have been waiting for government to make the first move. It’s – we’re not going to do something unless we’re paid for it. And governments are saying we’re not going to do something unless it’s demonstrated. We get a bit of a stalemate. We need really well-funded pilot projects, and we’ve done a great job here, but sometimes it’s still not enough for government to get a visual for what can be accomplished. Sometimes I don’t think pharmacy knows what can be accomplished. We’re still having a bit of an identity crisis and we don’t know where we’re going ourselves. What I’d like to see happen is ways to navigate the existing financial frameworks to provide patient-centred care, like the Appointment-Based Model. There are pharmacies using it who are less reliant on dispensing fees. I think that’s going to be our frontier, navigating and getting back to the basics. We assess, we prioritize drug-related problems, we make recommendations and we follow up on them. A lot of that is the basics of pharmacy and always has been, but it was never really practised in reality to its full potential, getting a comprehensive discussion around medication and goals.
So what are you doing differently?
Hugh: We’re thinking differently. That’s the biggest thing. In order to be successful in life you have to do the right thing long enough, and everything you do – all your actions – have to stem from your thoughts. And we’ve been doing a lot of thinking, a lot of talking, a lot of masterminding, and dreaming and talking and shaping.
Brandon: I think there’s maybe too much focus on what are you doing. Before the doing is the thought. Eventually enough is enough and things just naturally happen. I think that’s the best: when it can be more inspired action and you can’t NOT change your practice, rather than, I need to change my practice because my company says you must change your practice or my bottom line says so. I think the change needs to come from the internal, and what the next step looks like to me is, let’s keep doing this, let’s keep meeting, let’s keep creating the conversation.
Hugh: We’re talking about competition. There’s always enough for everybody, and what you do is you focus on you and what you’re doing and you focus on what you can do to do better.
Brandon: it’s not a simple problem, it’s not a simple solution, so that’s why I like the discussion. Let’s just keep talking and eventually the right ideas resonate and take hold. How can they not?
This interview has been condensed and edited.