This seems a little bit like Woody Allen in the movie "Sleeper"

It's better than reading!!

The future keeps coming at us faster and faster

Should prescription drugs be insured?

Drugs are so expensive these days that it is getting that only the rich can afford them.

I recently spent over 200 dollars for a small tube of ointment at a pharmacy.  I asked the pharmacist for the generic, and she said, "That is the generic."

I used to think that insurance for prescription drugs was unnecessary.  Now I am starting to argue that it is.  The following presentation from slideshare gives my reasoning.

Should prescription drugs be insured

View more presentations from Virginia Commonwealth University

Why insure health care?

Many people who argue against Obamacare don't know what they are talking about.  The same is equally true for those that argue for it.

To inform those individuals and anyone else who may care, I have developed the following slides which ask the question, "Why insure health care?"

Why insure health care?

View more presentations from Virginia Commonwealth University

10 Ways to Frustrate Your Advisor

I teach graduate students in pharmaceutical sciences -- primarily in economics and outcomes research.  These graduate students learn many ideas and skills needed for success in future jobs.  But there are some things that that may cause failure in their future careers.

I have labeled these things "10 ways to frustrate your advisor".  These are the types of things that will annoy any boss and can lead to failure in careers.  Here is what I tell students:

Your advisor wants you to succeed.  If you succeed, your advisor succeeds. 

But he (or she) needs your help.  When your advisor feels like you are not fulfilling your part of the bargain, he will become frustrated.  Want to frustrate your advisor, harm your chance of getting an excellent recommendation after graduation, and hurt his opinion of you?

Do any or all of the following 10 things.

1.  Make excuses.  Excuses are for losers.  Take responsibility, own up to your mistakes, and then move on.

2.  Be afraid to take chances.  Graduate education is about learning.  You learn complex skills by trying new things and taking chances.  If you make a mistake -- learn from it -- and then try something different.

3.  Make the same mistakes over-and-over again.  This means that you are not learning.  Make mistakes, but not the same ones.

4.  Be too sensitive to feedback.  If you are to become a PhD, you need to learn to welcome feedback and criticism.  It too is a part of learning.  If you become sensitive to feedback, you will make it harder for your advisor to teach you what you need to know.  And you will stop learning.  Develop a tough skin and use that feedback to get better.

5.  Waste time.  Time management is critical for success before and after graduation.  Use your most productive times of the day well.  Use your less productive times for tasks that don't need much thought.  Use your school holiday and summer periods well.  You are now in graduate school and wasting those periods is unacceptable.

 6.  Wait to be told what to do.  Each advisor is different.  Some are micromanagers, but most do not provide a lot of guidance.  The freedom you receive from hands-off advisors comes at a cost.  You must find out what to do on your own.  Thus, you need to plan ahead for times when you have no assigned tasks.  Ask yourself, what skills do I need to develop?  What kind of projects can I work on?  How can I use this time well?

7.  Take your TA responsibilities lightly.  If you are a TA, go to the class professor and offer to help.   If you are not contacted immediately, contact the professor periodically to let her know that you want to contribute.  You are being paid very well to be a TA.  It is not a right; it is a privilege.  Provide the university with real value. 

8.  Be rude or selfish.  Graduate education is a collaborative effort.  Rude or selfish behavior reduces learning. 

9.  Wait until your final year before you get serious about managing your career after graduation.  If you wait until just before graduation, you put yourself at a disadvantage.  Starting early can help you develop your curriculum vitae to highlight your capabilities and strengths.  Starting early can help you develop relationships with potential employers or people who can connect you with potential employers. 

10.  Worry about what your advisor thinks.  Of course, you should listen to your advisor, because he is a genius and a fountain of wisdom.  But at some point, you need to reach a point where you care less and less about the opinions of others -- not enough to prevent you from doing what you think is right.  If you become the expert your advisor hopes you will be, you will do what you think is right and ignore what others think.  At that point, you will be ready to graduate. 

Comments on Steve Jobs Commencement Speech

If you have't heard Steve Jobs commencement speech on youtube, I recommend you watch it.

The take-aways from my viewpoint are:

1. Don't go to college if you are not benefiting from it.

2. You are more motivated to learn if you have the choice -- and are not made to do so.

3. Sometimes your greatest failures lead to your greatest successes.

4. Doing what everyone else does will not lead to greatness.

5. Live each day as if it is your last. Because one day, it will.

What should every person know about money?

I still read magazines. I mean real magazines, made of paper, that you can buy at a news stand. One of my favorite magazines, Men's Journal, asks famous people (like Gene Hackman) questions about life such at "Have you ever cheated death?" or "What's the best cure for a heartache?". I like to answer the questions myself before I read the celebre-answer.

This month, they asked "What should every person know about money?". Here's what I think.

Money is a way of keeping score in life -- just not a very good one.

People with more money tend to be considered more successful in life than those without. Still...

"Money" is to "life" like "hits" are to "baseball".

In baseball, the team with the most hits tends to win more often. Not always, because it's possible to get a lot of hits and not score any runs.

And in life, it is possible to fail with a big pile of money, just like it is possible to succeed with little money.

The key is to find better ways of keeping score. Count the number of your friends. Total the number of times you help someone each day. Tabulate the smiles you cause.

Don't ignore money, but don't make it your only scorecard for success.

Marketing to Men -- It's not easy

I gave a recent presentation on marketing to men at a Men's Health Seminar. The main argument of my presentation was that "Marketing to Men -- It's not easy".

I decided not to go with the original title: "Marketing to Men -- It's Hard" to avoid any immature "That's what she said" comments.

We had a big auditorium, a panel of expert presenters (physicians, exercise physiologists, dietary researchers, and me), raffles, free food, and vendors. It was heavily advertised on the radio and TV. Advertisement posters were placed strategically above urinals in key bathrooms across the J. Sargent Reynolds campus (all four). It was well designed and promoted.

How many men do you think attended?

Answer: 15

My point was made. "Marketing to Men -- It's not easy".

Common sense in pharmacy is rarer than you think

Pharmacy students often complain that many of the things I teach are "just common sense."

I typically respond by asking, "if managerial decision making is just common sense, why are good managerial choices so uncommon?"

Don't get me wrong -- there are many excellent managers and pharmacists who make solid decisions day-in-and-day out. However, almost all pharmacists have been on the receiving end of monumental blunders made by co-workers and bosses. In hindsight, many blunders could have been avoided by better decision making processes.

So, how do we improve our decision making?

The first step is do understand the various forms of decisions we face in pharmacy practice.

There are five types of decisions pharmacists face -- legal, clinical, economic, managerial, and ethical. Different inputs and processes go into each.

If we incorrectly identify a problem, we will use the wrong process to solve it. This can result in poor solution.

For instance, if we look at all ethical problems using a legalistic framework, we might make decisions that legally justifiable but morally indefensible.

Identifying knowledge which is "common" in common sense requires a detailed understanding of all five processes of decision making -- legal, clinical, economic, managerial, and ethical.

I suggest that most students and many pharmacists need more knowledge and training to successfully apply common sense to pharmacy problems.

Nurses are the only essential in health care

I know nurses. My mother was a nurse. My sister is a nurse. My brother is a nurse. My sister-in-law is a nurse. My niece is a nurse. My other niece is a nurse. And my beloved wife is a nurse.

Nurses can never be replaced by technology.  Machines may eventually replace many of the tasks done by doctors and pharmacists, but machines will never be able to "care" like nurses.   Nurses are the best!!

++ Click to Enlarge Image ++

Via:Master Degree Online.com

Thinking your glass as half-full can kill you

National Public Radio had a story recently discussing research on how to live well and long. The story described Helen Reichert, a one-hundred-and-nine-year-old woman who lives at home, has all of her mental abilities, and likes chocolate truffles and Budweiser.

Her doctor, Mark Lachs, attributes her longevity, in part, to her "adaptive confidence".

Adaptive confidence describes one's ability to bounce back from life's stressful moments.

"You don't get to be 109 without life hurling a few curveballs at you, and Reichert has had more than her share: bereavement, gender discrimination, medical issues. And after each, she dusts herself off and moves on."

Adaptive confidence is positively associated with optimism. Optimists have been found to live more than 7 years longer than pessimists -- possibly due to their ability to recover from setbacks.

The lesson from this story is summarized by Dr. Levy who says, "So if you're a boomer and you don't think your outlook on aging has any impact on the rest of your life, you might want to brighten your attitude a bit."

I don't know the future but...

There are a lot of blow hards who predict the future of pharmacy.

Since I was a student, educators and leaders have been saying that pharmacy needs to change. It needs to move from a drug-centric focus to a professional-service-centric focus. Well, we still focus on the drug product.

And we may be product-centric in the future. I don't know.

But I do know that change will occur. One of the reasons is illustrated in this website which totals up the cost of various elements of each taxpayer's tax bill.

Health care's portion of the tax bill is 24%. That is unsustainable.

We can't afford to continue doing things the way we always have. Taxpayers -- including you and me -- will not stand for it.

The only question is, "How will pharmacy change?"

The answer is......beats me.

Crack dealer "Freeway Rick" is intrinsically motivated

This morning, I was listened to a Planet Money podcast interview of Freeway Rick Ross, a former big time drug dealer who talked about the economics of dealing illegal drugs.

Most of the podcast dealt with how making drugs illegal, also made them highly profitable, thereby leading to unintended consequences like violence and crime.

One striking admission by Freeway Rick was his joy in doing the job -- i.e., intrinsic motivation. Rick said, "I loved it...I felt like I was powerful...It was every man's dream to be free...I'd rather be doing that than anything else, almost."

Rick talked about how engaged he was in his job. He enjoyed cooking the drugs. He enjoyed the status it gave. He enjoyed being in control.

Of course, Rick's experiences and his view of the world are quite different from the average pharmacist, but we can learn from Rick.

To be intrinsically motivated, we need autonomy in our jobs. Autonomy encourages responsibility and meaning. We also need to maximize periods of "flow". Flow is a state where you are so engaged in your work that you lose track of time. Flow occurs when we challenge ourselves to achieve goals that stretch ourselves (but not so much that it leads to frustration). Finally, we need to seek mastery of what we do. Mastery encourages feeling so control and achievement. Rather than seeking to master the market for illegal drugs -- we need to master the medication use process for our patients. This journey toward mastery gives us a goal to work toward that can sustain us when our jobs dissatisfy us.

This is why the image of PhRMA is so bad!!

Pharmaceutical companies spend significant time and money developing, "The first and only approved FDA treatment for inadequate and not enough lashes," and come up with new diseases like "hypotrichosis."

I predict that there will soon be a series of studies presented at medical meetings showing the burden of Hypotrichosis on society and the cost effectiveness of Latisse compared to fake eye lashes.

“Procrastination: A hardening of the oughteries.”

I hate hearing students say, "I don't do my assignments until the last minute because I work better under pressure." One reason this is a sore point with me is that I have to grade some of the crap they submit. Another reason I hate to hear it is because I know that procrastination will hurt them in the future.

Procrastination might be one of the most important things that influences the success of anyone including pharmacists. That's the message coming from Piers Steel, author of the Procrastination Equation. Steel says that people who procrastinate are more likely to be poor, put off necessary health care, have damaged relationships, and many other bad things.

I doubt that our students are any worse than earlier generations at procrastinating. The difference today is that there are too many distractions that permit procrastination -- the Internet, cell phones, and 24-hour media.

Success in pharmacy requires individuals to learn to control their tendency toward procrastination. One strategy I have used which made a big difference in my life was removing all games including solitaire and hearts from my computer.

Now I know have plenty of time to find other excuses to procrastinate.

I used to be an international drug smuggler

When visiting my in-laws in Yuma Arizona, I used to accompany them on trips across the border to Algodones, Mexico. We would stop by pharmacies where I could purchase cheap, prescription-strength ibuprofen (AKA Motrin). As you might expect, the prices were amazingly cheap.

And then, we would illegally bring them back across the border.

Yes, illegally. There is a law against importing prescription drugs. The border agents just don't enforce it. People often don't know about the law against importing drugs, and even worse, they don't realize how unsafe it is. That's because drugs outside of the US are outside of the FDA system of safety and manufacturing control

Last night, I watched a 60 Minutes episode on TV which illustrated the risks of drug importation. I recommend you watch to get some idea about the risks of importation.

Google's guide to better bosses

The New York Times had an article today describing Google's plan, code-named Project Oxygen, which sought rules for building better bosses.

If these rules are generalizable to other settings, like pharmacy (and I think they are), pharmacists can learn from them.

One finding is that professionals want a boss with technical skills. These technical skills help in advising the team and when pitching in to help as needed. Having and using technical skills helps the boss retain credibility with the team and show that she cares.

The other finding is that technical skills are much less important than people skills -- ranked eighth of the eight skills measured.

These findings are consistent with my experience which is that pharmacist managers can help relationships with staff by rolling up their sleeves and helping out from time-to-time.

However, helping out too often can take the pharmacist manager away from their other job -- managing people. And ultimately, managing people is much of what managers add to the team.

Pharmacist managers who can't juggle the competing technical and people skills will ultimately hurt the team.

Robots were too late to replace me

One of the reasons I left hospital pharmacy practice was the mind-numbing tedium of much of my daily tasks. I kept thinking, "When are they going to develop robots to do this, so I can find better ways of helping the patient?".

Well it seems that finally have invented such robots.

Too late for me, though.

Can pharmacists be replaced by computers?

In the New York Times recently, the Nobel Prize winning Paul Krugman discussed the mistaken belief that higher education will ensure a good career.

He cited other economists who state that computers will be able to replace anyone who is doing, “cognitive and manual tasks that can be accomplished by following explicit rules.” Computers are much better at doing these things. These are exactly the kinds of tasks that many pharmacists have excelled in over the years and therefore likely to be replaced by computers.

Success in the pharmacy of the future is more likely for pharmacists who are good at jobs that can’t be carried out by following explicit rules — communications, pharmacoeconomics, personnel management, social marketing, and many other problem solving skills that students seem to resist.

If pharmacy students don't want to learn to work with ambiguity, there is another option suggested by Krugman. Most manual labor being done in the U.S. is hard to automate. Therefore, many jobs of the future will be truck driving, janitorial work, and other forms of physical labor.

Its the student's choice.

Attributes of a great pharmacist

A colleague of mine, Laura Morgan, asked students what attributes make a good pharmacist. She then put their responses in a word cloud. This is the result.

At first, I thought "these are great!"

Now, I've changed my mind. I now think the listed attributes indicate a certain level of passivity. I don't see advocate, leadership, innovative, or other proactive attributes. The attributes they list are nice but seem wussy to me.

The future of health information

I edited and authored several chapters relating to health information technology in the textbook, "Introduction to Hospital and Health-System Pharmacy Practice." 1st ed. Bethesda, Maryland: American Society of Health-Systems Pharmacists; 2010.

Sometimes it's hard to explain in text about the future of health information. Now, I have help with this great video from YouTube.

Why lectures suck

People learn by:
1. listening
2. doing
3. reading
4. talking to other about what they know
5. watching others do something
6. making mistakes and correcting those mistakes

Lectures only utilize (1) listening which is usually tied with (3) reading. That is the way education used to be and still is in many places.

Project-based learning (also called case-based or problem- based) can employ all six of the above ways of learning for students. The problem is that it requires a teacher who is knowledgeable, flexible, creative, and committed to student learning. It also requires much more time from the professor. These things are not always available in pharmacy educational settings.

Watch this video. It clearly illustrates the value of project based learning. But to really understand, you need to apply the method on sayyyy.....a PROJECT!

Why curricular design is not pretty

Curricular design and sausage making are very similar.

Lay out your main ingredients

A bushel of faculty members with different agendas
A fond memory of the good old days of pharmacy education

Add spices and other ingredients

Put people in charge who do not have sufficient training and/or authority to manage the different faculty agendas.
Give inadequate guidance.
Use anecdotal evidence to decide what works and what does not work.

Grind all of the ingredients into a casing and call it a curriculum.

Marketing doesn't hurt people -- people hurt people

I love to read the comics each day in my local newspaper -- yes, that thing that used to be "black and white and read all over" but is mostly just "black and white" now.

One common stereotype seen in comics is that marketers are useless, lazy, carbuncular, and so on. The reason this stereotype is so funny is that it is often true.

Nevertheless, just like with handguns and pitbulls, marketing is only bad because people who use marketing are lazy, stupid, careless, unethical, and sometimes even criminal.

In other words, "marketing doesn't hurt people -- people hurt people".

Marketing is just a tool. And as we know, a tool can be used for good or evil.

People who learn the proper philosophy and practice of marketing can do good and change the stereotype of marketers.

But I won't hold my breath.

Four stages of competence

Young people think they know everything.

Of course, that is a wild exaggeration, but many younger people are more confident about life than they should be. That is because many are unaware about how much they do not know. That knowledge tends to come with age and maturity.

In psychology, Abraham Maslow (Yes, the hierarchy of needs guy) stated that we go through 4 stages of competence.

The first is Unconscious Incompetence where we don't know what we don't know. In this stage we are highly confident in our ignorance.

The next stage is Conscious Incompetence where we realize our ignorance, but don't know how to address it. We have not yet learned.

The third stage is Conscious Competence where individuals understand and know how to do things -- but only with conscious effort.

The last stage is Unconscious Competence. At this stage, competence is so ingrained that it is "second nature" and internalized.

When students in the Unconscious Incompetence stage are taught by professors in the Unconscious Competence stage, it can sometimes be a case where a person who thinks they know it all is being taught by someone who has so internalized his knowledge that he can't teach it every well.

This is not the case in all educational situations but it is more common than desirable.

You don't negotiate? It'll cost you!

National Public Radio recently broadcast a piece about a subject near and dear to my heart -- negotiation. The piece was titled "Ask For A Raise? Most Women Hesitate" and it can be found at www.NPR.org.

My interest in negotiation was peaked after reading the book, "You Can Negotiate Anything" by Herb Cohen.

When I talk about negotiation with my students, I tell them that if they apply the basic principles of negotiation, they will be $100,000 richer by the time they retire. I now realize that I may have underestimated the benefits of negotiation.

According to economist Linda Babcock of Carnegie Mellon University, "by not negotiating their job at the beginning of their career, they're (women in particular) leaving anywhere between $1 million and $1.5 million on the table in lost earnings over their lifetime,"

And women are FOUR TIMES LESS LIKELY TO NEGOTIATE than men. Why don't women negotiate? The reasons are complicated but according to Babcock, "women often just don't think of asking for more pay. If they do, they find the very notion of haggling intimidating, even scary."

Now this is a complicated topic and can't be covered in a single blog post. I will periodically talk about negotiation in upcoming blog posts. Stay tuned.

How pharmacists can become indispensable

The key to survival in pharmacy practice is to never be comfortable with the status quo. If you are a pharmacist, you should try to work toward being indispensible to your employer by doing the following:

1. Be the one the patient asks for when they visit the pharmacy. If you develop a strong patient clientele, employers will see you as an asset more than an expense.

2. Generate business. If you aren't generating revenue, you are generating costs.

3. Don't be a jerk. You have to generate a lot of revenue to overcome the negative impact on your career of being a jerk. Even high earners are dispensible if they are big enough jerks.

The Colbert Report -- Giving a shout out to CVS

Tasing a CVS customer in the parking lot.

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Pharmacy and Beer -- Never Fear

In a previous post titled "Beer and Pharmacy -- Two of my favorite things" I talked about how a Duane Read Pharmacy in New York is now serving BEER. The beer is a microbrew that sounds pretty tasty.

Not to be one-upped by any New York pharmacy chain, Walgreens has introduced their own beer brand called "Big Flats". As made clear in my previous post, I am not against pharmacies selling beer. I am just against pharmacies selling bad beer.

I have some expertise on this topic because Walgreens pharmacies in Chicago used to be my beer supplier back in the 80's. I clearly remembered that their beer tended to get skunky -- meaning that it got stale setting on the shelf for way too long.

I think that selling bad beer can hurt the Walgreens brand. I am not accusing "Big Flats" beer of being bad because I have never tasted it. I do know someone who HAS tasted "Big Flats" beer (see the clip), and he does not think too highly of it.

Word Clouds

I love word clouds. I think they elegantly depict the meaning of complex texts. Attached is a word cloud of my article, Managing oneself: an essential skill for managing others. J Am Pharm Assoc. 2009 May-Jun;49(3):436-443. The word cloud provides some idea of what concepts are important for successfully managing yourself.

What is your personal mission?

On one of the first days in my management class, I ask our pharmacy students at Virginia Commonwealth University is to complete a personal mission statement. A personal mission statement is the foundation for good leadership/management -- you need to establish what you stand for if you want to establish a vision for others.

I have included my mission statement in this post so you will know where I stand.

Placebo effect

Daniel Ariely is a behavioral economist who provides interesting insights into consumer behavior. In this presentation, he describes how placebos provide a real therapeutic benefit.

Really -- Pharmacists are going to need to change

As pharmacy students, many years ago, we were told that pharmacy practice needed to move from a profession that focuses on drugs to a patient centered profession. Since then, pharmacy practice in community settings has continued to focus on selling drugs. And pharmacists and their employers have been highly paid for doing so.

Now it is different.

Really.

Here is why.

Economics.

We can't afford to pay pharmacists to do what they are doing. Over the years, pharmacists made a good living by counting and pouring. Now, the profit margins are shrinking for the dispensing of drugs. And the way to increase profits is to either make up the revenues elsewhere in the pharmacy (on greeting cards and motor oil) or reduce dispensing costs. To reduce dispensing costs, pharmacies need to use more technology such as ATM-style dispensing machines, hire more low paid pharmacy technicians and give them greater responsibilities, prepare drugs for dispensing in assembly line type centralized medication filling centers, and/or find some other way to remove the pharmacist from drug preparation.

So, it is clear to me that pharmacists need to change the way they help patients.

The $64,000 question is "change to what?"

You may not realize it, but it is probably a threat

Pharmacists who supervise others often use threats to influence behavior. They may not mean to threaten, but to the people they supervise -- it is a threat.

Threats occur whenever a pharmacist manager emphasizes rewards or punishments in motivating behaviors. Rewards and punishments are opposite sides of the same coin -- I will punish you, I will reward you, I will punish you by withholding a reward, or I will reward you by not punishing you.

Threats can be strongly worded, “Do this or you will be fired,” or oblique, “If you don’t meet the deadline, I don’t know what we’ll do.” Any threat causes employees to protect themselves.

Pharmacists often carelessly make explicit and implicit threats on employees without realizing the consequences on employee productivity. When employees feel threatened, they may protect
themselves in multiple ways – join unions, avoid the boss, withhold information, organize resistance amongst coworkers, or find a new job.

The take-home point is ---- use threats sparingly and know the potential unintended consequences when doing so.

The Problem of Pay for Performance (P4P)

Linking the performance of health care professionals to their compensation is a good start but unlikely to work alone in changing behavior. Health care professionals will continue their current behavior because of some of the following reasons.

They don’t know what they are supposed to do to change.
They don’t know why they should change.
They don’t know how to change.
They think something else is more important.
There are no positive consequences for them to change.
There are no negative consequences for them not changing.
They are rewarded for not changing.
They are punished for changing.

If the health care system does not provide what professionals need to change, they will not change or they will change in undesirable ways. Compensation will not make a significant difference. Pay-for-performance schemes cannot replace the other changes necessary for improving the quality of health care -- they can only support them.

Ten Common Marketing Misconceptions of Pharmacists

1. My job is not to market. The design and promotion of pharmacist services is someone else's job -- not mine.
2. Everyone gets the same service, no matter their need or interest.
3. I know what is best -- not the patient.
4. Patients only care about low drug prices.
5. It is OK to provide exceptional service one day and mediocre service the next.
6. Loyal customers will always be loyal.
7. Satisfied customers are loyal customers.
8. Patients know what pharmacists do.

9. Talking with patients is not "market research". Market research is done by marketing departments.
10.Marketing is advertising and advertising is marketing.

How to stop worrying

In the last post, I described a book by Dale Carnegie, "How to Make Friends and Influence People." I have another one of his books to recommend. It is "How to Stop Worrying and Start Living." There are all kinds of great ideas in this book, but I want to focus on a single one. It deals with HOW TO STOP STRESSING OUT OVER YOUR PROBLEMS.

If you think about it, a lot of things can go bad in this world. If we let them get to us, we can forget to enjoy all of the good things in life. So, if you find yourself worrying about some problem like, "What if I lose my job? What if I do really bad on this exam? What if my political candidate does not get elected?", ask yourself the following questions,

1. "What is the worst that can possibly happen if what I fear happens?"

I often ask this of my students when they worry what they are going to do with their life. I am kind of sadistic in even asking that question because their faces scrunch up and they exude stress as they think about the question. After listening to their fears, I ask them, "What is the worst that can reasonably happen to you after graduation?"

They usually answer, "I won't get a job."

2. The next thing to ask is "What is the likelihood that the worst case situation will occur?"

When I ask the students, what is the likelihood that they will not get a job, they typically say, "Not very likely, but still possible." I tell them that they are correct, that they might not get a job and they need to prepare themselves mentally to accept the worst--if they think it can happen.

3. The final 2 questions to ask yourself are, "What steps can I take to reduce the possibility of the worst case occurring, and how can I increase the chances that some other better outcome occurs?"

Immediately after asking this question, students typically start thinking of actions they can use to reduce the threat. They take control and their worry starts to disappear. It also steels them to do what it takes to be successful.

One of the benefits of this process is that answering these simple questions can help identify and assess the cause of the worry. In many cases, the worry is overblown and can be put into better perspective.

The other benefit is that even if the worry is real, imminent, and scary -- taking action helps give the worrier a sense of control over the problem. And worry is reduced when we feel in control.

How to win friends and influence people

If there are any more people out there that read books, I highly recommend Dale Carnegie's "How to Win Friends and Influence People." It is easy to read and offers some basic insights that can improve the effectiveness of any health care professional.

What I still remember after reading it a couple of decades ago is that the way to to become likable and credible is to stop talking about yourself. Instead, listen to others. Ask them about their favorite subject -- themselves. That may not be the case in all people, especially in cultures that don't like to bring attention to themselves, but it is for most people.

You might say "Duh!", that is so common sense. And you would be right. But we often forget or get into the habit of making everything about us.

And in our tweeting; Facebook; me-me-me society, we often spend more time focusing on ourselves than on others.

Read the book. Dale Carnegie is still relevant to human interactions today.

Testing is the best way to learn

The New York Times discussed research about the best methods for retaining information learned by students. The study found that students who read some information, and then test their recall of that information, will retain information better (50% better) than simply studying or using a learning method called concept mapping.

Recall of material is essential for pharmacists. It is an educational building block to higher levels of problem solving. I have been increasing the use of little quizzes to test student knowledge prior to class discussion. I think I will do more testing in the future.

Physicians need help in choosing the best medicines for patients

This image presents a simplified (yes, simplified) model of what goes into choosing an antibiotic for a cellulitis infection. It comes from a paper titled "Analysis of Empiric Antimicrobial Strategies for Cellulitis in the Era of Methicillin-Resistant Staphylococcus aureus".

The model lays out the options, patient population of interest, outcomes, probabilities, and costs of a relatively simple therapeutic decision. In real life settings, it is unlikely that this information is actually used in prescribing.

How strong is your brand?

Each pharmacist has a personal brand whether they like it or not. Your name is your personal brand. You can chose to manage perceptions of your personal brand. Pharmacists who effectively manage their brand are more likely to be successful in their practice and career.

Branding is the process of developing strong, positive, and consistent images of your brand in the minds of patients and others. Your brand’s strength is determined by the extent that people (1) recognize your brand when they see it and (2) recall it when making a choice. The more familiar and memorable your name, the more likely patients will choose you when they need a pharmacist. The more positive and consistent your image, the more coherent the message patients have about your brand.

What images and adjectives come to mind when people hear your name?

Using Marketing Principles in Teaching

Marketing can be useful in many ways. Take teaching for instance.  I segment my students into the following three market segments. 


The first is "dedicated learners".  They are easy to teach.  Just guide them to what they need to know.  They do well in almost any educational environment whether it is lecture, online teaching, or group instruction.  Just give them good content and provide them with opportunities to apply the concepts in problems, discussions, and exercises.  Typically, they already know a lot because by nature, they are learners.  Sometimes, I have to even tell them to back off a bit.  


The next segment is  "skeptical learners."  These people want to learn, but they need to be convinced.  They have been asked to learn a lot hogwash over the years and are choosier in how they spend their time.  They are often older, mature students who have stronger opinions of what is important and not.   Skeptical learners require the instructor to build a persuasive argument for the value of the material and the need to learn.  Once that is done, they are often even better learners than dedicated learners because they fit the ideas into their daily lives.  


The last, and most difficult segment is "unmotivated learners."  For them, learning is not important, so coercive educational strategies are needed.  Rewards and punishments, such as assigning attendance grades, are needed.   Even then, they often do the minimum amount possible unless you can spark their interest enough to turn them into skeptical learners.  


My target market is the skeptical learners.  Good teaching can influence their learning.  My secondary market is the motivated learners who will succeed if I do a good enough job with the skeptical learners.  Unmotivated learners are NOT my target students.  Of course, I will encourage them to engage, to learn.  But time is better spent on the other two student groups.  

Which is more important -- a good process or a good outcome?

In the long run, a good process will be more likely to result in better outcomes over time.
Let's say you want to hire a new employee.  You can get lucky once or twice with a poor selection and hiring process, but over time your luck will start to fail you.

The problem with good luck and bad processes is that it can be hard to tell them apart.  Thus, an incompetent person who does not know what he is doing can be labeled a genius because of some short term good luck.  And once labeled a genius, it can be hard to recognize or admit a person's incompetence until major damage has occurred.

Therefore, it is essential to employ good processes in order to achieve good outcomes.

Discussing Pharmacoeconomics with Clinicians

This is the way a typical conversation goes when I talk about pharmacoeconomics with clinicians.

In case it is not obvious, I am represented by the character on the left and the clinician is the character on the right.

Top 10 Principles of Pharmacoeconomics

1.  Resources are limited.  You can’t have everything.

2.  All choices are tradeoffs.  When you choose one thing, you have to give up something else.  It may be time, money, attention, or something else.  

3.  The Real Cost of Something is What You Give Up to Get It.* This refers to marginal costs or the additional amount paid for each addition amount of benefit you receive.  

4.  Rational People Think at the Margin.*  A rational decision-maker takes action if and only if the marginal benefit of the action exceeds the marginal cost. 

5.  Your costs may differ from my costs. Costs depend on the perspective of the individual evaluating them.  Costs from the patient perspective differ from those of the provider and payer perspectives.

 6.  Rationing occurs whenever we make a choice.  People who are against health care rationing are naïve or disingenuous.

7.  All costs and outcomes are probabilistic.  This means that the costs and outcomes used to assess the cost benefits of medical care might be correct, but they probably are not.  Always conduct sensitivity analyses.

8.  The value of money typically varies from year to year. Always make certain that cost comparisons are standardized to the same year.

9.  All studies are biased.  You need to understand how and if it hurts your ability to use it in your practice setting.

10.  Assume that most patients and clinicians are economically illiterate.  Simplify your presentation of data to their ability to understand.

How to manage Generation X

A blog in the Harvard Business Review Website Titled "Managing and Motivating Employees in Their Twenties" gives some excellent recommendations for managing people in their 20's.

Advice includes a number of basic recommendations like "ask frequent questions", "give them personal attention", and "wear authority lightly". My question is, "Why haven't the other generations demanded the same type of treatment? It seems to me that these are basic ways of motivating and managing anyone -- not just 20-somethings. Why have we learned to accept poorly communicated management expectations, abuse of power, and demotivating managerial practices? I say, "Right On, Generation Y!"

Why pay-for-performance in health care will probably not work

Daniel Pink describes my viewpoint about the science of motivation exactly!!

You will probably not believe him, but he presents what we already know about motivating ourselves and others. The evidence is clear. We just don't use it in the practice of pharmacy and health care.

Can motivational posters motivate?

The short answer is "yes". Despite the large number of "demotivational posters" available on the Internet which make fun of motivational posters (and rightfully so), motivational posters can help motivate in the following ways.

1. When an individual uses the poster to remind herself about aspirations and goals. A classmate of mine in college had a motivational poster above his desk titled "Justification for Higher Education". This poster showed an expensive beach front house with a five car garage filled with expensive autos. He is now a successful entrepreneur who I envision has a house similar to that on the poster.

2. When the motivational poster communicates a message that is accepted by team members. Motivational posters only work when they are consistent with the beliefs of those being motivated. They cannot change cynical or pessimistic viewpoints in the workplace.

3. When the motivational poster reinforces the message of a trusted leader. Without trust in the leader, the message of motivational posters will probably be resisted and mocked. However, if the team trusts the leader, the message communicated by motivational posters is more likely to be seen as credible.

Beer and Pharmacy -- Two of My Favorite Things

From the New York Times January 13th, 2011

A Duane Reade pharmacy in Brooklyn now sells BEER. The pharmacy serves Fire Island Lighthouse Ale and eight other beers in take-home growlers — refillable 64 ounce glass containers. They also conduct tastings, but beer is not consumed on the premises.
Does this hurt the pharmacist/pharmacy brand? What message does it send to the public? On one hand, it might say that the pharmacy is part of the community and is willing to serve community needs. On the other hand, it might send a message inconsistent with health care.
I don’t know the answer. If my local pharmacy offered beer in growlers, I would probably be first in line for a fill-up. I’ll have to admit, I like beer. And I can compartmentalize the selling of beef from the provision of health care. But that’s just me. Others might not feel the same. What do you think?

The image of pharmacists need improvement?

Although pharmacists are one of the most trusted professionals, their image in the minds of the public is weak and poorly defined. Google the phrase "pharmacist are" and you will get the following output. I think that this indicates some work we need to do to project a more positive, stronger image.

How to be awesome

Common Sense

Students often complain to me that managerial problem solving is just "common sense."

In truth, common sense is not really all that common in actual work situations, because common sense is typically based upon mental models that are not tested or examined. Common sense also tends to disappear in times of stress and emotion. Common sense also does not work well for complex problems.

In real life, we don't have time to use our common sense, so we just wing it and suffer the consequences.

Bad Management Kills!

People don't typically think about true costs of poor management in health care settings. But bad managers kill people!

They do it by making it difficult for physicians, nurses, and pharmacists to serve their patients. Bad managers waste the time of people they manage. They cause distractions, waste resources, and hurt productivity. They reduce the performance of health care professionals with unnecessary paperwork, meetings, interruptions, and aggravation.

Let's get rid of bad managers in health care and save lives.

How do pharmacists succeed in helping their patients?

In an earlier post, I asked the question, "Why don't pharmacists do more to help their patients?" It provided a list of many of the reasons why pharmacists are doing much less than they are capable of doing for their patients. I now suggest reasons how so many pharmacists succeed in helping their patients.

They have a clear personal mission to help their patients.
They take ownership of their practice setting.
They accept responsibility for their patients' health.
They keep up to date with the best methods for helping their patients.
They think nothing else is more important than helping patients.
They are more motivated by the work itself, rather than the rewards that are offered by their employer.
They have balance in their life which prevents personal problems from getting in the way of helping patients.

Why don't pharmacists do more to help their patients?

Pharmacists could be doing much more to help their patients to achieve optimal health outcomes. According to a book by Fournies titled "Why employees don't do: what they're supposed to do and what to do about it," many pharmacists don't do all they can to help patients because:

They don’t know what they are supposed to do help patients.
They don’t know why they should help patients.
They don’t know how to help patients.
They think something else is more important than helping patients.
There are no positive consequences for them helping patients.
There are no negative consequences for them not helping patients.
They are rewarded for not helping patients.
They are punished for helping patients.
They are not and will never be capable to help patients.
They have personal problems which prevent them from helping patients.

That brings up a related question, "Why do so many pharmacists do such a great job helping patients when they have so many excuses not to do so?"
What motivates them to overcome the barriers present in many practice settings?

Best Video of Pharmacist value

Welcome to the first post in The Pharmaco Marketer Blog.  I really wanted to name this blog "What I should have learned in pharmacy school".   But I wondered if people could remember that name.  And abbreviating the site with the first letters results in WISHLIPS. 

So I decided to name the blog "The Pharmaco Marketer" because that pretty much describes my approach to solving problems in pharmacy.  I use a marketing mindset which consists of:

• a focus on serving the consumer/customer/patient,
• providing real value that meets the consumer's needs and wants,
• a realization that no matter what you do, you are competing with others, and
• knowing that you can't satisfy everyone so you must target those who you can best serve

I will talk more about this in future posts.