Who are the Pilots?
In the analogy, prescribers are the aircraft pilots. Ultimately, the pilot is the one in charge of the aircraft. What they decide determines if the plane flies or burns. Air Traffic Controllers may only deal with one aspect of the flight, but no reasonable pilot would dismiss an ATC order except in extreme circumstances.
Can you imagine what it would be like to be an ATC in a world where pilots didn’t listen most of the time? Sure, often ATC commands are just out of caution. There are probably some orders that could be ignored without major disaster. But a lot of the time, bad things are going to happen. This is what it’s like being a pharmacist. As a pharmacist, you have the knowledge and information to save lives and improve people’s health, but no one listens to you. So you have to sit back and watch as the bad things happen that you knew would happen.
I really struggled with this early in my career. I moved into the hospital world thinking that if I had access to charts I could get more information to either be more persuasive or to feel more assured that the prescribers were making the correct decision. This did ease my mind to an extent. At least in the hospital, I knew I had access to the same information and I could feel more informed before making a recommendation. But even then, most of my recommendations continued to be denied or ignored.
I started to wonder if I was just a bad pharmacist. Maybe I didn’t learn enough in school. So I started studying. Every patient I encountered I read everything I could about their conditions. I slowly gained confidence. The number of recommendations I made, however, continued to drop, to nearly zero. It wasn’t because there weren’t things to recommend, it was because I had learned what types of things the providers were willing to listen to and what they were not. Sadly, I came to the realization that I could prevent nothing but the most egregious mistakes. And even then, it was not a guarantee.
For a while I worked as the only pharmacist in my hospital. Even as I was learning and growing, in that setting it was still hard to know if I actually did know anything or not, since I so frequently disagreed with those around me. I legitimately wondered if I just somehow fundamentally misunderstood pharmacy and medicine. There was one way to find out. I could try to become Board Certified.
I’ve never been one to get nervous about tests. I barely studied for my pharmacy licensure exam and passed with a high score. But, after years of self doubt, I was scared to take the Board of Pharmacy Specialties exam in Pharmacotherapy.
I felt like I knew the subject matter, but I just wasn’t sure because I seemed to always be the one with the opinion that didn’t fit the mold. This would be the deciding factor. The moment of truth that would reveal if I was just a bad pharmacist, or if I had a bad case of professional gaslighting.
Nearly two months went by after I took the exam before I got the results. When the word “PASS” showed on the screen and my name was listed in the registry of Board Certified Pharmacotherapy Specialists, I was elated and vindicated. But, in a way, it would have been easier if I had failed. If I was just a bad pharmacist, that would almost be easier to swallow than facing the fact that I HAD been witnessing years of poorly managed patients and hundreds of unheeded and valid recommendations. The ATC knew what he was doing, and the pilots still ignored him.
