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A Story from a Clinical-Pharmacist-to-be By Yovita Diane Titiesari -7 March 25, 2015 14 1625

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.

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Yovita Diane Titiesari http://pinkishsailor.blogspot.com

A pharmacist who love to cook, sing, reading, and listen to music. Deeply in love with choir and any classical performance. Could not deny any creation of Indonesian and Chinese food. Wishlist including summer cruise to Greece, watching opera at Royal Albert Hall, and a lifetime supply of Pringles/Doritos/Walkers. Currently pursuing master degree at School of Pharmacy, University College London (UCL) with LPDP scholarship grant.

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