I miss sports. I didn’t realize how much it would mean to have them taken away, even if temporarily. And I miss being part of a team. Well, I am still part of a team, but due to the COVID-19 pandemic, we are functioning independently and remotely but still together. So this is how I am connecting sports and healthcare, two separate entities that thrive only when the following are in place: shared goals, clear roles, mutual trust, effective communication, and measurable processes and outcomes.1 Whether it is a patient returning to work due to well-controlled chronic pain or a three-peat basketball championship (anyone else watching The Last Dance?), such an outcome cannot happen without a group of people prioritizing the “we” over the “me.” From a historical perspective, it was not always easy for pharmacists to have a seat at the table. (I still have days when I hear shock in another healthcare provider’s voice when I share with them my role and responsibilities for patients with chronic pain.) We are here, and we matter. But more importantly, we are only as good as our team. This begs the question, what is the recipe for success? Let’s walk through the qualities necessary for an interprofessional team to go from simply delivering healthcare to saving and transforming the lives of patients with pain.
Responsibility and Accountability
We have bills to pay, mouths to feed, plants to water, and as part of our oath, people to care for to relieve suffering for the welfare of humanity. We have a lot on our plate, and finding that elusive work-life balance can be a challenge. However, when we work as a team, we feel less alone and that distributed burden can become surprisingly manageable. While we are responsible to the patient, let’s not forget that the patient is part of the team. Integrating shared decision-making by providing the patient with options for care to discuss and determine together demonstrates the value of their input and our respect for their autonomy. We are accountable when we accept the responsibilities of being a team member and healthcare provider, and by doing so, we show up, we prioritize the patient, and we give it our all.
Our incredible efforts as a team are on full display in light of the COVID-19 pandemic, and our responsibility to patients extends far beyond the hospital and pharmacy. For my team, caring for patients with chronic pain has shifted from in-person clinic visits to telehealth visits, and responsibilities have adjusted to account for redeployment. Our team has not missed a beat, but alas, not even a pandemic can alleviate the burden of completing medication prior authorizations….
Coordination and Communication
So you know your role as a member of the team – great! But knowing is only half the battle. Coordination of care ensures that patients have access to necessary health services and resources and involves effective communication among all team members. As pharmacists, we need to be well informed of what those resources are and how we connect the patient to them. I spend a good amount of time educating patients with chronic pain on nonpharmacologic interventions, such as acupuncture, but recommending this option to patients with limited resources is an exercise in futility.
Communicating the needs of the patient to the care team should be timely and concise yet accurate. It is not that anyone else’s time is more important than ours, but we should be mindful of how we approach communication with other healthcare providers. We are all multi-tasking throughout the day so being specific about the problem and providing realistic recommendations can keep us juggling while balancing the problems (or pies?) being thrown at us.
Cooperative and Assertive?
Can you really be cooperative and assertive at the same time? The answer is yes. People disagree, but when faced with disagreement, we do not need to be defiant. Making decisions about patient care is NOT the time for conspicuous demonstration of superiority. The art of compromise, however, especially for the sake of the patient, should never put you in a position to abandon your own ethics. We are all well trained and well educated; the only variables are confidence and communication skills. So stay calm and state your case.
This advice hit home when a patient was recently referred to me for “opioid tapering.” Upon contacting the referring provider for additional information, I was told that opioids did not seem justified “simply for chronic low back pain,” and the provider was no longer comfortable prescribing them to this patient. Ultimately, my assessment was very different. While we had opposing views on the role that opioids can play for chronic pain, we agreed that what was best for the patient was to optimize, rather than taper, the opioid regimen. And in case you are wondering, the patient is doing great – go team!
Mutual Trust and Respect
The members of my care team are often not even working in the same building at the same time. With some I only communicate through email. So how do we build and maintain trust and respect when we function together, yet apart? Fortunately, it is not about physical proximity, especially in a time of physical distancing. What matters is commitment, consistency, dependability, listening before speaking, sharing in successes, and learning from failures. Whenever possible, we should spend time with each team member to develop connections and attempt to see healthcare from their perspective. Lastly, and more than ever, we need to spread the word about our impact on patient care through publication, and there are several success stories of pharmacists in innovative roles demonstrating their value in team-based pain management.2-4
It is only fitting to end this commentary with a teamwork cliché, so here you go: Coming together is a beginning. Keeping together is progress. Working together is success.
- Mitchell P, Wynia M, Golden R et al. Core principles & values of effective team-based health care. Discussion paper. Institute of Medicine, Washington, DC; 2012. https://nam.edu/perspectives-2012-core-principles-values-of-effective-team-based-health-care/ (accessed 2020 May 5).
- Coffey CP, Ulbrich TR, Baughman K et al. The effect of an interprofessional pain service on nonmalignant pain control. Am J Health Syst Pharm. 2019; 76(suppl 2):S49-S54.
- Strickland JM, Huskey A, Brushwood DB. Pharmacist-physician collaboration in pain management practice. J Opioid Manag. 2007; 3:295-301.
- Dole EJ, Murawski MM, Adolphe AB et al. Provision of pain management by a pharmacist with prescribing authority. Am J Health Syst Pharm. 2007; 64:85-9.