How long have you been preparing medications for people living with HIV?
I have been working with HIV medications for two years now. Our county was in need of a clinical pharmacy program. The pharmacist is sort of the front line person after the patient sees the doctor, since, for the next six refills, I will see the patient, and the doctor won't. During these meetings I will help patients understand what all the tests and their viral load means. It's like I give them a mini-refresher course every time they come in to refill their meds. I find there are many errors in judgment and misconceptions about the drugs in the patient's mind. A patient will get a cold and they will stop taking their medications, because they get confused about HIV having so many medications, and they appreciate that little reminder. I also give them pill boxes so they remember when to take what. I remind them they are supposed to be tested for viral load and CD4 count every three months.
What is your patient demographic?
All of my patients have HIV, but they aren't just getting HIV meds; some need prescriptions for diabetes, blood pressure or cholesterol. It used to be that when you were diagnosed, you didn't have that long to live, but I have a lot of patients who are getting older age diseases. The differences in the patients surprised me when I first started, because I have both soccer moms and prostitutes. We fill a lot of prescriptions, about 250 a day. The patients are about 60/40 men/women, but the number of women is on the increase. The majority of our patients seem to be African American men. The highest risk factors are for women between the age of 25 and 45, and that is the age of most of our women, as it would be expected. We rarely have children, in any case there is another facility for them.
When did you decide on pharmacy school?
I was a chemistry major in college. I worked part time in a hospital and transferred to the pharmacy. When I saw what pharmacy was all about, I changed direction; I filled out the application for admission to pharmacy school, submitted my transcripts, took the Pharmacy College Admission Test, endured the admission interview, and finally received word that I had been accepted.
Does your most successful work come as a result of working in a team environment?
Well, not a team that has the same players on a consistent basis. I consider myself part of a team. The team players are rotated. I may counsel the patient about their medication regimen and follow this up with a call to the social worker for compliance issues, or, the physician, patient and I may need to discuss a dose adjustment. The goal for the patient is the same; to maximize medication efficacy, minimize adverse side effects and reduce opportunistic infections, suppress viral load, increase CD4 and maintain a desired quality of life. Of course, we take prescriptions from any physician -- so my "team" is from all over Jacksonville. I do have a core group of physicians and assistants and nurses who I work with all the time. This core group has lunches every Monday and during them we do some kind of continuing education. People who work in HIV are extremely compassionate people. They are so knowledgeable. I respect them very much.
Is there anything you do to establish a better relationship with your patients?
I try to maintain a professional, yet personal relationship with my patients. I definitely know more about them then they know about me. What I know about them helps me assist them when they come in and pick up their meds. For example, I can tell when a patient hasn't been taking their asthma medications and they will admit that they haven't been and I will have to give them "the lecture" on the importance of keeping up with their medication commitments.
Do you have any involvement with patients when they are first put on medications?
When they first go on the medications, we have a counselor who sees them first. I counsel them as well, when they first start, which helps reinforce the ideas and gives them a chance to ask any questions that may have come up between the time they saw the counselor and me. I try to go over the meds with anyone who is first starting. I try to listen to all their concerns, because sometimes they deal with more imposing quality of life issues. If they are having to go to the bathroom seven or sometimes more times a day because they have diarrhea, that affects their life. I've had a patient who needed to get an anti-diarrhea prescription refilled early because he wasn't able to function without it. I knew that this could be a sign that he had something more than just normal side effects of his HIV meds and I sent him to the doctor. It turned out he did, but it was easily cleared up because I was able to catch his irregularity. Sometimes it just helps to have someone to talk to who understands what is going on with your body. The patients are more cheerful when they come in to talk when they know we are concerned.
Is there anything special you try to do for people living with HIV when they come to pick up their medications?
I always have notes on their prescription bags that I want to talk with them about specific ideas. I may advise them of a side effect to watch for when they are starting a new medication, or ask them why they are late on their refills, or offer encouragement when I see that they have been following their medication regimen very well. Each person has a different therapy need and I just try to address them all. HIV medication therapy can be challenging and when someone has overcome a challenge with their medication therapy, I notice and acknowledge it.
If I were to follow you for a day what would I observe you doing?
I do lots of things every day including reviewing medication regimens, calling physicians for dose clarifications or concerns, counseling patients, alerting a social worker to the special needs of a patient regarding medication therapy, maintaining the medication formulary, taking prescriptions over the phone, discussing payment sources, filling prescriptions, etc.
What is the best thing about your job?
The best thing about my job is being involved in patient care and networking with other HIV healthcare providers. It is very rewarding. The HIV healthcare providers' network is made up of truly caring professionals.
What is the biggest challenge you face as a pharmacist?
I don't know that I would call it a challenge, but my biggest pet-peeve is when people think that all a pharmacist does is count pills. I have had patients get irritated when I call a physician about a concern and the patient will say, "Just fill the prescription." There is a lot of professional judgment that goes into the dispensing of a medication. I cannot dispense a medication unless I can assure the optimal drug therapy outcome.
What do you think is the biggest risk factor for HIV?
I think risk factors depend on where you live. In the U.S., I think the biggest risk factor is unprotected sex and multiple partners. The fastest growing group at risk for HIV in the U.S. is women, a major part of this is due to unprotected sex. Unprotected sex among people who are already HIV positive just opens the door for different strains of HIV that may not respond to current therapies.
What do you think are the biggest problems people with HIV face today?
I think one of the biggest problems facing people living with HIV/AIDS is the development of more drug resistant strains of HIV that do not respond to current therapies. In other words, be diligent and don't let your guard down. People living with HIV should avoid at-risk practices and always practice safe sex.
What is the most important/memorable/useful thing you have learned from people living with HIV?
HIV/AIDS affects everyone. I have patients from working professionals to the unemployed, heterosexuals to homosexuals, children to geriatric, all have been devastated by this disease.
How do you maintain a positive outlook and avoid burning out?
I think that there are so many positive improvements in HIV therapy and the reduction in morbidity and mortality help to maintain a positive outlook.
Where did you grow up?
I grew up in a small suburb outside of Pittsburgh, PA.
What did you want to be when you were a kid?
First, I wanted to be a veterinarian, then I changed to a marine biologist. I almost made the marine biologist, until I started working in a hospital pharmacy and loved it.
Have you had any other types of jobs besides pharmacy?
I left home when I was 18 and worked my way through college, so I had quite a few jobs during that time, but then I graduated and started working in pharmacy.
Who have been the most influential people in your life, professionally and personally?
The most influential person in my professional career was a pharmacist I worked with who I viewed as a mentor. This pharmacist taught me to think clinically and about disease state management. Not, "just count the pills!" I worked as a hospital pharmacist and we never saw the pills. We reviewed patient profiles, a technician would fill the prescription, the pills were unit-dosed in individual foil wrap and we would check the label printed against the label on the pill.
Where do you live now?
I live in a suburb of Jacksonville. I like it because I can be outdoors. I like hiking and kayaking. It is the sunshine state. I've been mulching lately, but I like to design the garden and I try to paint with flowers, using color and texture and fragrance.
If you weren't a pharmacist what would your profession be?
Landscape architect. I really like designing yards to their maximum potential. Well, anyway, my yard. I put in Easter lilies, a big trumpet flower, very fragrant, in an area by the bench and it makes you want to go out and sit in the yard and appreciate the beauty of nature. It's a nice sized yard, and I sort of chop it up and I have a meditation area that I described with the lilies, and then I have an eating area, so that I can entertain people around all the greenery. I cannot grow vegetables; part of the problem is amending the soil mixture. I just don't spend too much time on that. There is a lot of wetness in Florida that mildews the soil. I like to be able to cut the flowers and bring them inside -- it is like bringing the outdoors in.
If you could live anywhere (besides where you live now) where would you locate yourself?
I really like Salt Lake City, Utah. The mountains are so beautiful and there is a lot of outdoor activity. I like to ski, and there isn't a lot of opportunity for that in Florida. I like things that are outdoors, so sports work well for me. I kayak every chance I get. I would probably like to do it more than I am. I have blisters on my hands from paddling. I like ocean kayaking, because with river kayaking the water is very cold. I make sure I don't turn over in those situations where I'm in a river. The ocean it is warm, so I can flip if I want to. I just got back from a kayaking trip in South Florida, and the water was crystal clear, but it was rough and we had to paddle hard. We paddled up to a spot where all the mangroves had grown into a tunnel and we coasted under the mangroves.
What is the best vacation you've ever had?
I have hiked into the Grand Canyon, rafted the Colorado, skied in Utah and North Carolina and been on history vacations to places like Williamsburg. They were all great.
How is your family affected by your profession?
I have had a wonderful time raising two wonderful kids. My daughter is 22 and my son is 17. They always have to put up with everything that I have learned as a pharmacist. They have learned all about drug abuse, and they have heard a lot about different disease management. We talk about sexually transmitted diseases and HIV and drugs and smoking and it is a great opportunity for them to ask questions.
What are you currently reading?
The biography of Pope John Paul II. I really like biographies, and I had gotten this book for Christmas; it's about 1,500 pages. I think he had a huge impact on the world. Whether it was good or bad, it was there. I have been reading more about him as well, because the newspapers and magazines have had a lot of information.
What kind of music do you listen to?
I like a lot of different music. Broadway musicals, James Taylor, John Denver, and jazz like Acoustic Alchemy.