Moving beyond the standard route

And so my main motivation when I enrolled in my B Pharm at Latrobe Bendigo was actually the degree was really just a means to an end in terms of getting my pharmacy degree, which would then allow me to compound radioactive pharmaceuticals in a lab environment basically at Peter MacCallum or at the Austin, which were the two main centers in Victoria do.

And so unlike most people, I was really engaged in the chemical analysis parts and all the pure chemistry stuff and less so in sort of talking patients through medicines or managing chronic diseases. And so I think the fact that I was forced to do a lot of that work did start to spark an interest in direct patient care rather than sort of just being you a scientist.

I interned at Peter MacCallum, namely because I'd been working as a research assistant there in the pharmacy area, but primarily as well because I thought oncology was a field that I was going to be pursuing. So I guess I started out thinking that I was going to go directly into a specialist role rather than going out there wanting to build a solid foundation. And I think that served me well in some areas, but in reality it probably was a disservice to myself because I wasn't going

into things open-minded. And so it was through that. But I then finished my internship and got a research ship role at the Austin Nuclear Pharmacy and I did that for three years. So at this point now I've done a three year nuclear medicine degree with honors, a four year pharmacy degree with honors by research, a one year internship, two years in Wooley at pharmacy. So that's now what, 10 years. And then I realized I actually don't want to do this.

So 10 years to then go, actually this isn't for me, full-time academia wasn't something that really interested me and that was kind of the trajectory that I needed to go in. And so during that time, I'd met a mentor of mine. Renee is the deputy director of Pharmacy for clinical services and education at Grampian Health. So her and I had a professional relationship and

mentorship since my intern year. And so I reached out to her, left my job at the Austin and took a three month contract at Ballarat Health Services, which is now known as Grampian Health. So walked away from 10 years of work to a three month casual contract. And to be honest with you, it really feels like it was then that my career started. And so in that time I was just doing work on surgical wards, a bit of general medicine work, trying to understand where I wanted to go.

And so an opportunity came up at my health service for a project in establishing telehealth clinics to help enhance the cardiology service because they had a really high, what they call DNA rates . And there were a lot of concerns around medication literacy within their cohort. So I thought that was interesting.

So I spent two weeks writing a literature in preparation for my, so I wrote a 3000 word paper describing the nature of cardiology pharmacy practice and how telehealth works and issues around regional gaps. I went to my interview for this position and they said, what can you tell us about the role? And I dropped a 3000 word paper on their lap going, I think there's something in this. I think there's an opportunity, I think there's a gap. And I got the role and that was in 2018.

And basically since then I've just been attempting to read the book on cardiology in terms of every guideline, every paper, every resource I could get my hands on. And it's only been sort of now in the last maybe 18 months to two years that I'm now involved in rewriting that book. So I sit on the National Heart Foundation Guideline Writing Committee for coronary syndromes and would use for the a and H and the Injectable Drugs Handbook.

And so that sort of is in a really short burst is that I work towards something that I thought I wanted for a really long time, got a lot of really good analytical skills in the process, and it was actually because I had to engage with patients as part of my degree. That was because I had to participate in these other clinical activities that I actually found that that's where my passion went. And since then, I've now moved into this specialist role.

So I think a good takeaway from that is Peter McCallum, if anyone even had a hint of chest pain, they were essentially put onto a catapult on the roof and shot across to St. Vincent's. So to go from there to now I guess co-chairing cardiology interest group, then if people think that they're too far gone to retrain or pivot around, I'd seriously say to reconsider that because it is possible to shift like that as long as you can appreciate the skills that are transferable.

It'll often be a point of difference in that role because the one thing you can guarantee cardiology pharmacists are going to know is cardiology drugs, the one thing we can guarantee they may not know are all the other things that are involved in patient care. So your other experiences will no doubt make you an asset in that particular team.

Can you tell us through grampian Health in your three different roles, I believe that you've had, how you've been able to navigate those and move forward and continue to create opportunities for yourself?

specialist. And so as a result, it makes sense that they might not have been at pharmacists that were going to train up in that special because people assume that you need to have someone above you to train into One of the benefits, and this was mainly through my relationship with the Society of Hospital Pharmacists and I guess just not being afraid to be wrong or to be seen as someone junior is I reached out and I actually made

connection with Dark Birds Eaton's the senior cardiology pharmacist at Barwon in Geelong. And I spent all my ADOS just volunteering at Barwon and shadowing him. And I asked him, I was like, how do I go about becoming a cardiology pharmacist at Grampian? And the advice he gave me was, change your email signature, tell everyone you're the cardiology pharmacist, and then make sure you've got the knowledge to back that up. He goes, the rest will fall into place. He's like,

don't wait for someone to create a role. Just become it and embody it. And that's exactly what I did. I gave my mobile number to all the cardiologists, to the cap lab nurses. I was like, you call me. There's are your questions. You let me know if there's anything I can do. We know often people use the phrase either research moves at the speed of trust or change moves at the speed of trust.

And so my primary objective in that first 18 months moving into the cardiology space was establishing a really strong sense of trust with myself and the clinicians in that multidisciplinary setting. And I think that's really what helped build that platform that eventually I could would overhear in the corridor or people saying, oh, talk to Adam. He's the cardiology pharmacist. Now, as soon as I'd overheard that, there was no formal title.

It wasn't in my ED or my job description, but it didn't matter because it was now embedded into the health system. And I think I've been working in and out of public health since 2005 when I was in orderly pushing beds at Northern hospitals, ED and on a Friday night and in high school is that culture always trumps strategy and something that becomes embedded is almost impossible to get out without a lot of force.

And so you can sometimes use that to your own advantage rather than always feeling like you're a victim to a victim to trying to get change working because people are stuck in their waves or there's resistance to change. And all the hundreds and hundreds of books and podcasts that exist around instilling change in an organization, especially one that's a public system based one too.

things. But in saying that, I've just taken those opportunities on and constantly tried to upskill myself and not be afraid of being, as I said, not all afraid of being wrong or being seen as someone who's junior in that space.

Probably the most humbling experience I've had is transitioning into being a PhD stage student as well as being a senior clinician here, because on a Tuesday afternoon that for example, I could be the clinical lead to clinical pharmacy services across the hospital, multiple staff that I'm accountable for, and then transitioned to a Wednesday morning and I was the most junior PhD student needed help logging into my computer level of knowledge.

And so I think it's been a really awesome experience. I'd encouraged people, not necessarily to go into a PhD, but don't be afraid to go into situations where you become the least knowledgeable of the most. It really reminds you of what it's like to be a new. And so when I add interns or residents make those comments like, oh, I was nervous submitting my work to you, or I'm not sure I'm afraid of being wrong while being critiqued, I'm like, I know exactly what you need.

12 hours from now I'll be having my manuscript torn up by my supervisors, no different to what's happening If you were me right now, if you were. So that's been the best asset is the understanding that it's just because you might be in a single role, it doesn't mean that, and it shouldn't mean that you know the most about all the things that you do.

In fact, I think having an attitude like that is probably going to lose you friends and respect and probably mean that you're not going to grow any further than you already are.

Just because I think the workplace has changed quite a bit?

A simple thing that someone could do early on in their career, if you are able to manage something like a pivot table in Excel, you're probably already better than 90% of the people in the department. And it's such a simple thing and you can help people out. And for the people that don't want to learn simple skills like that or understand that, you will automatically then seen as someone who's very busy and very knowledgeable. And so I think on one hand,

people could value on skill and experience. I think if you can also demonstrate your attitude to how you can facilitate challenge, how you can understanding information that it itself might sell you as an asset as well. So that to another organization, and again, I think you may then need to, it might not be a promotion, it might be a sidestep or a step down, and that's something that need to consider and however people value their role, that also might be a reality that they have to do as well.

That's definitely what happened with me and I've since built that back up and now I'm further ahead than I would've been if I had stayed in the same role.

well. And so what we wanted to do was design a service that was going to make everyone's experience enhanced in some way. So in the case of the clinic environment, what we were able to do was reduce the amount of did not at attend that came through that service. So that was an efficient concern that we were able to develop to the clinicians.

We were able to improve the medication and health literacy of the patients attending it. So it meant that in a standard consultation, the cardiologist didn't have to explain to them what heart failure was that had already been discussed. So it meant that their appointments were about making decisions rather than having to provide information and then asking them to make a decision with three minutes experience with the knowledge they had.

And then with regards to the patients, it was then about launch in their ability to not only understand their medicines, but also to know that they can advocate for themselves around, I'm sure everyone listening to this podcast knows that despite the fact that we seem to have such a strong cultural shift in self-advocacy, I often find that when it comes to medications, it still feels very directive in that, well, I've been given a prescription that I have to do what's on pr,

otherwise bad things will happen. And so that was sort of the way we approach it. And since then we've now got services running in atrial fibrillation, post heart attack care, namely for patients that are receiving cardiac stents, heart failure clinics, and also renal services clinics.

So both for patients who are on the path to needing dialysis, and we're trying to slow that down or patients who already are on dialysis and we're trying not to optimize their outcomes while they're on dialysis as well, whether they're destination for transplant or whether they're destination dialysis as well.

And it's all been building on that same idea of how do we enhance the experience of everyone around us rather than how do we make ourselves seem important, which I think is often a huge challenge when it comes up. I've done systematic reviews on pharmacist clinics and it feels like we're always trying to justify what we're doing rather than just trying to look at an outcome and improve that outcome regardless of who's doing the role.

And I know at least with my time at the Cardiac Society of New Zealand that they are definitely, it feels like they're moving in that direction in that they're just interested in seeing that the thing is being done, not who was doing the thing. I think we have a bit of a benefit in tertiary specialist care compared to primary care. It doesn't feel as politically motivating in terms of it actually does matter who does the thing, not whether the thing is done.

How we shift that paradigm, I don't know. But I know that even on your podcasts that are already being some pretty big movies and shape is in that space that are trying and call that.

I'm not myself well versed. So at the moment, no, I essentially look after the subacute services, that's palliative care, geriatrics and rehabilitation, look at general medicine, but then also the rebuild, gastroenterology, neurology, oncology, hematology, all of these different specialties. And that in itself has been a challenge. But again, I've had a really good role model in that with Renee Diamond,

who is then my boss. She's a pediatric pharmacist, but she doesn't even really manage people that are over the age of 18, yet she's been able to chant in so many initiatives across our health services by trusting and recognizing the strengths of her clinicians, and then just being able to fill the gaps rather than them trying to be or trying to be the most senior. It's instead just about, again, identifying the gaps in our staff and then providing them with those tools.

So I think that's probably been the biggest shift for me. I mean, even at the moment, I'm covering a respiratory and general medicine unit to support one of my staff members to do interviews for our interns. And so yeah, that's again, been a very humbling experience because I'm now having to manage things that aren't sort of within my skillset. And so I rely on the other pharmacists in the team to help through that process.

And I'm not afraid to say that I feel like I've done the wrong thing more, but I'm not sure of something.

hospital to go to. So jump into it again, respect the fact that whilst you might be an experienced pharmacist elsewhere, that there might be some transferable skills, but there may be other skills, which means you will start in a grade one role. That doesn't mean that you can't then progress into a grade two role and then further on to grade three if you're willing to then put in that work, something like first point is looking at it, looking at it that way.

The other, I guess component to that as well is you can't rely on just your workplace. You need to be going beyond that and you need to be studying, in my opinion, studying beyond what your standard workplace training is going to give. That's how you can accelerate in your progress. No, no different to any other pursuit or activity that a person might want to do. You want to be able to lift heavier your weights, you're going to have to go to the gym more and train smarter and train harder

than anybody else. It's the same thing would be career. And so I think that's the other piece of advice I'd give to people and just find mentors wherever you can. Don't just think you need one person in some super amazing person. I can assure you, once you meet them and you realize that they're human, all of their faults will come to the surface signal to very disillusioned.

Instead, you might have four or five people where you're sampling the best of what they had in order to make you better as well.

And yeah, I think that's sort of where I'm moving towards, I guess is hopefully a mixed clinical research and clinical role for me. But we'll see what happens. I mean, as I said this time, this time, 10 years ago, I thought I was going to be working in a lab for the rest of my life, so I dunno, we'll see what happens.

And I think that's one thing to definitely consider is if you're sitting in a room and you're feeling like I'm either not doing something cool or I'm not hanging out with cool people, my suggestion is to make a change.

Thank you. That's pretty amazing. That was very motivational. I'm like, oh, what can you do next?