However well-founded our roots and well-intended our work is, there exists the nasty fact that we are not living health care's "Do no harm" creed.
The following thoughts are expressed with the highest regard toward the pharmacy profession and its solid educational and legal foundations, its thousands of pharmacists and pharmacy technicians with deeply rooted professionalism, and its sincere desire to help patients.
It is not meant to imply that we are not saving countless lives and health care dollars on a daily basis.
The profession of pharmacy serves a key function in the overall health care spectrum, and our value is increasingly being recognized. This rise in status, however, comes with a concurrent increased need to begin a heart-to-heart and frank discussion of how the risk of certain negative (and certainly unintended) outcomes is a reality of our professional and personal lives.
Before I continue with my comments, please note that I am a neuroscientist who has studied the human brain for nearly 20 years. Although this should give me some credibility, I openly admit that I am only scratching the surface of understanding how the brain works. I am in very good company because any neuroscientist with honest neurons in their head will admit the same thing. What we lack in specifics, however, is not enough to deter a constructive conversation on the topic or a discussion of ways to make us smarter and less likely to kill someone.
However well-founded our roots and well-intended our work is, there exists the nasty fact that we are not living health care’s “Do no harm” creed. This article will not concentrate on how many medical errors happen on a daily—let alone cumulative—basis. We are well aware of the magnitude of the problem even if we are not up-to-date on the specific statistics. There have been other articles summarizing the multitude of causes behind medication errors and mortality, but few, if any, have concentrated on perhaps the single most important (and nearly 100% correctable) cause: your brain.
To understand why you are killing your patients, we need to talk about your attention or, more accurately, your lack of ability to maintain attention. If what I just said has raised your interest, please note that this does not mean much. Why? Because: 1) a large part of your mind is already focused on something else, 2) you are already formulating a “reality” in your mind to dissolve any future cognitive dissonance of what might come, and 3) you have already begun becoming desensitized to the words on this page because it has taken longer than a few minutes to read them.
Evolutionarily, we know that our neocortex, the thin shell involved in our highest functioning capacities, is as weak as it is relatively new. Sure, it can perform some heroic stunts, but these usually pale in comparison to the stronger and more resilient brains that live below. Our lizard, mammalian, and primate brains evolved between 300 million and 2 million or so years ago, with our higher hominid capacities arising perhaps 300,000 years ago. Some contend that what we consider full human consciousness is only about 20,000 years old, and some suggest it is less than 6000.
Again, whether or not the full details are conclusive, we must admit we are, to paraphrase Jonathan Haidt from his landmark book, The Happiness Hypothesis, driven by the “elephant” parts of our lower-functioning brain and not the neocortical “elephant rider.”
How the different brains work is likewise an important concept to grasp. In his book Hardwiring Happiness, Rick Hanson, PhD, elegantly summarizes our propensity to look for, memorize, and concentrate on the negative parts of life and to be relatively unaffected by the positive parts, as: “Velcro for the bad, Teflon for the good.” In essence, it serves us much better to dedicate neuronal structures, energies, and abilities to the threats of the world that will end our life than to things that bring pleasure. My own field of chronic pain research clearly shows that pain is the most important and effective sensory system that keeps us alive, and it is that importance that creates its overwhelming and incapacitating effects when it goes awry.
Finally, the ways in which these separate systems were bolted together over the course of a few hundred million years or so was anything but elegant and efficient. The end result (ie, our brains) is akin to 3 separate computers (the first being the abacus) from vastly different time points and operating systems trying to run as a single unit. The sheer number of “brain bugs” that are a natural consequence of this process is entertainingly summarized in the book with the same name by Dean Buonomano, PhD. Suffice it to say that we are all far from perfect, from a purely neurophysiological standpoint.
What compounds this rather messy situation is the series of untended traumas we have endured (some before we gained the ability to process them in helpful ways); the misinformed education and training we have received from well-meaning teachers, coaches, and parents; and the fast-food mentality our society drives as the new norm. We encourage and reward behaviors that promulgate an army of “knowers” at the cost of people wanting to learn throughout their life and openly admit when they do not know something. We also support the abdication of our inner power at the expense of being able to blame someone else if and when something goes wrong, powerfully summarized by Fred Kofman, PhD, in Conscious Business. This collective attack nearly takes our ability to weather common life events in a constructive fashion to its knees, let alone during times of stress.
This piece is meant to set the stage for additional articles that will detail the impact our brain bugs, stress levels, and other daily events (including our work settings) have on our efficiency and our efficacy in being professional stewards of health to others and to ourselves. Although the early PLEI Perspective articles might have challenged (or even offended) your sense of security and fundamental belief in how “well” you are, the latter ones will ensure you that there are many, many things we can do to transform ourselves and our profession.
Gary Keil, PhD, RPh, serves the Pharmacy Leadership & Education Institute as a board member; acts as national program codirector at Beautiful Mind Strong Body Center, LLC; and is the co-owner of Evolutionary Health.