Dr Christine Nimmo (United States) told participants that “we have more
information than we ever dreamt of or probably ever wanted. We are the lucky,
or unlucky, inhabitants of the information age. If some information is good,
then more must be better. But maybe not if you can’t make sense out of
it.”
She said that pharmacists were struggling to organise and make sense of this
information overload when faced with making patient decisions.
Dr Nimmo then presented the Billington formula illustrating the relationship
between data, information, knowledge and wisdom. The formula suggested that
one started off with raw data, which might provide information. This information
was then rigorously and scientifically examined and was thus transformed into
knowledge. The application of this knowledge using sound clinical judgment was
wisdom. In order to practise evidence-based medicine, the practitioner had to
be conscientious, explicit and judicious in applying knowledge at the individual
patient level.
Model of professional competence
She then introduced participants to a model of professional competence as applicable
to evidence-based pharmaceutical care.
The three areas of importance were psychomotor skills, intellectual problem-
solving skills and pharmaceutical care values and attitudes. By constantly engaging
in reflective practice, pharmacists could develop their clinical judgment to
help solve complex problems.
In order to develop these skills it was necessary to understand how the brain
worked and solved problems. The dominant model to explain the brain’s action
of acquiring, retaining and storing knowledge was the computer. Information
from the short-term memory or consciousness was sent into the long-term memory
after the mind had encoded it and given it an “address”. Short-term
memory could only hold five to seven pieces of information and this could be
increased by the mechanism of “chunking”, which means sending related
information to the same address. This would then be remembered together as one
piece of information. Dr Nimmo likened this storage system to a tree. When there
was a relationship between different pieces of information, for example, the
same drug being used to treat two different disease states, the branches of
one tree join the branches of another to reflect this relationship.
She stated that “clinical judgment is a highly sophisticated form of problem
solving” and the brain strove to be efficient when problem-solving. Therefore,
the more precisely a problem was defined, the less time was wasted sifting through
irrelevant information that did not apply to the particular problem.
However, “the problem you define is usually the one you will solve”,
she said. Therefore experts spent more time in ensuring they had defined and
structured the problem so that it was not susceptible to more than one interpretation.
Thinking about one’s own thinking along the way, known as metacognition,
provided the checks and balances to ensure one was not wandering off at a tangent.
“Self monitoring of the thinking process is important.”
Dr Nimmo urged participants to “constantly reflect on the process and outcomes
of their clinical decisions — determine weaknesses, identify sources of
learning to shore up those weaknesses and apply what you have learned. The development
of clinical judgment is a shaping process that takes place over countless cases
and probably never stops because there is no end to how good we can become.”
Developing more than one thinking strategy, known as heuristics, would increase
this problem-solving ability.
Increasing professional growth
Dr Nimmo warned against just depending on pharmaceutical reference sources to
provide pharmacists with all the information they might require. Instead it
was important that pharmacists looked into the realms of psychology, ethics,
education and marketing, among others, in order to increase their professional
growth.
The individuality of the patient was another point that she emphasised. Factors
to take into account were emotions, patients’ own health beliefs, non-acceptance
of adverse effects, preference for “natural” remedies, cultural differences,
and short-term and long-term goals. By broadening the focus from the physiological
needs of the patient to include the emotional and cultural requirements, pharmacists
would be in a better position to secure the optimum therapy for the patient.
She suggested that the pharmacist’s role would, therefore, shift from caring
“for” a patient to caring “about” a patient.