What Price Success in Hospital Pharmacy?
It is with a deep feeling of humility that I accept the 10th annual Harvey A. K. Whitney Award. I had planned to begin my talk with a few jokes, Bob Hope style I hoped, but after witnessing the presentation of the first Whitney-Spease Scholarship Award this morning to Harvey Whitney, Jr., and knowing that I was the person who suggested to the chairman of the Award Committee, Walter Frazier, that such a memorial would be the best approach to a fitting remembrance, I was just as emotional and choked up as Harvey Whitney, Jr.
The presentation of the plaque to the memory of Mr. Whitney by the Michigan Society was well done, but some of the details can be filled in by me. I will attempt to tell of Harvey’s contribution by bringing to light for the first time the background of his organization of the Corresponding Society of Hospital Pharmacists and then the Forum of Hospital Pharmacists, and how this led to the beginning of our Bulletin and later on to our present Journal.
Then I will evaluate a few of the problems which we face, a self-rating chart which could be a guide to professional advancement, and finally a tribute to Robert S. Fuqua, the gentleman who was most responsible for starting me off in the right direction in my professional career.
Before I start with my story I would like to contribute a sure-fire old-fashioned remedy for success in any endeavor. I found it in Dan Rennick’s column of the American Druggist and it was written by Maury Goldsmith of Belmont, Massachusetts:
Take time to think–It is a source of power.
Take time to play–It is the secret of perpetual youth.
Take time to read–It is the fountain of wisdom.
Take time to worship–It is the highway to reverence.
Take time to be friendly–It is the road to happiness.
Take time to dream–It is hitching your wagon to a star.
Take time to love and be loved–It is the privilege of the gods.
Take time to work–It is the price of success.
“I know of no way of judging the future but by its past” is a quote of a great man in American history, Patrick Henry. Therefore, I will now tell you a bit of our early history.
The name Harvey A. K. Whitney has always been associated with whatever success has come our way in hospital pharmacy. I met Harvey for the first time in the summer of 1936, just 23 years ago, in Dallas, Texas, at the annual meeting of the American Pharmaceutical Association. I was encouraged to join the APhA that year by the late Dr. E. F. Kelly, who was my dean at the University of Maryland School of Pharmacy in Baltimore and who at that time was the Secretary of the APhA. He told me that he had heard some organizational activities might be contemplated at this meeting. It proved to be a true statement of the facts. Hospital pharmacy, an unorganized stepchild of pharmacy, was to be put on the map in 1936. Harvey Whitney contacted me the same morning of my arrival and, with Marvin “Jack” Andrews from the University of Maryland Pharmacy School faculty, we had a breakfast meeting with the President of the APhA, the President of the National Association of Boards of Pharmacy, and other top officials at that time. I was caught in the “net” by a few men who were interested in “success in hospital pharmacy.” Our Sub-Section on Hospital Pharmacy in the APhA was born.
At the annual APhA meeting in Minneapolis in 1938, one of the featured speakers for the sessions was unable to attend, and Dr. E. F. Kelly, a wise gentleman of the old school, had heard that one of our hospital pharmacists, J. Solon Mordell, from the Pharmacy Department of Syracuse University, was a good speaker. With less than 24 hours notice, Jack Mordell appeared at the General Session of the APhA and told the story of hospital pharmacy. He spoke of the needs of our group and the responsibilities and possibilities, and his talk was the top one of the annual session.
Hospital pharmacy was off to a good start from the point of interest, enthusiasm, and possibilities of organization. I had prepared a paper about our work at the Duke Hospital Pharmacy for the New York meeting in 1937 and was flattered at the attention I received. I was elected chairman to preside at our meeting in Atlanta, Georgia, in 1939, and I well remember asking for funds to help defray some expenses that would be incurred. Dear old Dr. Kelly told me that we could possibly get a contribution of $25 from the APhA if I thought that would be of some help. Needless to say, I took the money and had the thrill of seeing my name in print on our official stationery.
Harvey Whitney was not satisfied with slow growth. He wanted more activity and a speedier accomplishment of our total needs. At our meeting in Atlanta in 1939, we had a display of pictures of equipment contributed from hospitals whose hospital pharmacists I had met in my travels. I had the opportunity to go to the West Coast in 1938 to see our Duke team play football in the Rose Bowl. I visited hospitals in Chicago, San Francisco, and Los Angeles; and when I told Harvey about my idea for pictorial display which, of course, included his own hospital at Ann Arbor, New York hospitals and the Baltimore area group, and the Charity Hospital of New Orleans, with Albert Lauve, whom I visited in 1936 en route to Dallas, Harvey’s eyes lit up with satisfaction and he commented: “Why can’t we go a step farther–why don’t we put these folks to work–why don’t we organize a ‘Corresponding Society of Hospital Pharmacists’?” We talked to Don Clark of the New York Hospital, Ben Howiler of the University Hospital in San Francisco, Jack Morrison from the University of Illinois Research Hospital, Eldon Roberts from the Medical College of Virginia at Richmond, and, later, to Roger Lager of the Lakeside Hospital in Cleveland and Louis Hickenall of the Cleveland City Hospital, who, Harvey commented, were to be found on the home grounds of that educator to whom we all owe a great deal, Dean Edward Spease of Western Reserve University.
Shortly thereafter the following confidential release was sent to a small group of active hospital pharmacists.
It is hereby proposed that there be formed a corresponding society of hospital pharmacists for the purpose of interchanging ideas, routines, formulations, and any other interesting or critical observations that might develop mutual benefits of any nature.
It is further suggested that the membership in this society be restricted to the active roll of members of the A.Ph.A, and loss of membership in the A.Ph.A. implies a loss of membership in the society.
It is proposed that membership in this society be by election by the several incorporating members or their duly appointed representatives. Membership in the society implies an active interest, for example, the submission at frequent intervals of ideas or observations through a corresponding secretary.
It may be suggested that the society actively interest itself in standardizing the hospital formulae. It is not unlikely that observations may be agreed upon, and, this information may be of such character of value that will permit its being passed on to the Revision Committees of the United States Pharmacopeia and the National Formulary.
A further suggestion would be that the society could actively interest itself in the evaluation of new drugs being offered for investigational use. A cooperative endeavor in this direction would
certainly reflect to the credit of the several members of the society.
Further, some proposition might be entertained such as taking an active part in columns of these publications that are now engaged in presenting articles on hospital pharmacy. It may be presumed that such activity may be in the manner of submitting comment on published articles, or the publication of articles by the several members, or perhaps with the consent of the society. To further create an interest it is also suggested that the several members take the responsibility of addressing themselves personally to the authors of particularly interesting and pertinent articles favoring hospital pharmacy.
It occurs to this proponent that the adoption and use of an appropriate name for the society might be considered. A name such as the Corresponding Society of Apothecaries would very well lend itself to the adoption of individual signatures, such as John Smith, C.S.A. Perhaps the curiosity developed through the recurrence of several such signatures of this order might very well provide a desirable impetus toward the development of a rather fecund society. The maintenance of a degree of secretiveness in divulging its character might well lead to some interesting results in furthering membership.
The feeling obtains that this society might very well be kept small in number during this formative period until the organizational detail can be thoroughly worked out. Accordingly only a small number of individuals are being approached and I feel the list is rather select because of my intimate knowledge of the individuals concerned. Furthermore, I feel that they are a particularly fertile group and for this reason I am earnestly soliciting your most candid criticism of this proposition. While this outline is somewhat sketchy, I believe you will understand what I am trying to accomplish.
Signed: H. A. K. Whitney
As a result of the messages received from the CSA, the name of this group of letterwriters was changed to “Forum of Hospital Pharmacists” with Harvey Whitney, as usual, supplying the secretarial energy.
In his Bulletin No. 1, he expressed the following opinions:
1.You can see by the heading the title having the greatest appeal to those voting (of which there is more later). It is relatively unimportant to our cause to attempt to make out a case for any one title, all are respectable, and probably none will stand strict interpretation on the basis of derivation alone. In the main the name will satisfy our purposes and it is to be hoped its existence as a professional tool will be justified by our subsequent interest.
4. This leads up to the proposal of another name for membership, that of Mr. Robert Emmett Church, B.S. Pharm. 1938 (Michigan). Mr. Church served his internship here and had just acceded to the post vacated by Griggs. I believe he will be a worthy addition to our “family” and should bring us the stimulating freshness of youth (and I might add inexperience if Church isn’t listening). I am inclined to this latter facetious remark because my own experiences have taught me it is usually revealing to have someone ask “why do you do something this way or that?” It is one sure way to keep in the van for too often we “acquire” a tradition of routine and develop “apothecaries astigmatism.”
Harvey asked all of us for a contribution on the following subjects to be printed in the next issue of his F.H.P. Bulletin:
Subjects for descriptive report:
- Home-made “GEL-CAPS” or binders for serum-bottles, etc.
- Adhesive-remover used.
- Experiences with manufacture of pollen extracts, vehicle used, etc.
- Experiences with manufacture of Alumina-gel (Aluminum hydroxide).
- Experiences with manufacture of “Hydrophilic Bases,” with particular reference to elements involved.
- As modestly as possible your Secretary remarks his election to the Sub-Committee of External Preparations of the N.F. Revision Committee. I am happy to report the selection of Howiler (California) to an Auxiliary Committee for the same group. This “advertising” is meant simply to solicit all of you to work off some “pet peeves” or “pet formulae” by submitting remarks, comment, criticism or formulae to your Secretary. Who knows; we may find it desirable to accept “Morrison’s Mucilage,” “Clark’s Cerate,” “Lager’s Lager” or even “Reamer’s Reamer” might be inserted in the next N.F.
Harvey A. K. Whitney was paying the price for success in hospital pharmacy.
He was thinking, reading, writing, being friendly, dreaming, worshipping, and working.
Not everyone agreed 100% with Harvey at all times. Jack Mordell commented, regarding the contemplated Corresponding Society: “Weren’t the aims of this group, as outlined by you, the original basis for the organization of the Sub-Section?” “Yes,” Whitney answered, ” . . . but don’t think harshly of me . . . the intimacy I’m attempting to develop with this group, an intimacy you suggested we foster by round-table discussion, has not seemed possible of realization. Recall too, JS, that not all of us can get together year after year and correspondence will lag for want of specific stimulation.” Whitney further commented that he hoped that all of this would lead to an increased interest and activity in the APhA. (“They are always in need of papers,” he said.)
The seeds planted in the thirties have grown and prospered during the forties and fifties but, in some ways, we see the glaring faults that stare us in the face. We know that our membership growth from 100 or so charter members to almost 3000 reflects a lot of doing. We also know that our Minimum Standard and institutes and seminars, our educational and internship program, research and development, public and professional relations, and long-range planning, all of these are on the plus side. But we still need and should demand much more than has been accomplished. Our personnel standards are not what they should be, our educational background needs expansion, our physical plants need overhauling, our salary demands leave much to be desired. Our story and needs are reaching the young administrators who are being trained at this period, but our efforts have not met with proper success in influencing the older group of hospital administrators.
What does a dean of a school of pharmacy think of us? Dean Sprowls of Temple University in Philadelphia, Pennsylvania, had this to say at a seminar last year:
The question really is this: Will hospital pharmacy continue to attract a fair share of the available graduate students? Here the future does not seem too bright. Large numbers of young men cannot be expected to enter hospital pharmacy as a career when the number of worthwhile positions which exist in the field are numbered, perhaps, in the dozens. So long as hospital administrators fail to recognize the services which a well-trained pharmacist can provide, and so long as they think of hospital pharmacy salaries on the same level as those of technicians, so long as law enforcement agencies permit a lower standard of pharmaceutical service in some hospitals than that required at the retail level, this condition will prevail. We must do everything we can individually and collectively to upgrade the position of hospital pharmacists both salary-wise and position-wise; for, only in this way can hospital pharmacy be made sufficiently attractive to be elected by the most qualified students. For those now in hospital pharmacy a special challenge exists. They must make worthwhile contributions through their work so that their value will be recognized, and so that others will be motivated to follow in their footsteps.
I did not realize before I read Dr. Sprowls’ contribution what our total responsibility was in relation to our working force. We dispense, he said, 30% of the total distribution of ethical pharmaceuticals. We also do this with less than 5% of the nation’s pharmacists. I started thinking about the distribution of drugs in my own hospital and came up with the following astounding facts. My four registered pharmacists dispensed an ethical drug volume equal to that of all the 20 drugstores of our city of Durham, where at least 40 pharmacists are employed. We have the responsibility, we do it with a minimum of help and at the lowest salary level. Salarywise 10 to 30% lower–and responsibility wise double or more. We not only have the larger volume, but we accept the responsibility of manufacturing mouthwash, soap solutions, eye solutions, parenterals such as dextrose, saline, procaine, etc.; package capsules, bulk ointments, etc.; teach nurses and physicians; prepare formularies, etc.
Success in our profession will not follow our footsteps by complaining. It is not unfashionable though to complain. Our own Medical Director, Dr. W. C. Davison, when he made his 30-year report to the President of Duke University, Dr. Hollis Edens, had this to say: “In our dissatisfaction with the Present–we have no Peers.” He also commented in his report: “The only rooms serving the 1930 original purpose are the toilets and the amphitheater–the cost of plumbing charges has stabilized the former and a hydrogen bomb would be needed to move the solid concrete of the amphitheater.”
How many hospital pharmacies need remodeling? Are we equipped to keep the inventory properly? Do we have air-conditioned rooms to protect our supplies? Do we have large walk-in type refrigeration units so that economies can be effected in large volume purchase of parenteral antibiotics? Many questions enter our minds when we think of some method of checking our work and our facilities to find out if we qualify as good hospital pharmacists. Do you enjoy your work? The following story implies that a job is what we make it.
Remember the old story of the man who approached the three construction workers and asked them what they were doing? The first man sighed: “I am laying brick.” The second snapped: “I’m working my arms off for two dollars an hour.” But the third man’s face lighted up as he said: “I’m helping to build a cathedral.”
A recent issue of Lilly’s Tile and Till contained “The Hospital Pharmacist’s Self-Rating Chart.” If you can pass this test with a high rating, you will know that you are a success in hospital pharmacy. I will list the 25 questions, and the answers are up to you.
The Hospital Pharmacist’s Self-Rating Chart
- Do you conscientiously try to dress as a professional man should?
- Are you ever asked to address groups in your hospital on professional subjects?
- Are you a member of the therapeutics committee in your hospital?
- Do you have an organized and up-to-date formulary?
- Do you have a statement of pharmacy policy in written form?
- Is it distributed or made available to all departments in your institution?
- Do you regularly inspect drugs and medications in ward cabinets and other areas outside the pharmacy?
- Do you have an organized file of company literature on new drug products?
- Do you belong to the American Pharmaceutical Association?
- Do you belong to the American Society of Hospital Pharmacists?
- Do you belong to a state or local professional group?
- Have you attended a professional meeting in the past year?
- Do you have any kind of regular conference with your administration?
- Do the staff physicians request much information from YOU?
- Do you get what you consider satisfactory cooperation from the nursing staff?
- Was your last salary increase given to you without your asking for it?
- Have you found any errors in orders for medication in the past week?
- Do you have a system for recording proof of use for hypnotics?
- Do you have an up-to-date inventory of your pharmacy stock?
- Are you familiar with the minimum standard for hospital pharmacy set up by the ASHP?
- Do you have up-to-date reference books in your pharmacy?
- Do you enjoy your work?
- Do you have an accurate accounting system?
- Does your pharmacy run efficiently when you are not around?
- Do you have adequately trained help?
Did you fail to answer “Yes” to more than five? If so, use this as a guide to professional improvement.
It is obvious that we do not rate a hospital pharmacist a success because of the profit he might show by having only an excellent financial record. Service is the key word to our success, service to the patient, the doctor, the nurse, and the administrative staff.
We do not always receive 100% cooperation from our staff when we try to make changes to overcome obsolete practices. I can recall when our first formulary was being worked out some years ago and we tried to eliminate some old-fashioned names such as Ward Cough Mixture, Schlesinger’s Solution, Bladder Mixture, etc. Our committee voted to change Bladder Mixture to H.P.C. Solution which, of course, was an abbreviation for Hyoscyamus and Potassium Citrate Solution. Within a few days, I received this note: “Dear Tom: I do not mean to continue our little argument, but I disagree with you thoroughly that H.P.C. is a preferable name to Bladder Mixture. Bladder Mixture at least denotes that it is a mixture we hope will help the bladder. H.P.C. could be a new government agency to help migratory birds get to Saskatchewan.”
We, in the pharmacy, also try to get our physicians to make some changes to improve service to the patient. One area in which we have failed to improve what I believe to be an unsatisfactory situation is the Investigational Drug Policy. The American Hospital Association has made a statement of principles which should be followed. These principles are as follows:
- Investigational drugs should be used only under the direct supervision of the principal investigator who should be a member of the medical staff and who should assume the burden of securing the necessary consent.
- The hospital should do all in its power to foster research consistent with adequate safeguard for the patient.
- When nurses are called upon to administer investigational drugs, they should have available to them basic information concerning such drugs–including dosage forms, strengths available, actions and uses, side effects, and symptoms of toxicity, etc.
- The hospital should establish, preferably through its pharmacy and therapeutics committee, a central unit where essential information on investigational drugs is maintained and whence it may be made available to authorized personnel.
- The Pharmacy Department is the appropriate area for the storage of investigational drugs, as it is for all other drugs. This will also provide for the proper labeling and dispensing in accord with the investigator’s written orders.
We are asked embarrassing questions when we are not included within the framework of a policy which is a sound one only when the pharmacy department is included according to the policy as stated.
Parenteral fluids were manufactured in an area other than the pharmacy when I arrived on the scene at my hospital. When difficult times were encountered, we accepted the responsibility for their manufacture.
Laboratory stains and reagents were taken care of for a period of time outside the pharmacy. When we were asked to assume this responsibility, we accepted the challenge.
Later on, we were asked to assume the responsibility of screening all chemical orders for all the research laboratories and governmental research projects so that the job of the purchasing agent would be much simpler; we accepted the challenge.
The point that I wish to convey is that we should at all times be ready to accept the challenge of increased responsibility within our hospitals.
In a recent issue of Southern Hospitals, June 1959, I read an interesting story of success. It was about a pharmacist whom we all know. He was good at folding powders, he knew the doses for morphine and codeine, he could turn out an excellent suppository, he could tell a good story, he was well versed in the law of pharmacy. But he knew nothing about the sulfas, penicillin, cortisone, or polio vaccine. I shall hold you in suspense no longer, his name was Dr. George Archambault. Alas, the year I refer to was 1931. George has climbed the ladder of success by making a study of every facet of our profession; he has traveled, studied, and lectured and has given his life to the improvement of hospital pharmacy whenever and wherever possible. There are many other success stories that I could bring to your attention. Dr. Archambault does not need my help to make you aware of his accomplishments; but another story needs to be told.
Early in the summer of 1925, I became tired of filling 25 to 30 prescriptions a day in a retail drugstore. My hand was becoming blistered dipping ice cream for children who flocked into my store because the “boss” liked to run specials, “2 big cones for 5 cents, a chocolate sundae for 6 cents.” I could not become accustomed to a 12-hour day of work. I wanted a more professional outlet for my training in pharmacy. When I mentioned the possibility of getting a job at the Johns Hopkins Hospital, my boss informed me that in a hospital you merely poured from the big bottles into the little ones. I refused to believe him. I visited Mr. Robert S. Fuqua, Chief Pharmacist at the Johns Hopkins Hospital, and he accepted my application. The challenge of hospital pharmacy was ahead of me. I had to learn bulk compounding, soap solutions, parenterals, ointments, toothpaste, laboratory stains and reagents, etc. Robert S. Fuqua came to work a bit late in the morning, perhaps 9:30 to 10 a.m., but he always put out the lights at night and stayed on until 10 p.m. or later most of the evenings. Bob always wanted to improve his formulas; he wanted to make sure that all the techniques used were the best; he was continually making up a “batch” of special solutions for research projects for higher staff physicians.
In 1931 when the opportunity came for me to take over at Duke University, he drove 350 miles over rough roads with me to Durham to look over the new hospital. He helped me draw the plans for all the cabinets needed, he did all in his power to see that I had the proper information to give the best professional advice; and when I wrote back to him for additional help, he always responded. My feeling tonight is that whatever honor is bestowed upon me, I can thank Bob Fuqua for starting me out in the proper attitude and frame of mind to pay the price for success in hospital pharmacy.
There are many others to whom I owe so much: Dr. W. C. Davison, the director of our hospital, who is retiring next year, for his wonderful cooperation over the past 28 years; and Don and Gloria and all the wonderful people who make up the ASHP. I could say that I have given a little of myself and whatever talent I may have possessed, but I received so much more in return. I also wish to thank the Michigan Society for having made this wonderful evening possible.
Any references cited in this lecture are available in the PDF version.
Originally published in Am J Hosp Pharm. 1959; 16:694-9.
© 1959, American Society of Health-System Pharmacists, Inc. All rights reserved.
Posted with permission.