Steph’s Note: Today we’re taking a break from clinical posts to return to an equally important skill - adaptability. Times, they sure are a-changin’, and life as a pharmacist certainly isn’t getting any less stressful. Quite the opposite, we’d wager, and preventing burnout is more important now than ever. So we’ve brought back Cory Jenks to share his methods for navigating pharmacy chaos. You may remember him from his previous tl;dr post on soft skills, but here’s a little about him just in case you’re new.

Cory Jenks is a practicing pharmacist, inhabiting the world of ambulatory care. However, amb care is not his true specialty. Rather, crowd management, object work, and improvised rapping are more his speed. He’s been a practicing pharmacist since 2011, and he’s been a practicing improv comedian since 2013. Since that time, he has taught, coached, and performed improv for thousands of people.

You can say hi to Cory on LinkedIn, Twitter @CoryJenksPharmD, and on Instagram @pharmacomedian. Also, be sure to check out his site to learn more about what he does (and have some fun along the way).

Yes, I am a speaker, but I don’t live in a van down by the river. (Image)

Hello there, tl;dr readers. It has been a minute, but I am back to hit you with some decidedly non-clinical, yet important knowledge to make you better pharmacists! Before I dive too deep, take a minute to head back in time and read my last article about soft skills. It will get you up to speed on some non-clinical skills that will help take your pharmacy career to the next level. And now, it’s time to level up even more with a deep dive into an area I specialize in: adaptability.

Wait just a minute. What makes me - a simple, handsome, and dare I say it, humble pharmacist - an expert at adaptability? Well, when I am not managing chronic diseases as an Ambulatory Care Clinical Pharmacy Specialist, I am an improv comedian and professional speaker.

Improv comedy is all about being on your toes, listening, and adapting to whatever happens on stage. You don’t need to take my word for it, but using these improv skills has made me a master at pharmacy adaptability. Read on for some specifics of how you too can be a more adaptable, resilient pharmacist.

There are no paper jams in Pharmatopia. (Image)

Why is adaptability even important for pharmacists? How can it be so important that the fine folks at tl;dr have given me yet another opportunity to write an article for their award winning site?*

*Cannot officially confirm if and what that award is, but doesn’t it sure feel like an award worthy site?

If you are asking those questions, perhaps you work in a place where everything goes according to plan. Your entire staff shows up, on time, ready to work. Your computers never crash right in the middle of a progress note. Patients kindly and patiently listen to your pharmacist advice. And your copy/fax machine never gets a paper jam.

The only thing better than one ticket to Pharmatopia? Two tickets. (Image)

If this accurately describes your practice environment, congratulations. You work in a magical land I like to call “Pharmatopia,” and I’d like a one way ticket there, please and thank you very much.

For those of us here in The Pharmacy Real World, which sounds like an excellent niche reality show spin-off for MTV someday, things generally don’t go as planned. So, let’s review five tips to help make you the Ultimate Adaptable Pharmacist.

Step 1: Stay Neutral

When the workday starts going sideways, our gut reaction is too often to react. Emotionally. In a big way.

Good luck finding the 19th story here. (Image)

I will let my improv comedy brain comment for a moment as to why this strong emotional response may not be your best approach for an adaptable approach. When I do an improv scene, the goal is to react emotionally and big to increase the comedic absurdity of that scene. As far as comedy goes, this strong emotional reaction serves to create a scene that quickly hits a high point of funny and absurdity.

However, when it comes to being a resilient, adaptable pharmacist, keeping your initial emotions in check can go a long way in keeping your head clear, your pulse low, and yourself focused on the task at hand. I have helped a lot of patients in the midst of a storm of chaos in my various pharmacy roles, but I can guarantee it is nearly impossible to help our patients if we are stuck in a glass case of emotion.

I call this approach “reverse engineering a rational response.” It’s not trademarked. Yet. But by doing the opposite of what an irrational, emotionally charged improv scene would be, it allows you to keep a calm, stable frame of mind to adapt and respond.

You can’t reach your patients outside, if you are inside a glass case of emotion. (Image)

If you are looking to take a deeper dive on responding neutrally, an excellent read on the importance of remaining mentally neutral when trying to handle the unexpected and remain adaptable is It Takes What It Takes by mental skills coach Trevor Moawad. Trevor has worked with some of the highest performing athletes in the world, and his suggestion is also to try to keep your mental frame of mind neutral so that it can take in the information and rationally react to form a solution.

Easier said than done when you are five cars deep in the drive through or you just got called to your 3rd code of the night. However, by focusing on keeping yourself from riding an emotional roller coaster, you will increase your ability to adapt with a clear mind.

Step 2: Expect Things to Go Wrong and Plan for Contingencies

Remember that fictional (or maybe not…I’m still waiting for my tickets) land of Pharmatopia where everything goes according to plan?

Exactly, it’s fictional.

Inevitably here in the Real World of Pharmacy, our day-to-day plans go awry. It would be foolish to expect everything to work perfectly. I spent too many years in the beginning of my career thinking on my worst and most challenging days, “When things come together and everything goes according to plan, this job will get easier.” Here I am now almost ten years since graduation and I am…still waiting for everything to come together and for things to get easier.

What’s that? Everyone’s insurance is changing? “Happy” New Year. (Image)

So instead of waiting for some day that will likely never come together, we would be well served to start practicing some good old fashioned (and I mean very old) Stoic philosophy. Those old Stoics talked about a concept called premeditatio malorum which means the premeditation of the evils and troubles that might lie ahead. Sounds like every community pharmacist’s annual nightmares on December 31st, amiright?!

Jokes at the expense of yearly health insurance turnover aside, imagining things that could go wrong doesn’t have to be sad or depressing. In fact, I would consider it empowering! Essentially, I am suggesting you plan for contingences if when something goes wrong in the pharmacy. If the computer system goes down, do you have an analog plan? What’s your workflow look like if one person is sick? What about two people? Do you have other members of your team cross-trained enough to keep the pharmacy train rolling down the tracks?

While it certainly is not possible to plan for every possible contingency, I suggest documenting problems that happen and then trying to come up with solutions for the future. The more problems or issues you document and “pre fix,” the smoother things will roll when the proverbial C.Dif. hits the fan. Of course, you are going to be the adaptable hero of the pharmacy because you’ll have already thought of a plan. As the Stoic philosopher Seneca said, “The unexpected blows of fortune fall heaviest and most painfully, which is why the wise man thinks about them in advance.”

Stoic philosopher Seneca, sometimes confused with the laxative senna. (Image)

Step 3: Listen and Remain in the Moment

When the unexpected happens, what is your reaction? Is it, “Cool, life has presented me with this challenging pharmacy situation, and I shall stay present in this difficult, but doable, moment to solve the problem at hand?” Or is it more along the lines of, “WHY ME?! CAN I GET A TIME MACHINE TO TRANSFORM ME FROM THIS MOMENT?!?”

Turns out in a pharmacy crisis, the reset button is the 1st thing to malfunction. (Image)

If you chose option number two, you are not alone, and I can totally empathize and relate. More than once in my career, I have found myself in a less than ideal pharmacy crisis that has challenged my resolve to remain focused on the task at hand. Nonetheless, as much as we’d love to hit the reset button on these times of crisis, the only way you can adapt and overcome in such a situation is to remain present in said challenging moment.

Even though these pharmacy challenges, like the years, start coming and they don’t stop coming…and they don't stop comin', the only way you are going to be able to overcome and, dare I say, dominate them like the adaptable pharmacist you are is to face them head on in the moment. One of the tricks I picked up from improv (and from repeated feedback from my dear sweet, patient yet assertive wife) is so simple, but not easy: listen.

Your brain can’t get no respect when it’s overthinking and not listening. (Image)

Oftentimes when crisis strikes, we get up on our own head trying to think so hard to get ourselves out of a problem. Unfortunately, sometimes our own head can be our own worst enemy.

This is no different when I am doing an improv scene. If I am thinking so hard about what next hilarious line to say, I am not listening to my scene partner who is providing everything I need to simply listen and respond to. Whether it is a patient problem, a technical issue, or a team member facing a crisis, the best thing we can do remain in the moment and find a solution is to listen.

As smart as you are, and I know you are smart because you are reading tl;dr, the best solutions are found by remaining in the moment, listening to others, and responding. As I said, listening is frustratingly simple, but not always easy. However, if you can learn to listen and remain in the moment, you will find that your ability to adapt and respond to the unexpected goes up like your confidence in dominating the MPJE.

Step 4: Be an Expert at What You Do

My Medicinal Chemistry teacher had a saying that I shall summon for this section. When approaching a new, yet challenging, concept, he would say something along the lines of, “The test will be be hard, but ‘y’all can be Cracker Jack good at it,’” if we just worked hard and studied enough.

Not sure what made less sense, understanding medicinal chemistry or what about a box of stale sweetened popcorn with a crummy “prize” was good. (Image)

I am not sure where Dr. Chapman got the idea to use a Cracker Jack reference, but now ten years out of school, I can say with certainty I have definitely used something I learned in Med Chem. Take that 2008 Cory, who thought I’d never use Med Chem after graduation!

With his confusing, but endearing saying, my Med Chem instructor had made an important point: if we know our stuff, when the tests of life come, they won’t feel as, well, “testy.”

Listen (point #3), I know pharmacy and healthcare can be hard, and when an unexpected twist throws a curveball at your day, it can be hard to adapt. However, your level of difficulty goes up exponentially if you don’t know your baseline pharmacist stuff.

Working in the ICU reviewing TPNs when the floor pharmacist calls out, forcing you to cover extra duties? If you don’t know your TPNs front and back, your long day just got longer and more frustrating.

Get a question on how best to treat a patient’s pneumonia when your favorite medical reference site goes down? Hope you studied up on pneumonia treatment.

Embedded in a Primary Care clinic when you get stuck gifted an extra student because your colleague who was precepting them called out sick? Hope you remember how to build a diabetes regimen.

Alright, this section isn’t just an advertisement for previous tl;dr posts, per se. Yet my hope is that you are realizing the more pharmacist tools you have firmly in your tool belt, the better you will be able to adapt when inevitably your day gets sidetracked. It is hard enough figuring out a staffing shortage or an electronic medical chart meltdown, let alone trying to recall how to adjust vancomycin properly. So if you want to be a pharmacist ninja of adaptability, know your stuff. It will be one less thing to worry about when a crisis hits.

Step 5: Humility

I get it. You have that shiny PharmD. Maybe a residency year or two. Perhaps even some fancy board certifications. On paper, there is no stopping you!

Unfortunately Secret Sauce is not yet available as a generic, so it’ll set you back. (Image)

I can say this is how I felt starting my career ten years ago. I had the training, the certificates, and the desire to go out and change the world, one patient at a time. Yet I lacked a little something. A little secret sauce, if you will. Some of my secret sauciness came as I developed as an improv comedian.

Yes, those pesky soft skills were developed as I learned to apply them on the comedy stage. So as I learned to be a better listener, communicator, and empathizer, I became a more adaptable and effective pharmacist.

Yet there was the one final ingredient: humility.

I want to avoid getting on my “old man” soapbox, but I have been at this pharmacy thing for nigh on ten years, and in that time I have been humbled more times than I am willing to admit, or remember. I am old, and my memory ain’t what it used to be.

I have worked with a lot of pharmacists, residents, and students. Some have been excellent adaptors. Some, well, not so much. Those that have failed to adapt have lacked the humility needed to work in healthcare. This profession can be humbling. Sometimes a medicine causes an unexpected side effect. Sometimes a totally stable patient takes a turn for the worst, despite doing everything “the book” says we should. Sometimes you don't match for a residency and need to adapt to find another plan. And sometimes, what you thought was the forever truth in pharmacy school turns out to change.

Those who are able to humble themselves before the immensely complex world of medications, the human body, and the healthcare system are often willing and able to adapt. Those who remain stubborn in their previous beliefs about guidelines, adverse drug reactions, and their own knowledge struggle to be adaptable.

The suggestion to practice humility may be the hardest to implement. Nobody likes to admit they may be wrong or fallible. However, evidence changes constantly. Pharmacists who can admit this truth and apply new knowledge will be the ones who can adapt and thrive.

The approach of humility is well summed up from the book The Biggest Bluff by Maria Konnikova. Maria, a journalist, goes from being just that, a journalist, to learning how to play (and spoiler alert: win) poker professionally. One of the quotes from her mentor sums up my approach to humility in healthcare: “Less certainty, more inquiry.”

Be curious. Be humble. Be willing to learn, and you too shall be an adaptable pharmacist.

The tl;dr on Adaptability

I hope you have found these adaptability tips useful. A running theme I have found in handling most of pharmacy’s unexpected crisis has been to control what you can control, and let go of what you cannot.

You can control how you prepare, react in the moment, and ultimately respond to the unexpected. Being an adaptable pharmacist means letting go of what is beyond your control, being prepared for what you can, and focusing on the steps you can take in the moment to solve your problem at hand. If you can focus on the five tips I discussed, I have no doubt that you will find yourself a more adaptable and resilient pharmacist.

While we are not all improv comedian/pharmacists, we can all apply these lessons to be adaptable in the inevitable chaos in world of pharmacy we inhabit.

Unless you practice in Pharmatopia. In which case. Tickets. Now. Please.

5 Simple Steps to Being a More Adaptable Pharmacist