Experts Discuss the Important Role of Charitable Pharmacy Programs

Christina M. Madison, PharmD, FCCP, AAHIVP, sat down with Lydia Bailey, PharmD, BCACP, pharmacy operations manager at St. Vincent De Paul Charitable Pharmacy, to discuss the valuable role of charitable pharmacies in communities and how pharmacists and others can get involved.

Christina Madison, PharmD, FCCP, AAHIVP: Hello, everyone, and welcome to another episode of Public Health Matters with me, your host, Dr. Christina Madison, also known as the Public Health Pharmacist. And just a friendly reminder, this is part of the Pharmacy Times Pharmacy Focus podcast series, so if you haven't already done so, please check out our other podcast offerings. So, without further ado, I'm extremely excited to introduce our next guest. This is somebody who I was so incredibly grateful to see up on the stage at our most recent American Pharmacists Association annual meeting. And it turns out, we have something in common because, you know, I am someone who's a huge supporter of individuals working in charitable organizations, nonprofits, and then in this instance, the charitable pharmacy space, which I actually wasn't as familiar with before getting to know Dr. Bailey. So, without further ado, I'm going to go ahead and let her tell you a little bit about herself. So, thank you, Dr. Bailey, for being here today. Tell us a little bit about yourself and how you got to your current position, which by the way, I will have to mention is pretty freakin’ cool.

Lydia Bailey, PharmD, BCACP: Thanks, Christina. Yeah, I am really excited to talk to you guys today. My name is Lydia Bailey. I'm the pharmacy operations manager for St. Vincent De Paul Charitable Pharmacy in Cincinnati, Ohio. And I guess [I’ll talk] about myself first, and then I'll talk about the pharmacy. But I got into pharmacy because my parents told me it'd be a good job. You know, in high school when everyone else is shadowing to pick their career, I [was] working on a farm, you know, I [had] like no idea what a pharmacist does. And so, in pharmacy school, I figured, you know, I'm in here now, I should probably get an internship. And so that was the first time that I'd ever even been in a pharmacy. And so, I got an internship, and it was at a really busy retail chain store. And I was so disappointed because in school they tell you you're going to help people, and this is a great career. And then I saw it firsthand at just a bad location, and it was not about helping people. It was about, you know, how fast can you do stuff, and everybody was stressed. So, I thought I was going to change majors, I was going to pick something else. But then I had this great opportunity to go on a mission trip to Pakistan, actually, and I got to serve in a pharmacy. And that was the first time I saw my career link up with, you know, something I'm so passionate about—helping people or helping the underserved, and kind of living my faith out that way. And that was the first time I was like, “Oh, I can find a job that I love. This is a possibility in pharmacy.” And so, I got into the underserved care thing.

And then there happened to be a residency at the University of Cincinnati especially in underserved care. And the practice site for that program was St. Vincent De Paul Charitable Pharmacy. And so I was here as a resident, and that was 7 years ago. I signed on [and] I've been here ever since. I hope this is my last job. My first job, you know, I just love it so much. I feel so lucky that divine intervention kind of put me here. So yeah, that's a little bit about that.

And then the pharmacy itself. We started the program in 2006 in Cincinnati, and it's really cool charitable pharmacies. I'm learning that people don't know, like what you said, it's kind of this unknown part of pharmacy. But basically, the laws have been changing to allow a subset of community pharmacies to have charitable pharmacy regulations so we're more lenient with certain kinds of donations we can take in. So that kind of is one of the things that makes a charitable pharmacy unique. And so, we opened in 2006 and we started filling prescriptions, and we filled 7000 prescriptions that first year. And then this past month, we filled 7000 prescriptions. And so, since then, 17 years later, we've done over 700,000 prescriptions total. And it's been a really big blessing for our community.

Christina Madison, PharmD, FCCP, AAHIVP: Wow, that's so incredible. So, I just want to take a pause because there was like so many amazing little nuggets in what you just said. So, first and foremost, can we talk about the fact that you said that you were working on a farm? Can we just acknowledge that for a second? Like how freakin’ amazing are you? I did not know that.

Lydia Bailey, PharmD, BCACP: Yeah. You just got to do what you got to do.

Christina Madison, PharmD, FCCP, AAHIVP: I know! It's so cool. Yeah, I think just rural health and engagement in, you know, historically marginalized populations, it's just so important. It's the fabric of, you know, what we do in the community and our ability to serve and be of service for those that are the least able to access care in our community. That's how we will be judged, right? So, you know, it's one thing to provide access to people who have means but even just who chooses to come to a charitable pharmacy, so like, it's all walks of life. And I think that's also a misnomer. What a lot of people don't realize is that there's lots of people out there who have full time employment and jobs that want to, you know, have access to health care, and for whatever reason don't. And then also the fact that when they seek care, it's not able to happen for them, because of whatever reason. They may have other debt that has come into play, they may have maternity payments, like there's so many different things that could impact your ability to pay for your prescriptions. I think it's just amazing. And then the one other thing, too, that I just want to address, because I don't often hear people speak about this, is that I love that you said that this is helping you to live your faith and really live out your passion. And so, I just really wanted to acknowledge that because it's something that you don't often hear. And, you know, the charitable donation does have a faith-based component. And so, I just wanted to know if you wanted to just briefly touch on that.

Lydia Bailey, PharmD, BCACP: Yeah, yeah, thanks. Yeah, I think for me, you know, my faith has been something that's been one of the most important things in my entire life. And I used to think that it was just a box, you know, like, faith is important, and work is important and family's important, you know, it was all just different boxes. And I never expected that, you know, my boxes could collide. And every day at work, I have this incredible opportunity to be open about my faith. So, we're an openly faith-based organization and so I offer to pray with my patients all the time, you know, and I sit in the room with them. And I see that medicine is one problem but then there's this whole other side of whatever they're going through personally, or the burden of having to embark on smoking cessation. And, you know, I can see that the conversations we're having, I can see that it's a lot for them. And so, when I say, you know, “Can we just pause? I know I said a lot here and I know I'm asking you to do a lot. Can I pray for you, as you go about doing this? Can I pray for you to be successful with quitting smoking, can I pray for you to be successful at, you know, cutting pop out of your diet to help your diabetes?” And it's incredible, the breath that just happens when I say that, because people love that. Even if they're not faith-based themselves, they just see that you care about them as a person, not just a number. And it's like, it makes it so real, you know. These are relationships, these are not just like patients that I don't know; these are patients that I know well. And, you know, it's really, really special. So, thanks for acknowledging that.

Christina Madison, PharmD, FCCP, AAHIVP: I love that so much. It's so funny that you said, you know, your patients are not just a number, because I say this all the time, especially because of my work within the LGBTQ community. A lot of times they have not engaged in a traditional health care system because of a previous trauma that has happened to them because of engaging with a non-affirming and non-supportive provider that, you know, has a different set of opinions with whatever their lifestyle is. And so, I really love that. And I always say, you know, your patients are not a number. When I'm teaching my students, I say they are a person that is deserving of care and compassion and that is your role. And you need to never forget that when someone is coming in and they are seeking care from you, that is a bond of trust that you should never break. So, I just I really feel that that is something that is not addressed as much as it should be. So, thank you again, Lydia, for bringing that up. And, again, I do really love the fact that you are living your truth and you’re being your authentic self because so many of our pharmacy colleagues or physician colleagues or nurse colleagues feel like, you know, when they step into their job or if they're working in maybe something that doesn't quite align with their mission and their vision and their purpose, that they're not able to be their authentic selves. So, I'm so grateful that you have found something that truly aligns with your heart and your soul.

And I guess you've probably already touched on this, but what is the best thing about running a charitable pharmacy? Because again, I want to empower other people to think about other things that they could do within pharmacy, and in particular public health, because I feel like this super aligns with my personal vision of how I see the profession and how we should be doing more to help historically marginalized populations.

Lydia Bailey, PharmD, BCACP: Yeah, I love this question. Because, you know, it just makes me think of, yeah, what do I love? I love all the things, but what I love the most is really changing perceptions of what underserved care is. You know, I think that one side of it is all the students that come in. You know, we're a teaching pharmacy, we do 90 student learners a year, every year, that are rotating through, and they all expect this certain thing with underserved care. And it's what I thought I was getting into, which is financially underserved, which means, okay, I'm going to be working with the poorest of the poor and the homeless. So, there's this whole other medically underserved group of people who have enough money for houses and cars, and they have jobs and all that stuff, they make too much money to qualify for Medicaid. So, they're on an insurance plan that's just not affordable. And it's not that it's not affordable for them; it's like not affordable for anybody. And I had a patient one time tell me, you know, we're all 1 disease state away from needing a charitable pharmacy. And that's this big group of patients that we serve, that they wouldn't call themselves underserved. But here, they are medically underserved. And so, when I see students see how close it is, they're like, “Wait, this person is just like my mom, or this person could be my grandma.” And I'm like, “Yeah, exactly.” So, when I see that shift of what underserved care means, I love that.

And then I love it for the patients, too, because they also come in so sheepish and embarrassed that they need help. And so, I just had this morning a patient coming in, and she was actually crying to one of our residents. And she was like, “I'm so sorry, I want to save this for someone who needs it more than me.” And it was so good to affirm that, hey, we are all one step away from being here. And I'm glad you're here and that has nothing to do with what you've done or how you've set up your life. It has everything to do with certain disease states are just unaffordable. If you happen to get COPD and diabetes, you're going to get charitable pharmacy. It's just too expensive to afford all these inhalers, all this insulin, you know, all these things. And so, when I get to see my patients’ perceptions shift into, they don't have to be embarrassed that they need help, that this is just like part of what everyone has to go through, then they feel appreciative. Like, wow, how lucky am I that I have a charitable pharmacy in my community? And so, I love seeing that shame turned into appreciation, it's so special. So, changing that perception of underserved care for all of us is so good.

Christina Madison, PharmD, FCCP, AAHIVP: Oh, my goodness. So good. So good. So good. Again, I really want to re-emphasize that point that you made about we're all just 1 step away, right? Like we're all just 1 step away from a medical crisis that could bankrupt us, we're all one step away from having an unexpected injury, car accident, cancer diagnosis, like all of these things, right? That could happen that could drastically change the trajectory of our lives and our ability to work and go to school, or to provide for our families. And I just am so grateful that you have that mentality and that you're able to change that perspective. And I love the fact that you said, you know, when you were talking about the resident, that you say, “Oh, you know, this person is just like my grandmother, they're just like my mom.” And I tell the students that as well. It's like, you should treat this person as if they were your family member. And when I hear them say things, when I hear them make these, like, what I would call micro-aggressions because of, you know, not recognizing their implicit biases, I'm like, “Would you treat your family member like that? Would you talk to your family member like that? And if the answer to that question is no, then why are you speaking to your patient that way?”

Lydia Bailey, PharmD, BCACP: Exactly. Yeah. That's good.

Christina Madison, PharmD, FCCP, AAHIVP: So, obviously, you are very blessed to have this in your community. So, I know that, you know, the impetus for this came out of, I believe, the background is that this was a family that came in and wanted to start this and didn't know how, and then got some infrastructure and got some funding. But can you talk a little bit about what you think the impact of having that charitable pharmacy is in Ohio? Specifically, from the standpoint of public health and preventative health care, because, again, I think it's a little different when you just think about chronic management versus health promotion and wellness. You talk about smoking cessation, you talk about vaccinations, you talk about, you know, changing people's minds, changing people's perceptions. So, if you can speak to that, I think that would really help the audience understand what you're working with.

Lydia Bailey, PharmD, BCACP: Yeah, yeah, it was actually a leadership initiative. So, they have every year in Cincinnati a leadership Cincinnati program where the C-suite executives get together and think of a project for how they could help their community. And in 2006, the project was to help with medication access. And so, they had lawyers that were able to rewrite the law in Ohio to get charitable pharmacy started and so that was actually how it came to fruition of getting these laws changed and starting a charitable pharmacy. And it was all about just the medication access, which is great. You know, if you're going to talk about doing charitable pharmacy, you’ve got to get that piece right first. But after a few years, the team kind of realized [that] just giving people their medicine doesn't guarantee they're getting healthier. And that was kind of the hope, like, well, at least if we can just get you your medicine, then your health will be get better. And like, that's just not all the way there. You know, we need to be tracking health outcomes. And so, we took a big shift as a program to look into being outcomes-based. Let's be an outcomes-based community pharmacy. And so, what that means is we're not [doing] better based on how many prescriptions we fill. We're [doing] better when our patients have success, as in their blood pressure goes down, their A1c goes down, their smoking cessation rates go up. And so, we’ve got to then track that. So, you know, those are our metrics of success now, are our patients’ outcomes.

And so that's when you can start talking about public health, because that's when you start seeing, what are we actually getting? Is this medicine working? Do you need to take 10 medicines, or could you take 5? What could you do in your life to promote wellness so that you wouldn't need to be on all of these medications? So, a lot of diet stuff, a lot of exercise, a lot of smoking cessation, all these things that could get you off of medicine. And in pharmacy school, and kind of like in our culture in general, I just feel like we're not talking about de-escalation enough. How could I be on less medicine? You know, pharmacists are incentivized to get people on less medicine, and so that's the issue is we've got to change community pharmacy from being a dispensary, being a dispenser, basically, to being a health care professional and, you know, kind of moving that bar. And that's when I think this model of outcomes-based care gets into even more public health, more patient empowerment issues, better care. You know, that's what it boils down to.

Christina Madison, PharmD, FCCP, AAHIVP: Well, also, I think, more of a collaborative approach as well, right? So, like, working with our physician colleagues, working with our nursing colleagues, and understanding it takes a village, right? It really takes all of us working together.

And then, obviously, wanting to make sure that if we are working with our physician and our nursing colleagues, that they know that we're a resource. So, it's not a 1-way street where, you know, we're contacting a provider because they've done something where there's a drug-drug interaction, or maybe not the best or optimal patient care. I'm doing my best, right? Because I'm not going to just come out and tell them like you messed up, right? Because obviously, I'm more qualified to prescribe because that's not really helpful, right? It's not helpful for dialogue. It's not helpful for any of that. And I guess the reason why I bring this up is because you see this movement within pharmacy for provider status, obviously. But then also you see this, like, state-by-state initiative to try to do individual medication management for things where you can have an established known diagnosis, either through testing or from a previously known diagnosis that's medication intensive that the pharmacist can manage. And I think part of the reason why we're seeing such pushback, especially at the federal and state level, is because of this issue around who owns the patient, right? And so, as pharmacists, because we are connected to the pill, right, or the prescription, and because that is the deliverable versus the outcome—which I love that that's what you guys are focusing on—we don't have ownership over the patient. And because of that, the physician colleagues and nursing colleagues that we know that are in private practice want to keep that ownership, right? “Oh, we don't want to share the pie.” But what they don't understand is that there's enough pie for everyone. And the last time we checked, we're doing a really crappy job. So, what's the harm in allowing us to come in and provide, you know, that extra step? Because let's be honest, you just said it. Giving someone a medication doesn't make them healthier. And how do you know that because you're not getting down to the underlying need of that person. Is it housing insecurity? Is it food insecurity? Is it transportation? When you start fining your patient for not coming to their appointment on time, did you know they had to take 4 buses to get here? And now you find them, you've traumatized them, and you've shamed them, right? What the heck, you know, this is not patient care. This is not being that beacon of hope and light that we need in order for people to make meaningful and sustained change.

So, with that being said, you know, medications don't work unless you take them. So, how do we help people take their medications? We do that by supporting them with wraparound services, right? So, “Oh, you weren't able to make your appointment? Well, let's talk about that. Was it because you didn't have childcare? Is it because you didn't have transportation? Well, let's talk about ways we can get you here. Let's talk about maybe doing a telehealth visit versus an in-person visit. Let's talk about how we can maybe get you some mobile services.” Like, that's how you figure this out, make an impact. I mean, obviously, I'm preaching to the choir over here grandstanding.

Lydia Bailey, PharmD, BCACP: Yeah, no, I know. It's a thing. And just what you said about collaborative practice agreements, I feel like pharmacies get a little tripped up in this. Like, we want collaborative practice agreements to do everything we want to, like, prescribe all the things. And I'm like, why don't we just start with therapeutic interchanges, because that's the thing that we can do, that we can do the best out of any other profession. Pharmacists can do the therapeutic interchanges and we can do it at the point-of-sale with the patient, you know, so if a patient is at your window and the doctor wrote for, you know, something really expensive [and the] patient can't afford it, they're going to go away. They’ve got heart failure, they're not on a first line treatment now, because they can't afford that treatment. So, whereas we know, wow, we could put you on valsartan and this is going to still be a great therapy for you, that's been proven, you know, and is $4. So, you know, those are the things that I think clever practice should start with. Like, let's just get some of those established to where we can do some therapeutic interchanges to ensure people don't go without. You know, 66% of hospital readmissions are due to medication access—66%, that's a ton. And so, it's because people are walking away from the pharmacy counter because they find out that the cost is too high, they didn't know that there was another option. And I'm not even talking about, like, interchanging statins because of formulary stuff. But that's another whole side of it that we could so easily and correctly do because that's our expertise. And so, I just feel like we should kind of start with that collaborative practice before we even go into, like, “I want to titrate insulin.” Like, that's great but let's just like make sure patients have the insulin, and then we can like go from there. So, I don't know. That's my 2 cents on it.

Christina Madison, PharmD, FCCP, AAHIVP: I actually haven't heard it spoken so eloquently before, so thank you for that. I do agree with you that I feel like we're losing the forest to the trees right now, because we're so focused on, you know, wanting to establish that we can practice at the top of our license that we're forgetting what did we go to school for? Like, we are the medication experts. We still need to start from there. And how do you move forward? How do we do things like de-prescribing because now you're on 5 medications because you went into the hospital. And then when you went to your primary physician, nobody decided to take them off, right? Or you’re on a medication because you have a side effect from that medicine, so we put you on another medicine to help with the side effects from the first medicine. Right? It's just crazy, like, crazy pants. Or we just go through your list of diagnoses and see, oh, you're on medications X, Y, and Z, but you don't actually have a diagnosis that X, Y, or Z treats. Maybe we should talk about that. Right? Like let's start with some basics, the basics of what we are and who we are as health care professionals and the medication experts. Let's do the thing that we know we do better than anybody else and then everything else is gravy.

Lydia Bailey, PharmD, BCACP: Right? That's it. We've solved the problem. Here it is.

Christina Madison, PharmD, FCCP, AAHIVP: Now we’ve solved these problems in a 25-minute podcast, right here. Let's mark it on the calendar. What's the date? Yeah, like Lydia and I fixed it. We fixed it, right?

Lydia Bailey, PharmD, BCACP: There it is. That's as easy as pie.

Christina Madison, PharmD, FCCP, AAHIVP: So, if somebody wanted to look into doing this kind of work, because, again, it is unique, it is something that is not often discussed within the pharmacy profession as being a viable option for pharmacies and pharmacists. Or if they are looking to start a charitable pharmacy in their own backyard or even if they're interested in finding where they could potentially move to get opportunities to work with a charitable pharmacy, where would you tell them to go?

Lydia Bailey, PharmD, BCACP: Yeah, it's pretty surprising. There's only, we think, about 100 to 150 charitable pharmacies in the country and those are like standalones. Charitable pharmacies are not the ones that are like closed pharmacies where you have to be patient, but basically just like a community pharmacy. So, there's not that many and there needs to be more, the need is huge. And, you know, we're very limited by, like, the radius around where the pharmacy is. And so, there's a lot of cities that don't have anything like this. And that doesn't even mention rural areas. And so, I would say if you're interested in charitable pharmacy and underserved care, you’ve got to just start one. That's it, you’ve just got to start with yourself. But there's a lot of resources for them to do it yourself.

So, the charitable pharmacy, I have the link here, charitypharmacy.org has a playbook that's already pulled together a lot of resources on literally step-by-step. If you're going to start a charitable pharmacy, you need this, this, this, this. So, it's a great resource for that, and you're going to need some prayer and divine intervention in there to get it to happen because it's hard. I mean, it's really hard, there's got to be a lot of things in place, you’ve got to have funding, you’ve got to have enough medication donations, you have to have a need, you have to have something like sustainability—a huge piece of it. I know charitable pharmacies that have shut down because of the lack of sustainability. So, it's not easy at all. But if you have all those pieces in place, there's that resource out there to kind of get it started. So go for it.

Christina Madison, PharmD, FCCP, AAHIVP: Are you currently accepting applications or have any resident positions? I mean, really, if you want an opportunity to give your own charitable pharmacy a plug, that's an option for you.

Lydia Bailey, PharmD, BCACP: Yeah, so St. Vincent De Paul is an incredible organization and there's actually a few St. Vincent De Paul [locations] specifically that have charitable pharmacies, but we're in the Cincinnati one. We have a residency program. I would say, if you're going to get involved in charitable pharmacy, you have to know someone or have done a residency to kind of see the ins and outs of it before you're just like, “Yeah, I know everything.” So, yeah, do look for residency. There are multiple charitable pharmacies that have residency options, but it's a great opportunity. I wouldn't be in, you know, charitable pharmacy care if I didn't do this residency. So yeah, it's a niche. It's a niche opportunity.

Christina Madison, PharmD, FCCP, AAHIVP: But just think of, like, all of those people that you impacted, and you probably don't even know, like, how many people's lives you've saved or how many people you've touched, and like, you've changed their perspective. And then they went and told their friend, and then they went to their friend, and it's just a ripple effect, right? And just how amazing of an impact you can make just by focusing on the 1 person and optimizing their outcome and making sure that they know the benefits of regular routine care. I think that's the biggest thing, too. For me, it's like, yes, we're helping you in a crisis, but I don't want to just be there in a crisis, like I want to be there for you every day, I want to be like your bestie. You know, I want you to come to me when you have any question, right? Like, it's allergy season, or like, I have a relative and, you know, they have questions and will let me help them, you know, or “Oh, I'm about to expect a new grandchild.” And it's like, “Oh, does the new the mom-to-be or the pregnant-person-to-be—do they have questions about chest or breastfeeding? Do they have questions about what vaccinations are safe?” Like, I just see us as so much of an unutilized portion of the health care system. And again, health equity, like looking at everything from a health equitable lens is access, right? And if you provide access and you provide, you know, that safety net—because really, that's what it is, it's a safety net—for those who aren't able to access the traditional health care system and are not able to afford care for whatever reason—they don't qualify because they make too much or maybe they meet the poverty threshold, but they don't have a way to get there or they don't know that they can get $4 generics and their doctor writes for crazy expensive brand names, right. Those are the things that we can help with and really make a big difference. And so, I applaud you for what you're doing. I would love to see more people engage in this space.

And even if they are not sure how to get started, you know, reaching out to people like you, you can reach out to me, I have a lot of different connections with nonprofits all over the country. I would love to see more engagement around, like, individuals who are migrant workers and people who work in farms and work in the fields. And that's a whole, like, subset of care that we're not engaging with, and I think pharmacists could just really do a really amazing job in. So, I always ask this question of people as we finish up our interview, and thank you so much again, for your time, I know you're super busy. And I know you're out there making meaningful change. If you were able to tell your younger self one thing that you know now that you wish you knew then, what would it be and why?

Lydia Bailey, PharmD, BCACP: Yeah, this is a fun question. I came up with transparency as my answer. Because when I first got into working in pharmacy, just in general, I felt like in school, I was like, alright, by the time I become a pharmacist, I'll know what I'm talking about because I don't know anything yet. And then I go to graduate, I took the exam, and I was like, wait, I still don't know what I'm talking about. I was like, “Well, let me just do a residency, and then I'll know what I'm talking about.” And then all during residency, I was like, “Wait, I don't know what I'm talking about.” So, I did this fake-it-till-you-make-it kind of attitude and it just kind of bled into my patients, you know. And so, I had this non-transparent attitude with my patients. I wanted them to think that I knew all the answers, I wanted them to respect me and all this stuff.

So, I remember, I can see it now, I remember the moment when I just got my foot put my mouth. And so, I was talking with the patient and she's telling me about her smoking, and I'm trying to talk to her about smoking cessation. And she's like, “Yeah, it’s really hard to, you know. The first cigarette in the morning is really hard for me to cut out.” And I'm like, “Yeah, I know, like, yes, it's so hard.” She just, like, stops me. She's like, “Have you quit smoking before?” And I was like, “Ummmm…” She’s like, “Have you ever even smoked a cigarette?” I was like, “Um…” And she’s like, “Okay, so don't try to act like you know what I'm talking about. Just tell me that you don't know and then we can move on.” And I was just like, gosh, you are so right. Thank you for putting me in my place. Since that conversation, I have then realized, like, I can just be transparent with my patients. “Hey, I don't know what it's like to have diabetes. But I know from my other patients that have told me this part is hard. Is that hard for you? Or what does it feel like for you?” And then, like, the defensiveness just goes down because they're like, “Yeah, you're not trying to pretend to be me or know what my experiences are.” And that's so good. So, I just feel like transparency and what you don't know is a big thing.

And then the other side of it that we never talked about is transparency and what you do know. I feel like now pharmacy has turned into like, the customer's always right. The idea of, okay, if that's what they want. If they don't want to take their metformin because they think it's going to cause cancer, okay, I won't tell them anything about that. No, like, we are the medication experts. And so, there's a lot that the patient doesn't know and so we have to be transparent about what we do know. And I say that to the patients—like, “Alright, I'm the medication expert, you're your life expert. I don't know what's happening in your life, you're the expert of your own life, but I'm the expert of your meds, so let's come together on this.” So, I can like de-emphasize my role in their life, but I can higher up emphasize my role as their pharmacist, and that's like, we’ve got to do both. We’ve got to try to stop pretending like we know what they're going through, and we have to stop hiding that the things that we know, they don't know, from, you know, a WebMD kind of thing. And so, when we're transparent in both of those, that's when I feel like we're doing a good job. And you’ve got to have direct conversations, you’ve got to say, “I know you think that I'm just going to tell you that, you know, as a pharmacist, that's not right because of this, this, and this. This is how I know this knowledge. This is why I believe this.” And that, you know, that can be uncomfortable. But when you show it to the patient as “I want I care about you, I care about your health, I'm not trying to make you feel bad or feel like I'm smarter than you for fun. I'm doing this because I want your health to get better. I care about you.” And when you say that, then every patient is like “Okay, yeah, tell me what you know. This is great.” And so, yeah, I just think we've got to be transparent, and I think it's really good.

Christina Madison, PharmD, FCCP, AAHIVP: Honesty is the best policy, right? Like, you know, I say that all the time. I'm a work in progress, like I can definitely improve, you know, so if I don't know something, I will definitely look it up and I will tell you that I do not know something, right? I experienced this firsthand when I started doing [transgender] health because I had a student who disclosed to me that they were trans masculine, and I didn't know how to help them. And I didn't know where there were resources. Like, they had moved here from a different state, and they had lots of resources in the state that they moved from, and then they started pharmacy school, and they were like, “Oh, during the summer break, you know, I decided I wanted to get some surgery done and so I ended up getting my top surgery done over the summer. And then I was wondering, you know, would it be okay for me to get my bottom surgery done during Christmas break?” And I was like, you cannot get a hysterectomy and be back and well in 2 weeks. It's just not possible. I can at least tell them that. But I was naive and did not know all of the different resources that were available in my community. And so, I educated myself. And then after that, I've just been a huge advocate for the LGBTQ community and allyship and, you know, making sure that I'm mindful that when people come to me, they come with all kinds of lived experiences. So, looking at things from a trauma-informed lens, especially with my BIPOC community, understanding that they have experienced discrimination and stigma and that they may have encountered implicit bias within the health care system that may have negatively impacted their care. And I just want them to feel safe. And I also want them to know that they can ask questions, they can be their authentic selves with me, I'm not going to judge them. I may not be, you know, part of the queer community necessarily, but I am their ally. I know I am also a minority, so I understand what it's like to be discriminated against and to have stigma and to feel like you are being mistreated by the health care system. And so, again, I think it's one of those things where, unless it's happened to you, you're not sure. But then also, like, if it has happened to you, right, where your patient corrected you, it makes you a better provider. It does. You, like, stop yourself in your tracks, and you're like, “Okay, you're right, I need to do better.” And I think that's where we just need to come from a place of growth. And you may not know all of the things and that's okay. You can be your best person without knowing everything and you can learn from your patients, like I learn from my patients every day, right? Every day, like all kinds of things. Like, I mean, obviously, I talk about sexual health a lot, but even just, you know, I don't need to know what happens in your bedroom or wherever you just choose to have encounters. But I do need to know what parts you play with and who you play with. Because that helps me to determine whether or not I need to give you something today, right? I mean, I know you're giggling but it's just one of those things where it's like, this is a conversation that in general, pharmacists are not taught. Like, we're not taught to talk about sexual history and even just our own selves, like, sex is how we all got here, guys. It’s time to get comfortable with being uncomfortable, right?

Oh, this has just been such a delightful conversation. Thank you so much, Lydia, for everything that you do for your community, and I love the fact that you're like, “This is my first job and I'm keeping it, and I don't want another job, and I am good to go.” I love that it's so aligned for you and your purpose. I also just want to mention that if there's new grads listening to this, and there's people who are going out getting ready to take their NAPLEX and their boards and stuff, also know your first job may not be your forever job. Like, you got super lucky. I thought of like a lot of not-great jobs before I found a job. So yes, like it's like Goldilocks. Someone's not too good. That's it. That's it. Bye bye. That's right. So just keep remembering that you are worthy. You're worthy to be in a position that aligns with your personal mission, your faith, whatever your beliefs are, and you should not have to sacrifice that for a paycheck.

Lydia Bailey, PharmD, BCACP: Yeah. Just ended right there.

Christina Madison, PharmD, FCCP, AAHIVP: Perfect. You should not sacrifice. Like, you are worthy. You are capable of greatness. I'm going to end it with that.

Lydia Bailey, PharmD, BCACP: Yeah, perfect. Mic drop.

Christina Madison, PharmD, FCCP, AAHIVP: There you go. So, I could talk to you for a whole other hour, but we can't. We got things work to do. You’ve got lives to save so I'm going to let you be. This was really great.

Lydia Bailey, PharmD, BCACP: Yeah, this was wonderful. Thank you.

Christina Madison, PharmD, FCCP, AAHIVP: Of course. So, I'm going to go ahead and end with my little update for our listeners. Just remember, this has been an episode of Public Health Matters. We are part of the Pharmacy Times Pharmacy Focus podcast series. And just know that in the Pharmacy Focus podcast series, we've got lots of other podcasts that you can subscribe to that are informative. We are on the precipice of just really wanting to educate the profession, not just around pharmacy, but just all things related to health care and how we can make meaningful and sustained changes for our patients’ lives. And please tune in for future episodes. I have been your host today, Dr. Christina Madison, also known as the Public Health Pharmacist. You can find me at your social media du jour at the Public Health Pharmacist, and you can also connect with my guest today, Dr. Lydia Bailey, on LinkedIn. And remember: Public Health Matters.