Culture, Professionalism and the Practice Of Pharmacy

Slide 1: Culture, Professionalism and the Practice of Pharmacy Billy Futter Rhodes University South Africa

Slide 2: Key questions 1. What is Culture? 2. How does Culture influence: • Practice of Pharmacy? • Professional status?

Slide 3: 4. Cultural Competence Communication 3. Professionalism 2. Culture 1. Pharmacy Practice

Slide 4: 1. Pharmacy Practice Emphasis on Product Emphasis on People

Slide 5: People Need medicine

Slide 6: People have Medicine-related problems

Slide 7: Pharmaceutical care services Based on Relationship of trust

Slide 8: But . . . People are different

Slide 9: See & do things differently How many legs?

Slide 10: Young lady? Old lady?

Slide 11: Need to understand differences between people

Slide 12: So . . .? • Important differences? • Impact on pharmacy practice? What is Culture?

Slide 13: 2. Culture Society has many sub-groups Each has its own culture Society

Slide 14: 2. Culture Society has many sub-groups Each has its own culture Society

Slide 15: 2. Culture Society has many sub-groups Each has its own culture Generic? Generic? Generic? Generic? Society Generic? Generic? Generic? Generic?

Slide 16: Different cultural groups group Generic group group group Society group group group group

Slide 17: Society GEOGRAPHIC Chinese Generic Indian Japanese American Society Australian Swedish European African

Slide 18: Society LANGUAGE Chinese Generic Hindi Russian English Society Italian Zulu French Xhosa

Slide 19: Society RELIGION Muslim Generic Hindu Tao Christian Society Jew Mormon Ancestor Sects worship

Slide 20: Society AGE and GENDER Female Generic Babies Male Kids Society Elderly Teenagers Mature Early adults Adults

Slide 21: Society ECONOMIC Middle class Generic Upper class Lower class Super rich Society Destitute Rich Poor Middle

Slide 22: Society SIZE and POWER Generic MAJORITY Minority Minority Minority Society Minority Minority Minority Minority

Slide 23: people people Therefore people people Society people people people people 1. No generic cultural groups! 2. Each group has its own culture

Slide 24: people people people people Society people people Group Culture people people Group Behaviour Routine, Predictable Difficult to change Prescribed limits

Slide 25: people people people people Society people people people people Cultural boundaries “Right way of doing things” B.E.V.A.N.S.

Slide 26: people people Different B.E.V.A.N.S people people Society people people people people Beliefs Expectations Values Assumptions & Attitudes Norms Symbols

Slide 27: people people Different B.E.V.A.N.S people people Society people people people people Beliefs – what is right and wrong Expectations – what should happen Values – priorities, standards Assumptions & Attitudes – positive/ negative Norms – traditional way of doing things Symbols - group identity, convey meaning

Slide 28: Cultural Symbols age, gender, language, race

Slide 29: Status symbols Wheels!

Slide 30: Other Status symbols

Slide 31: Cultural symbols The Five Friendlies Beibei JingJing Huanhuan Yingying Nini Bei jing huan ying ni Fish Panda Olympic Antelope Swallow Welcome to flame Beijing sea forest fire earth sky

Slide 32: people Influence of Culture on Behaviour people people people Society people people people people ‘BEVANS’ Routine Qualityo Beliefs f life Expectations Values Behaviour Outcomes Attitudes Norms Symbols Patterns Quality of service

Slide 33: So: How does Culture influence 1. Health behaviour? * Patients? * Health professionals? 2. Health outcomes?

Slide 34: Health Beliefs of different cultures Yin yang Yoga

Slide 35: Tai Chi

Slide 36: Gym

Slide 37: Traditional Healers Rituals

Slide 38: Expectations Queuing for health care

Slide 39: Values pyramid Care Courage Respect, Fairness Competition, Equality, Informality

Slide 40: Values pyramid Care Respect Fairness, Honesty Cooperation, Status, Formality

Slide 41: Norms Right hand Greetings

Slide 42: Responding to Visual cues

Slide 43: Responding to Visual cues Oprah

Slide 44: How do you respond to HIV/ AIDS Response to HIV/ AIDS? LOGO?

Slide 45: ACTIVISTS?

Slide 46: VICTIMS?

Slide 47: Beliefs – Diagnosis? Cause of illness? Stress Evil spell Yin Yang imbalance Hereditary Lack of chi Environment Hot cold Imbalance Bad habits Punishment for sins Old age Microbe or Virus

Slide 48: How do you respond to Symptoms? Visit Doctor or Pharmacist Get a prescription Self-medicate Vitamins Herbal treatments Rest and relax

Slide 49: Response to Symptoms? Restore balance Avoid hot / cold Remove “spell” Visit Traditional healers Consult ancestors

Slide 50: Conclusions Culture influences Signs and Symptoms – Interpretation different – Response different Communication different

Slide 51: Consequences Professional advice Not sought Not trusted Not followed

Slide 52: Serious? Health outcomes Cultural inequalities Unmet medicine needs Medicine related problems

Slide 53: Serious? Access Quality of care Quality of life

Slide 54: 3. Implications Professional Status of pharmacists?

Slide 55: 3. Professional status Level of authority given by society to – make judgements – give directions

Slide 56: Who decides? Society decides the roles it needs Social institutions give and limit authority to practice

Slide 57: Criteria for Professional Status? Competent Committed to satisfy needs that are: Valued Complex Personal

Slide 58: Perceptual haze Evidence? Competent Committed to satisfy needs that are: Valued Complex Personal

Slide 59: Combining criteria Hi Commitment Lo Lo Hi Competence

Slide 60: Combining criteria Combining criteria Hi Commitment Professional Lo Lo Hi Competence

Slide 61: Combining criteria Combining criteria Hi Commitment Caregiver Professional Lo Lo Hi Competence

Slide 62: Combining criteria Combining criteria Hi Commitment Caregiver Professional Lo Robot Lo Hi Competence

Slide 63: Combining criteria Combining criteria Hi Commitment Caregiver Professional Lo Thief Robot Lo Hi Competence

Slide 64: Combining criteria Combining criteria Hi Commitment Caregiver Professional Lo Thief Robot Lo Hi Competence

Slide 65: Therefore Professional status can be increased Show evidence of Competence Commitment

Slide 66: Therefore Professional status can be increased Show evidence of Competence – applied Commitment – service before self

Slide 67: But: REAL WORLD - not laboratory group Generic group group group Society group group group group

Slide 68: REAL WORLD IS CHANGING In the next 20 years . . . Global drift more people visiting foreign countries Urban rush 60 - 80% will live in town Population explosion additional 1.6 billion people on the planet

Slide 69: REAL WORLD IS CHANGING

Slide 70: REAL WORLD Communication Digital Revolution Mobiles Information on Web Web based marketing

Slide 71: REAL WORLD IS CHANGING Professional tools

Slide 72: Communication challenges Digital divide - less access Efficiency Pressure - Impatience Cultural filters - Misunderstanding Minorities - Intolerant

Slide 73: Conclusion Cultural diversity increasing Communication challenges

Slide 74: So . . . What can pharmacists do Agenda Competence, Commitment? Communication? Professional status?

Slide 75: The Solution? Develop Cultural Competence!

Slide 76: Cultural Competence Ability of health system to deliver consistent quality health care to patients in cross cultural situations irrespective of the culture of fellow professionals or patients.

Slide 77: Cultural Challenge Lo Hi Incompetent Competent 1. Intolerant 5. Empathy 2. Impatient 6. Concerned 3. Dismissive 7. Caring 4. Judgemental 8. Respect

Slide 78: Cultural ladder Cultural Proficiency Cultural Competence Cultural Pre-competence Cultural Blindness Cultural Incapacity Cultural Destructiveness

Slide 79: Pre-competence to Competence COMPETENT Hi (Empathy, concerned, caring, respect) Desire Encounter Skill Knowledge Awareness INCOMPETENT Lo (intolerant, impatient, dismissive, judgemental)

Slide 80: Everyone benefits! Patients - better QoC & QoL Health professionals - higher esteem Health system - more cost effective Medicine - improved use Employers - Legal protection - Satisfied staff - Loyal patrons

Slide 81: And Pharmacists improve professional status! Hi Professional Commitment Lo Lo Hi Cultural Competence

Slide 82: This is not the end but the beginning!

Slide 83: Thank you