Culture, Professionalism and
 the Practice of Pharmacy


                   Billy Futter
                Rhodes University...
Key questions

1. What is Culture?

2. How does Culture influence:

  • Practice of Pharmacy?
  • Professional status?
4. Cultural Competence


              Communication

3. Professionalism               2. Culture


              1. Pharm...
1.   Pharmacy Practice
     Emphasis on Product
      Emphasis on People
People
Need medicine
People
          have
Medicine-related problems
Pharmaceutical care
     services

     Based on
 Relationship of trust
But . . .
People are different
See & do things differently

      How many legs?
Young lady?   Old lady?
Need to understand
    differences
  between people
So . . .?

•   Important differences?
•   Impact on pharmacy practice?

         What is Culture?
2. Culture

Society has many sub-groups
  Each has its own culture



        Society
2. Culture

Society has many sub-groups
  Each has its own culture



         Society
2. Culture

Society has many sub-groups
  Each has its own culture
                  Generic?
     Generic?               ...
Different cultural groups

                 group
                          Generic
        group
                        ...
Society

               GEOGRAPHIC

                     Chinese
       Generic                        Indian

Japanese   ...
Society

             LANGUAGE

                  Chinese
      Generic                       Hindi

Russian              ...
Society

                RELIGION

                    Muslim
      Generic                   Hindu

Tao                  ...
Society

        AGE and GENDER

                     Female
       Generic                         Babies

Male          ...
Society

               ECONOMIC

                  Middle class
        Generic                  Upper class

Lower class...
Society

           SIZE and POWER

       Generic
                 MAJORITY           Minority

Minority                 ...
people
                                                       people



           Therefore
                             ...
people
                                              people

                       people                       people
  ...
people
                                                   people

                              people                   p...
people
                                                people



Different B.E.V.A.N.S
                          people   ...
people
                                                        people



 Different B.E.V.A.N.S
                          ...
Cultural Symbols



   age, gender,
 language, race
Status symbols
    Wheels!
Other Status symbols
Cultural symbols

          The Five Friendlies




Beibei JingJing Huanhuan Yingying Nini
               Bei jing huan yi...
people




Influence of Culture on Behaviour
                                                                people


    ...
So:
How does Culture influence

   1. Health behaviour?
    * Patients?
    * Health professionals?

   2. Health outcomes?
Health Beliefs of different cultures
  Yin yang             Yoga
Tai Chi
Gym
Traditional Healers



Rituals
Expectations

Queuing for health care
Values pyramid


               Care

           Courage

      Respect, Fairness


Competition, Equality, Informality
Values pyramid

             Care

          Respect

       Fairness, Honesty


Cooperation, Status, Formality
Norms

Right hand
Greetings
Responding to Visual cues
Responding to Visual cues




                    Oprah
How do you respond to HIV/ AIDS
 Response to HIV/ AIDS?
          LOGO?
ACTIVISTS?
VICTIMS?
Beliefs – Diagnosis?
          Cause of illness?
Stress                     Evil spell
Yin Yang imbalance         Heredita...
How do you respond to Symptoms?

      Visit Doctor or Pharmacist
      Get a prescription
      Self-medicate
      Vitam...
Response to Symptoms?

   Restore balance
   Avoid hot / cold
   Remove “spell”
   Visit Traditional healers
   Consult an...
Conclusions
   Culture influences
Signs and Symptoms
– Interpretation   different
– Response         different

Communicat...
Consequences

Professional advice
   Not sought
   Not trusted
   Not followed
Serious?

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

Access
Quality of care
Quality of life
3. Implications
Professional Status
  of pharmacists?
3.    Professional status
Level of authority given by society
               to

      – make judgements
       – give dir...
Who decides?

Society decides the roles it needs


Social institutions give and limit
authority to practice
Criteria for
    Professional Status?

Competent                    Committed
       to satisfy needs that are:



       ...
Perceptual haze
         Evidence?


Competent                       Committed

            to satisfy needs that are:


 ...
Combining criteria

             Hi
Commitment




             Lo

                  Lo                        Hi


     ...
Combining criteria
                Combining criteria

             Hi
Commitment


                             Professio...
Combining criteria
                Combining criteria

             Hi
Commitment


                   Caregiver   Profess...
Combining criteria
                Combining criteria

             Hi
Commitment


                       Caregiver    Pr...
Combining criteria
                Combining criteria

             Hi
Commitment


                       Caregiver   Pro...
Combining criteria
                Combining criteria

             Hi
Commitment


                       Caregiver   Pro...
Therefore
Professional status can be increased

Show evidence of
    Competence
    Commitment
Therefore
Professional status can be increased

Show evidence of
    Competence – applied
    Commitment – service before ...
But:
REAL WORLD - not laboratory


                     group
                              Generic
            group
    ...
REAL WORLD IS CHANGING
          In the next 20 years . . .

Global drift
    more people visiting foreign
countries

Urba...
REAL WORLD IS CHANGING
REAL WORLD
   Communication

Digital Revolution
 Mobiles
Information on Web
 Web based marketing
REAL WORLD IS CHANGING


Professional tools
Communication challenges

Digital divide        - less access
Efficiency Pressure   - Impatience
Cultural filters      - M...
Conclusion


Cultural diversity increasing
Communication challenges
So . . .
What can pharmacists do

         Agenda
Competence, Commitment?
Communication?
Professional status?
The Solution?


      Develop
Cultural Competence!
Cultural Competence

Ability of health system to deliver
consistent quality health care to
patients in cross cultural situ...
Cultural Challenge


Lo                                  Hi

Incompetent              Competent
 1. Intolerant         5. ...
Cultural ladder

Cultural Proficiency

    Cultural Competence

       Cultural Pre-competence

            Cultural Blind...
Pre-competence to Competence

                      COMPETENT
Hi
           (Empathy, concerned, caring, respect)


      ...
Everyone benefits!
Patients             - better QoC & QoL
Health professionals - higher esteem
Health system        - mor...
And Pharmacists improve
               professional status!

              Hi
                            Professional
Com...
This is not the end
      but the beginning!
Thank you
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Culture, Professionalism and the Practice Of Pharmacy

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presented at FIP congress, Beijing 2007. Challenges pharmacy curricula to make provision for cultural competence. Includes notes,

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Culture, Professionalism and the Practice Of Pharmacy

  1. 1. Culture, Professionalism and the Practice of Pharmacy Billy Futter Rhodes University South Africa
  2. 2. Key questions 1. What is Culture? 2. How does Culture influence: • Practice of Pharmacy? • Professional status?
  3. 3. 4. Cultural Competence Communication 3. Professionalism 2. Culture 1. Pharmacy Practice
  4. 4. 1. Pharmacy Practice Emphasis on Product Emphasis on People
  5. 5. People Need medicine
  6. 6. People have Medicine-related problems
  7. 7. Pharmaceutical care services Based on Relationship of trust
  8. 8. But . . . People are different
  9. 9. See & do things differently How many legs?
  10. 10. Young lady? Old lady?
  11. 11. Need to understand differences between people
  12. 12. So . . .? • Important differences? • Impact on pharmacy practice? What is Culture?
  13. 13. 2. Culture Society has many sub-groups Each has its own culture Society
  14. 14. 2. Culture Society has many sub-groups Each has its own culture Society
  15. 15. 2. Culture Society has many sub-groups Each has its own culture Generic? Generic? Generic? Generic? Society Generic? Generic? Generic? Generic?
  16. 16. Different cultural groups group Generic group group group Society group group group group
  17. 17. Society GEOGRAPHIC Chinese Generic Indian Japanese American Society Australian Swedish European African
  18. 18. Society LANGUAGE Chinese Generic Hindi Russian English Society Italian Zulu French Xhosa
  19. 19. Society RELIGION Muslim Generic Hindu Tao Christian Society Jew Mormon Ancestor Sects worship
  20. 20. Society AGE and GENDER Female Generic Babies Male Kids Society Elderly Teenagers Mature Early adults Adults
  21. 21. Society ECONOMIC Middle class Generic Upper class Lower class Super rich Society Destitute Rich Poor Middle
  22. 22. Society SIZE and POWER Generic MAJORITY Minority Minority Minority Society Minority Minority Minority Minority
  23. 23. people people Therefore people people Society people people people people 1. No generic cultural groups! 2. Each group has its own culture
  24. 24. people people people people Society people people Group Culture people people Group Behaviour Routine, Predictable Difficult to change Prescribed limits
  25. 25. people people people people Society people people people people Cultural boundaries “Right way of doing things” B.E.V.A.N.S.
  26. 26. people people Different B.E.V.A.N.S people people Society people people people people Beliefs Expectations Values Assumptions & Attitudes Norms Symbols
  27. 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
  28. 28. Cultural Symbols age, gender, language, race
  29. 29. Status symbols Wheels!
  30. 30. Other Status symbols
  31. 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
  32. 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
  33. 33. So: How does Culture influence 1. Health behaviour? * Patients? * Health professionals? 2. Health outcomes?
  34. 34. Health Beliefs of different cultures Yin yang Yoga
  35. 35. Tai Chi
  36. 36. Gym
  37. 37. Traditional Healers Rituals
  38. 38. Expectations Queuing for health care
  39. 39. Values pyramid Care Courage Respect, Fairness Competition, Equality, Informality
  40. 40. Values pyramid Care Respect Fairness, Honesty Cooperation, Status, Formality
  41. 41. Norms Right hand Greetings
  42. 42. Responding to Visual cues
  43. 43. Responding to Visual cues Oprah
  44. 44. How do you respond to HIV/ AIDS Response to HIV/ AIDS? LOGO?
  45. 45. ACTIVISTS?
  46. 46. VICTIMS?
  47. 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
  48. 48. How do you respond to Symptoms? Visit Doctor or Pharmacist Get a prescription Self-medicate Vitamins Herbal treatments Rest and relax
  49. 49. Response to Symptoms? Restore balance Avoid hot / cold Remove “spell” Visit Traditional healers Consult ancestors
  50. 50. Conclusions Culture influences Signs and Symptoms – Interpretation different – Response different Communication different
  51. 51. Consequences Professional advice Not sought Not trusted Not followed
  52. 52. Serious? Health outcomes Cultural inequalities Unmet medicine needs Medicine related problems
  53. 53. Serious? Access Quality of care Quality of life
  54. 54. 3. Implications Professional Status of pharmacists?
  55. 55. 3. Professional status Level of authority given by society to – make judgements – give directions
  56. 56. Who decides? Society decides the roles it needs Social institutions give and limit authority to practice
  57. 57. Criteria for Professional Status? Competent Committed to satisfy needs that are: Valued Complex Personal
  58. 58. Perceptual haze Evidence? Competent Committed to satisfy needs that are: Valued Complex Personal
  59. 59. Combining criteria Hi Commitment Lo Lo Hi Competence
  60. 60. Combining criteria Combining criteria Hi Commitment Professional Lo Lo Hi Competence
  61. 61. Combining criteria Combining criteria Hi Commitment Caregiver Professional Lo Lo Hi Competence
  62. 62. Combining criteria Combining criteria Hi Commitment Caregiver Professional Lo Robot Lo Hi Competence
  63. 63. Combining criteria Combining criteria Hi Commitment Caregiver Professional Lo Thief Robot Lo Hi Competence
  64. 64. Combining criteria Combining criteria Hi Commitment Caregiver Professional Lo Thief Robot Lo Hi Competence
  65. 65. Therefore Professional status can be increased Show evidence of Competence Commitment
  66. 66. Therefore Professional status can be increased Show evidence of Competence – applied Commitment – service before self
  67. 67. But: REAL WORLD - not laboratory group Generic group group group Society group group group group
  68. 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
  69. 69. REAL WORLD IS CHANGING
  70. 70. REAL WORLD Communication Digital Revolution Mobiles Information on Web Web based marketing
  71. 71. REAL WORLD IS CHANGING Professional tools
  72. 72. Communication challenges Digital divide - less access Efficiency Pressure - Impatience Cultural filters - Misunderstanding Minorities - Intolerant
  73. 73. Conclusion Cultural diversity increasing Communication challenges
  74. 74. So . . . What can pharmacists do Agenda Competence, Commitment? Communication? Professional status?
  75. 75. The Solution? Develop Cultural Competence!
  76. 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.
  77. 77. Cultural Challenge Lo Hi Incompetent Competent 1. Intolerant 5. Empathy 2. Impatient 6. Concerned 3. Dismissive 7. Caring 4. Judgemental 8. Respect
  78. 78. Cultural ladder Cultural Proficiency Cultural Competence Cultural Pre-competence Cultural Blindness Cultural Incapacity Cultural Destructiveness
  79. 79. Pre-competence to Competence COMPETENT Hi (Empathy, concerned, caring, respect) Desire Encounter Skill Knowledge Awareness INCOMPETENT Lo (intolerant, impatient, dismissive, judgemental)
  80. 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
  81. 81. And Pharmacists improve professional status! Hi Professional Commitment Lo Lo Hi Cultural Competence
  82. 82. This is not the end but the beginning!
  83. 83. Thank you

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