Living the Oath: A Pharmacist’s Promise

Isabella Tobin:

You are listening to Living the Pharm Life, the official podcast of Purdue University’s College of Pharmacy. I’m your host, Isabella Tobin, a PharmD candidate with a passion for telling the stories of our college’s, phenomenal and loyal students, faculty, staff, alumni, and friends who persistently pursue excellence in all they do.

Claire Reyes:

Drs. Patti Darbishire and Chelsea Baker are not only licensed pharmacists, they are true advocates for the future of the profession. Dr. Darbishire is the executive associate dean in the College of Pharmacy, and Dr. Baker, a 2011 PharmD graduate from Purdue is a clinical associate professor who practices as a clinical pharmacist at the Center for Healthy Living.

Listen as they dive deep into the purpose behind the oath of a pharmacist and how it has helped shape the integrity of the pharmacy profession for generations, while also forging a path for future pharmacists. My name is Claire Reyes, a third year professional student in the College of Pharmacy and guest host for this episode.

I’m so excited to welcome Drs. Patty Darbishire and Dr. Chelsea Baker on the Living the Pharm Life podcast. Dr. Darbishire is the executive associate dean in the College of Pharmacy, and Dr. Baker is a clinical associate professor who practices as a clinical pharmacist at the Center of Healthy Living on Purdue’s West Lafayette campus.

Thank you both for being on the podcast today. I can’t wait to dig into the oath of the pharmacist. Let’s start off with each of you sharing a few words about your professional background, your pharmacy path, and your current position in the Purdue College of Pharmacy.

Patti Darbishire:

Sure, I’d be happy to begin, Claire. So, I am a Purdue alum, and I obtained my bachelor’s degree in pharmacy, which was the terminal degree for licensure back in 1985, and I spent the next 15 years working in a variety of what you would consider traditional community pharmacy settings. But I was really fortunate to work with one company that agreed to provide resources so that I could develop disease state management programs, and we started one of the first diabetes clinics in a community pharmacy.

It’s also here where I discovered my love of teaching. I precepted a lot of pharmacy students and was able to develop an advanced clinical rotation site in a community pharmacy. Then in 2000, the PharmD degree was mandated as a terminal pharmacy degree. So I decided to go back to school while I was working full time and raising two small children, so that was rather challenging. And in 2002, I was hired by the college to design and direct a new experiential education program. A couple years later, at the ripe old age of about 45, I transitioned to a position as a faculty member and I worked my way up through the ranks to full professor. In 2019, I was asked to serve as the associate dean for Academic, which led to my current position of executive associate dean.

Chelsea Baker:

Awesome. And yeah, Claire, so I’m Chelsea Baker. So, I also graduated from Purdue University. Afterwards, I pursued my additional training in pharmacy administration. I did a PGI-I and PGI-II at the Johns Hopkins Hospital in Baltimore, Maryland, and got my MBA in medical services management.

But it wasn’t very long before I made my way back to Purdue and I actually worked in medication safety and community pharmacy settings in the interim. And then in 2017 I took my faculty role in skills coordination for skills lab here on campus. So, currently I’m coordinator for P2 students for our professional skills laboratory, and then I also serve as a clinical pharmacist at Center for Healthy Living.

Claire Reyes:

Today, we are going to delve into the oath of a pharmacist. So, Dr. Darbishire, can you tell our audience what it is and why it is important to the profession of pharmacy?

Patti Darbishire:

Absolutely. So, the original oath was developed as a joint effort in the early ’80s by the American Association of Colleges of Pharmacy, AACP, and the American Pharmacists Association, APHA. It’s typically introduced to students at their professional program induction ceremony or their white coat ceremony, which is where we welcome students into clinical practice. So donning that white coat and reciting the oath, they’re considered to be the first steps in building a professional identity and it vocalizes the willingness to fulfill the obligations of the profession.

There are actually eight promises within the oath, but they all revolve around the concepts of respect and ethics and competence. I will tell you one really quick memorable story that I have about a white coat ceremony, which included a blender on my part. So, as the emcee of a white coat ceremony during the final moments of the program, I ask that the 150 newly inducted pharmacy students and all of their pharmacist friends and relatives in the audience, I asked them to stand and recite the oath with me.

And they’re usually about a thousand people in the audience and about half of them end up standing up reciting the oath, and then they put the oath up behind me on a very large screen for the audience to read. So we’re reciting the oath and all’s going well until it doesn’t. Unbeknownst to me, I was reading from the latest version of the oath and the 500 people in the audience were reciting from the previous version that was behind me on the big screen.

So, in seconds it goes from this loud booming volume of 500 people down to just me in the microphone, and I had absolutely no idea what was happening. So, I just finished reading and I walked to my seat and then the dean whispered to me what had happened. And, anyway, it was a very kind of memorable experience. And Claire, I was wondering if you remember when you took the oath, what that moment felt like?

Claire Reyes:

Oh my goodness. For me, that was three years ago, but I do remember it actually. I remember standing there with all my peers and I didn’t know everybody at the time, but now I do. So that’s very fun to know that just in that moment I wasn’t sure of anything. But as I was reciting the oath, I just felt immense pride for myself, for the college and all that we’ve accomplished, and I also remember just feeling a sense of duty and responsibility that I had to live up to this oath. I have my white coat, I’m going to be in this professional program, I really have to show that I am worth it and that I can prove myself in this program. And so it was just very, all these overwhelming feelings of just joy, a little bit of anxiety as well. But it was such a great honor to even be able to recite that in that moment since, I mean, not everybody is going to be able to in their lifetime. And pharmacists accomplish incredible things and I am just so proud to be here.

Patti Darbishire:

Oh, that’s great. Thank you.

Claire Reyes:

Yes, thank you for asking me. It’s been a while, but I do remember reciting it. So can each of you share a specific moment or experience from your career that shaped your understanding of the oath and its relevance to your day-to-day work?

Chelsea Baker:

Yeah, I’d be happy to take this one first, Patti. So, for me, I think back to right when I started my career as a pharmacist. So a new practitioner, I’m a pharmacist resident in Baltimore, and you guys [inaudible 00:07:44] to do the math. But it was during Hurricane Sandy, so I was in Baltimore, it was actually projected to hit Baltimore and then as we know, went up and actually affected more of New York City.

But during that we were preparing for it, getting ready for it [inaudible 00:08:03] all preparedness, and they told us, which I knew, but pharmacists, healthcare workers were emergency personnel. And so it was an expectation of us to be on site and provide care for our patients for those affected both by hurricane and then obviously those who also needed other urgent care.

And I remember driving around Baltimore, because I was a part of our management team as a resident, and I was picking up our pharmacy technicians and bringing them in to take care of our patients. And for me and how this reflects back that oath and that conviction that you had is for me [inaudible 00:08:43], I was putting or considering it was the welfare of community in place of [inaudible 00:08:48] my primary concern.

So, there’s literally a massive storm, there’s flooding going on around us, but we’re there. We’re there to provide care for our patients. And so, for me, that really kind of shaped my understanding. I have devoted myself to a lifetime of service and helping others and I’m going to meet that call when I need to.

Patti Darbishire:

That was great. Thanks. I was sitting here thinking about it while you were speaking Chelsea, and honestly, there have just been so many different experiences. I think my one regret while I was in community pharmacy was not keeping a diary of all the poignant things that happened. Some of them really funny when you work with the public, but when I think about this, there’s one situation that kind of stands out in my mind and it involved this very wealthy and influential couple that would frequent the pharmacy.

And on almost every occasion when they came in, they were just exceedingly rude and condescending to everyone around them, all the way from the other patients that were standing in line to the stock boy to the pharmacy personnel. And it just always struck me as odd why anyone would go out of their way to sort of degrade or humiliate others. But it was pretty clear it originated from this sense of entitlement, but it always brings to mind to me how important the concepts of respect and equity are and why they’re included in the oath. So, I think that one is really special to me.

Claire Reyes:

Yeah, thank you guys both for sharing your experiences. They both seem to have profound effects on how you work day to day and your understanding of the oath and how we apply it. So, profession of pharmacy is changing, Dr. Darbishire, and has the oath ever been adapted and why?

 

Patti Darbishire:

It has. The oath has been revised three different times since the original 1983 version. And that was in 1994, 2007, and then at the last time, 2021. And each time it was based on societal changes and adaptations by the profession. But I’ll tell you the last change, the latest change included specific language that embraced diversity and inclusion and health equity. And, in my opinion, that was long overdue.

Claire Reyes:

Those are two topics I’m very passionate about, so I’m very happy to hear that they’ve been adapted to include those things. Dr. Baker, would you like to include anything on that?

Chelsea Baker:

I think Dr. Darbishire did a great job in summarizing those changes. But, yeah, I think it’s one of those things that we have to recognize that the profession’s changing, that the healthcare itself is changing. And so I think we have to adapt that with the pharmacist to do that while understanding some of those corporate [inaudible 00:11:45] that are really, still hold true for us as well.

Claire Reyes:

Yes, exactly. I agree with that. So, each of you tell me what is one lesson or principle that the oath emphasizes which you believe should be a cornerstone for every new pharmacist regardless of their specific practice area, like hospital or retail, academia?

Chelsea Baker:

Yeah, I’m happy to lead with that one. So, for me, and it kind of reflects back to this evolution of the oath, but this idea that we are committed to furthering our professional knowledge, expertise and selfawareness regardless of [inaudible 00:12:28] practice. Because our profession is changing so much, healthcare and how we deliver it is changing so much. We are doing so much more telehealth, things like this that we really haven’t done before. And so, I think it’s just really critical that everyone stays abreast of current developments.

I mean, I think back and [inaudible 00:12:47] will chuckle at this because she’s made references to this three therapeutics. It was like Insulin and Metformin when she started and started teaching about diabetes. And now, for me, all of our SGLT-2s, our GLP-1s, these heavy hitter injectable products that are literally driving industries. I mean Eli Lilly here in Indianapolis is booming as a result of a lot of these really great things and developments that we’re making in diabetes care. But, again, it speaks to, I didn’t learn of that stuff when I was going through pharmacy school and it’s just so important for everyone to stay up to date and make sure that they’re providing the best care for their patient.

Patti Darbishire:

And I would say, in my role, that the language on holding oneself and colleagues to the highest principles of our profession’s moral, ethical, and legal conduct, it really resonates with me. Pharmacists are one of the most trusted healthcare professionals and it’s up to each of us to maintain that standard. And I think that the first time that students are challenged to uphold this principle, it can be really difficult. So, for instance, in my role, students may come to me and they’ve seen a peer do something wrong, like perhaps cheat on an exam, and they really struggle with how to confront the situation. And, oftentimes, I have to remind them of the principles in the oath, and to be able to come back to that really helps them understand what they need to do.

Claire Reyes:

Yeah. Those are both situations that I can see how the oath really applies. And I know [inaudible 00:14:24] would also chuckle at what you said, Dr. Baker, as she’s told us many a times, she’s like, “Oh, back in my day we only had this and this, and now you’re just going to have to keep learning all these things.” It makes me laugh every time because it just makes me think about, well, the profession of pharmacy is just a never ending learning journey. And as pharmacists, that’s something that you should know from the get-go and be prepared to just keep wanting to learn and keep being curious about everything. So Dr. Baker, what advice would you give our professional program students or recent graduates about keeping the oath at the forefront of their professional endeavors? How do you keep the oath real to students?

Chelsea Baker:

I love that. How do we keep it real? Well, for me personally, I reflect back to why did you want to be a pharmacist, right? And I think back, and I’m sure, Claire, maybe your answer was something similar, but mine was like I wanted to help others. And so, the oath so reflects that it’s putting the welfare of others before ourselves. And I think if you can keep that in mind and keep thinking back to your why, why even pharmacy school, and then how the oath then reflects and provides structure around that. For me, I think that’s how you keep it real.

Claire Reyes:

Yeah.

Chelsea Baker:

So actually… Oh, I have a question for you too. So based on, Claire, on your academic and work experiences, which of the principles of the oath do you think are most important to pick? Or if you had to pick one, which would be most important, and which do you think can be most maybe difficult to employ?

Claire Reyes:

Oh, okay. That’s a challenging question since I think the oath in its entirety is very important. If I had to choose one phrase or principle from the oath, I would probably choose the very first phrase underneath the very first statement. It says, “I will consider the welfare of humanity and relief of suffering my primary concerns.” Because at the end of the day, that’s what we’re here for. We’re here for our patients. We’re here to provide the best quality care that we can. And we should always keep that at the forefront of our mind, like you said, Dr. Baker. And just asking us why are we doing this? Who are we doing this for? And for me personally, my why is my family.

I want to be someone who can be there for my parents if they need anything, if they have questions about their medications. And as parents get older, they have more health problems. And seeing that in real time really affects you and makes you even more passionate about your career and wanting to be the best healthcare professional you can.

I think the most challenging one to apply is one that we mentioned already, which is holding yourself…

Oh, hold on. Accepting the responsibility to improve my professional knowledge, expertise, and selfawareness because it does take a level of maturity and just wanting to be a better person in improving yourself. And it takes that some sort of level there for each of those concepts to really self-reflect and just sit with yourself and be, “Hey, how can I improve? Do I want to keep going with this? Do I have the passion still? Do I have the drive to learning and wanting to provide?” So, I think that’s the most challenging, at least in my opinion. So, thank you for asking that. That was a hard question.

Chelsea Baker:

Thank you for sharing. I think that you were so honest, and yeah, it takes just a level of this intrinsic motivation, I think, to really do that last piece too, so thank you.

Claire Reyes:

Yes. So, Dr. Darbishire, you mentioned the more recent inclusion of health equity verbiage in the oath. The world we live in is more diverse than ever and so is the Purdue population where you serve at the clinic, Dr. Baker. So, as a clinical pharmacist, how do you determine the unique needs of a patient in your clinic when there are so many cultures abound?

Chelsea Baker:

Oh my gosh, that’s such a great question because you’re totally right, Claire. I mean, Purdue attracts so many different people, not just our student base, but also our faculty, our staff, and their dependents, just who I serve at the Center for Healthy Living. And so, for me, I think it’s just so critical to keep those social determinants of health concepts at the forefront when treating our patients, and not to look at somebody like one-size-fits-all, like guideline diagram.

You would think it’s so easy, right? First line… Go back to diabetes. First line for so many of our patients are some of these new injectable products, but there are a subset because of income, because of transportation abilities, because of fear of needles. There are just so many different considerations you have to take into account to select what is the best therapy for them.

And so, for me, as I think about that equity piece, that’s what I’m always thinking about with my patients. It’s not, “What do my guidelines say?” But what is the solution, what is the treatment option that I can pick that is going to best treat your needs based on your medical status, but also be something that you can successfully do as well as a patient. So, yeah, that’s how I approach it.

Claire Reyes:

I am in complete agreement. Dr. Darbishire, do you have anything you want to add to that?

Patti Darbishire:

No, I think that was great. Thank you.

Claire Reyes:

Yeah. It’s very hard as a student sometimes since we will just sit there and look at cases and we don’t actually get to see these patients and really see them for all their issues that they may be having and all of their background. So I really like the phrase looking at the patient as a whole, because for me, it really encompasses what we need to do as pharmacists. And we’re more than just medications. We are still looking at them as people and including them in their care and helping them make the best decisions. So, thank you for sharing. As a follow-up to that, Dr. Baker, pharmacists are increasingly involved in more than just medication dispensing, such as immunizations, sorry, chronic disease management, and even policy. How do you see the profession of pharmacy continuing to evolve, and how does the oath apply as pharmacists roles expand?

Chelsea Baker:

Claire, that is a fantastic question, and I’m going to give you a couple reasons why. So, right, we’ve already talked about in just this short episode a couple of times how our healthcare is evolving, how profession’s evolving. And I think it’s so important to advocate for that as a pharmacist, as a practitioner, because for us, I think, I’m going to be a little biased here, but we’re the unsung heroes of healthcare, right? I think we’re those people that are working in the background, we’re helping make things happen. We were the people on the literal frontline during COVID-19 when our healthcare clinics we’re closed for access, where are hospitals were overburdened, but we continue to provide care for patients through a national and a global pandemic.

And so, for me, I think it’s just so important to advocate for what we do and to tell people about we do and to brag about what we do, which I know as pharmacists, it’s so hard because we’re such a lovely bunch. We’re all so humble. And I think just, “Oh, I’m part of a team.” Well, yes, we’re part of the team, but we have such a critical role.

And so, that [inaudible 00:22:18] shines through in advocating for our profession here in Indiana. So, I’m also the president of the Indiana Pharmacy Association and really actively involved in making sure that pharmacists and pharmacy technicians and our pharmacies are able to practice at the full scope of that training or ability of those individuals or that space. And so, I think that is something that we have to keep in mind, especially our students have to keep in mind as that kind of clarion call to advocate for your profession, tell people what you do, because we’re the people who also get to drive what we’re able to do in our practice through our legislative processes. So, I just think that’s really important to keep that in mind as well.

Claire Reyes:

Yeah, exactly. That’s wonderful. I can definitely see how we’re very easily overlooked as pharmacists and as healthcare professionals. People don’t see us for really what we are. And the best thing that we can do for our patients is just tell them, “Hey, I’m here for you. This is what we can do and our roles are expanding. Here’s what else we can do.” So, yes, I think those are very important. And the oath really does play a role into how we provide care for our patients and the continuing changes that we’re going to see in the future. So, before wrapping up each episode, I like to ask a fun question. So, here it is, which historical figure would you guess had the most interesting pharmacy needs?

Patti Darbishire:

Well, I’ll start off with that one. And I have to say, luckily we were forewarned that this question might be coming because it enticed me to spend about two hours of tremendous fun asking ChatGPT about historical figures and their disease state. So I got really wrapped up in that, it was really fun, and there were so many interesting cases.

But I landed on Vincent van Gogh. He was born in 1853, and he died by suicide at the age of 37. So, if you’re a fan of his works, you’ll know that a striking feature of his paintings was his fascination with the color yellow. And it’s been proposed that this was caused by self-medicating with large doses of digitalis, which historians believe caused him to see the world in yellow hues. So, in fact, in one of his paintings, he’s actually holding a stem of foxglove, and as you know, that’s the plant from which the drug is extracted.

So, both of his medical conditions, which interestingly happened to be epilepsy and manic depression, could have been managed quite well today. But definitely as we know, not by digitalis, which is a drug intended for a heart condition. And I also thought this was interesting too. In one of his final letters that he wrote before he committed suicide, he said, “If I could have worked without these accursed diseases, what amazing things I might have done.” I thought that was pretty amazing.

Claire Reyes:

Oh, wow. That is a very impressive history. Historical figure too. Oh, wow. I don’t even know what to say to that.

Chelsea Baker:

And I saw the van Gogh exhibit too, and just, oh my gosh, his work is absolutely beautiful. I wish he could have been around longer as well. I will say I’m not going to provide as much context as Dean Darbishire but for me, because I looked back and I saw that, in theory, in this posthumous diagnosing of some historical figures that Jane Austen was shown to have Addison’s disease, which can reduce the life expectancy for an individual. And so, for me, I love Pride and Prejudice. I would have loved if she could have been able to write additional novels, but she died at an earlier age and possibly as a result of that condition. So, for me, I think I could have helped her as a pharmacist.

Claire Reyes:

Wow. Those are both very impressive historical figures to choose from. And I am also a fan of Jane Austen, so I’m glad that you brought her up, Dr. Baker. So Drs. Darbishire and Dr. Baker, thank you for being on the Living the Pharm Life podcast. It’s been great having you.

Patti Darbishire:

Oh, thanks so much for having us. We really enjoyed it.

Chelsea Baker:

Yeah, thanks, Claire. Really appreciate it.