Culture, Professionalism Culture, Professionalism

and the Practice of and the Practice of

PharmacyPharmacy

Billy FutterBilly FutterRhodes UniversityRhodes University

South AfricaSouth Africa

Key questionsKey questions

1.1. What is Culture?What is Culture?

2.2. How does Culture influence:How does Culture influence:

• Practice of Pharmacy? Practice of Pharmacy?

• Professional status?Professional status?

Communication

3. Professionalism

1. Pharmacy Practice

2. Culture

4. Cultural Competence

Emphasis on Product

1.1. Pharmacy Practice Pharmacy Practice

Emphasis on People

People People

Need medicine Need medicine

PeoplePeople

have have

Medicine-related problemsMedicine-related problems

Pharmaceutical carePharmaceutical care services services

Based on Based on

Relationship of trustRelationship of trust

People are differentPeople are different

But . . .But . . .

See & do things differentlySee & do things differently

How many legs?How many legs?

Old lady?Old lady?Young lady?Young lady?

Need to understand Need to understand

differences differences

between peoplebetween people

So . . .?So . . .?

• Important differences?Important differences?

• Impact on pharmacy practiceImpact on pharmacy practice??

What is Culture?What is Culture?

2. Culture2. Culture

Society has many sub-groupsSociety has many sub-groups

Each has its own cultureEach has its own culture

SocietySociety

2. Culture2. Culture

Society has many sub-groupsSociety has many sub-groups

Each has its own cultureEach has its own culture

Society

2. Culture2. Culture

Society has many sub-groupsSociety has many sub-groups

Each has its own cultureEach has its own culture

Society

Generic?

Generic?

Generic?

Generic?

Generic?

Generic?

Generic?

Society

Generic?

Different cultural groupsDifferent cultural groups

group

group

group

group

group

group

group

Society

Generic group

SocietySociety

Generic

Japanese

Australian

European African

Swedish

American

IndianChinese

Society

GEOGRAPHICGEOGRAPHIC

SocietySociety

Generic

Russian

Italian

French Xhosa

Zulu

English

HindiChinese

Society

LANGUAGELANGUAGE

SocietySociety

Generic

Tao

Jew

SectsAncestor worship

Mormon

Christian

HinduMuslim

Society

RELIGIONRELIGION

SocietySociety

Generic

Male

ElderlyMature adults

Early Adults

Teenagers

Kids

BabiesFemale

Society

AGE and GENDERAGE and GENDER

SocietySociety

Generic

Lower class

Destitute

Poor Middle

Rich

Super rich

Upper classMiddle class

Society

ECONOMICECONOMIC

SocietySociety

Generic

Minority

Minority

Minority Minority

Minority

Minority

MinorityMAJORITYMAJORITY

Society

SIZE and POWERSIZE and POWER

1.1. No generic cultural groups!No generic cultural groups!

2. Each group has its own culture2. Each group has its own culture

people

people

people people

people

people

peoplepeople

SocietyThereforeTherefore

Group CultureGroup Culture

Group Behaviour Group Behaviour

Routine, Predictable Routine, Predictable

Difficult to changeDifficult to change

Prescribed limitsPrescribed limits

people

people

people people

people

people

peoplepeople

Society

Cultural boundariesCultural boundaries

“ “Right way of doing things”Right way of doing things”

B.E.V.A.N.SB.E.V.A.N.S..

people

people

people people

people

people

peoplepeople

Society

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

BBeliefseliefs

EExpectationsxpectations

VValuesalues

AAssumptionsssumptions & & AAttitudesttitudes

NNormsorms

SSymbolsymbols

people

people

people people

people

people

peoplepeople

Society

BBeliefseliefs – – what is right and wrongwhat is right and wrong

EExpectationsxpectations – – what should happenwhat should happen

VValuesalues – – priorities, standardspriorities, standards

AAssumptionsssumptions & & AAttitudes ttitudes – – positive/ negativepositive/ negative

NNorms orms – – traditional way of doing thingstraditional way of doing things

SSymbols ymbols - - group identity, convey meaninggroup identity, convey meaning

people

people

people people

people

people

peoplepeople

SocietyDifferent B.E.V.A.N.SDifferent B.E.V.A.N.S

Cultural SymbolsCultural Symbols

age, gender, age, gender, language, racelanguage, race

Status symbols Status symbols Wheels!Wheels!

Other Status symbolsOther Status symbols

The Five FriendliesThe Five Friendlies

Beibei JingJing Huanhuan Yingying NiniBeibei JingJing Huanhuan Yingying Nini

Fish Panda Olympic Antelope SwallowFish Panda Olympic Antelope Swallow

flameflame

sea forest fire earth skysea forest fire earth sky

Bei jing huan ying niBei jing huan ying ni

Welcome to BeijingWelcome to Beijing

Cultural symbolsCultural symbols

Influence of Culture on BehaviourInfluence of Culture on Behaviour

BBeliefseliefs

EExpectationsxpectations

VValuesalues

AAttitudesttitudes

NNormsorms

SSymbolsymbols

Behaviour

‘BEVANS’

Routine

Patterns

people

people

people people

people

people

people

Society

people

Outcomes

Qualityof life

Quality of service

So:So:How does Culture influenceHow does Culture influence

1. 1. Health behaviour?Health behaviour?

* Patients? * Patients? * Health professionals? * Health professionals?

2. 2. Health outcomesHealth outcomes??

Health Beliefs of different culturesHealth Beliefs of different cultures

Yin yang Yin yang YogaYoga

Tai ChiTai Chi

GymGym

Traditional HealersTraditional Healers

RitualsRituals

ExpectationsExpectations

Queuing for health careQueuing for health care

CareCare

CourageCourage

Respect, FairnessRespect, Fairness

Competition, Equality, InformalityCompetition, Equality, Informality

Values pyramidValues pyramid

CareCare

RespectRespect

Fairness, HonestyFairness, Honesty

Cooperation, Status, FormalityCooperation, Status, Formality

Values pyramidValues pyramid

NormsNorms

Right handRight hand

Greetings Greetings

Responding to Visual cuesResponding to Visual cues

Responding to Visual cuesResponding to Visual cues

OprahOprah

How do you respond to HIV/ AIDSHow do you respond to HIV/ AIDS

LOGO?LOGO? Response to HIV/ AIDSResponse to HIV/ AIDS??

ACTIVISTS?ACTIVISTS?

VICTIMS?VICTIMS?

BBeliefseliefs – – Diagnosis?Diagnosis?Cause of illness?Cause of illness?

StressStress

Yin Yang Yin Yang imbalance imbalance

Lack of Lack of chichi

Hot cold Imbalance Hot cold Imbalance

Punishment for sinsPunishment for sins

Evil spellEvil spell

HereditaryHereditary

EnvironmentEnvironment

Bad habitsBad habits

Old age Old age

Microbe or VirusMicrobe or Virus

How do you respond to Symptoms?How do you respond to Symptoms?

Visit Doctor or Pharmacist Visit Doctor or Pharmacist

Get a prescriptionGet a prescription

Self-medicateSelf-medicate

Vitamins Vitamins

Herbal treatmentsHerbal treatments

Rest and relaxRest and relax

Restore balance Restore balance

Avoid hot / coldAvoid hot / cold

Remove “spell”Remove “spell”

Visit Traditional healersVisit Traditional healers

Consult ancestorsConsult ancestors

Response to Symptoms?Response to Symptoms?

ConclusionsConclusions Culture influencesCulture influences

Signs and SymptomsSigns and Symptoms

– Interpretation Interpretation different different

– Response Response differentdifferent

CommunicationCommunication differentdifferent

Consequences Consequences

Professional adviceProfessional advice

Not soughtNot sought

Not trustedNot trusted

Not followedNot followed

Serious? Serious?

Health outcomesHealth outcomes

Cultural inequalitiesCultural inequalities

Unmet medicine needsUnmet medicine needs

Medicine related problemsMedicine related problems

Serious?Serious?

AccessAccess

Quality of careQuality of care

Quality of lifeQuality of life

3. Implications 3. Implications

Professional Status Professional Status

of pharmacists?of pharmacists?

33.. Professional statusProfessional status

Level of Level of authorityauthority given by society given by society

toto

– make make judgementsjudgements

– give give directionsdirections

Who decides?Who decides?

Society decides the Society decides the rolesroles it needs it needs

Social institutionsSocial institutions give and limit give and limit

authority to practiceauthority to practice

Criteria forCriteria for Professional Status? Professional Status?

CompetentCompetent CommittedCommitted

to satisfy to satisfy needsneeds that are:that are:

Valued

Complex

Personal

Evidence?Evidence?

CompetentCompetent Committed Committed

to satisfy to satisfy needsneeds that are: that are:

Valued

Complex

Personal

Perceptual hazePerceptual haze

Combining criteriaCombining criteria

HiHi

LoLo

Lo HiLo Hi

Competence

Co

mm

itm

ent

Combining criteriaCombining criteria

HiHi

LoLo

ProfessionalProfessional

Lo HiLo Hi

Competence

Co

mm

itm

ent

Combining criteriaCombining criteria

Combining criteriaCombining criteria

HiHi

LoLo

CaregiverCaregiver ProfessionalProfessional

Lo HiLo Hi

Competence

Co

mm

itm

ent

Combining criteriaCombining criteria

Combining criteriaCombining criteria

HiHi

LoLo

Caregiver Professional

Robot

Lo HiLo Hi

Competence

Co

mm

itm

ent

Combining criteriaCombining criteria

Combining criteriaCombining criteria

HiHi

LoLo

CaregiverCaregiver ProfessionalProfessional

Thief RobotRobot

Lo HiLo Hi

Competence

Co

mm

itm

ent

Combining criteriaCombining criteria

Combining criteriaCombining criteria

HiHi

LoLo

CaregiverCaregiver ProfessionalProfessional

Thief RobotRobot

Lo HiLo Hi

Competence

Co

mm

itm

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Combining criteriaCombining criteria

ThereforeTherefore

Professional status can be increasedProfessional status can be increased

Show Show evidenceevidence of of

Competence Competence

Commitment Commitment

ThereforeTherefore

Professional status can be increasedProfessional status can be increased

Show Show evidenceevidence of of

Competence – Competence – applied applied

Commitment – Commitment – service before selfservice before self

But: But: REAL WORLD - not laboratoryREAL WORLD - not laboratory

group

group

group

group

group

group

Generic group

group

Society

REAL WORLD IS CHANGINGREAL WORLD IS CHANGING

In the next 20 years . .In the next 20 years . . . .

Global driftGlobal drift more people visiting foreign countriesmore people visiting foreign countries

Urban rushUrban rush 60 - 80% will live in town60 - 80% will live in town

Population explosion Population explosion additional 1.6 billion people on the planetadditional 1.6 billion people on the planet

REAL WORLD IS CHANGINGREAL WORLD IS CHANGING

REAL WORLD REAL WORLD

CommunicationCommunication

Digital RevolutionDigital Revolution

MobilesMobiles

Information on Web Information on Web

Web based marketingWeb based marketing

REAL WORLD IS CHANGINGREAL WORLD IS CHANGING

Professional toolsProfessional tools

Communication challenges

Digital divide Digital divide - less access - less access

Efficiency Pressure Efficiency Pressure - Impatience - Impatience

Cultural filters Cultural filters - Misunderstanding - Misunderstanding

Minorities Minorities - Intolerant - Intolerant

Cultural diversity increasing Cultural diversity increasing

Communication challengesCommunication challenges

ConclusionConclusion

So . . . So . . . What can pharmacists doWhat can pharmacists do

Agenda Agenda

Competence, Commitment?Competence, Commitment?

Communication? Communication?

Professional status?Professional status?

TheThe Solution?Solution?

Develop Develop

Cultural Competence!Cultural Competence!

Cultural CompetenceCultural Competence

Ability of health system to deliver Ability of health system to deliver consistentconsistent quality health care to quality health care to patients in cross cultural situationspatients in cross cultural situations

irrespective of the irrespective of the cultureculture of of

fellow professionalsfellow professionals oror

patientspatients..

Cultural ChallengeCultural Challenge

LoLo

Incompetent Incompetent 1.1. IntolerantIntolerant

2.2. ImpatientImpatient

3.3. Dismissive Dismissive

4.4. JudgementalJudgemental

Hi Hi

CompetentCompetent1.1. EmpathyEmpathy

2.2. Concerned Concerned

3.3. Caring Caring

4.4. RespectRespect

Cultural ladderCultural ladder

CulturalCultural ProficiencyProficiency

CulturalCultural CompetenceCompetence

CulturalCultural Pre-competencePre-competence

CulturalCultural BlindnessBlindness

CulturalCultural IncapacityIncapacity

CulturalCultural DestructivenessDestructiveness

Pre-competence to Competence Pre-competence to Competence

HiHiCOMPETENTCOMPETENT

(Empathy, concerned, caring, respect)(Empathy, concerned, caring, respect)

DesireDesire

EncounterEncounter

SkillSkill

KnowledgeKnowledge

AwarenessAwareness

LoLoINCOMPETENTINCOMPETENT

(intolerant, impatient, dismissive, judgemental)(intolerant, impatient, dismissive, judgemental)

Everyone benefits!Everyone benefits!

Patients Patients - - better QoC & QoLbetter QoC & QoL

Health professionalsHealth professionals - higher esteem - higher esteem

Health system Health system - - more cost more cost

effectiveeffective

MedicineMedicine - - improved useimproved use

EmployersEmployers - - Legal protection Legal protection

- Satisfied staff - Satisfied staff

- Loyal patrons- Loyal patrons

And Pharmacists improve And Pharmacists improve professional status!professional status!

HiHi

LoLo

Lo HiLo HiCultural

Competence

Co

mm

itm

ent

ProfessionalProfessional

This is not the end This is not the end but the but the beginning! beginning!

Thank youThank you