Sandbox:Digital Tattoo Case Studies Project/Pharmacy/Case Study Drafts

From UBC Wiki

Case Study #1: Community Pharmacist

Themes Addressed

  • Professional and personal boundaries
  • Interconnectedness of small communities
  • Patient trust
  • Off-duty professionalism

Learning Outcomes

Students will ...

  1. Identify key resources (ADD)
  2. Consider a given scenario from the perspective of multiple stakeholders
  3. Discuss the tension that can arise between one's personal values and that of the profession

Instructions

Essential Question(s)

As you read the case, consider your personal response to the question:

How have online spaces impacted the relationship between online and in-person and communities?

Case

Kai has recently moved to a small town in inland BC for their 8-week community pharmacy practicum.

Coming from Vancouver, they were a bit apprehensive about the placement, and feel a little lonely and isolated.

Upon starting their degree, Kai set up a Facebook account for group work and event organizing. They have a group chat with some friends from their graduating class. They use this group chat to stay connected to their friends, which has helped make their stay in this small town a bit less lonely. There is an unspoken assumption that this group chat is a safe space to talk about their work lives, especially now that they are all doing their third year practicums.

Everyone is well aware of the higher social standards to which pharmacists are held, and this is their way of keeping their venting out of posts on their social media accounts. They are aware of the onus put on pharmacists to maintain society's trust in the profession and have been taking steps to separate their professional and personal life.

A couple of weeks into their practicum, Kai encounters one of the pharmacy's regular patients named Susan, who is picking up a refill for a calcium channel blocker.

Susan has lived in this community almost all her life, except for a brief interim when she moved to Vancouver about 20 years ago to work in various jobs. That is where Susan first met, in her words, "people like you." She moved back about seven years ago because she didn't like the high costs of living in the city. Kai learns all of this while trying to crosscheck all of Susan's details in the system and drug history.

The refill is for Norvasc, which is a branded medication. When Kai inputs the prescription, the system automatically switches it to the generic, amlodipine.

Kai confirms the refill with Susan, reading it out loud. Susan takes exception and says that the doctor said the name 'Norvasc' to her.

Whilst Kai is explaining that the generic is cheaper and essentially no different from Norvasc, Susan interrupts to insist on talking to "the actual pharmacist." However, the pharmacy is pretty busy, and Kai's preceptor is currently occupied with giving someone else a set of travel vaccinations.

Apologizing, Kai tries to explain again but Susan starts getting loud and saying things like, "Of course, I should have expected you to be cheap."

As there is a bit of a line forming at the drop-off, Kai backs down and tells Susan that she can have the Norvasc and that nobody is trying to cheat her of anything; they're just trying to inform Susan of alternative options. Kai puts a note on file that Susan prefers brand, and passes the refill along. Susan walks off, muttering something about "who does this kid think he is" to the next person in line.

On their lunch break, Kai retells this encounter in the group chat.

Chat .png

Unbeknownst to Kai, another friend in the group chat knows someone in the town. This friend, Kyla, screenshots the chat and sends it to her friend, when talking to them about what living in a small, rural community is like. After learning that edema means swelling, given the small population size and description of the patient, they know exactly who Kai is talking about.

With good intentions, this friend-of-a-friend tries talking to people they know about making Kai feel more welcome in the community.

This being a small town, the news makes its way around to Kai's preceptor, Carol, pretty quickly.

Carol broaches the subject with Kai a few days later, on a quiet morning when they're just opening up the pharmacy. Carol opened fairly neutrally with "Hey, so I heard something upsetting happened to you recently here? Something to do with Susan?" and tried encouraging Kai by saying, "I want you to feel supported here. Do you want me to reach out to the university's Office of Experiential Education?"

However, Kai is both taken aback and unsure of how to respond. They feel pretty justified in their emotional response to the situation and wasn't expecting the preceptor to find out about what happened, or to know exactly who was involved. They don't know how the preceptor found out: if the preceptor has seen the actual chat or just heard from someone who was in the pharmacy at the same time. Now, they are worried about their job future and how they will be perceived professionally.

Discussion Questions (REVISIT)

  1. What are some professional resources that can be consulted before posting online? How could such resources have been used to guide Kai's actions in the scenario described above?
  2. perspective of various stakeholders
  3. Tensions between personal and professional values

Potential "If Time Allows" Resources

Case Study #2: Viral Venting

Themes Addressed

  • Permanence and public nature of the internet
  • Patient confidentiality
  • Raising the profile of the profession
  • Group affiliation
  • Interconnectedness of the pharmacy community

Learning Outcome

Students will ...

  1. Describe notions surrounding the private/public nature of online spaces
  2. Discuss notions of presumed anonymity on the internet
  3. Illustrate the benefits and drawbacks of high-profile social media accounts dedicated to elevating the profession

Instructions

  1. While reading the case study, consider the Essential Question(s) posed below.
  2. In small groups, discuss the case study using the Discussion Questions noted below the case study.

Essential Question(s)

As you read the case, consider your personal response to the question: How does the term "act conscientiously" apply to digital spaces?

Case

Sarah is in her second year of the Pharmacy program. She has been working part-time at "Canada Plus Pharmacy" in Vancouver for 2 months to help offset the high costs of being a student.

Sarah has regularly checked and posted on her personal social media accounts throughout her pharmacy degree, specifically Facebook, Snapchat, and Instagram. Since moving to Vancouver from Prince George to attend the Pharmacy program, these social media accounts have helped her stay connected to friends and family. This has helped her feel less isolated in a new city.

These accounts have also allowed her to make new friends and connect to people in her program. She often responds to event invitations on Facebook, and invites classmates to study with her over Snapchat and Facebook Messanger. In particular, Sarah often checks her classmates' Instagram stories during exam periods to destress. Since beginning the Pharmacy program, Sarah has actively ensured that all of her social media accounts are private, including Instagram, which she uses the most. As such, only her username and bio - which notes her institutional affiliation - is visible to the public.

Because the particular "Canada Plus Pharmacy" branch Sarah is working at is centrally located in Vancouver’s downtown core, it tends to be quite busy. Average wait times are approximately 15 minutes, but can often run as long as 30 minutes. Sarah typically enjoys this fast-paced environment, however the past few days have been especially busy and stressful. Sarah is also experiencing high levels of stress outside of work due to an upcoming, difficult exam which she is studying for.

A particularly rushed patient named Carol comes into the pharmacy to pick up medication for her Type 2 Diabetes, Hypertension, Osteoarthritis, and Gout. Upon looking up Carol’s file in the pharmacy’s computer system, Sarah sees that Sharon is 71 years old.

There are already several patients waiting for their prescriptions who arrived before Carol, so Sarah gives her a wait-time of 20 minutes. Carol, irritated, comments back: “Why does it need 20 minutes, don't you just put a label on the bottle?"

Sarah calmly explains that, due to the number of patients currently waiting for prescriptions, the wait time will be a bit longer than usual. This explanation does not seem to calm Carol, who angrily stands at the counter, glaring at Sarah and the supervising pharmacist while they work.

Sarah feels frustrated by the comment Carol made. While she had heard remarks like this from patients in the past, she wished patients would be more understanding of the long wait times, particularly for larger prescription refills like Carol’s.

While on her lunch break, Sarah takes a picture of one of the vitamin shelves at the pharmacy. She posts the image to her Instagram Story accompanied by the following rant:

Pharminsta.png

Sarah elected to post the rant on her story rather than timeline, as it will self-delete in 24 hours. She also replaced Carol’s name with the fake name, “Lisa.”   

Finding the rant funny and relatable, one of Sarah’s followers, who is also a pharmacy student and stressed about the same upcoming exam as Sarah, screenshots it and passes it along to another classmate. This classmate saves it, and dm’s it to the @pharmacymemes Instagram page, which has over 27k followers. The @pharmacymemes page posts it to their timeline with a caption that credits Sarah’s username.

Sarah’s manager, Henry, is a recent graduate of the UBC Pharmacy program. As he is close to Sarah's age, the two have gotten along while working together, bonding over their experiences in the pharmacy program. During his time at UBC, Henry started to follow @pharmacymemes. Shortly after Sarah's rant is posted, Henry happens to come across it while on his own Instagram account, and sees that Sarah is tagged in the post. Henry is immediately worried about the reputation of the pharmacy, and his reputation as a manger. He thinks that this does not reflect well on their organization, their patient-centred care, and violates the patient’s privacy. He is also concerned that their specific pharmacy location will be distinguishable based on the image Sarah used.

Henry confronts Sarah about these concerns, who is unsure how to proceed; the post on her own Instagram story has already been deleted since the allotted 24 hours have passed.

Sarah is immediately regretful and feels sorry for the position she has put Henry in. Henry saves the screenshots on file for future reference. Sarah is now stressed about how this incident will impact her professionally as she moves on in her career. She is also unsure if she should resign as a result of the incident, and realizes she can no longer use Henry as a professional reference.

Discussion Questions

  1. To what extent are private social media accounts truly private? How might the digital path between Sarah's Instagram Story and the @pharmacymemes account impact her relationship with various stakeholders?
  2. How has social media complicated the professional boundaries between patients and Healthcare Providers?
  3. Discuss the implications of @pharmacymemes sharing Sarah's post. Did they have the right to share it? What positive and/or negative effects do pharmacy-based social media accounts - like @pharmacymemes - have on the profession?

Potential "If Time Allows" Resources

Case Study #3: Good intentions gone awry

Themes Addressed

  • Professional relationships with various stakeholders
  • Methods for addressing misinformation online
  • Public health advocacy in online spaces
  • Limitations of privacy settings

Learning Outcomes

Students will ...

  1. Discuss the significance of virtual collegiality as it pertains to Healthcare Professionals
  2. Examine the benefits and limitations of online public discussion boards/forums
  3. Identify the ways in which advocacy relates to, and is shaped by, online spaces

Instructions

  1. While reading the case study, consider the Essential Question(s) posed below.
  2. In small groups, discuss the case study using the Discussion Questions noted below the case study.

Essential Question(s)

As you read the case, consider your personal response to the question: How do the principles of professional accountability and advocacy apply to online spaces?

Case

Devon is a graduate of the UBC Pharmacy program. During his time at the program, he was a top student who was actively involved in the UBC Pharmacy Undergraduate Society.  Within two years of his graduation, Devon was able to land his dream job. After passing his Pharmacy Examining Board of Canada Qualifying Examination and completing a year-long residency at Vancouver Coastal Health, Devon landed was hired as a pharmacist at Vancouver General Hospital (VGH).

Devon has been working for VGH for 6 months, and has thrived in this fast-paced environment. Devon especially enjoys having the opportunity to collaborate inter-professionally with physicians, nurses, physiotherapists, social workers, and the rest of the team.

With peak Flu season approaching all patients and visitors must receive the Flu Shot before December 1st (or wear a face mask before entering all facilities) per VGH’s requirements. Healthcare providers at VGH have been asked to verify if incomers have received the flu shot.

Devon is completing rounds with Ryan, a physiotherapist he was worked with a few times before. While stopped outside of a patient’s room who is immunocompromised, Devon asks Ryan to verify that the patient and her two visitors have been vaccinated for the flu.

Ryan appears hesitant. When Devon inquires further, Ryan tells Devon that he is skeptical about vaccines due to concerns about autism, and that he used to get the flu shot "still got sick every year.” As a result, Ryan does not feel comfortable discussing the subject with patients.

Devon is floored, and is inclined to argue with Ryan about this misinformation. Before he can, Devon is approached by a physician to inquire about a different patient. Due to the high number of admits to the hospital that day that, Devon does not have the opportunity to discuss the matter before Ryan's shift concludes in an hour.

In the days following, Devon cannot stop thinking about his interaction with Ryan. He feels shocked that someone who works in the healthcare profession could hold such a view about vaccines. Finally, after a few days of considering his role as a healthcare provider, and professional obligation to share evidenced-based information, Devon decides to take action.

Devon goes on his personal Facebook account to post about the incident. His current privacy settings ensure that his status can only be viewed by those on his Friend List. He shares the following exposition about the importance of vaccines:

Facebook post.png

The post immediately receives several “likes,” as well as “angry” and “sad” reactions from healthcare providers and non-experts on Devon’s Friend List. Many also begin to add comments to the post. Some comments merely express shock (more than one person added “wow,” and “I can’t believe this!”), while others make more inflammatory statements (including “what an idiot,” and “this physiotherapist should be fired!”).

Devon feels immediate vindication at the swift response to his post. One of the commenters - Devon's former UBC Pharmacy classmate, Stephanie, - requests that the post be made Public so that she can share it on her own Facebook page. While initially hesitant, Devon believes that it is his responsibility to call out such beliefs. Before he makes the post public, he deletes the inflammatory comments. Once public, the post is shared by 9 of Devon’s followers.

A Facebook friend of Stephanie named Ali - who happens to be a personal friend of Ryan's - sees the post. Ali is curious about where the incident took place, so decides to look up Devon on LinkedIn to see where he works.

Ali sees that Devon works at VGH. Knowing that Ryan is a physiotherapist at VGH, he sends the post to Ryan on Facebook Messenger along with the following message: “Is this about you, LOL?”

Realizing that the post is about him, Ryan immediately feels angry and defensive at both Devon, for sharing the experience online, and at the many commenters who have directed inflammatory statements towards him.

The next day at work, Ryan is working with Devon on rotations once again. He displays cold, and passive aggressive behaviour towards Devon throughout his shift, making comments like “I better not say anything or it might end up online.”

Devon suspects that Ryan has seen his Facebook post. However, Devon is adamant that it is his duty to advocate for public health, and is pleased that Ryan was “put on blast” for his views online. He decides not to discuss the issue with Ryan directly, instead acting cold and defiant back to Ryan in response.

Devon begins to question what might happen to him as a result of the conflict between him and Ryan. In particular, he is worried that the standoffishness between them will happen every time they are on rounds together, and how this tension may impact his reputation with his colleagues.

Discussion Questions

  1. How might collegiality extend to online spaces? List some potential parameters that could be used to guide direct, and in-direct, interactions with colleagues online.
  2. In what ways have online discussion boards impacted professional communities? What opportunities and/or consequences do these discussion boards present?
  3. How might a pharmacist’s role as a public health advocate extend to online spaces? Should there be limits to this advocacy?

Potential "If Time Allows" Resources

Case Study #4: Product endorsement

Themes Addressed

  • User-generated medical information
  • Personal/professional affiliations
  • Implications of public social media accounts
  • Professional relationships with various stakeholders

Learning Outcome

Students will ...

  1. Discuss how professional credentials apply to online spaces
  2. Examine the relationship between one's professional and personal online presence
  3. Identify how tensions between civil freedoms and professional obligations apply to online spaces

Instructions

  1. While reading the case study, consider the Essential Question(s) posed below.
  2. In small groups, discuss the case study using the Discussion Questions noted below the case study.

Essential Question(s)

As you read the case, consider your personal response to the question: What is the relationship between in-person and online outreach?

Case

Anita is a recent graduate of the UBC Pharmacy program. She was a high-achieving student during her time at UBC, and was well-liked by her peers and professors. Wanting to remain in Vancouver after her graduation, Anita was fortunate enough to land a job at an independent pharmacy in the Kerrisdale neighbourhood called "Your Pharmacy." Her colleagues and patients are friendly and supportive, and Anita feels very fortunate to work in such a nurturing environment.

During her undergraduate degree, and subsequent time in the pharmacy program, she amassed a large social media following, particularly on her public Instagram account, which presently has 3K followers. Her account, with the username @PharmacistAnita, is dedicated to promoting health and fitness. Typical posts on Anita’s Instagram include her various yoga recommendations, homemade protein shakes and vegan recipes, and workout videos. In addition to her username, her Instagram bio reads the following:

Vancouver-based pharmacist dedicated to promoting daily wellness | Based at "Your Pharmacy"

For Anita, her Instagram account was her outlet during periods of high stress in the pharmacy program. In addition to providing her with a creative outlet, the platform also allowed her to connect to, and befriend, other health and fitness Instagrammers in Vancouver. Presently, her account's popularity also enables her to meet and connect with her followers while at work. Young customers will often come into Anita's pharmacy and recognize her from her Instagram account. Anita enjoys these interactions, and feels she is making a positive difference by promoting healthy habits.

Recently, Anita has been approached by several brands - spanning the industries of fitness, skincare, and natural remedies - to endorse their products on her account. She typically accepts these endorsements, as having the extra income helps offset the high cost of living in Vancouver. They also provide her with the opportunity to try new products for free; she is sure not to endorse products that she does not use herself.  

One day, Anita is approached by a particularly well-known brand of diet teas. Anita is initially hesitant about endorsing their products, as she is aware of the lack of scientific evidence associated with popular weight-loss teas. After thinking it over for a few days, she ultimately decides to accept the endorsement and post about the tea, resolving that one post will likely be inconsequential.

On a day when Anita is not working at her pharmacy, her supervisor, Emmet, is approached by a young patient, who follows Anita on Instagram. The patient asks if the pharmacy carries the particular brand of diet tea Anita is endorsing. Having never heard of it, Emmet immediately investigates, only to discover that the diet tea is merely Senna, a laxative, and other natural ingredients branded as a quick weight-loss measure. Emmet feels weary about Anita endorsing the tea as both a pharmacist and public affiliate of their pharmacy.

During Anita’s next shift, Emmet discusses the situation with her. He states that endorsing the tea, while also having a public affiliation with the pharmacy, does not reflect their organization's values. Emmet adds that the tea may also harm patients by causing adverse effects such as diarrhea and abdominal cramps.

Anita feels a combination of guilt and defensiveness: she understands that the product is not supported by the pharmacy, but also feels she has a right to support brands outside of work. She has also already accepted monetary support from the tea company, and will be in violation of their agreement if she deletes the post.

Anita is worried that Emmet will feel weary of her as a result of the incident. She is also concerned that he will be skeptical about her priorities and dedication to the profession.

Discussion Questions

  1. As non-experts increasingly create and access user-generated medical knowledge in digital spaces, what role do you think pharmacists play in asserting evidenced-based medicine online?
  2. Can your personal and professional personas be separated online? Would this situation have been different if Anita had not noted her institutional affiliation, or profession, on her accounts? Why or why not?
  3. How might using your professional credentials while discussing healthcare online benefit patients? What are the drawbacks of engaging in participatory healthcare through the Internet?

Potential "If Time Allows" Resources

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