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Jim Kodman: A Pharmacist’s Perspective on Healthcare

Rob Oliver interviews Jim Kodman to get a pharmacist’s perspective on healthcare in this episode of the Perspectives on Healthcare Podcast. Jim operates a pharmacy in Indiana, PA that offers a unique variety of resources including compounding pharmacy, infusion therapy, durable medical equipment and traditional medications. He is a member of Generation X.

Here are 3 things that I took away from the interview with Jim Kodman:

· Quality healthcare is about achieving a desired outcome
· Healthcare needs to focus on the entire person, not just their diagnosis
· Pharmacists contribute with counseling, safety and monitoring

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Here is the transcript of Jim Kodman: A Pharmacist’s Perspective on Healthcare:

Rob Oliver: Welcome. Today’s. Perspective comes from a good friend of mine, Jim Kodman. He is a pharmacist in Indiana, Pennsylvania. He is a member of Generation X, and he works with Compounding Home infusion all kinds of what I would call unique. And maybe Jim can help me with this but nontraditional kind of pharmacy stuff. Jim, welcome to the show.

Jim Kodman: Thank you. Appreciate you having me on Rob.

Rob Oliver: Absolutely. So let’s jump right into this. The first question is, tell me about yourself and your role in health care.

Jim Kodman: Sure. So I’ve been a pharmacist for 24 years now. I hate to date myself, but can’t get away from that. I’ve worked in just about every aspect of pharmacy, retail hospital, long term care. Now specialty home infusion Compounding. So pretty wide variety of work environments. I’ve owned my own pharmacy for the last 15 years here in Indiana, Pennsylvania, and we currently provide a pretty wide variety of services. Retail pharmacy, you can walk in and get a regular prescription filled compounding, durable medical equipment, home infusion and specialty, so pretty diverse operation at the moment. Okay, Jim, can you just elaborate a little bit for folks that aren’t familiar with compounding pharmacy compounding? What is that? And then can you also talk a little bit about home infusion and what that is? Sure. So compounding is just custom made medications to meet a specific patient need. The doctor feels that your traditional therapies your commercially manufactured therapies aren’t going to be the best option for the patient, and they’ll order something that’s custom made could be a different strength, a different combination, a different dose, each form. Probably the simplest examples would be a child that can’t swallow a tablet or a capsule, and we’re going to make it into a liquid. Veterinary is a very big area for that. Also, if you can’t get your cat, your dog, whatever to take a particular medication, we can put it into a form that’s going to be easier to administer. Home infusion deals primarily with IV medications. Some of them are self infused by the patient, some we have a nurse that will come to your house, start an IV line and run the medication just depends on what it is or what type of therapy. So we’re providing education, monitoring. We’re kind of the go to resource for that patient a lot of times. Those are patients that are coming out of hospitals have a little bit more difficult or complex to manage diseases or conditions. So we’re kind of a go to resource for them to make sure that they’re getting what they need and have all their questions answered.

Rob Oliver: Okay. So I do have to tell a quick, funny story is we came to visit you one time. I remember, and you had been doing some compounding for a cat, and I believe that you had some fish flavoring, which you spilled, and it was all over your shoes. And so when you came home, your wife was making you keep the shoes outside because they just reeked of fish oil, which was quite an interesting thing. Tell me this. What does quality health care mean to you?

Jim Kodman: Well, I mean, you have the government definition of it in terms of efficient, effective, safe. I guess what I would say from quality health care, you’re looking for a desired outcome for that patient. Hopefully it’s a cure for whatever condition they’re dealing with. That’s not always an option to manage that condition to the best of their ability. And it really needs to be patient centered, getting the patient involved in their own care, helping them to understand. I guess I would give an example if you have a patient that’s newly diagnosed with diabetes. As an example, as a clinician, we look at that patient and we’re looking at blood glucose readings and a one C readings and kidney function. How is your vision doing? We’re looking at a lot of those clinical things, but the patient just got a diagnosis that’s going to be life altering for them to help them understand that to basically help them to avoid some of the long term consequences so that they can maintain their health, they can maintain their activity. This doesn’t mean that I can’t live a normal life at this point. So is it going to be maybe a little more complicated? Sure. There are going to be a few more steps involved. Yes. But just to help that patient through a difficult time of probably accepting that diagnosis and what all lies ahead for them and then guiding them through how they’re going to manage that condition going forward.

Rob Oliver: It’s so interesting that you said that because the episode just previous to this one we had on Nicholas Smith, who is a pediatric psychology fellow down in Tampa. And he deals exactly with this helping kids who have had that diabetes diagnosis. And he talked about this exact thing that so many times the medical professional is focused on the numbers and the diagnostic side of things that they miss out on. What you’re talking about, which is the life impact and the psychological impact that the diagnosis has for them. You’ve given us a great example. Can you give me any other examples of what quality health care would look like for you?

Jim Kodman: Well, for us as pharmacist, we handle a lot of the safety aspect of the medication. We’re looking at drug interactions, drug disease interactions. We’re looking at the appropriateness of the therapy. Also, we don’t have the authority to change a therapy or to prescribe our own therapy. But on numerous occasions, we’ll go back to the physician or the nurse practitioner or whoever the prescriber was, and we’re suggesting a different therapy. There might be something that works better for that patient. We do a lot of monitoring of antibiotics and other types of infusions. Some of those medications are very hard on the kidneys. So a big part of our job and this is dealing more with the home infusion realm. We’re making sure that that patient is getting regular labs done, because if there is any sort of kidney damage occurring, we need to catch that very quickly and get the medication changed to something else that’s not going to damage the kidneys. So those are the types of things that we deal with a lot. So I think just staying in contact with the patients, staying on top of their therapy, making sure they’re getting all the correct labs done and making sure that they’re staying compliant, because ultimately, if you don’t take a medication, you’re not going to get the benefit from it. So those are the things that we’re really focused on.

Rob Oliver: Okay. And what I’m hearing you say kind of as the subtext there is that it is kind of a collaboration as a health care team where it’s not like the doctor just makes the order and the pharmacist kind of carries it out regardless. But the pharmacist and the doctor and the nurses are all working together to make sure that a it’s the correct treatment for the diagnosis and B to make sure that as the treatment is moving forward, that it’s not causing any damage and that it all is basically ameliorating the symptoms that the person is having dealing with the disease and it’s not doing any damage long term. Is that an accurate summation of what you said?

Jim Kodman: Yeah. Absolutely. Going back 30, 40 years, 50 years. I’m not sure the exact time frame. The physician wrote the order and everybody else just sort of blindly followed it and assumed that the doctor knew what they were doing. There’s been a lot of progress in recent years. A lot of hospitals, you’ll have physicians, pharmacists, dietitians, they all do rounds together. A lot of physicians are far more open to the suggestions that we make and having us manage the therapy. A lot of times the orders are written, the patient needs blank pharmacy dose and manage it. The physicians are busy. There’s a lot of responsibility with them, and they’re one person, and it’s always better to have multiple sets of eyes on the same thing. And that’s where we really come in. And that’s where we found that a lot of physicians, a lot of nurses, healthcare staff in general, are very appreciative whenever you can bring additional value and additional service and additional patient monitoring to the table for them.

Rob Oliver: Yeah. We had Lindsay Parks on a couple of episodes ago, and he was saying as a family physician, he is expected to have such a breadth of knowledge, basically, from Pediatrics to geriatrics, that there is just so much information that one person can’t be can’t house all of it. So having that collaborative effort between the doctor and the pharmacist and the rest of the team is phenomenal. What do you wish people understood about the role of a pharmacist in health care?

Jim Kodman: Well, I think you run into this maybe more in the retail realm where you walk into your busy pharmacy and it’s kind of the lick it and stick it. You count out 30 pills, you slap a label on it, and that’s basically all that we do. It’s a very clinical role in terms of dosing, counseling, monitoring for interactions. We’re in a society where more and more people in a healthcare system where more and more people are taking multiple medications and when you start taking 3410 different medications, interactions occur, and sometimes some of the medications you’re taking are just simply to counteract the side effects of other medications. And I think patients get frustrated with that. Whenever you start your day with a handful of pills, that’s frustrating. If there’s a way that burden can be reduced, whether there’s another medication that reduces some of those side effects, maybe you can eliminate a medication or two. I think that’s very important from a compliance standpoint. If you tolerate it better, you’re more likely to take it. And if you don’t have to take as many or as often, you’re more likely to take it. So you’re going to get better results that way. But just that we’re contributing with a lot of the safety and the monitoring and those types of things are a lot of what we do.

Rob Oliver: Very well said, what excites you about the future of health care?

Jim Kodman: I think anytime you’re dealing with health and improving people’s lives from a health standpoint, I think that’s exciting in itself. A lot of people will say our health care system is broken. I think broken is a little strong. I still think we’re one of the best healthcare systems in the world. Unfortunately, we’re the most expensive health care system in the world. I think we can do a better job. I think we can do a completely better job. I look at the price of some of these medications. I mean, we have patients on medications that are $75,000 a dose and you sit there and you scratch your head. How can this possibly be that expensive? But that’s where we’re at at this point. So I’m excited about the health care. I’m excited about improving people’s lives. I’m excited about the advances that have been made and some of the amazing things that can be done at this point through medication and different therapies and procedures and things like that. There’s a frustration with the system that’s behind it. It needs address. It needs improving. The frustrating thing. And this wasn’t really your question. The frustrating thing is sometimes the people making the decisions on how to better the health care system have little to no experience in health care. I feel that you could probably do better by getting people that are actually on the front lines, more involved with some of the changes that need to be made, whether you’re dealing with the availability of health care to everybody and making it as available as possible, the cost, the quality in terms of the effectiveness. There’s a lot of things to look at, so I’m not saying it should be only healthcare workers because there’s certainly a business financial side to it, but I feel like sometimes it gets just lumped into that business model way too much.

Rob Oliver: It makes sense. I had someone complaining to me recently that it hardly makes any sense. That the first question that’s asked when someone is looking at a treatment plan is what kind of insurance that they have and that your treatment depends on your insurance, and it’s determined not by a practitioner but by someone that’s behind the desk, which is a topic that can be discussed at a different point in time. What is one thing that medical professionals can start doing today to improve the quality of health care?

Jim Kodman: I think it’s remaining patient focused very early on in my career. A pharmacist that was older that I worked with gave me the advice. Always keep the patient first and the results will take care of themselves. If you get worried about the financial side of things or other difficulties, I know a lot of people. They get jaded by the health care system over time, and you end up focusing on the frustrations and things like that and you lose sight of the patient. The number one thing is the patient. That’s why health care exists in the first place. So just stay focused on the patients, stay focused on taking care of them, on meeting their needs. The other things will hopefully get figured out over time. But I think as long as we stay focused on the patient and getting people better and as healthy as we can get them, we’re at least on the right track.

Rob Oliver: I think that is an excellent way to end our time together. Jim Kodman, thank you so much for being with me, and I really appreciate you sharing your perspective on healthcare.

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