A former colleague once told me that no one is indispensable. This was in response to her retirement. The entire team was going to miss her. We all knew how capable she was and how instrumental she was to the success of the team. During her retirement speech, she said no one is indispensable. She explained somehow we would be able to go on without her.

When I think of how different health professions are eager to justify our existence, to validate our important roles or chart new grounds to take on new roles, there is an air of selfcentreness in the attitude. I know many will be quick to point out how wrong I am in this view but perhaps deep down, we all know that no one is indispensable. The manner in which we see an individual or health profession to be indispensable is circumstantial – it depends on the patient population, the acuity of the health concerns, the specific procedures or services that are required and more importantly, how well we bring value to the team.

Recently I completed two medication reviews for two new admissions at a long term care facility. Both new admissions were fairly similar in their past medical histories and medications that were taking prior. The main difference was that they were admitted under different physicians.

With the first admission, the physician has already seen the resident, reviewed lab results, discussed with family, completed his assessment and made some adjustment to the medications. In his documentation, he was clear of his plan, his assessment findings and other thoughts that were important to the case. So by the time I completed the medication review, he has already resolved many of the drug related issues, or at least they were on his radar to revisit at a later time. There was  not much for me to contribute.

In the second case, I wasn’t sure if the physician has seen the resident. There was no documentation in the chart, no lab results to review, many drug related issues were still glaring in my face, either with doses too high, or taking medications that were no longer necessary. I wrote up my recommendations but several weeks later, little has changed.

In the first case, I was not needed. Honestly, the physician was capable to address many of the drug related concerns. He was up-to-date on his therapeutic knowledge, has a strong awareness of best practices and is in my opinion, one fine physician!  But if all physicians are like him, my job will not be needed.

But in the second case, I am not sure my contribution made any difference. If the physician didn’t have the time to see the resident. He also did not have time to review my recommendations. So perhaps I can justify my existence but I think the real solution is to replace this physician.

Indeed, no one is indispensable. We can define our roles, justify our existence and advertise what we do and how well we do our job. But to really validate our existence is to bring valuable contribution to the team.  Otherwise with time, we will be dispensable.

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