As part of our focus on careers in rheumatology, we've been talking to a few of our members about what's it's like for them to work in the specialty and how they got here. In the first of this series, we caught up with rheumatology pharmacist Amit Sahni.
Why did you choose to become a rheumatology pharmacist?
My pathway to becoming a rheumatology pharmacist started due to an accident; I became department-based for a period of recovery after a Lisfranc fracture in my foot. My role was to clinically screen all drugs charts for patients attending the infusion unit, which for the majority were biologics to treat their autoimmune inflammatory disease. I gained a great appreciation for these innovative, complex and costly drugs by ensuring the prescribing was correct (e.g. brand, dose, frequency), blood result monitoring and ensuring commissioner funding approval.
As I worked in a consultant and clinical nurse specialist clinic, I appreciated being able to ‘put all pieces of the puzzle together’, observing and appreciating patients sharing their life-changing experiences from biologic drugs. As a pharmacist, I recognised the unique added value a specialist pharmacist could contribute to the multidisciplinary team, resulting in improved patient outcomes through the safer and more effective use of drugs whilst saving the Trust money; for example in the introduction of biosimilars.
More importantly, I love my work with the rheumatology specialty, as I can actively contribute to improve the quality of the service we provide to our patients.
Tell us about your career journey
Following my masters degree in pharmacy, after completing one year of pre-registration training in hospital and final assessment, I became a qualified pharmacist. I then worked for the NHS as a clinical pharmacist, rotating around different areas of medicine such as elderly care, respiratory, cardiology, endocrinology and gastroenterology – all to provide a strong foundation of how drugs are used in the wider discipline of medicine.
I happened to start working with high-cost medicines and homecare, which is where I discovered my passion in working in rheumatology. This led to my experiences in supporting the development of high performing multidisciplinary clinical rheumatology teams improving patient care.
Why do you love what you do?
I particularly love patient interaction and seeing the impact you can have on someone’s quality of life. With my specialised knowledge of medication, I love to alleviate patients pre-existing beliefs or anxieties on drugs via effective education and counselling. We can make a dramatic impact on rheumatology patients’ lives via effective medicines management, as these patients often have polypharmacy and complex drug histories requiring careful review.
It's wonderful to be part of a team working collaboratively with unique roles to improve the quality of patient care we provide together. We have frequent multidisciplinary team meetings where we rationalise the decision-making around which drug to initiate in patients who may require treatment escalation. The team highlights patients who could be referred into my clinic where a focused consultation on their drug history can be conducted to improve care.
I recognise the vital importance my role forms in building bridges between all the actors essential for patients to have rapid access to the right treatment, such as the pharmacy, specialty, commissioners and homecare companies. I love communicating and supporting all the players, ultimately to the benefit of the patients.
What are the main challenges?
The major challenge has been establishing the new role of the ‘rheumatology pharmacist’ in the hospital. It's been critical to shape the responsibilities to meet the expectations of different members of the specialty and pharmacy department, this can be challenging and requires strong working relationships.
It's important to quickly establish how to integrate into the team and reduce work load and pressures from an already over-worked, busy team. There's a risk that the team can have differing understandings of the role. This can divert energy and create more tension and work rather than productivity.
Having experienced the integration of the specialist rheumatology pharmacist role in multidisciplinary teams, it would be good to have more support via further national representation, involvement and recognition. This will continue to establish the function and development of the role in the team.
What’s your advice for someone thinking about a career as a pharmacist in rheumatology?
Approach your local rheumatology clinical lead and line manager so you can sit in an outpatient clinic for experience. Explore the events organised by the BSR; every time I go to an educational meeting or conference, I feel inspired by the value pharmacists can offer.
Check out our Careers in Rheumatology section for more info on how to get into the specialty.
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