3 How did you become the lead author in this study?
The previous summer I'd done a study with Professor Peter Black at Auckland University looking at medication errors. Most medication errors occur when patients first arrive at hospital - during that interface of care. I found that 70 per cent of patients had at least one error in how their medications were recorded on admission. By the end of the study that had dropped by about half. We were able to show doctors how getting medications charted right the first time can save a lot of time later on. So the next year, when I graduated, I asked Peter if he had any more research I could be involved in.
4 What does your job as a clinical pharmacist at Auckland City Hospital involve?
Clinical pharmacists work directly with patients to make sure they're on a safe mix of medications that's right for them. My day typically involves going down to the ward to do a reconciliation of patients' medications. That often involves bit of detective work to confirm what they were taking at home. You're often ringing GPs, community pharmacists and next of kin. I then review whether it's safe and appropriate for them and make recommendations to the team.
5 Do problems occur when patients are prescribed a cocktail of drugs from different doctors?
In the hospital setting we have very unwell patients who might be seen by a range of different teams. My job is to try and piece those bits together and make sure it is safe, for example the patient might be on three medications that drop blood pressure giving them low blood pressure.
6 Is it common for patients to not take their medicine?
We know patients take their medications about 50 per cent of the time, regardless of their background and education. These can be divided into two groups. About 30 per cent are "unintentional" - they might forget because they're busy. About 70 per cent are "intentional" - they don't believe it works or they don't think they need it or they have side effects. A lot can be solved by sitting down with patients to find out their concerns.
7 Did you have trouble remembering to take your asthma medicine as a child?
Yes, Mum said we often missed my morning dose because that was the most hectic time for our family. I was the first person in my family to get asthma. My poor parents were really worried. They're from Hong Kong where asthma rates are low, but we know that when people immigrate they tend to get the same diseases or conditions as the people in the country they've moved to. In New Zealand, one in four people get asthma.
8 What was it like growing up Chinese in small town New Zealand in the 1980s?
My parents moved to Whanganui when Dad got a job as a pathologist there in 1985. I was born there. Back then I could easily count on one hand the number of Chinese families. Unfortunately I did experience quite a bit of bullying. People would taunt me and say "ching chong Chinaman" - those kind of things. Kids tend to target difference of any kind because they don't understand it. But there's definitely been a culture shift. New Zealand has become more multicultural and difference is now celebrated which is a really good thing.
9 What needs to be done to meet the challenges of super diversity?
We can start with simple things like using different languages and international symbols in signage and leaflets. Where I work, in mental health, we have an Asian mental health service for Asian patients, and the same for Maori and Pacific patients. You see a difference in rapport when a care worker talks to a patient in their own language - they light up. One of the kidney doctors at Auckland Hospital learned basic Samoan and Tongan so he could improve his consultations with patients. I applaud people who make the extra effort like that. Just knowing a few phrases can help. It's also important to ensure your workforce reflects the cultural make-up of the population it's serving.
10 Are you worried about the TPP?
A deal has been done and it looks like pharmaceutical patents will be extended which will potentially make some medicines more expensive. What that means for the patient we still don't know. Will the Government redistribute resources to cover the increased cost from other areas? At the moment Pharmac sometimes funds several different generic options for medicines that are off-patent. They might need to reduce that to just the one most cost-effective brand.
11 Drug companies say research is expensive so they need to make their money back. Do you agree?
It's a fair point. Profit is a driver for what types of medications are developed. An obvious example is Ebola which was parked for a long time. Research wasn't reinvigorated until the disease re-emerged and became rampant. Arguably they should have done that years ago but demand was low. Perhaps extending patents will give drug companies more motivation to invest in researching less common diseases because the longer return time will offset the lower demand.
12 At 26 you were named Young Pharmacist of the Year. Now at 29 you've just won Medicine New Zealand's $20,000 Value of Medicines Award. Where to from here?
More patient-centred research in a hospital setting. My passion is patient behaviour because while we have really good medications available, in the end the patient is a human who must use it. I'm interested in finding out more about why people do and don't take their medicines and coming up with practical solutions.
