In 2013, the Society of Hospital Pharmacists of Hong Kong (SHPHK) released a micro-movie on its YouTube channel. It was the first-ever micro movie for pharmacists in the city. Unlike the traditional educational videos you watched before, which simply illustrate the job duties of the professionals, the micro-movie has brought out something more with a narrative—depicting the core value of pharmaceutical care, echoed through an inspiring tagline that reads: “Curing with Medicine. Caring with Heart (用藥醫病 用心醫人).”

Riding on the same theme, SHPHK has released another micro-movie this March, featuring hospital pharmacists. Once again, the video has received overwhelming responses within the healthcare community.

MIMS sits down with William Chun-Ming Chui, President of SHPHK, Cherrie Li, Resident Pharmacist and Ellen Lai, Clinical Pharmacist in this exclusive interview—as our guests share about the reason and driving factor behind the decision to produce the movie from the very start, and more behind-the-scenes sneak peeks and actions.

A clinical pharmacist discussed the case with a doctor by telephone.
A clinical pharmacist discussed the case with a doctor by telephone.

MIMS: First of all, as the President of SHPHK, why did you initiate a micro movie on community pharmacists, instead of hospital pharmacists, four years ago?

William: If you recall, the government was actively promoting the importance of primary care years ago. They were trying to raise public’s awareness on various healthcare professionals under primary care system, including family doctors, community nurses, physiotherapists, occupational therapists, optometrists and dietitians. Ironically, they have left out community pharmacists, also called family pharmacists, intentionally.

Community pharmacists are the most accessible healthcare professional in the community. More importantly their professional advices are free of charge. They are actually the most cost-effective health gatekeepers for the public. If a patient encounters drug-related enquiries, they can simply walk into any community pharmacy or pharmacy chain stores to seek for the professional advice from a community pharmacist.

If you take a look at the situation in the UK, the National Health Service (NHS) has been encouraging patients to stop by their community pharmacies not just for drug-related enquiries; but also for minor ailments, such as common cold and influenza. Unfortunately, this was not the case in Hong Kong. That’s why we believe there’s a need for us to speak up by making a micro-movie to promote the vital roles of community pharmacists in disease prevention and health promotion in the society.

MIMS: What about now? What triggered you to film a micro movie on hospital pharmacists this year?

William: We noticed the government is aware of the importance of pharmacist professional who plays a check and balance role in the healthcare system. In the Policy Address this year, the government stated it will strengthen and make better use of the pharmacist manpower of the Hospital Authority (HA) to expand clinical pharmacy services in order to promote proper drug consumption and reduce drug wastage.

Additionally, we think now is a right timing to film a micro-movie on hospital pharmacists due to the shortage of doctors, which will persist even after 10 years. This way, we can highlight the roles of hospital pharmacists and suggest our government to utilise our roles in enhancing patient treatment outcomes and safety.

The cast and the crew were having discussion and rehearsal.
The cast and the crew were having discussion and rehearsal.

MIMS: Both micro-movies are riding on the same theme: “Curing with Medicine. Caring with Heart” Apart from the stories illustrated in the movies, may I know if you have experienced this value before from your personal experience?

Cherrie: One day, a doctor prescribed a patient a new inhaler and referred the case to me for drug counselling, so that I could teach the patient how to use the new inhaler. The patient was a woman in her 40s, but her intellectual ability was equivalent to only around 5-year-old, due to mental retardation.

During the drug counselling session, I noticed she was reluctant to use the new inhaler. In this case, we could not just leave it and forced her to use the new inhaler. What I did was to talk to her with patience—like how we communicate with children—and try to find out the reason behind her resistance. As it turned out, she refused to use the new version because she disliked the appearance of the new inhaler. Then, I explained to the doctor the situation and realised the doctor prescribed a new inhaler as he misunderstood and thought that the patient didn’t know how to use the old inhaler. Eventually, after the patient has showed us that she was using the inhaler correctly and promised to adhere to the drug instruction in the future—we helped her to switch back to the original inhaler that she had been using.

What I want to emphasise here is that the prescription is just a black-and-white document. It cannot reflect patients’ drug-related problems. It can neither show us if the patients have really taken the medications, nor whether the patients adhere to the correct administration. As a hospital pharmacist, what we have to do is to listen to our patients with our heart and cure them with care. What we are meant to deliver is not only pharmaceutical treatment, but also pharmaceutical care.

Ellen, the main actress, was talking with a young actress with smiles and patience.
Ellen, the main actress, was talking with a young actress with smiles and patience.

Ellen: I work as a clinical pharmacist in a paediatric ward. There is a number of considerations when the children take medications. For example, if the child cannot swallow the pills, we have to see if it’s possible to switch to liquid formulation. For some immunosuppressive drugs, they might be a bit ‘smelly’ for the children. In this case, we can explore if the drugs can be mixed with juices. We also need to manage expectations and enquiries from their parents. When we answer their questions such as why their children need to take these medications or what are the side effects of the medications—it’s important that we put ourselves in their shoes and understand why they have these concerns.

William: When we conduct interviews for recruitment of hospital pharmacists, we seldom assess their medical knowledge. For some pharmacy graduates with good academic results, we may not consider their applications because we cannot see their passion and caring heart during the interviews. If the patient come to you with no prescription for rescue medication, how can you help? If the patient is prescribed a medication and you found out he/she is also taking a lot of medications prescribed by different specialists, have you ever attempted to find out any drug related problems? Being a hospital pharmacist is much more than simply dispensing drugs.

MIMS: Have you encountered any challenges while filming this micro movie?

Ellen: The pressure is indeed less than what I expected being the leading actress of this micro movie. One of the reasons is, instead of recording our voices; the micro movie uses texts to express our thoughts. In this case, we feel less nervous in acting out our conversations as we don't need to be worried about speaking the wrong dialogues.

The cast shared the joy and laughter during filming.
The cast shared the joy and laughter during filming.

Cherrie: Definitely, since it was my first time directing a micro-movie! At the very beginning, we have already decided to use continuous uninterrupted shots to illustrate a patient’s journey—from a pharmacist discussing the drug treatment with a doctor by telephone, patients awaiting their medications to an oncology pharmacist providing drug counselling to a patient with breast cancer. This is one of the most difficult challenges since we need to retake the shots starting from the very beginning whenever actors make any wrong moves.

Another challenge was to brainstorm a storyline that could link up the various healthcare professionals and different roles of clinical pharmacists of different specialties. Although we want to enhance public’s awareness on the roles of pharmacists, it does not mean that pharmacists can replace another professional. Towards the end of the micro-movie, you can see how clincial pharmacists are assisting the doctors. In the end, doctors gain more time for taking care of their patients. It is a win-win-win approach.

Besides advocating a multidisciplinary approach, we also want to promote the different specialties of clinical pharmacists—such as outpatient pharmacists, oncology pharmacists and paediatric pharmacists to the public.

The micro movie was filmed in one long take. Shots had to be retaken whenever actors made any wrong moves.
The micro movie was filmed in one long take. Shots had to be retaken whenever actors made any wrong moves.

MIMS: I notice there is oncology pharmacist and paediatric pharmacist featured in the micro movie. Are there any other departments that pharmacists are providing clinical pharmacy service?

Ellen: Apart from Oncology and Paediatrics, we also offer clinical pharmacy service in Haematology, Adult ICU, medical and surgical admission wards. The reason why we provide service in these departments is either because of the high volume of patients and the high risk in these clinical areas. For instance, oncology pharmacists need to carefully deal with the toxicity of cancer chemotherapy. Paediatric pharmacists, on the other hand, need to verify the dosage based on the child’s body weight, surface area and/or age.

In the future, we are looking forward to introducing clinical pharmacy service in all medical wards and the Accident and Emergency Department with one clinical pharmacist to 30 beds ratio.

Being a clinical pharmacist in a specialty doesn’t mean that the clinical pharmacist is not equipped with broad drug knowledge. Rarely do you go to an ophthalmologist and consult his opinions on medications for treatment of cardiovascular diseases. It’s a different case for clinical pharmacists, though. If a patient asks whether there is any drug-drug interaction between the medications from two or more different therapeutic areas—the clinical pharmacist still needs to know the answer to that question.

The clinical pharmacists need to advise the doctors on drug treatment based on updated clinical evidence. For this, they need to know how to read the pathological results or ECG tests. Moreover, they need to know the signs and symptoms of various diseases. For instance, patients taking high dose aspirin may develop tinnitus as a side effect. The clinical pharmacist needs to be aware that the medication may be the reason for patient’s complaint about the hearing disturbance. The deterioration of a transplanted patient may be due to his drug hypersensitivity to the immunosuppressant.

MIMS: How could pharmacy graduates become clinical pharmacists?

Cherrie: After the pharmacy students completed their four-year pharmacy education, they need to undergo a one-year internship. Once they get the practicing license of registered pharmacist, they can consider furthering their study into clinical pharmacy. They can study a two-year Master of Clinical Pharmacy, where they get to learn the clinical knowledge in different specialties. After that, if they are interested in pursuing in-depth of one specific specialty, they can take the Board of Pharmacy Specialties (BPS) Certification. Some hospitals may offer clinical attachment, so you can put your knowledge into practice while you are still learning. It takes approximately another two years for you to complete the exam. In other words, it takes at least 9 years to be a Pharmacist Specialist.

Ellen: The Chief Pharmacist's Office of HA also offers advanced specialty course on Oncology and Paediatrics. It’s a 10-day workshop, approximately, and you are required to record your clinical training in the log book.

The shots were reviewed before choosing the final one.
The shots were reviewed before choosing the final one.

MIMS: Regarding the success of this micro movie, is there anything else you want to share?

Cherrie: I sincerely thank the crew for sparing their personal time for this micro movie. Some come to our movie shooting right after their overnight shift. Even for the ‘doctor’ you see towards the end of the movie, he has practised for an entire week to learn how to act naturally as a doctor! MIMS

Read more:
Pharmacist surplus: Interview with William Chun-Ming Chui on how Public Private Partnership (PPP) and maximizing the role of pharmacists in public hospitals can close the gap
Young pharmacists geared up to reshape the future of pharmacy in Hong Kong
From outreach pharmacists to joint school outreach program