EPISODE 4: Let’s Talk About Drugs, Baby- Greg Meola, Pharm.D

Today’s guest is Greg Meola- emergency pharmacist extraordinaire! I first met Greg while completing my Emergency Medicine residency in Syracuse, NY. He has certainly taught me a lot about medication usage, antibiotic stewardship and how to be an effective teacher.

Today’s Guest

Greg Meola

Greg Meola is a clinical pharmacist in Emergency Medicine at SUNY Upstate University Hospital in Syracuse, NY.  He completed his PGY-1 pharmacy residency at Upstate in 2014.  He is a Board Certified Critical Care Pharmacist and has clinical and research interest in acute management of medical, surgical, and neurological emergencies.  He regularly participates in the multidisciplinary management of emergency department patients, as well as inpatient cardiac arrests.

Email: greg.meola@yahoo.com

Key Takeaways

• Greg used to think that approaching older physicians was difficult due to difference in experience, however he came to realize that it was in fact his own insecurities.
• Greg uses a non-confrontational approach when approaching physicians/nurses focusing on how medication choices can be improved.
• Greg attributes learning how to communicate with families to watching how physicians interact effectively.

Resources (Click for Amazon)

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Join me for the next episode… Security…Not Just Muscle with Rick Jordan!

Transcript

Andrew Tisser 0:10
Hey, Greg, welcome to the Talk2MeDoc podcast.

Greg Meola 0:13
Hey, Andrew, great to be here.

Andrew Tisser 0:15
Yeah, thanks so much for agreeing to be here. I already gave a little bio about you, but in your own words, if you can tell the listeners a little bit about who you are, and what you do in this great healthcare world.

Greg Meola 0:29
Sure. So my name is Greg Meola. I’m a pharmacist. I work in the field of emergency medicine. I work at Upstate University Hospital in Syracuse. That’s how Andrew and I got to know each other. As an ED pharmacist, I work regularly with the Department of Medicine or Emergency Mmedicine. I also work with a bunch of different consultant physicians, neurologists, surgeons, so on and so forth. We help facilitate the delivery of optimized treatment of patients in the emergency department. Whether that be emergency department patients, patients boarding in the emergency department, or those who need acute resuscitation, such as stroke patients, trauma patients code, resuscitation, so on and so forth.

Andrew Tisser 1:13
Very interesting. I know Greg certainly saved my butt quite a few times when I was a resident. That’s how we first met. Correct me if I’m wrong. I think we had a pretty good relationship.

Greg Meola 1:24
I thought we had a great relationship. I started working full time in the ER probably about five or six years ago now. And the relationships have have grown and strengthened over time, but specifically, I think, starting with your class is kind of when we flipped the switch and became more of a person instead of a service.

Andrew Tisser 1:48
Why do you think that is?

Greg Meola 1:51
I don’t know. I don’t know if it was the comfort level of the attendings or us just, being there. I think, being a face to face rather than a phone call made a made a big difference to start. And as that, face to face relationship grew, I think everybody became more comfortable with each other and, were able to bounce ideas off each other and became, as a pharmacist, me being more comfortable coming to you with something I may not have called you over the phone with if I didn’t know you, but since we had that relationship, we could, bounce ideas and be a little bit more forthcoming with recommendations with each other.

Andrew Tisser 2:34
Absolutely. Yeah. I mean, I personally thought it was great having a pharmacist right there, especially as a trainee when maybe are a little more nervous to go to your attending. But you can ask one of the pharmacy guys down there I thought I thought it was awesome. Have you guys been tracking data and trends in regards to outcomes since you started?

Greg Meola 2:55
We’ve been doing it in certain areas. We’ve we’ve looked at code stroke notifications within the ER we’ve looked at, medication errors within codes and things like that we’re still we’re still kind of digesting the data and seeing how we how exactly we chalk up to patient important outcomes. But as far as time spent and time to treatment has has been positively impacted with us being down there versus,, being a phone call away.

Andrew Tisser 3:31
Absolutely. And so, do you also respond to inpatient resuscitations?

Greg Meola 3:38
As of right now yeah, so, being the only, “satellite” we use the term satellite and in the pharmacy world, satellite coverage on the on the evening shift, I’m usually working until about midnight, where the only satellite coverage in that time frame between four and midnight so we do respond impatient codes as well.

Andrew Tisser 4:02
Okay, so this this show is about communication. So do you feel that within the team that is within physicians to all the other staff, including pharmacy, including everybody? Do you feel that there’s an issue with Team communication as a whole?

Greg Meola 4:24
Being in a, in a teaching hospital and an academic center, I think it’s a little bit more open. Being that, a lot of the physicians that I that I work with are on the resident level, outside of the emergency department. I think they’re a little bit more apt or a little bit more receptive to certain ideas, so they can bounce it off their attendings in turn. I also moonlight in a community hospital in that that growth curve as far as communication was a little steeper. From from being in an academic center to a to a smaller community hospital where the physician rules, they’re the only one in the hospital and kind of what they say goes. But I think once that barrier was broken down that communication barrier and, coming to them with ideas again and again and again, I think kind of gave them a little bit more a better comfort level with what we have to offer.

Andrew Tisser 5:29
Could you explore that a little more? What barriers Did you see at another hospital?

Greg Meola 5:36
My moonlighting job, it’s, it’s a, it’s a small community hospital, we’re only it’s closer to my house. So it’s only about 20-25 beds, the entire hospital. And I think the the culture for a long time was that what the physician says goes and that was they were kind of the end all be all A lot of different things and pharmacists through no fault of their own, but they’re not residency trained, they they didn’t have, they didn’t have that type of relationship with the physicians and, it was kind of more, we’re, we’re going to check the medications, and then we’re going to deliver them to the patients versus maybe this isn’t the best thing, we can we could certainly pick medication x for disease y but why not pick medications z for when it may may do better? And I think specifically when I came in, it was a little bit different for for the physicians and for the pharmacists, but I think once once that communication line was opened it helped the physicians and it actually helped a lot of my colleagues become more comfortable going to the physicians with but their ideas as well.

Andrew Tisser 6:57
That’s great. And I’m sure that trickles down to to the patients. I mean you guys came in there you especially with just charming good looks and your suave personality, and really just took care of it. But no, that is really interesting, especially looking at an academic center versus a small community hospital. Do you feel that there are generational differences with communication and not only within the trainee versus attending level but older physicians or his younger physicians?

Greg Meola 7:31
I used to think that, especially when I started my, my second job was that a lot of the physicians that I worked with at this other hospital were a generation ahead of me. And me being a younger person talking to someone a little bit more seasoned and a little bit more experienced. It took me a little bit a little while to to adjust to that as well. But I think once I kind of got over the hey, they’ve been practicing for 20 plus years, and I’ve been practicing for less than 10 I think once I got past that and still had the ideas and still kind of got over the, the fear of going to someone with a lot more experience than me, I think they were actually more receptive because they weren’t used to having someone come to them and being like, Hey, what about doing this instead of what we’ve been doing for so long?

Andrew Tisser 8:42
So is it more like, instead of you coming in there and challenging their power, you were like, Hey, we can both help our patients a little better doing XYZ and that kind of broke the shell. Do you think?

Greg Meola 8:55
Sure I try and teach my own pharmacy residents never to come, guns blazing and saying, you’re doing something wrong. I always say, don’t come at or don’t approach the problem, like it’s a problem approach it like an opportunity for a better solution. And I never tried to approach physicians or advanced practice providers or even some of our nursing colleagues with hey, you’re doing this wrong versus hey, what do you think about doing this instead?

Andrew Tisser 9:33
Sure. I mean, I think that’s great advice for anyone in any role. Instead of trying to make this an adversarial relationship we’re trying to everybody’s got the same goal. Hopefully, people yeah. And I think even as a resident, even as a junior resident, when looking back I thought I knew a lot but I didn’t know anything. When you would come up, come up to me and be like, Hey, Tisser, we do you think we could do this, this and this, it would definitely soften the blow of no, you’re not doing something wrong, but there’s a better way to do it. And I always appreciated it.

Greg Meola 10:09
Yeah, I think I think that’s exactly the the idea is that we’re not necessarily doing something, isn’t wrong, but it could be optimized, it could be better. And I think that especially me as a pharmacist working in the ER is that, I’m not trying to prevent catastrophe. I’m just trying to optimize care.

Andrew Tisser 10:36
But if there was a catastrophe, I know you single handedly would prevent it.

Greg Meola 10:40
If there was a catastrophe, we would try and prevent that as much as possible as well.

Andrew Tisser 10:45
That’s great. So I know some of our listeners are not in the medical field, but are just curious. And so what what exactly is an emergency pharmacist and how would someone pursue that kind of nice girl Instead of let’s say being a commercial pharmacist or a someone who works for the pharmaceutical company or an inpatient pharmacist, could you just explore what what that means?

Greg Meola 11:10
So, so working is a pharmacist in the emergency department is is a little bit different, especially from from many fields of pharmacy. But even even from the inpatient pharmacy world itself, I think we spend a little bit more time at the bedside. We’re not mixing stuff in the IV room, we’re mixing stuff at the bedside.

And then specifically our practice model is being at the bedside mixing stuff, delivering it to our nursing colleagues for, for administration to the patient, but also being at the bedside during these acute resuscitations to optimize medication use and medication care to the patient. So, having those split second decisions and Working right at the bedside, right in front of the patient in front of the patient’s family. A lot of pharmacists may not be comfortable with that I thrive on that kind of stuff. And I’ve found that a lot of our a lot of our pharmacy residents that that go through the training program, come to overcome their, their fear of making those decisions and having those conversations in front of families versus, being the phone call away being being the person at the other end of the phone.

Andrew Tisser 12:32
Sure, it makes sense. Do you? Do you think that families appreciate that?

Greg Meola 12:37
I think it’s a it’s kind of a, I don’t want to say a dance, but I think you it’s a it’s definitely a learned kind of skill set is to have those conversations with families and seeing seeing our physician colleagues working and and kind of giving the benefits and risks with whether it be blood administration, whether it be a central line, all of those things. It kind of helped teach me how to how to talk to patients and family members and seeing here’s what we can do. here’s a, here’s a bunch of options. And it gave me the ability to have those conversations a little bit more effectively. And which I can in turn teach my residents how to do that.

Andrew Tisser 13:30
Well, you just answered my second question. So thank you. The other issue I was always wondering about is the greater goal of this show is communication within the team, eventually will affect patient care. It’ll trickle down to improved care if we had improved communication. Do you think that’s true, and how would that happen?

Greg Meola 13:58
I definitely think it does. I think having having that open line of communication and having that that positive type of relationship with between anyone and a physician, whether it be myself, whether it be a respiratory therapist, whether it be a security guard, I think that helps, build that relationship helps build into better patient care for for myself, I think affecting patient care. As far as, say someone came in with a UTI and they are septic. You know, you guys as physicians have to deal with what am I going to do for their workup? What am I going to do as far as imaging all all the all the things that I’m not good at?

And then you have to worry about the treatment as well, which the entire time you’re doing the workup I’m digging into the patient’s chart and seeing to the hospital cultures Do they have any allergies any other meds that they would be on that would that would affect my choice and what what an antibiotic would be and, no fault of the physicians but a lot of the time there’s there’s not there’s not enough time from from workup to treatment that would allow you to make the same choice that I make. So say you chose subtract zone for the patient with with the UTI when I look back, they had, a culture within the last six months, and it was an ESBL ecoli (Editor’s note: a multi-drug resistant bacteria).

And I say, hey, maybe we should do something, like cefepime, or maybe it was, maybe it was even resistant to cefepime. So we may have to use meropenem. So, all of those things kind of go back to that, that healthy line of communication and saying I can, I can have that conversation with you because we have that open line of communication. We have that good relationship versus it’s Zosyn or ceftriaxone it’s a UTI, it’s fine, which, through no fault of my colleagues upstairs that work in the main pharmacy, but they also have all the other hospital to look at. So they may not have the same time that I have to look through the patient’s chart as well.

Andrew Tisser 16:21
Absolutely, that’s, that’s, I mean, that’s huge for those of us that don’t practice in in the year, it’s pretty hectic place you got a lot of moving parts and having someone pretty much who has your back and looking through some of those old records is a real a real relief. Absolutely. So, going back to something we talked about earlier some of the barriers that you had faced in your career in communication. So I know sometimes you have to change orders and sometimes you disagree with some of the physician decisions which we talked about earlier you come at with a very non argument that kind of approach. But can you think of a time in terms of communication that you had a positive and a negative experience in this regard?

Greg Meola 17:09
Sure. I actually, when you when you sent me the email with this question, and I was like I have, I actually have the perfect story because it was kind of a negative experience that turned into a positive one. I there was being that, we’re, we’re kind of on the front lines, and we we work with our neurologists, colleagues with with stroke code management. We had a we had a patient come in probably a few years ago now.

And she had a low NIH stroke scale, but there was a, there was a, one of the more aggressive neurologists and using TPA, and I had looked back in the patient’s record and I’d seen that she’d received TPA before and she had a small intracranial hemorrhage because of it. So I spoke with the resident saying, she, she told me that her attending wanted to give the wanted to offer the patient TPA. And I, I expressed my concerns and as most residents do, they said, Well my attending wanted it. I was like, okay, but, this is kind of one of those times where my attending wants, it just didn’t really cut it with me. So that was kind of the the negative aspect of it. So I ended up getting on the phone with the attending, and that’s kind of where it turned positive was, we, we just, we had the conversation, I expressed my concerns, and she kind of expressed her her side of things, saying, I don’t think this was a spontaneous hemorrhage would be more androgenic.

I went through the, through the inclusion exclusion criteria. And we kind of worked through saying she she didn’t have that low of a burst didn’t have that high of a NIH stroke scale. My concerns as far as the risks her concerns as far as the benefits and and we kind of came to the conclusion that there was enough stuff on the differential that it could have been something other than a stroke. So we decided not to give it but I think that was kind of a negative turn positive. And in a single story in a nutshell was my relationship with someone I hadn’t even known before and kind of opening up that line of communication and saying, these are my concerns and, her going back with me, or her relaying her concerns back to me was it was a, it was a, I thought, overall good experience.

Andrew Tisser 19:44
Yeah, I think that’s a very powerful story. Honestly. I, I know that’s, again, some of our listeners aren’t medical. Could you give it just a few sentences on what TPA and all that means for some of the people that might not understand?

Greg Meola 19:58
Sure. So TPA Essentially a clot busting medication that we will give to people with with suspected strokes which are caused by a small blood clot in one of the vessels in the brain. So with that comes a risk of bleeding. So the the benefit being that we could dissolve that clot and restore the regular blood flow in your brain and hopefully get rid of those stroke symptoms versus the risk of bleeding, whether it be in the brain as she had in the past or, or somewhere else, which could be life threatening.

Andrew Tisser 20:34
Great, thank you. You always had a way of making things understandable to me, that’s for sure. So, we’re going to shift gears a little bit. This part of the show is really kind of to get to know the guest and who they are as a person. So first off, why did you decide to become a pharmacist?

Greg Meola 20:55
So it’s a kind of a crazy story. I started as all, high school students do, my parents were like, you have to get a job. If you want to keep driving your car and, you got to pay for your own gas once, once a certain time comes so I actually just applied to eckerd back then. And I was a cashier turned tech. And I kind of stuck with it. I worked in I worked in retail pharmacy between eckerd Rite Aid and Walmart for probably eight years or so, through high school in pharmacy school and then decided I was going to shift gears and and do a residency and I’ve been an upstate ever since.

Andrew Tisser 21:43
Great, awesome. And so this next question is a bit of a two part question. I’m a bit of a book nerd. I love reading, whether that be on Audible or in physical form. Could you give me your favorite book ever? Then a current book recommendation,

Greg Meola 22:02
and favorite book ever I haven’t outside. Unfortunately outside of reading manuscripts I haven’t read a whole bunch of books lately I have I have gotten into audible since I have a long commute myself every day. But one book that I couldn’t put down anything in the Dan Brown series, but specifically, I think the last one I read was the lost symbol. One of them that’s not a movie, it’s not the Da Vinci Code, but kind of follows that same same idea. And that one, that one was tough to put down.

But that was again a long time ago and I had more time on my hands. As far as a current recommendation. I is is much of a nerd as I sound. David Allen’s getting things done his I don’t want to say changed my life but definitely made it better. You know, all the other things that I I keep on my plate. I couldn’t imagine for the physician listeners how much they keep on their plate, but picking things out of that book and and applying them to your own life definitely frees up some of your brain to, to think about other things rather than all the other things on your to do list and being being a lot more efficient as a as whatever kind of worker you are.

Andrew Tisser 23:26
Great that I haven’t read that one yet. I’ll have to check that one out. And for the listeners, the any of these recommendations will be in the show notes. So Greg, what do you like to do for fun Besides, say residents behind?

Greg Meola 23:41
Well, when I’m when I’m not at work, and when it’s not, six inches of snow on the ground like I’m looking outside my window right now. I do enjoy golf, I like anything in the summer boating. My wife and I picked up a couple paddle boards in the past couple years and we’ve been using those quite a bit Fishing, and then in the winter, trying to trying to keep any sort of aerobic exercise up, whether it be running or, or spinning or something like that and trying to stay busy during the winter months and try and try and get a lot of my long term work done during the winter. So I have a little bit more free time in the summer.

Andrew Tisser 24:24
Fair enough for those of you that do not live in balmy Western New York, Central New York or on the east coast. The winter is a bit of a hibernation period for most of us. So we just kind of Bunker down and and get through it. But the summers are fun. So the next question is, if you as a pharmacist could give physicians a single piece of advice in the area of communication, what would that be?

Greg Meola 24:56
I think going back to the attendings versus APPs (editor’s note: physician assistants and nurse practitioners) and, and nurses and so on and so forth. I think just being receptive to new ideas is, is huge. Going back to that stroke conversation I hadn’t even met that neurologist in person before, but we had that, we were receptive to each other side of the story.

We can all learn each other, learn from each other. I can’t tell you how much I’ve learned from my physician colleagues and upstate, you included and how that makes me a better pharmacist, having those bedside conversations with with families when it when these are sometimes life and death decisions. And that that’s made me a better pharmacist. Having that open line to communicate with each other is really the basis of a great working relationship. And if we can communicate openly, we can we can definitely learn from each

Andrew Tisser 26:01
Absolutely I agree. The time I spent it upstate was was certainly improved by our relationship and your pharmacist colleagues and I learned quite a bit from you guys and took it with me. onwards. So yeah, that was I certainly miss having it. Emergency Department pharmacist that was that was awesome.

Greg Meola 26:26
We like we like being down there too. We’re we’re of a different breed when it comes to pharmacists a lot of times but and being down there and we enjoy it.

Andrew Tisser 26:38
Awesome. Well, Greg, I I really enjoyed this this talk here. I think a lot of important things were touched on in the communication aspect emergency pharmacy and patient pharmacy etc. And I’m sure our listeners will really enjoy this if if people wanted to reach out to or learn more or learn about emergency pharmacy or anything. You do? How can they get in touch with you?

Greg Meola 27:02
if they have any questions for me unfortunately, I’m not one of the not one of the guys that are blowing up the the Twitter world, but you can just email me at Greg.mila@yahoo.com.

Andrew Tisser 27:15
Great, awesome. I’ll put that in the show notes as well. Well, once again, Greg, thanks so much, and we’ll talk soon.

Greg Meola 27:24
Yeah, thank you, Andrew.