The Best Medicine
It was March 2011, halfway through the Montana state legislative session, and Bob Mehlhoff was tired. The Democratic representative from Great Falls was working fourteen-hour days writing and debating bills on the House Appropriations Committee and the Education Subcommittee, and the relentless schedule was taking a toll on his body. He was short of breath. His heart raced. Climbing a flight of stairs felt like the Boston Marathon.
“I didn’t think much of it,” Mehlhoff recalls. “With the six-day weeks and the stresses and pressures of being on the finance arm of government, I expected to be tired.”
During the session, Mehlhoff always had more work than time to do it. So when a van of University of Montana pharmacy students rolled into the Capitol to host a health screening, it was fortunate that Mehlhoff had just left a meeting and had a rare block of free time.
“I usually don’t go to those kinds of things,” he says. “But I thought I might as well.”
The pharmacy students were running some basic wellness tests—checking people’s cholesterol, blood pressure, and blood sugar. A fourth-year pharmacy student named Chad Abbot put a cuff around Mehlhoff’s arm, inflated it, and then listened for the pulse. Then he did it again. Something was wrong. Pharmacy Professor Donna Beall was leading the group that day. She still remembers the look Abbot gave her.
Beall came over to check on Mehlhoff herself. His pulse was rapid. His blood pressure was through the roof. Beall could tell that Mehlhoff’s heart was in atrial fibrillation.
“You’ve got to get to a hospital,” she told him.
“Can it wait till the weekend?” Mehlhoff asked.
“No,” she said. “This requires immediate attention.”
Another legislator—a former nurse—overheard the conversation and volunteered to drive Mehlhoff directly to St. Peter’s Hospital, where he was admitted into the ICU. He was at imminent risk of a stroke.
Mehlhoff’s condition soon stabilized with medication, rest, and rehydration. And although he would rather have been pacing the House floor than shacked up in a hospital ward, he was grateful that van of pharmacy students had come when it did.
“I was very fortunate that they came that day,” Mehlhoff says. “They might’ve saved my life.”
The makings of that day in Helena go back 101 years to 1913, when UM hatched a deal with Montana State College in Bozeman to trade UM’s engineering program for Bozeman’s six-year-old pharmacy school. And so one summer day in 1913, all of the paraphernalia of a pharmacy program—crates of drugs, specimen jars, glass percolators, and more—were loaded onto a flatcar train and sent west to Missoula.
Pharmacy as we know it was a nascent profession then, just garnering public appreciation after the federal government passed the Food and Drug Act in 1906 to regulate medicine. Before that the West was the terrain of snake-oil salesmen and quacks. UM’s 1913 registry promised an end to that era, vowing to educate students equipped to serve the medical profession “in which pharmacy occupies a necessary, separate, and distinct field, which comprises the collection, preservation, standardization, and dispensing of preventative and remedial agents.”
It was a good time to be a pharmacist. “Splendid opportunities exist in this state,” the registry extolled, “for men and women who are well trained in the principles of the science and art of pharmacy and their practical application.” Employment was all but guaranteed: “All of the graduates of this school are occupying responsible positions and there has been a greater demand for clerks than the school has been able to meet.”
The School of Pharmacy moved into the first floor of UM’s old Science Hall, where pharmacy students shared eight classrooms with the Domestic Science and Household Arts, and the Manual Arts programs. It was humble beginnings for the only pharmacy school in Montana. But there was plenty of room to grow.
A hundred years hence, the program and the profession both have changed a great deal. In 1981, the school moved into a new building. In 1998, it received almost $6 million from the ALSAM Foundation to add a wing to that building. The ALSAM Foundation was created by L.S. “Sam” Skaggs, the owner of a successful pharmacy chain, and his family in order to provide philanthropic support for causes they valued.
“He gave back to the places that helped him grow his businesses,” says David Forbes, the twenty-six-year dean of UM’s College of Health Professions and Biomedical Sciences. “It’s a very unique individual that gives money back with essentially no strings attached. He wanted his name on the building. That’s all.”
Another addition in 2007, also with ALSAM Foundation support, added even more research space and learning laboratories. The resulting Skaggs School of Pharmacy now is part of the College of Health Professions and Biomedical Sciences, housed in a $28 million building that’s longer than a football field and one of the largest on campus. It’s a state-of-the-art facility for one of UM’s most respected programs. But as Representative Mehlhoff can attest, the school’s real worth lies as much in what happens outside that building as in it.
Real-world, hands-on training such as the Capitol health screening is integral to the curriculum at UM’s pharmacy school. Those experiential learning opportunities expanded in 2004 when the University replaced its bachelor’s of pharmacy degree with the six-year doctorate that now is the industry standard.
“We almost had to triple the practical experience in the program,” says Gayle Hudgins, a professor at the school for thirty-seven years and the architect behind many of its experiential opportunities. Accreditation guidelines require pharmacy students to obtain 1,500 hours of practical experience in four years.
“At UM,” Hudgins says, “they’ll have more than 1,600 hours from academic coursework, if they do nothing else.” Most exceed that with internship experience in pharmacies.
In class and out, a doctorate in pharmacy is a demanding education. Students spend their first two years on campus taking prerequisite courses in chemistry, biology, math, and economics. They apply to the School of Pharmacy in their second year. Each year the school admits a class of sixty-five students, who take professional classes together for three years and then spend their final year entirely in the field, learning alongside medical professionals in real heath care settings.
Hudgins says when she went to pharmacy school at the University of Washington in the late ’60s, her education focused more on the makeup of the medication than the practicalities of treating patients. Today’s UM graduates, she says, have a much better grounding in the relational skills required of a pharmacist.
“They still get a good scientific base,” Hudgins says. “But they’ve had a lot more opportunities to practice communication skills, to learn how drugs are used, and to practice counseling patients. Before, it was about the drugs. Now, it’s about the patient.”
Students learn that lesson during their first year in the program. Hudgins assigns every incoming student to an older person in the community. At first, the students just get to know their companion and their medical needs.
“But as the semesters go by,” she says, “they’re able to engage with this older person on their health care.”
That direct interaction complements the work of the Montana Geriatric Education Center, a federally funded program that Hudgins and other UM faculty members started twelve years ago to train students and medical professionals in the best practices of caring for the elderly—an increasingly relevant field as Montana’s population ages.
The Montana Geriatric Education Center also funds a student training initiative called IPHARM [Improving Health Among Rural Montanans]. IPHARM travels the state with fourth-year pharmacy students, conducting health screenings in communities around Montana. In ten years, IPHARM has traveled more than 110,000 miles to all corners of Big Sky Country, testing more than 14,500 Montanans in bars, senior centers, and Hutterite community centers.
“We go anywhere,” says Beall, IPHARM’s coordinator. “The only stipulation is we need electricity to plug in our machines.” Beall, who divides her time between teaching and working at UM’s Curry Health Center, enjoys IPHARM outings.
“It brings together everything,” she says. “I’m with students, but I’m with patients, too.”
She says the fourth-year pharmacy students get valuable lessons on communicating with patients, everyone from a twelve-year-old kid to a 100-year-old woman. And Montanans benefit, too. They get free or low-cost health screenings, and they get a chance to see what a pharmacist actually does.
Most people think they know what a pharmacist does. They’re the white-coated ones behind the counter in the drugstore, putting pills from a larger bottle into a smaller bottle, “counting and pouring, licking and sticking,” as one professor puts it. In the modern model of a medical home, though, a pharmacist is a valuable part of a patient’s medical team. Pharmacists can advise physicians in hospitals, manage the side effects of common treatments in clinics, or resolve a patient’s drug conflicts in community pharmacies. And unlike doctors, whose patient interactions are rushed, pharmacists often are the most accessible, highest-trained professionals most people see.
“It’s not just about being able to fill a prescription properly,” says Mike Rivey, chair of the Department of Pharmacy Practice. “There’s a lot more patient consultation now.”
Rivey coordinates the postgraduate residency program at Community Medical Center in Missoula, where he sees pharmacists occupying an expanding role in a patient-centered health care model.
“Thirty years ago,” he says, “a physician didn’t want to hear anything from the pharmacist. Twenty years ago, they tolerated you. Fifteen years ago, they realized you might have something to add. Five years ago, they realized they need you.”
Changes in the profession don’t take long to find their way into the curriculum at UM’s pharmacy school, where most faculty members also are practicing pharmacists. There’s a solid grounding in the timeless basics, too. In labs, students learn sterile techniques for compounding medicines into an IV drip. They learn their way around the shelves in a mock drugstore pharmacy. And they practice patient consultation and screening procedures with “Sim Man,” a 120-pound computerized dummy that professors can program to present specific symptoms of bad health.
“He’s a hit,” says clinical lab coordinator Lisa Venuti, opening the door to the closet where the dummy lies on a gurney in navy sport shorts and a red T-shirt, with an IV hanging out of his right arm. “We usually call him ‘Simmie.’”
Venuti says these lab situations prepare students for practice by forcing them to apply what they’ve learned in lectures. The small “integrated studies” sections of ten to twelve students are a particularly intimate learning environment where problem-solving skills are reinforced.
“It really does become like a family,” Venuti says. “It’s not always the Brady Bunch, but it’s very supportive. They start out like your kids, and they end up as your colleagues and friends.”
UM’s pharmacy family is a diverse one. The Native American Center of Excellence recruits Native students interested in studying pharmacy. The Skaggs Scholar program offers five $10,000 scholarships every year to Native American students. As a result of these programs, UM’s pharmacy school has the fourth-highest population of Native students in the country.
UM’s pharmacy students also are the type to get involved.
“We build a student body that gives back,” says Assistant Dean for Student Affairs Lori Morin. “They’re active. They’re very community-minded. Not because we tell them to, but because they want to.”
Student organizations such as the Academy of Student Pharmacists and pharmacy fraternities host regular health screenings and educational programs in schools, shopping malls, and around campus. Through events like these, pharmacy students can help give vaccinations, teach children how to tell medicine from candy, volunteer at a summer camp for kids with asthma, and more.
Ali Bierer is a third-year student and president of the UM chapter of the Academy of Student Pharmacists. Bierer got involved in extracurricular activities early on in her pharmacy education. She says these events have been invaluable to developing her skills.
“It supplements what we’re learning in the classroom,” she says. “You can’t learn how to take a blood pressure from taking notes. You have to physically do it.””
Bierer says her education has been comprehensive, and she’s excited to take her skills out into the field in her fourth-year experiential rotations. But she’s nervous, too.
“I’m a little scared about the rotations in the real world,” she says. “But I think that’s sort of a good thing. I wouldn’t want to go out feeling over-confident. Education is always something that you have to continue to build on.”
One of the rotations Bierer hopes to do in her fourth year is IPHARM, the program for which Representative Mehlhoff will be forever grateful.
After a day and a half in the hospital, Mehlhoff was able to talk his doctor into releasing him so he could get back to the legislative session. There was important work to be done—a funding bill was going up for a vote, and Mehlhoff was the only minority representative on the Education Subcommittee. Mehlhoff spent thirty-four years teaching math in Big Sandy—his former students include U.S. Senator Jon Tester and Pearl Jam rocker Jeff Ament—and he already was a firm believer in the value of education.
“I just had to convince some people from the other side of the aisle,” he says.
And as he gingerly stood to speak in favor of pro-education amendments to the bill, he had a prime example to point to—himself. Mehlhoff told his fellow legislators the story of his recent experience and the students who helped identify a condition that could have killed him.
He said that’s the kind of higher education system we ought to support.
“They make people’s lives better,” he says. “I’m a living example of it.”