Date of prep: December 2020
Prescribing information and
adverse events reporting
For healthcare professionals only
I have interacted with Professor Watson online over recent years so it was a pleasure to sit down with her recently in person. We chatted for three hours. Conversation flowed and the time flew by. Margaret (Mags) has a wealth of experience and has spent the vast majority of her career working as a pharmacist in academia.
I found Mags to be extremely modest about her myriad of achievements. Her work in gathering evidence to prove the value of community pharmacy was an aspect of her career that caught my eye. This is just one aspect to a varied and interesting journey as a pharmacist working in academia in which she has delivered a range of very impactful research outputs.
I recommend any pharmacist considering a career in academia to read her thoughts below.
Why did you become a pharmacist?
I became a pharmacist because I wanted to do something health-related and have a career which would involve helping people.
If you hadn’t become a pharmacist what career path would you liked to have pursued?
Before being accepted for pharmacy, I considered a variety of careers including medicine, veterinary medicine, etc. Latterly, I would’ve enjoyed being a marine biologist. This would have reflected my interest in science as well as my interest in the environment and natural history.
What roles have you undertaken as a pharmacist over the years?
I have had different roles in the pharmacy since I qualified in 1987! The first eight years of my career were spent in secondary care during which time I worked in a variety of hospitals; I also completed an MSc Clinical Pharmacy. I really enjoyed my time as a hospital pharmacist especially working as part of a team and the patient contact. I also undertook locums in a variety of community pharmacies and hospitals during this time. In 1994, I started my PhD in the School of medicine, the University of Bristol and I have worked in academic research since then with different universities including the University of Aberdeen, University of Bath and currently the University of Strathclyde, Glasgow, Scotland. During my time with the University of Aberdeen, I undertook a three-year 50% secondment to the public health team with NHS Grampian where I developed, delivered and evaluated a wide range of public health initiatives, most of which involved pharmacy in some way, usually community pharmacy.
Which role did you find most challenging and why?
Each role has different challenges. Academic research is challenging. You need to LOT of resilience to pursue and maintain a career in research in the UK. There is a constant drive for seeking research funding. This process is highly competitive and the need to produce high-quality publications of the results derived from your research is therefore high. I always tell colleagues if you can’t take rejection then don’t do research because research comprises a huge element of rejection! No sympathy required-it’s just part of life J I thrive on working with can-do people -people who have enthusiasm for their role, whatever it is, and a willingness to help others. It’s incredibly challenging to work with people whose work ethic does not reflect a collegiate, collaborative approach. I’ve yet to work out how to detect these people and avoid them or optimal ways of working with them when we have no choice. I think life is largely about relationships with others that are the most challenging but also most rewarding. I have had the pleasure and privilege of working with some wonderful colleagues over the years, and I hope this continues for the remainder of my career.
What led to your career in research?
My research career started ‘properly’ when I worked as a rheumatology and self-medication pharmacist at Bristol Royal infirmary. The rheumatology team was incredibly research active, and I caught the bug. As a pharmacist, I was used to making retrospective interventions to influence prescribing that had already taken place and I became frustrated with NSAID prescribing for our rheumatology patients. There were huge variations and no apparent rationale for the drugs that were being used. I knew that if I was to influence non-steroidal prescribing with these patients, it was general practitioner prescribing that would need to be targeted. So with the support of Professor Paul Dieppe who led the Rheumatology Unit, I successfully applied for a research and development training fellowship which fully funded my PhD for three years.
The thing I really enjoy about research is identifying real-world challenge i.e. questions, problems, and then devising strategies about how to try and explore and improve these challenges and ultimately improving patient outcomes; that’s the ultimate goal of my research.
What is a predatory journal?
I’m not sure what a predatory journal is!? I had to look this up to answer the question. I believe that research should be peer-reviewed before it is published to try to ensure that only good quality, rigorous and ethical research is made available within the public domain.
Do you think the impact factor of research is a useful measure?
The impact factor of a journal is constructed from the number of citations of its articles. Some journals have impact factors, and some don’t. Usually the higher the impact factor, the more prestigious the journal. The decision to award a journal an impact factor is complex. In terms of pharmacy, it can be frustrating because I’m a member of the editorial board for the International Journal Pharmacy Practice and it does not have an impact factor despite trying really hard to achieve one. The research published in this journal is high quality and peer-reviewed. And yet we don’t have an impact factor. So this can be frustrating. In addition, even high impact journals get things wrong sometimes e.g. the Lancet and the MMR story. We also know that female academics tend to submit their research to journals with lower impact factors compared with male contemporaries, and this introduces a bias into the process. So, while the impact factor of a journal can be used as an indicator for prestige and standing amongst the academic community, it’s not the be-all and end-all. Some universities will consider the impact factor of a journal for individual researcher’s promotion applications, but this is not the case across all universities. The important thing to consider when looking for a journal in which to publish research is the likely readership of that journal and how relevant the readership is to the research that you are presenting.
Is research governance adequate in the UK?
I think the UK has very strict research governance processes and procedures, the main purpose of which is to protect patients and other participants and to ensure that the research is ethical, necessary, and rigorous.
What piece of research that you have published are you most proud of and why?
I have two pieces of research which I am most proud off for different reasons. The first is a Cochrane systematic review that was published in 2018 on the same day that I presented it at the FIP conference in Glasgow. It’s the largest collection of randomised controlled trials of pharmacist services to non-hospitalised patients that have ever been undertaken. It was a huge effort for the research team which I led and we really needed a lot of resilience and tenacity whilst conducting this review. However, it was worth it, because the results clearly showed the very important clinical benefits that could be derived for patients from pharmacist interventions for some health outcomes such as HbA1C and blood pressure reduction. So, in terms of scale and importance, I’m really proud of what we achieved. A few years ago I led a research program called the MINA Study. Part of that study was to develop, deliver and evaluate a cohort study which compared symptom resolution of minor ailment consultations for people who presented with these consultations either in pharmacies, general practices or emergency departments. It was incredibly difficult to plan and deliver but the results were worth all the effort. The study showed that for people with similar minor conditions presenting in different healthcare settings, their health outcomes were similar irrespective of the setting from which they chose to seek care. In other words, symptom resolution was as likely if you went to a community pharmacy compared with a general practice or emergency department. This study has been used but in some health policy documents to promote the use of community pharmacy for the management of these conditions, particularly during out of hour periods.
Given your extensive research in community pharmacy what is your advice to community pharmacists on over the counter patient interactions?
Over the counter patient interactions are incredibly important. One person who I interviewed referred to them as “the shop window for community pharmacy”. These consultations are healthcare consultations: an individual has actively chosen to seek care from the community pharmacy and buy their products or seek advice from that setting. These consultations are an important opportunity to identify the major disease and refer appropriately, as well as effectively managing minor disease or illness with effective evidence-based recommendations. I cannot emphasise enough the importance of information gathering during these consultations to make appropriate, safe and effective recommendations. Many people dismiss OTC medications and consultations as inconsequential and focus more on prescription medicine services etc. OTC consultations are SO important and we need to enhance the quality with which they are managed. The cohort study that I mentioned above provides valuable evidence of how effective these consultations can be and, if we are encouraging the public to seek care from community pharmacies for these types of consultations, then we really need to treat these consultations with the respect and importance they deserve. Yes, this is something I feel very strongly about and I’ve spent years researching to try to improve practice…with limited success.
What was the toughest lesson you had to learn as a pharmacist?
I suppose there have been several lessons learned throughout my career in different roles. As a hospital pharmacist, the importance of getting things right, avoiding error, maximising safe and effective advice and care is paramount. As an academic researcher, tenacity and resilience when research applications and publications are rejected: when this happens repeatedly it can be daunting but if you believe you are undertaking worthwhile, meaningful research it’s worth the pain. Usually 😉
What is your advice to the next generation of pharmacists?
My advice to the next generation of pharmacists is to remember that healthcare is a multidisciplinary endeavour: good communication and interpersonal relationships with whoever your other team members are is imperative even more so than technical knowledge! Place the patient at the centre and listen to their voice; find out what matters to them. Find yourself good role models and ask them to be your mentor. Be open to new learning throughout your career, actively seek information and intellectual stimulation whatever role you find yourself in. If you don’t know something, ask someone or look it up, or both! In the not too distant future, pharmacists will be defined not by the setting in which they work, i.e. community, practice, etc.; they will be defined as a pharmacist member of the team. We are living in very dynamic, challenging times, so it’s important to be agile in our thinking and our behaviour and our willingness to change when change is required. Pharmacists are society’s experts on medicines – let’s remember that, focus upon that and help to ensure that the most commonly used intervention in healthcare (i.e. medication) is done in a safe and effective manner.
How does it make you feel being a member of the RPS?
I think it’s really important to be a member of one’s professional body and to contribute to that organisation as well as to benefit from it. Being made a Fellow of the RPS recently was a career-high for me as a pharmacist, as it reflects my efforts throughout my career and the opinions of my peers.
There are lots of self-declared leaders in our profession. Which pharmacists have inspired you in your career?
Many pharmacists and other health professionals have inspired me throughout my career. As a pre-registration pharmacist with NHS Tayside, people like Libby Service and Lucy Burrows showed me what can be achieved as clinical pharmacists and a set me on the path to seeking a hospital pharmacy career. I find many community pharmacists inspiring because of their innovative and entrepreneurial approaches to developing health services. These include people like Ade Williams (Bristol) and Bernadette Browne (Glenrothes). Then there are the educators in pharmacy, people like Dr Philip Rogers and Lyn Hanning at the University of Bath, who work tirelessly to develop effective and stimulating curricula for undergraduate pharmacists and to support them throughout their degrees. In terms of research, Professors Christine Bond (Scotland) and Alison Blenkinsopp (England) and Dr Ross Tsuyuki (Canada) have undertaken meaningful research which inspires me to continue my research career.
What’s next for you?
One of the things I’ve learnt in life is that you never know what opportunities will come your way, or that you will create for yourself and your career. I’m going to continue to build health services research and pharmacy practice research with my colleagues at the University of Strathclyde where I work 50% time. I will continue to grow my consultancy business, Watson Research and Training Limited, by providing consultancy, research and training to and for individuals and organisations who need these services. But one of the important elements of my business is coaching and mentoring and I want to do a lot more of this in the future because this is a hugely important part of enabling other people – pharmacists, other health professionals and academics – whoever they are, to try and achieve their potential. Who knows what else the future holds? I certainly know that the older I become, the more willing I am to take risks in terms of career development and change and to seek opportunities for healthcare improvement, creativity and as well as enjoyment.
Pharmacy in Practice is a UK pharmacy publication with its roots in Scotland.