have spent over 30 years in pharmacy education. am excited and frustrated about the future of pharmacy education and the profession. So, for what it's worth thought would share some of that excitement and frustration. In the month of July this year was asked to serve on 2 national adherence panels over a period of 2 weeks ... 1 in Washington, DC, and 1 in Boston. There were many important constituents there ... the American Academy of Family Practice Physicians, National Association of Chain Drug Stores, Pharmaceutical Research and Manufacturers of America, American Association of Retired Persons, the National Consumers League, CVS Caremark, Centers for Medicare & Medicaid Services, National Council on Patient Information and Education, etc. What struck me was how little some people knew about what pharmacists could do or how little they really saw pharmacists as part of the solution to the adherence problem (crisis). What also struck me was how many of the solutions discussed had nothing to do with how we (any health care provider) talk to patients .... instead we heard about e-prescribing, dosage simplification, more information and education for patients, electronic pill bottles, assessments of patients (electronic or written), identifying potential adherence problems, etc. There is no doubt that all of these tools or methods are useful and may be very helpful. However, they are all somewhat limited. And if we do identify an adherence problem with a patient or discover a potential problem, do we know how to talk to a patient in a way that does not create defensiveness and more resistance? What seemed equally important to some attendees was how can we do all of this in 2 to 5 minutes? Both conferences focused on adherence to medication regimens. If we do assist the patient in being more adherent to his/her diabetes drug regimen, do we need to talk to the patient about lifestyle changes? It is unlikely that the medication alone is sufficient to manage the illness. Here is something that has become very apparent to me ... there are several fundamental inadequacies inmost health care (pharmacy) practitioners' training in school: Still taught a paternalistic model of care. Students are taught that they are the expert and this leads to a very paternalistic model of care in which patients are told what to do and failure is attributed to the patient's actions, not their own. A more effective model is a patient-centered model in which patients are also experts.. .experts on how they make sense of what is happening to them, whether they want to engage, what the illness means to them, how they will fit managing the illness into their lives, etc. This must be assessed and care must be negotiated. Adherence is done at the individual level. It is not a statistic. A few examples will clarify this point. Two patients forget to take their medication on a regular basis and as a result, they are not controlling their illness. One patient has a difficult time remembering because it is hard to work taking his medication into his daily routine. He wants to take it but forgets. The other patient does not think the medicine is necessary or all that important and therefore forgets to take it. Two very different solutions and approaches are needed to improve adherence with these patient. Example 2: A patient has osteoporosis and the physician is about to prescribe a once-a-month dosage regimen because the pharmaceutical company representative told the physician that adherence improves as you simplify the dosage regimen. Unfortunately, this patient would prefer to take the medication daily because that would help her establish a routine and once a month would not. But, she is not asked and consequently has difficulty with the once a month dosage regimen, eventually stopping it. At the pharmacy, the medication is dispensed without question or consultation. The patient is asked to sign here when she picks up the medication, after a box is checked that says, I do not want to talk to the pharmacist. …