The good of every patient

Ethical Decision-making in Pharmacy

The pharmacy patient approached the pharmacy counter to pick up his prescription, which he had dropped off a few minutes before. The prescription was for warfarin. When the pharmacist presented the completed prescription to the patient, the patient went out of his way to make sure the pharmacist saw he was also buying full-strength aspirin. The pharmacist did not warn the patient that there could be a problem in taking aspirin along with warfarin.

Timely reminder

Actually, this was not a real patient or a real prescription. It was part of both an ABC News investigation and a study conducted by Auburn University School of Pharmacy.[1] The “patient” was an ABC “20/20” producer who, along with his colleagues, surreptitiously filmed 100 encounters testing various aspects of pharmacy counseling and errors. In the 25 cases similar to the one above, only eight “patients” were warned of the potentially serious combination of warfarin and aspirin.

The producers all paid cash. Of the 100 new prescriptions presented by ABC producers, counseling was offered for only 27%. Twenty-two percent of the prescriptions contained some error, although many were minor. ABC commented, “. . . with only a few exceptions, our producers were never told they were signing forms that also included language to waive the legal right to counseling with a pharmacist.”

This study and the resulting television episode presented on ABC’s “20/20” took place in 2007. Whether the results would be different today could be a subject of debate. This investigation can still provide pharmacists and technicians with a warning that they may be on “Candid Camera,” as well as an opportunity to consider how important their role is in the health of their patients.

More than a science

The second tenet of the Code of Ethics for Pharmacists is “A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner.” In the midst of hectic and stressed days we can all be guided by the words accompanying this standard, which reads in part, “With a caring attitude and a compassionate spirit, a pharmacist focuses on serving the patient in a private and confidential manner.”[2] It presents a lofty goal.

Pharmacy is a science. It involves the science of pharmacokinetics and pharmacology, as well as biology and sometimes psychology. In pharmacy schools today, students spend countless hours learning about drugs, including what makes them work and factors that may make them work better. Each semester and each quarter, these students are tested on how well they have absorbed this knowledge. 

But today pharmacy practice is more than a science. It is also an art - the art of communication. When the ABC producer laid the aspirin on the counter in front of the pharmacist delivering the warfarin prescription, there was doubtless no lack of knowledge on the part of the pharmacist that could have placed a real patient at risk. What was lacking was effective communication.

Communication is key 

If we as pharmacists are to live up to the principle set forth in the code to “promote the good of every patient” we must each study, practice, and excel in the art of communication. Good communication entails more than counseling. A Pharmacist's Letter continuing education program on counseling made the point this way: “Communication is much more than speaking clearly. It involves listening and understanding.”[3]

Pharmacist communications involve finding out what patients already know and communicating to them what they still need to know in order for them to make full use of their medications in the best way possible. Communication is a combination of the written and the oral. They are also caring and compassionate.

References

1. Program was broadcast on ABC 20/20 in 2007, see Results of the ABC News ’20/20′ Undercover Pharmacy Investigation, March 30, 2007, http://abcnews.go.com/blogs/headlines/2007/03/results_of_the_/ [accessed 3/2/2013]

2. http://www.pharmacist.com/code-ethics (last accessed March 3, 2013). The APhA website give adoption added of this edition of the Code as October 27, 1994.

3. Pharmacist's Letter, Online Continuing Education and Webinars, Communication Skills for Effective Patient Counseling, Volume 2010, Course No. 224, Self-Study Course #100224.