Passing the Buck

A gentleman approached me just before I was about to step on stage at the last PXP Pharmacy Experience Pharmacie conference.  He shared with me an experience he had with his mother’s pharmacist.

His mother, a senior in her 80’s, needed a renewal of her ramipril so he went with her to the pharmacy to assist.  The pharmacist had a look at his mother’s file and said she would have to contact the doctor as there were no more refills. The gentleman, being in the know with the profession of pharmacy, advised her that this was not the case, the pharmacist indeed had the authority to extend the prescription if needed. The pharmacist insisted she must contact the doctor and refused to discuss it further.

While certainly there are times when referral to a physician is most appropriate rather than prescribing for continuity of care, what is highly disappointing in this case is that no assessment took place.  The pharmacist did not speak to the patient; no questions were asked, no discussion regarding her hypertension control, when her last appointment with her Dr. had been, does she home monitor, is she having any dizziness, etc.

I find this situation disappointing, but I also understand it is quite common.  As I’ve travelled across the country and had conversations with many pharmacists in community practice, management, academia and leadership positions, it seems a common trait for pharmacists to have difficulty making a clinical decision and taking responsibility for patient care.  The preference seems to be to defer decision making to another professional rather than take responsibility for the possible outcomes.   But what are the outcomes for the patient when our choice is to refuse care?  

Choosing not to provide care for a patient is a clinical decision in itself.  In this case, the outcome could be a gap in adherence or inappropriate accessing of emergency services or a walk-in clinic.   It is puzzling to me that many pharmacists seem to have a fear of causing harm by taking action, but do not feel a sense of responsibility towards the patient for the possible harm caused by inaction or delay of care. 

I have no doubt some will say that I must not have all the facts.  The pharmacist was likely under pressure, short of time, had many others waiting, etc.  We are all busy.  We all have patients waiting, phones ringing, billing issues and insane rules for paperwork.  Many of us, as we have heard, are feeling anxious, frustrated, worried, unsupported, jaded, disappointed and bitter.   But let’s look at this from the patient’s shoes.  A patient comes to a pharmacist requesting care, and the health professional turns her away; that’s the patient experience

Caring for the patient and taking responsibility for the decisions we make is a hallmark of being a health care professional.  If we want to be treated as professionals and not mere dispensers of drugs, we need to ensure we act like health professionals in every patient encounter.   Not taking action is not the solution to uncertainty and choosing not to care for a patient when it is within our competency and scope is a decision we are still responsible for.  There is simply no passing the buck or skirting the responsibility for care.  At some point it comes home to roost that if we are merely filling orders rather than caring for patients, we will continue on the path of being considered glorified technicians.

After speaking with this gentleman I stepped on stage and was heartened to see the engaged group of pharmacists who took the time out of their busy lives to attend an event meant to push pharmacy forward and make us all better professionals.  There was hope, not just fear,  brainstorming instead of stagnation, empathy replacing bitterness, and new energy in place of exhaustion.  We all face pressure, and pharmacy is in a tough place on many fronts;  I feel it every day when I walk into my dispensary.  But we must never forget to care for the patient, because without patients to serve there is no “pharmacist”.

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