Martine Kruijtbosch

156 Chap t e r 4 participants]) , action option F (‘ I contact the primary care physician again and open the discussion with him ’ [one participant]) and action option G (‘ I tell the primary care physician that I contact the psychiatrist if the former does not want to prescribe ’ [one participant]) . The differences were rooted in different viewpoints regarding the pharmacist’s attitude in relation to the disruptive behaviour of the primary care physician. The CP wanted a physician’s consent to dispense the extra lithium pills. She felt that her professional autonomy was equivalent to ‘bypassing’ the primary care physician when she would contact the psychiatrist instead. The dialogue revealed here that other participants were not so hampered by the primary care physician’s disruptive attitude in their actions to help the patient. Participants choosing action option A would dispense the extra lithium and, after that, talk to the physician. Participants choosing action option F would confront the physician with their shared care responsibility towards the patient’s well-being. Based on the professional values commitment to the patient’s well- being, pharmaceutical expertise and reliable and caring, one of the participants who chose action option A expressed the following: ‘ It is important for me that the patient attaches importance to his treatment adherence. That is important with this therapy. I think that I have insufficient reason to doubt that the patient is not adherent to the treatment. But given the risks of two days of dispensing the (extra) lithium pills, I would choose to reassure the patient so that he can continue with his therapy. But, of course, afterwards share your concerns with the primary care physician: where is the follow- up, when is the patient monitored.’ (Participant) The participant who chose action option F shared her view on the handling of the dilemma case in the light of professional autonomy and responsibility to society: ‘ You understand that the primary care physician may not have the expertise to optimally treat the patient and may therefore withdraw from it. You can interfere with the treatment, but ultimately, the primary care physician has a more coordinating role in this. So somewhere it is not going well in the care chain . . . I think it is very good that you as a pharmacist show the physician . . . that the relationship is not quite right, and that by confronting him, you show that you want to treat the patient together. And that is not the case now. ’ (Participant) Participants’ evaluation of the MCD session All participants reported in the online questionnaire that the MCD session was useful and they felt supported in all the relevant phases of ethical decision-making (Tables 2 and 3). One participant evaluated the MCD session as follows: ‘ Ultimately, it helps to choose a more well- founded conclusion and course of action. I think it is a nice method to be involved in the profession. More fun than intervision .’ (Intervision is a meeting in which peer supervision and methodical discussions help participants to reflect on their personal and professional development. 41