Martine Kruijtbosch

32 Chap t e r 2 .1 TABLE 1: Themes of moral dilemmas experienced by community pharmacists in clinical practice (N=128) Category 1: The pharmacist-patient relationship n=59 • Drug abuse or addiction 10 • Drug misuse 6 • Deviating treatment preference 10 • Claiming and/or aggressive behaviour 7 • Medication understanding 6 • Patient’s privacy 6 • Sharing relevant patient data with health professionals 5 • Public health policy and third-party payer regulations 9 Category 2: The pharmacist-colleague relationship n=35 • Disruptive behaviour of a physician* 9 • Disruptive behaviour of a colleague 5 • Pharmacist and physician have a different opinion about appropriate pharmacotherapy 7 • A troubled relationship with the physician 4 • Deviating from a prescription with the physician* absent 3 • Missing relevant patient data with the physician* absent 3 • Loyalty conflicts 3 • Physician's* self-prescribing 1 Category 3: Various relationships or involved parties n=34 • Reimbursement for a pharmaceutical product or pharmaceutical care 9 • Risk of harm to children 7 • Risk to the unborn child 5 • End-of-life pharmaceutical care 6 • Dispensing without a prescription 5 • Quality defects 2 * In this study dentists were also grouped as physicians PHARM-1082: The pharmacist is aware that a student has been collecting methylphenidate only twice a year (coinciding with exams in January and June). The prescriber is the patient’s father. ‘ Should I cooperate, give priority to the patient’s autonomy and dispense this medicine when I doubt whether the drug is actually indicated for a ‘chronic’ illness? Or do I need to address this presumed off-label use? ’