Martine Kruijtbosch

33 Mo ra l d i l emmas o f commun i t y pha rmac i s t s Deviating treatment preference Patient treatment preferences might not be supported by evidence-based medicine or professional guidelines. In these situations, the pharmacists considered patients’ preferences potentially ineffective or harmful. PHARM-1235: A mother requested paracetamol for her 1-year-old baby who had a high fever for a week. ‘ I tried to convince her to consult her GP as her baby might have a dangerous infection. She didn’t agree. Her attitude frustrated me. I want to do what is best for the baby, but at the same time have to respect the mother’s decision .’ Claiming and/or aggressive behaviour Claiming or aggressive behaviour of patients undermines the trust-based relationship pharmacists have with patients and frustrates pharmacists because it might prevent them from providing adequate care. This is a complex situation, especially if there are other patients waiting in the pharmacy. PHARM-1062: A patient asked the pharmacist for a prescription of oxazepam that had been faxed 2 months ago. The electronic patient record, however, suggested that the prescription had already been dispensed. The patient became furious and insisted that he had never received the drug and needed it urgently. ‘ I felt attacked, but also had my doubts because of his convincing manner of speaking. Did we make a mistake? Should I dispense once again without a prescription? ’ Medication understanding Patients (or their carers) who had difficulties understanding drug information because of language deficiency or limited health literacy, posed a particular problem. Pharmacists doubted whether these patients would use the drug safely, but not dispensing was not an option if the patient clearly needed treatment. PHARM-314: An elderly Spanish speaking patient did not understand the pharmacist who explained the need for gastroprotection during NSAID use. She kept repeating that she was in pain and only needed the NSAID. This situation did not change even with a translator. ‘ I wanted to assist and advise her correctly but poor communication made that impossible. I had my doubts about dispensing the NSAID without gastroprotection because of the possible health risks .’