Martine Kruijtbosch

34 Chap t e r 2 .1 Patient’s privacy/Sharing relevant patient data Sharing patient data with either health professionals or informal carers may be necessary from a clinical perspective. Dilemmas occurred when the pharmacist felt a need to share data, but patient’s consent to share data was absent or patients even requested not to share these data. PHARM-252: A woman treated for a bipolar disorder told her pharmacist that she wanted to discontinue mirtazapine. She explicitly asked the pharmacist not to notify her psychiatrist. ‘ I explained to her that I couldn’t provide proper pharmaceutical counselling because I didn’t have relevant background information .’ Although the pharmacist wanted to respect her autonomy, he also felt he should notify the psychiatrist. Public health policy and third-party payer regulations In general, current health policy is directed at curbing increasing health expenditure. Dutch health insurance companies reimburse only generic products unless the physician has medical reasons for prescribing a branded drug. While pharmacists recognised their responsibility to reduce health expenditure, this also disturbed their relationship with patients who strongly objected to generics. PHARM-84: A patient, objected strongly to generic salbutamol. ‘ After persistently trying to explain the drug reimbursement policy to him, I convinced him to try the generic for at least 14 days. A few hours later, he reported numerous complaints. Later the patient came with a prescription for the branded aerosol and a statement from his physician declaring the necessity of him having the original drug. Somehow, I felt the patient had never really tried the generic .’ The pharmacist had doubts about whether he should start the conversation with the patient again or fill the prescription. Category 2: The pharmacist-colleague relationship Disruptive behaviour of a physician/A troubled relationship with the physician Pharmacists described situations in which the relationship with physicians was troubled. Sometimes physicians even behaved disruptively e.g. by not listening to the pharmacists’ pharmacotherapy suggestions. This deprived the pharmacists of relevant information and caused frustration because their expertise was not appreciated. Pharmacists had reservations about the safety or effectiveness of prescribed treatment. Not dispensing, however, was equally problematic because reasons for the chosen treatment might have been valid. Moreover, pharmacists were anxious to further disrupt their professional relationship with the physician.