Martine Kruijtbosch

36 Chap t e r 2 .1 PHARM-350: A dentist prescribed amoxicillin. The pharmacist knew that the patient had previously had an allergic reaction on amoxicillin. The dentist could not be reached, but the patient urgently needed medication. ‘ What if the dentist does not agree with the alternative antibiotic clindamycin? ’ Loyalty conflicts Pharmacists had a conflict of loyalty when their decisions would either affect their professional relationship with colleagues or result in suboptimal patient care. PHARM-115: A physician asked the pharmacist to urgently prepare a midazolam infusion to start palliative sedation for a patient registered at a neighbouring pharmacy. The physician explained that the pharmacist of that pharmacy was not able to prepare the infusion that day. ‘ In my opinion not dispensing wasn’t an option because of the condition of the patient. On the other hand, I didn’t want to overrule the decision of my colleague-pharmacist who is the responsible professional for this patient. ’ Physician's self-prescribing Although this is a well-known issue 47 , only one case of physician self-prescribing was reported: PHARM-1176: A physician prescribed midazolam for himself. ‘ Dispensing felt problematic because sleep medication might have negative effects on the physician’s daily functioning .’ Moreover, the pharmacist did not want to become the accomplice of an addicted physician. However, not dispensing could damage the professional relationship and future collaboration. Category 3: Various relationships or involved parties The previous categories of dilemmas involved patients or health professionals. In the following themes other ‘stakeholders’ were involved, such as health insurance companies and manufacturers. We also included dilemmas with (unborn) children and adolescents in this category, as pharmacists in these situations have a complex responsibility towards these unborn children, minors and their parent(s) or legal representatives. Reimbursement for a pharmaceutical product/ care activity or additional service Pharmacists experienced dilemmas when patients were not insured and not able to pay their medication out of pocket, because these patients needed their medicines. Also, concerns about pharmacy workload sometimes conflicted with pharmacists’ wish to deliver optimal but time-consuming patient care. Providing additional services for some patients would mean compromising on other services.