The Pharmaceutical Journal
Vol 271 No 7260 p146
2 August 2003

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  Community pharmacy
  Cholesterol
  Prescribing
  CPD
  The Journal

Letters to the Editor

Community pharmacy

Acting in the patient's interest

From Mr H. P. Radnan, MRPharmS

Recently, while working as a locum, I dispensed a prescription for diclofenac tablets 50mg three times a day for a woman. That afternoon her husband telephoned me. He had been reading the patient information leaflet and was concerned about the possibility of gastric side effects. He told me that, on a past occasion, his wife had experienced severe and prolonged gastric irritation after taking an aspirin tablet and they were concerned that diclofenac might invoke a similar adverse reaction.

I reassured him that he was correct in contacting me, adding that I agreed with his concern, and they should contact the doctor for him to review the prescription.

Later that afternoon, the patient's husband came into the pharmacy to speak to me. He told me that he had spoken to the doctor, had explained the reason for his concern and had mentioned his subsequent conversation with me. The doctor's response was that the patient had the option of either taking the tablets as prescribed or continue suffering the pain of muscular spasms in the neck with which she had presented and, furthermore, he was not prepared to reconsider his prescription. What was his wife to do, he asked me.

From this incident I learnt three things. First, always make sure that there is a PIL with dispensed medicine. I know how difficult this can be, particularly when dispensing from bulk. But, not only is it a legal requirement, in this patient's case being unaware of potential adverse reaction could have resulted in severe iatrogenic consequences. Secondly, take the time to listen to patients with sympathy and courtesy. One cannot be sure of the patient's mental state or level of comprehension, and the manner and tone of one's response might well make the difference between compliance and non-compliance.

Thirdly, and most importantly, is that I find myself in conflict between my own professional judgement and the advice given by the patient's doctor. The dilemma is that, on the one hand, there is the requirement that we, as pharmacists, should not say or do anything which might undermine the patient's confidence in his or her doctor and, on the other hand, we, as pharmacists, have our own professional responsibility to the patient and we are independently held accountable for our professional actions.

I decided, in this situation, that my first responsibility was to act in the best interest of the patient. The risk-benefit ratio was stacked in favour of the risk of an iatrogenic outcome, and I advised against taking the tablets, knowing that in giving this advice, I could well be undermining the position of the general practitioner. I then gave advice on suitable medication which would avoid the use of non-steroidal anti-inflammatory drugs.

Paul Radnan
Salford

We must play a waiting game

From Mr H. Argomandkhah, MRPharmS

Here we go again! Pharmacy announcements are like the number 10 bus: you wait for hours then three come along at once.

We have now had the long-awaited response to the Office of Fair Trading report from Patricia Hewitt, the Secretary of State for Trade and Industry (PJ, 26 July, p105). It has raised more questions than it has answered and has muddied the already murky waters of the contract application system.

Then the new Minister of Health announced the aptly named "Vision for pharmacy in the new NHS", which is full of rehashed old initiatives, many of which were launched in September 2000 but never fully delivered (ibid, p106).

Finally, Dr Jim Smith, the chief pharmaceutical officer for England, has identified 10 key roles for pharmacy, none of which any pharmacist would disagree with (ibid, p111).

However, in a Government obsessed with spin, counter spin and a wish to bury the bad news, we should not get overexcited until we have had a chance to look at the details. We must wait until a properly constructed and rewarding new contract has been fully negotiated and agreed in the community. We must wait until full details of the Government's response to OFT are given. And, finally, we must wait to see if Jim Smith's 10-point plan is worth the paper it is written on.

Hassan Argomandkhah
Liverpool

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