Good sense has prevailed
Pharmacists, it is widely acknowledged, are the health care professionals whom members of the public consult most frequently and they are held in high regard by many sectors of society. It is, therefore, with some relief that we note
that guidance designed to safeguard and promote the welfare of children — published
last week by the Department for Education and Skills (p432) — makes some
pragmatic recommendations about
when health professionals should contact social services professionals when
a child is sexually active.
The problem area has been what to do when a sexually active child is under the
age of 13 years. Late last year it was revealed that a number of child protection
committees were drawing up protocols that would oblige all health professionals
to report automatically to social services all such children, irrespective of
the circumstances. The DfES guidance backs away from that black and white view
and leaves the decision up to the discretion of the professional.
Some commentators, including the British Medical Association, suggest that the
DfES approach is confusing. Children under 13 years of age are considered too
young to consent to sexual activity and the Sexual Offences Act 2003 makes clear
that sexual activity with a child aged under 13 years is always an offence. However,
when children are sexually active there may be rare circumstances when they may
benefit from support and advice rather than being reported to authoritarian agencies.
Clearly, if there is any suspicion of them being abused, professionals, including
pharmacists, should not hesitate to take action. This view is supported by the
Royal Pharmaceutical Society, whose Law and Ethics Committee has already approved
guidance for pharmacists on child protection (PJ, 6 August 2005, p175
PDF (80K)). This
will be now be updated to take the new DfES guidance into account.
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Concordance in the real world
Most parents faced with a child with a fever would want to make things better and do as little harm as possible. At first glance it might seem to be a simple issue: if it is a mild fever do as little as possible; if the child's temperature is high give appropriate medicines.
However, a literature
review in the Journal of Advanced Nursing (p435)
reveals how complicated the treatment of even a simple problem can be.
Parents do not understand the implications of mild versus moderate fever
and all too often they either overdose or underdose their children.
The review is instructive for any pharmacist interested in improving
compliance with medicine-taking and illustrates how important, but how
difficult, reaching concordance is. Moreover, if there are barriers to
best practice in treating a relatively straightforward symptom, how much
harder is it for doctors, pharmacists and patients to get things right
when the disease is complicated and unlikely to be self-limiting?
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The
Pharmaceutical Journal