Tomorrow's Pharmacist October 1999 p24-26
Edited by Pamela Mason

Professionalism

On being a professional

By Judith A. Rees, PhD, MRPharmS

What does being a professional mean? During the transition period between being a pharmacy student and becoming a pharmacist, this is a reasonable question to ask. What will patients, colleagues and other healthcare workers expect of you as a professional person?

Read any newspaper, magazine or watch TV and you will see and hear the word "professional". It is bandied around to describe footballers, soldiers, salesmen and even students. More traditionally, the term profession is reserved for lawyers, doctors and clerics. One of many definitions for the term profession is: "an occupational group that reserves to itself authority to judge the quality of its own work". By this definition, the existence of the Royal Pharmaceutical Society with its Charter and Statutory Committee signifies that pharmacy is a profession and thus pharmacists are professionals, but students are not.
What is different about a person when they become a professional compared to someone who does not? What do the public expect of a professional? What do colleagues/other health care workers expect of a professional? What is meant by the term "professional judgement"? In this short article I would like to suggest ways in which a professional behaves and acts and what may be expected of professionals by the rest of society.

Code of ethics

Since each group of professionals has its own code of ethics, this is one place to start. All pharmacists should be conversant with the Code of Ethics published by the Royal Pharmaceutical Society. But being conversant is not enough. A professional needs to be "at one" with the code, to be committed to, and have the same attitudes that are expressed by the code. For example, principle one of the Code of Ethics states "a pharmacist's prime concern must be for the welfare of both the patient and other members of the public." But what does this statement mean in practice to a new pharmacist? Clearly, as a new pharmacist, you would not wish to harm the patient and others, but what is "prime concern" and "welfare?
Basically, it means that as a pharmacist, you should be the sort of person who:

Has time for, and considers the needs of, the patient
Respects the views of others
Is empathetic and non judgmental towards others
Acts fairly towards the patient and others at all times.

This does not mean that every request from a patient must necessarily be fully met. As a pharmacist you will need to use your professional judgment in order to decide if the request can be fulfilled, taking into account both ethical and legal values. Under no circumstances should you, as a pharmacist, compromise yourself by acceding to unacceptable patient requests. For example, as a community pharmacist if you consider a medicine is inappropriate for a patient, then, no matter how eloquently or persuasively the patient makes the request, you should not sell it to them. It is your professional duty and responsibility to refuse to sell.

Trust

In making the patient your "prime concern", it is important that as a pharmacist you do not betray the trust expected by the public of a professional. But what is this trust expected of professionals? Trust means, firstly, that as a pharmacist you are expected to be honest in all your dealings with the public, not telling half truths or misleading patients or others. Secondly, as a professional you will be expected to keep promises. Therefore, if you offer to do something or find out information for a patient, then this offer is a promise and, as a professional, it is essential that you keep that promise. If you cannot keep your promises, then you will need to find some way to avoid making them without discrediting yourself and the profession. Thirdly, trust means that you should not betray confidences. For example in their daily work, many pharmacists acquire details about patients' illnesses, medicines, social circumstances etc. This information, whether acquired indirectly or directly from the patient, should always be treated as confidential and not divulged to anyone else without the permission of the patient. Only in an extreme situation would a professional ever consider breaking this confidence. So as a pharmacist you will be a repository for information that is confidential and you must learn not to break this confidentiality, however tempting.
However, while patients are the pharmacist's "prime concern", pharmacists do not exist in a world that is exclusive of people who are patients. Pharmacists work with colleagues, and in addition, interact with other professionals (eg, doctors, nurses, accountants), and indeed, non-professionals (eg, counter staff, porters). The relationship between you, the pharmacist, and all these other individuals should always be professional. In a similar way, to the relationship with patients, as a pharmacist you will need to respect the autonomy of these colleagues and healthcare professionals, their opinions, ideas and views. Instinctively as a professional pharmacist you will not want to betray their trust and so you should be honest, act confidentially and keep promises to these colleagues and others. One of your main aims should be to work with these individuals, maintaining good relationships, which will benefit the patient and ultimately promote and secure the future of pharmacy.
However, in the same way that a pharmacist would not accede to an unreasonable request from a patient, as a pharmacist acting professionally, you would not compromise yourself or other pharmacists by acceding to an unacceptable (unethical or illegal) request from another colleague or health care professional, even if it makes you unpopular.
So far I have described what is expected of the relationship between pharmacists, their patients and others. But what of pharmacists themselves? How do you as a pharmacist need to behave and what activities should you undertake in order to be described as a professional? It should go without saying that a pharmacist should act within the law and at the same time act according to the Code of Ethics. But is this possible? In most situations the answer is yes. However, at some time or other, as a pharmacist, you may find that the law and the Code of Ethics conflict or indeed there may be some internal conflict within the Code itself. In such a situation, as a pharmacist you will have to use your professional judgement to resolve the problem.

Professional judgement

What do we mean by professional judgement? Professional judgement involves finding out all the facts of the situation, as far as possible, then based on these facts, determining the options or courses of action that are reasonable and open to the pharmacist. At this point the pharmacist has to choose the option that he or she considers to be the best. This chosen option may not be considered the best by another pharmacist, but remember it is the individual pharmacist's choice or judgment of the situation. Having used your professional judgment, it is essential that you should be able to defend your choice based on ethical and logical reasoning.
Similarly, as a professional, a pharmacist should act fairly or with justice at all times. Thus, whatever the situation and whoever is involved, a pharmacist should always seek out the facts and evidence and act on these, not jump to false conclusions. In this way as a pharmacist you may not please all the individuals involved in the situation, but you will be seen to have acted in a fair and just manner, that is in a professional way.

Continuing education

If as a pharmacist you are going to perform your duties competently, then you will need to keep up to date with all aspects of professional practice. Thus, there will be a need continually to update your existing knowledge and skills, as well as acquiring new ones. Such skills and knowledge are essential if as a pharmacist you are going to be able to maintain and progress pharmaceutical standards, whatever branch of the profession you are employed in. Indeed the Code of Ethics requires pharmacists to "keep abreast of the progress of pharmaceutical knowledge". So any new pharmacist, if they are to be a true professional, must embark on continuing professional education.
Continuing education involves more than passively attending a few courses, it involves the pharmacist taking some responsibility for his or her own learning. Thus, as a pharmacist, you should approach continuing education in the broadest sense, using all available resources at your disposal. These resources include, among others, the pharmaceutical literature, branch meetings, and distance and computer assisted learning. Without competent, committed and up to date pharmacists who use their skills and knowledge, the profession will not progress, and any profession that stays stationary will ultimately disappear. Therefore, it is the professional responsibility of all new pharmacists to progress the profession, so that it survives well into the next millenium, for the benefit of patients and others.

Dr Rees is senior lecturer, school of pharmacy and pharmaceutical sciences, University of Manchester

Tomorrow's Pharmacist October 1999 p24-26 Edited by Pamela Mason