The Power of a Pharmacist

Mate Hegedus-Gaspar Pharmacy Practice

The day-to-day routine of pharmacy work has the tendency to make you forget the power that comes with your position as a pharmacist. Even charge pharmacists often concentrate so much on managing the prescription flow, patient queries, consultations etc, that they think about their position in terms of responsibilities rather than powers.

Of course, you may object, we are constantly reminded of our responsibilities, the things we have to do and how we have to do them. Where is the power in that?

With great power comes great responsibility

Stan Lee

Everybody heard of the Peter Parker Principle that goes “With great power comes great responsibility”. Now let’s not forget that this principle is just as true the other way around. If you are responsible for a particular task, if you are the one that must face the consequences in case something goes sideways, then you must also have the power over that task to make sure you can indeed take responsibility for it.

Note that I said “must” have the power. It is not always obvious that you do, but if you think about it, how could it be otherwise? It would be foolish to accept responsibility for something you cannot control.

These are difficult times for pharmacy. Owners feel the crunch more than ever before. Large corporates have arrived to the market and they are here to stay. Employees and locum pharmacists also feel the crunch, but in different ways. Employment opportunities are not too bad with the expansion of some of the corporates for now. But…

The fact that we see relatively little in the way of questionable, unethical or irresponsible behaviour in pharmacy, shouldn’t lull you to sleep, thinking this is how this is always going to be, so why worry. Despite some concerns raised on social media about some of the market actors, there is nothing anyone can hang their hat on for now. But this is no reason to be complacent.

We must remain true to our calling, keep the highest ethical and professional standards. Every individual pharmacist is responsible for maintaining the required standards, therefore, has the power of control.

You have discretionary powers in your pharmacy over deciding whether to dispense a particular prescription or not, whether to sell a particular product (in general or to a particular person) or not, whether to advertise or allow the advertisement of a particular product or not, whether to display a particular product or not, whether to let someone into your dispensary or not. And the list goes on.

You have powers, use them! Use them so that you can take responsibility for your tasks, and sleep well at night. Don’t let anyone tell you willy-nilly what you can or cannot do. Don’t forget, it’s your backside on the line, not theirs.

Of course, in a team environment others will be affected by your actions as well. Your employer may also bear responsibility for many of the things you do, so they may very well have a say in how you should do your work. Also, there is always more than one way to do things right, and this is not a call for argument over personal preferences.

To sum up, remember to use your powers that come with your responsibilities, be sensible about it, but don’t let yourself be lead down the wrong path.

Self-Prescribing Quiz Results

Mate Hegedus-Gaspar Pharmacy Practice

Last week I posted this quiz as a fun exercise for pharmacists. I was quite surprised by the results, so I decided to share it with you. I will lay out the answers here with my comments. The results reflect the answers submitted until yesterday afternoon.

This quiz was based mainly on the Medical Council’s statement on self-prescribing.

Spoiler alert! If you haven’t done the quiz yet and would like to, you may want to go there first and come back to this analysis afterwards. It shouldn’t take longer than 5 minutes.

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The True Role of Advance Directives

Mate Hegedus-Gaspar Health Law

autumn-10484_640The first National Forum on Advance Care Planning was held in Auckland last week. As much as autonomy is a cornerstone of the New Zealand Health Care system, Advance Care Planning is being taken up rather slowly. Perhaps this is because talking about a patient’s end-of-life expectations and choices can be challenging, but I think there is at least one other reason.

Advance Care Planning involves the recording of a patient’s treatment preferences, future choices in case he/she is no longer able to make decisions. The Code of Rights establishes that a person may use advance directives for this purpose. However, there is a bothersome legal uncertainty around advance directives. As it stands, no-one is quite sure how to tell if an advance directive is valid, and what if an advance directive is not quite in line with established medical practice. There is, perhaps, a certain resistance from health care providers toward advance directives because they are uncomfortable about the ethical and legal issues that may raise.

Unfortunately, advance directives are often depicted as legal instruments with binding force on health care providers, with reference to Right 7(5) of the Code of Rights, which is not helpful. Granted, a legally valid advance directive does have binding force in the same way as a competent person’s informed choice, but in practice it is far less certain how to secure or determine the validity of an advance directive. My suggestion is that it would better to treat advance directions purely as evidence of a person’s wishes regarding treatment decisions. Instead of focusing on validity as a threshold issue, it would be better to apply a holistic view and give advance directives appropriate weight in the decision-making process as evidence of the individual’s personal views and preferences.

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Mail Order Pharmacies in New Zealand

Mate Hegedus-Gaspar Pharmacy Practice

Mail order delivery

Mail order pharmacies haven’t really been a thing in New Zealand. You can find a couple of them on the internet, but they are mainly focused on non-subsidised medicines. Pharmacists I’ve talked to agree that it is part of our health care culture that patients prefer to see pharmacists in person, and most think that it is unlikely that traditional pharmacies are going to face any meaningful competition from mail order pharmacies any time soon.

What’s changed now, though, is that we have a Pharmacy Action Plan, which, amongst other important things, envisages a health system that is “closer to home”. Also, the next Community Pharmacy Services Agreement (CPSA) is currently being negotiated and, as we have been informed at the Guild meeting in Christchurch, some new ideas have been floated by the DHBs that suggest that we may be headed in a direction where the market will become more favourable for mail order pharmacies in New Zealand.

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Consent to Loss of Autonomy

Mate Hegedus-Gaspar Health Law

Drug dependenceThe right to refuse medical treatment is a fundamental human right recognised in our uncodified constitution. The protection of our autonomy is deeply embedded into our health system. Yet, there are situations when we, if unwittingly, expect patients to simply give up their right to the freedom of consent to being treated. Worse, being treated with medication that potentially ruins their life.

The College hosted an excellent Webinar on Drug Misuse last month. It started with a brief summary of our current understanding of the neurobiological basis of addiction. There was a powerful statement that got me thinking about a very interesting but also very concerning aspect of drug dependence that goes all the way to a fundamental principle of our healthcare culture, the principle of informed consent.

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Pharmacy Ownership Liberalisation – What’s The Policy?

Mate Hegedus-Gaspar Pharmacy Practice

mohlogoThe Ministry of Health decided to put the deregulation of pharmacy ownership on the agenda as part of the reform of the New Zealand health system. This is a very controversial topic and you’ll be familiar with it already unless you’ve avoided talking to other pharmacists, or just lived happily under a rock. We know the arguments that have been voiced so far, and the sentiments invoked by the announcement, and I don’t feel it necessary to repeat them here. But I wanted to address the Ministry’s reasoning (or lack thereof) for going ahead with this idea.

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Pharmacy Accuracy Checking Technicians – Where Does Responsibility Lie?

Mate Hegedus-Gaspar Pharmacy Practice ,

check_640There is so much going on in the pharmacy sector at the moment, it’s difficult to keep up with it. You may have read this post about the Pharmacy Action Plan 2016-2020, and you will most certainly have heard about the PACT project. The implementation of the PACT will bring about fundamental changes in our practice. It will help make use of the pharmacists most valuable skills by enabling the delegation of the demanding and time-consuming task of accuracy checking. But, of course, many of you are worried about the idea of allowing technicians to do the final checking of a prescription.

The Question of Responsibility

What isn’t the pharmacist’s responsibility in the pharmacy?

One of the most intriguing questions about the idea is this: Who is responsible if the checking technician makes a mistake and the wrong medicine is given to the patient? The pharmacist or the technician? I’m sure this question occurred to other pharmacists as well. Perhaps the reason for many pharmacist not buying into the idea of implementing the PACT in New Zealand is that they answered the question with the pessimistic, albeit rational, “Of course, the pharmacist will be responsible, duh!” True enough, because what isn’t the pharmacist’s responsibility in the pharmacy? Well, let’s find out!

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Drug Abuse Prevention vs Health Information Privacy – Part III – The Canterbury Model

Mate Hegedus-Gaspar Pharmacy Practice

Network

In this part of the series I’m going to show you the system we use in Canterbury to deal with OTC codeine misuse. This system has been endorsed by the Police and three of our professional bodies (Guild, PDA, and PSNZ), and it is built on a close co-operation between pharmacies in Canterbury. The most interesting aspect of the system is the way it enables pharmacists to fulfil their duty of preventing harm to the patient and the public while addressing all health information privacy concerns, outlined in Part II – A Practical Analysis.

If you haven’t read Part I – The Codeine Problem, and you would like a brief overview of why this is an important issue, please click and have a quick read.

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