Author: Mate Hegedus-Gaspar
Self-Prescribing Quiz Results
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.
Not Fronting Up? Bad Idea – Cautionary Tale Series I.
Pharmacists are human beings (despite popular belief), and it’s a human thing to make mistakes. In my view, making a mistake is not the real problem. The problem almost always comes from what happens after someone made a mistake. That is, unless someone is incompetent and makes really serious mistakes, in which case they should not be allowed to practice. But apart from that, it’s all about taking responsibility for one’s actions.
This Cautionary Tale is about how taking responsibility for one’s mistake can mean the difference between getting a warning from the HDC, and getting censured by the HPDT.
Cautionary Tales
How is it possible to know all the rules? Reading the laws and regulations, codes and guidelines is one way, but seeing how they work in practice can help a lot too. The purpose of my upcoming Cautionary Tales series, is to help my esteemed pharmacist colleagues understand better the legal environment we work in.
A pharmacist’s day-to-day work is saturated with rules. It is difficult to find any area of our profession that is not regulated, and very closely at that. Whether this is a good thing or a bad thing is a topic for another day, but the fact is undeniable. Indeed, there are so many rules, that we have to constantly learn and reinforce the rules. We are regulated by countless laws and regulations, most of which, by the way, are badly in need of an overhaul (and this is also a topic for another day, but you can check out some of my previous posts here and here).
The True Role of Advance Directives
The 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.
Mail Order Pharmacies in New Zealand
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.
Consent to Loss of Autonomy
The 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.
Pharmacy Ownership Liberalisation – What’s The Policy?
The 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.
Pharmacy Accuracy Checking Technicians – Where Does Responsibility Lie?
There 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!