The ethics we live and die by

As some of you may know, I have of late been struggling with the ethics of my profession.  Strange as it may seem, there has been a ’bout’ of incidences that have pushed me with my back against the wall.  I have had to look deep within myself for guidance and strength and there has been one or two occasions where I have been surprised at what I had found during these episodes.  Introspection is never easy, more so when you find something there that does not sit well with you.

I would like to take this opportunity to tell you about one of these incidences and also what the subsequent introspection threw up.  To get the full effect of this narration, treat yourself to JS Bach’s Suite for Cello Solo No 1 in G (Prelude) as played by Yo-Yo Ma.

It was an early autumnal Saturday morning when I was confronted by a very irate customer, whom I had never seen before.  Turns out that she has her medicines dispensed by another pharmacy down the High Street, who had in all their wisdom decided some weeks ago not to trade on Saturdays.

Turns out that the customer is leaving for a holiday early the next Monday, and had come into town for the express purpose of picking up her antidepressants.  Having found herself in front of closed and locked doors, she thought to avail herself of my services.  Here is her introduction, verbatim: ‘My pharmacy has cocked up, I need my antidepressants before Monday, they have cocked up, what are you going to do about it?’ And what am I going to do about it? I kid you not.

Firstly, this is SO not the way to approach me if you need my assistance, and secondly, your health is your responsibility.  The second point was borne out by her inability to identify the exact product she was after, nor was she able to provide any proof in the form of either a repeat request or an old labeled box.  She was however able to inform me that she ‘thinks’ that the tablets were 75mg strength and that the name started with a ‘V’.

Being aware of my responsibility, new-found as it was, towards the patient, I explained to her that the only way open for her was to either visit the local Walk-In Centre or to get into contact with the local after hour medical service, where she would be able to request a prescription from the on-duty doctor.  Not knowing the telephone number of the local after hour service, I provided it to her.  At this point I was then subjected to yet another ‘moment’.  ‘Here is my phone, you talk to the doctor.’ NO MAM, your health, you talk.  Even though I have a reasonable good idea which tablet you are after, I certainly am not going to put words into your mouth, nor am I going to talk to the doctor on your behalf, requesting something that I have no evidence you are on.  At least that is what I was thinking.  I stood my ground, and had her speak to the doctor.

Once again she used the word ‘cock-up’ twice in the conversation that followed, and without providing any evidence she got 14 days supply of Venlafaxine!

Ok, so here is the problem, did I do the right thing?  Did I serve this patient to the best of my ability? Should I have done something differently?  Why did I allow her to get under my skin, so to speak?  Am I allowing my professional judgement to be clouded by my personal belief that each individual is responsible for their own health?

I am convinced in my own heart that I did the right thing, so why am I left with a bitter after taste?

It has now been more than two weeks, and this incident is still haunting me, why? I invite you to comment.

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3 thoughts on “The ethics we live and die by

  1. It is a shame that it is a misquote but for many years I have followed the following creed:-

    “You can please all of the people some of the time and some of the people all of the time but you cannot please all the people all of the time.”

  2. You did the best you could and acted in good faith. She was not prepared to take responsibility for her own health and own actions (not ensuring she had sufficient tablets for her holiday) Of course that could be one of the symptoms of the depression . Having been there myself I know it is ALWAYS someone else fault!

    The potential harm that could have come to her if she hadn’t had her Venlafaxine is much greater than the potential harm in the unlikely scenario that you (and the Doctor) have jumped to the wrong conclusion her drug, or that she is not actually on a drug at all..

  3. A difficult one, and IMHO you acted responsibly and ethically. You had no evidence that Venlafaxine was the correct drug, she could have brought an empty packet in to confirm and you could possibly have done an emergency supply.
    Rule 1 Put your patient first, and in this case the chances of harm by giving the wrong drug outway the chances of harm by not giving any. (Although others may disagree)
    You signposted (Hate that phrase) to an alternative place to obtain a script, I fail to see what more you could reasonably do
    On other levels, she was not your patient, and I suspect she had well known she was going away for some time, she shouldn’t have left it till the last gasp. And if the other pharmacy had “cocked up” (They hadn’t) then thats her problem for choosing to use them instead of your measurably superior service (No invidious distinctions there then)
    If you happen to be on duty Xmas eve this year be prepared for it all over again 🙂

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