مغایرت بین اخلاق و کسب و کار در داروخانه جامعه: در مورد مشاوره بیمار چه می دانید؟ The Conflict Between Ethics and Business in Community Pharmacy: What About Patient Counseling?

Introduction The conflict between ethics and business in community (also known as retail) pharmacy is as old the occupation itself (Kronus, 1975; Ladinsky, 1971; Quinney, 1964). The conflict arises because community pharmacy is a business but community pharmacists are health care profes sionals. Community pharmacists are in the business of selling medicines but they also have ethical and legal responsibilities to their patients. The American Pharmaceutical Association’s Code of Ethics gives top priority to the dignity and welfare of patients. According to the Code: – A pharmacist respects the covenantal rela tionship between the patient and pharma cist. – A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner. – A pharmacist respects the autonomy and dignity of each patient (American Pharmaceutical Association, 1994, p. 1). This commitment to the dignity and welfare of patients can be compromised when pharmacists allow business objectives to influence and control their conduct. For example, pharmacists face this kind of conflict when they must decide whether to sell tobacco products and unnecessary food supplements, whether to fill prescriptions from Medicaid patients, and whether to recommend less expensive generic equivalents for medications (Gupta and Rappaport, 1996; Taylor, 1992). For the purposes of this article, we will not explore all of these possible conflict situations, but we will discuss how the conflict between ethics and business can have adverse effects on patient counseling in community pharmacy. Although governments have enacted some legal mandates designed to promote patient counseling, such as the Omnibus Budget Reconciliation Act of 1990 (OBRA ’90), we will argue that strengthening the commitment to ethical practice is the best way of supporting patient counseling in com munity pharmacy The obligation to counsel patients Taking the time to counsel patients is one of the most important elements of ethical pharmacy practice. First, counseling plays a key role in compliance with prescription regimens and thus helps to promote the health of patients. Patients require proper counseling to take their medicine as indicated and to avoid dangerous drug inter actions, drug allergies, or activities that should not be undertaken while on medications (Bailey, 1995; Park et al., 1996; Carroll and Gagnon, 1983). Patient counseling can help reduce pre scribing errors, and a failure to provide proper counseling can result in ineffective medications, wasted money, drug overdoses, illness, injury, suffering, or death (Rupp, 1992; Headden, 1996; Brushwood and Simonsmeier, 1986). Pharmacists who fail to counsel patients properly can also be sued for malpractice or even found criminally negligent if their transgressions adversely affect the health and safety of patients (Brushwood and Simonsmeier, 1986). Overall, high quality coun seling is one of the most effective tools in ensuring favorable patient outcomes in pharma ceutical care (Dobie and Rascati, 1994). Second, patients require counseling to safe guard their dignity, autonomy, and informed consent. If patients are to make free, informed choices concerning their healthcare, then they need to obtain information about the medica tions they take (Lamsam, 1997). Patients cannot make free, informed choices when they lack important medical information, and pharmacists play a key role in communicating medical information to patients. Third, the patient advocate model of pharmacy practice also implies a commitment to patient counseling since one of the best ways to promote the interests of patients is to provide them with the information they require to make responsible and effective deci sions (Schulz and Brushwood, 1991). Fourth, the covenant (or fiduciary) model of pharmacy practice implies a strong commitment to patient counseling since counseling plays an important role in establishing and maintaining trust between pharmacists and patients (Lamsam, 1997). Although most pharmacists recognize the importance of patient counseling, social and economic forces are conspiring against this key element of ethical pharmacy practice.