Pharmacist Autonomy

Several recent conversations have caused me to wonder how many community pharmacists feel they actually have autonomy as professionals to do what they think is in their patients’ best interests. One conversation occurred in the context of a group planning a 1-day meeting for pharmacy leaders on hot topics in pharmacy. One participant suggested that we focus on pharmacy workforce issues because many community pharmacists feel they are forced into dispensing situations that jeopardize patient safety.

The second conversation was with a former student whose son had just been accepted into pharmacy school. She wanted my opinion on how pharmacy practice has changed. She talked about her experience with a pharmacist in a “big box” pharmacy whose expanded role into immunization administration had just put more pressure on the pharmacist’s workload because additional help had not been provided to deal with the increase in responsibility. What was going to happen to our profession, she wondered, if pharmacists are forced into unsafe working conditions? When I replied that a pharmacist has a choice to not work in that situation, she countered, “But there are so many new schools and so many more graduates, and pharmacists are concerned about losing their job.”

Yes, I have heard from some community pharmacists that they feel pressured to do things they feel are unsafe. When I suggest to them that they ought to report this concern to the Board of Pharmacy, most indicate a reluctance to identify themselves with the situation, fearing for their job security. In all cases, these individuals are employee pharmacists who usually work in a corporate environment. Of course, I have talked to many pharmacists working in the same environment who love their job, feel professionally secure, and know they are helping their patients make the best use of their medications. If 2 pharmacists working in the same environment have opposite reactions to the situation, I wonder, is the problem with the pharmacist and not the employer?

I do not believe that any pharmacy owner, whether an individual or a corporation, would intentionally create an unsafe work environment that could lead to injured patients, clients, or customers. I have also come to realize that what some might see as a “black-and-white” situation is really open to different interpretations. Therefore, I am more inclined to put the responsibility for the situation on the pharmacist rather than the employer. Yes, I can hear your disagreement with my position; it’s always easier to blame someone else rather than look at ourselves. Could it be possible, however, that a pharmacist may not be cut out to work in a particular situation? Yes, I think so.

When pharmacists determine that their work environment is unsafe, yet they continue their employment, are they acting like a professional? The first 2 principles of The Code of Ethics for Pharmacists adopted by the American Pharmacist Association, October 27, 1994, seem to relate to this situation:

1. A pharmacist respects the covenantal relationship between the patient and pharmacist. Considering the patient—pharmacist relationship to be a covenant means that a pharmacist has moral obligations in response to the gift of trust society has place in him or her. In return for this gift, a pharmacist promises to help individuals achieve optimum benefit from their medications, to be committed to their welfare, and to maintain their trust.

2. A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner. A pharmacist is dedicated to protecting the dignity of the patient and places concern for patients’ well-being at the center of his or her professional practice. In doing so, a pharmacist considers the needs stated by the patient along with those defined by health science. With a caring attitude and a compassionate spirit, a pharmacist focuses on serving the patient in a private and confidential manner.

Pharmacists who continue to work in an unsafe environment would seem to be in violation of these 2 principles by putting their own needs for a job ahead of their patients’ needs. That is why I question if they are acting as real professionals. Professionals do what is right, not what is convenient.

As health care delivery becomes more interdisciplinary, our understanding of professional autonomy is being redefined. Rather than complain, each pharmacist needs to help redefine it for their own work situation so we can continue to do what is right for our patients.

Mr. Eckel is professor emeritus at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He is emeritus executive director of the North Carolina Association of Pharmacists. A lifelong advocate for the profession of pharmacy, Mr. Eckel has lectured on pharmacy issues and trends in all 50 states and has traveled to 6 continents to promote and educate audiences on the role of the pharmacist.