Fa cu lt y of Scie n ce
D e pa r t m e n t o f Ph a r m a ce u t ica l Scie n ce s
http://www.uu.nl/science/pharmacoepidemiology
Moral dilemmas of community pharmacists
M. Kruijtbosch1, W. Göttgens-Jansen2, M.L. Bouvy3, A. Floor-Schreudering1,3
1
SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands;
2
Radboud university medical center, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, the Netherlands;
3
Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, University Utrecht, Utrecht, the Netherlands
E-mail: [email protected]
Aim, setting and method
This study aims to give an overview of themes of self-reported moral dilemmas experienced during daily clinical practice. A qualitative study
using self-reported narratives of early career Dutch pharmacists. The first researcher and a team of pharmacist experts checked the narratives
against a working definition of a moral dilemma. A moral dilemma was defined as ‘a situation in which there is a choice to be made
between at least two courses of actions, neither of which is obviously morally preferable’. Subsequently relevant text parts reflecting
the moral problem were coded. When no consensus was reached a third researcher was consulted. Themes emerging from the coded text parts
were categorised.
Themes of moral dilemmas of community pharmacists (N=128)
...primarily within the relationship with
The pharmacy information system
showed that three boxes mebeverin had
been scanned and dispensed. A patient,
however insisted that one box hadn’t
been delivered. She shouted she would
go to another pharmacy. “You don’t
want this in your pharmacy”.
the patient
n=61

Patients' (suspected) drug abuse or addiction
10

Patients' (suspected) drug misuse

Patients' treatment preference

Patients’ claiming and/or aggressive behaviour
7

Patients' understanding of their medication
6

Sharing relevant patient data with relatives or carers
5

Sharing relevant patient data with other health care providers
5

Communication problem with the patient
3

Public health policy and third party payer regulations
9
6
10
…primarily within the relationship with
a health care provider
n=27

Disruptive behaviour of a physician
9

Disruptive behaviour of a colleague
5

Pharmacist and physician have a different opinion concerning appropriate
5
pharmacotherapy

Collaboration with the physician
4

Collegiality
3

Physician's self-prescribing
1
…not
primarily within these two relationships
The GP, even after several reminders, didn’t
keep his promise prescribing an anticoagulant
for a patient. “Should I ask the cardiologist to
prescribe instead?”
n=40

Risk for harm in children caused by drugs
7

Risk for harm in unborn children caused by drugs
5

Reimbursement for a pharmaceutical product
6

Reimbursement for a pharmaceutical care activity or additional service
3

Palliative and end of life pharmaceutical care
6

Dispensing without a prescription
5

Deviating from a prescription
3

Missing of relevant patient data
3

Product quality
2
Conclusion
Pharmacists recognize moral dilemmas. The themes identified in
this study are more diverse than previously reported. This may be
related to the prospective collection in daily clinical practice
instead of retrospective collection with recall problems as applied
in previous studies.
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