Y’know, once upon I time I wrote a blog…In it I questioned how the future of my profession is being represented.I asked a few other things as well, like how the countless problems that pharmacists are the key to fixing are still not part of the system we work in to the extent possible (or needed).I also wondered why this doesn’t seem to be among the important things our professional associations are representing us for.But before I go further, I should point out what I did not say (despite the responses of several who made assumptions based on, well, I’m not sure).What I didn’t sayI did not say I was quitting my association. I only asked why I (or anyone) would want to be a member, and I was looking for answers.Disappointingly, I didn’t really get any answers to sway any decision.I have always found the suggestion to look at our website unsatisfying, but it may be because I am old and, well, old fashioned.I looked anyway, but didn’t get past the part about enabling and inspiring our members. By the way, there was nothing about what may be the most important thing they need—wait for it.In terms of the response that if I don’t like it, go somewhere else—well, that seems both uninspired and uninspiring (although, to be fair, I did ask if there were any other options). Admittedly, the five-year-old in me wants to say ‘no, you go somewhere else’.I also did not say a new association should be formed, and I am also pretty sure I didn’t talk about starting one.Not because we don’t need an association of pharmacists—we need one badly. But we already have one, and we just need to make it better (although the irony is not lost when those who suggest everyone get involved and have their input attempt to pillory those that do).But we should move on to more important things than who said what. And maybe better that we think of one thing at a time. That way instead of attacking the person with a question, we can focus on the question.Code for clarityIn the last few months, the College of Pharmacists in Ontario has reminded us about our Code of Ethics being made more explicit—nothing new, but clearer—as well as why, and what it means.(Again, I apologize for my ignorance of where things are at in other provinces, although I suspect similar issues exist.)The revised code hammers home rule #1: that the pharmacist’s primary responsibility is the patient. This obligation takes priority over any selfish needs, the code clarifies, adding that there is no excuse not follow rule #1.So why after all these years does the code need to be more explicit? I first learned of a potential internal conflict when I was in pharmacy school 30-some years ago.As a first-year student I was asked to participate in a study. A number of us were questioned how we would handle the conflict between profit and commercial concerns as a pharmacist and business owner (interesting in that there appeared to be no question then that this was what we were going to be doing).Our professional and ethical responsibility to patients meant thinking of someone else first, so this was going to be important.They wanted to know how I would deal with the problem. This was all pretty new to me, and I was 17-years-old at the time, so of course I said no problem.The follow up of the study was several years after I had graduated from pharmacy school, had a job, a home and children.The professor visited our home and asked us if we’d participate (my bride is a pharmacist, and a damn good one—y’know, the kind you would want caring for your parents). My answer was the same—no problem.Simpler timesBut I had it a little easier back then. Pharmacists, who (largely) understood the conflict and accepted that helping patients was more important, owned most pharmacies.And, the things we could do to help patients were not nearly to the breadth and scale of what is capable now under our scope of practice. What’s more, it was clearer what compensation was for at the time.But also, the seeds were already growing. After less than a year of being licensed, I was working for one of the chains when the associate pulled me aside. She told me that I was spending too long talking to patients.I suggested to her that the next time she observed me speaking too long to a patient she should come and tell us the discussion was over. She told me that she could not interrupt a clinical conversation, and I responded, “Neither can I.” (Like I said, a bit of a 5-year-old smart-ass.)But, as I said, it was easier then. Pharmacists were in short supply, so I was not too worried about standing up for patients because it would be hard to get rid of me.A new worldIt is a new world now, though, which is clearly the reason that the college has determined to make the code of ethics more clear.Owners are no longer predominantly pharmacists, there are more pharmacists around (although not too many, particularly if we start doing what we can and should) and the skills our newest pharmacists have learned are not yet fully engaged, as many owners see pharmacists as a disposable commodity.And if you take a read of the Code, you will notice that there are all kinds of instances where pharmacists, in doing what they can and should for patients, would find themselves in conflict with a business owner.Like actively making decisions (1.2). And taking notice of things like the responsibilities to make sure there are enough resources (2.17). There are plenty more.After all, there are countless things we are capable of doing that are not billable.But the want for profit will attempt to trump all, and when that want is unclouded by professional ethics, well, you get the idea. They even made sure to remind us that doing nothing is not an option.My burning questionOh, and by the way, I can’t not ask the following question (1.16) And so here it is (professional associations and the public, take note).A pharmacist can be put in a situation where they are forced to decide for the benefit of a patient going against dicta from an employer.This means they will have to choose between the patient and their livelihood, their job and their family. No pharmacist, no health professional should be put in this situation.This is not good for our profession, and it is not good for those we care for—our patients.So what happens when the pharmacist chooses for the patient and not the business owner? Who has our back?More to come—please discuss.Ken Burns is a pharmacist at the Diabetes Care Centre at Sudbury Regional Hospital.
