ethics questions - an exercise

[bananaface]

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starsweet submitted these ethics questions:

1) If the 16 year old daughter of a close friend you have comes in with a prescription for birth control what would you do?

2) A doctor comes in with a prescription (self-prescribed) for Valium. You suspect he is abusing it. What should you do?

3) It's legal to dispense needles in 30 states. Will you dispense needles?

Feel free to discuss them. 🙂

 

[dgroulx]

starsweet submitted these ethics questions:

1) If the 16 year old daughter of a close friend you have comes in with a prescription for birth control what would you do?

2) A doctor comes in with a prescription (self-prescribed) for Valium. You suspect he is abusing it. What should you do?

3) It's legal to dispense needles in 30 states. Will you dispense needles?

Feel free to discuss them. 🙂

1) I'd fill it and counsel her that oral BC won't prevent STDs, so be sure that her boyfriend uses a condom as well.

2) I'd need more info on why I suspect he is abusing it. Is it based on frequency of fills or is this just the first time? Maybe he has to fly somewhere. I know I won't fly without Valium. I'd probably give him the benefit of the doubt if he's not coming in frequently.

3) I do dispense needles now to anyone who wants them. I had a diabetic cat and went in for needles all the time without a prescription.

 

[CatSpam]

starsweet submitted these ethics questions:

1) If the 16 year old daughter of a close friend you have comes in with a prescription for birth control what would you do?

2) A doctor comes in with a prescription (self-prescribed) for Valium. You suspect he is abusing it. What should you do?

3) It's legal to dispense needles in 30 states. Will you dispense needles?

Feel free to discuss them. 🙂

1. Of course you will fill a legally prescribed medicine (and, as the previous responder mentioned, counsel her about STDs.). You should say NOTHING to ANYBODY regarding this prescription except the patient and the doctor. This is an issue of patient confidentiality.

2. I absolutely would NOT dispense a physician's self-prescribed prescription for a controlled substance, irrespective of the reason. If he needs the medicine for any reason he should have another physician prescribe it. Allowing any physician to prescribe himself any addictive controlled substance is a recipe for disaster. Also, the physician may be abusing to the point where he could become so impaired by the substance that he might jeapordize the welfare of his own patients.

3. I would certainly allow the legal dispensing of syringes, needles, etc. where allowed by law and would wish to see more states make it legal. A lot of moralizing persons have objected to dispensing of clean needles as abetting the use of illegal drugs. People addicted to illegal drugs are going to take them with or without a clean needle. Why further condemn this person to the possibility of a blood-borne disease (particularly HIV, Hepatitis, etc.) simply because he has acquired a habit. Also, you will have created another source for the spread of an epidemic. Our focus should ALWAYS be on what is best for the health of people, regardless of our feelings about them.

 

[imperial frog]

starsweet submitted these ethics questions:

1) If the 16 year old daughter of a close friend you have comes in with a prescription for birth control what would you do?

2) A doctor comes in with a prescription (self-prescribed) for Valium. You suspect he is abusing it. What should you do?

3) It's legal to dispense needles in 30 states. Will you dispense needles?

Feel free to discuss them. 🙂

1) Fill it.

2) I would have to know more about why I suspect he's abusing it.

3) Yes.

 

[starsweet]

Sorry if this is a dumb question, but I've never worked in a retail pharmacy before. Regarding the first question, does a minor have to have parental consent to get their medication from a pharmacy? Or is a prescription all that is needed? I guess I thought the question was testing whether you would or wouldn't tell your friend that his/her daughter is using BC and thus having sex. Am I right? So the questions is really asking how strong your patient confidentiality ethics are. By the way, thanks for the replies.

 

[yupyup]

1) give it 😀
2) give it
3) give it 😴

 

[Delphi80]

1) give it and counsel!!!

2) give it but place note on profile to keep an eye out for repeats..

3) give it.


I also have another one to add. This actually came from my write up exercise during an interview.

A patient has a heart condition and is on vacation but forgot his medication. You, the pharmacist, call the MD but he/she will not be in for three days and can't reach them. Do you dispense the drug (propanol hydrochloride) or leave the patient without it for three days?

 

[off2skl]

1) give it and counsel!!!

2) give it but place note on profile to keep an eye out for repeats..

3) give it.


I also have another one to add. This actually came from my write up exercise during an interview.

A patient has a heart condition and is on vacation but forgot his medication. You, the pharmacist, call the MD but he/she will not be in for three days and can't reach them. Do you dispense the drug (propanol hydrochloride) or leave the patient without it for three days?

1. dispense and counsel
2. wouldn't dispense; I agree with catspam

3. our pharmacy does not sell needles without a prescription, however I've learned that needle "replacement" programs are actually beneficial, so as long as it was not against my company's policy or the law I would probably sell needles.

As to the above post. I would call the pharmacy where he normally gets his propranolol and transfer the script (which I'm sure the patient would hae to pay cash for, but that's an insurance issue) or try to get ahold of the on call physician for his doctor's office. If for some reason neither one of those options panned out then I would refer the pt to either an urgent care to obtain a prescription or the hospital.

 

[tsubasa]

starsweet submitted these ethics questions:
1) If the 16 year old daughter of a close friend you have comes in with a prescription for birth control what would you do?

2) A doctor comes in with a prescription (self-prescribed) for Valium. You suspect he is abusing it. What should you do?

3) It's legal to dispense needles in 30 states. Will you dispense needles?

1) fill it. -patient privacy. BC pills may be prescribed to regulate her period.
2) As a tech, I processed the order as long as they have a legal prescription. C-IV meds should not be that abusive. Since Valium can help the condition of status epilepticus, I can assume he has to have meds to perform his job. I don't think it is good idea to discontinue abruptly. I would probably check his med history or records from the system.
3) Yes, if I am in those 30 states. I also check if a patient has other meds in the prescription, like insulin.

A patient has a heart condition and is on vacation but forgot his medication. You, the pharmacist, call the MD but he/she will not be in for three days and can't reach them. Do you dispense the drug (propanol hydrochloride) or leave the patient without it for three days?

As a pharmacist, I would check the history in the system, give emergency (3+1 days) refill by checking he has a previous prescription bottle (label) and ID.

 

[KUMoose]

1) Fill it. Counsel her as if it were some stranger off the street (i.e. no more, no less) and leave it at that. My friend's 14 year old went on BC for hormonal regulation (really bad periods).

2) I wouldn't fill it right away. Part of writing a script is (suppose to be) a diagnosis to go along with it, and I don't believe that a doctor can self-diagnosis with objectivity. Nor would I likely fill such scripts for his family. Now if I were in a position to be able to verify the diagnosis (say a hospital, where someone can do a quick check/verify the medical soundness), then it's possible I would fill the script, in the end it comes down to my gut. When it feels good, all is right. 😀

3) Absolutely, I'd give needles to anyone asking. People that need them shouldn't have to waste time getting a script and people who use them for illegal activities will do so with or without clean needles. With all we know about disease prevention with clean needles, to not give them away seems criminal to me. If I worked in retail I would get a name or two of drug rehab social workers and if I thought they were using them illegally, I'd include the card in the box/package, without judgment.

 

[tsubasa]

Sorry if this is a dumb question, but I've never worked in a retail pharmacy before. Regarding the first question, does a minor have to have parental consent to get their medication from a pharmacy? Or is a prescription all that is needed? I guess I thought the question was testing whether you would or wouldn't tell your friend that his/her daughter is using BC and thus having sex. Am I right? So the questions is really asking how strong your patient confidentiality ethics are. By the way, thanks for the replies.

(1) is more HIPPA stuff to me. You need a patient consent if a designator can speak for a patient, like a minor or HIV patients. ..I think.

 

[tsubasa]

(1) is more HIPPA stuff to me. You need a patient consent if a designator can speak for a patient, like a minor or HIV patients. ..I think.

Hi Again 😀 ,
(1) MD/PA/nurses are very good at catching any unusual behavior/appearance during their diagnosis. I will probably rely on their plan. During the initial diagnosis, if there is any of her sponsor with her, a doctor usually makes another appointment for second counseling. I guess I assume prescriber did their part for the pharmacy to dispense.

 

[hookemhorns]

oh wow, they asked me that exact question (#1) in my interview @UT...so beware if you are interviewing @ UT. Only, my interviewer added a bit more info, she said that I was aware the girls family would be totally against it, and that I had contact with her family members on a daily basis. And, if the family found out I had filled it, they would distrust me! hum....still fill it and say nothing, right? My interviewer actually said that if you asked pharmacists this question 50% would fill, 50% would not!

 

[MoXiEguRl]

I had something to add to this thread...

What if a patient of yours with AIDS became involved with your childhood friend.

How would you handle this?



Working in retail i came across a few childhood friends that would come in for medications that had to do with STDs. I always knew better than to say anything to anyone.. but in the back of my mind i always wondered how i would deal with a situation like this as a pharmacist.

 

[starsweet]

oh wow, they asked me that exact question (#1) in my interview @UT...so beware if you are interviewing @ UT. Only, my interviewer added a bit more info, she said that I was aware the girls family would be totally against it, and that I had contact with her family members on a daily basis. And, if the family found out I had filled it, they would distrust me! hum....still fill it and say nothing, right? My interviewer actually said that if you asked pharmacists this question 50% would fill, 50% would not!

Wow, that is tough! I don't know what I'd do. I'll probably fill it but then feel really guilty whenever I saw the friend! 🙁

 

[tsubasa]

oh wow, they asked me that exact question (#1) in my interview @UT...so beware if you are interviewing @ UT. Only, my interviewer added a bit more info, she said that I was aware the girls family would be totally against it, and that I had contact with her family members on a daily basis. And, if the family found out I had filled it, they would distrust me! hum....still fill it and say nothing, right? My interviewer actually said that if you asked pharmacists this question 50% would fill, 50% would not!

It became an issue if you use "the right to refuse" based on own moral and religious beliefs. As a pharmacist and health care professional, not only checking if doc's order but being a patient adovocate, I don't want to block patients from receiving the legal medication. I believe oral contraceptives has been around such a long time and it is a common medication. Her parents may distrust you, but I don't want her to come back and ask for "morning-after pills" neither. ...short answer. I still fill it.

 

[bananaface]

I had something to add to this thread...

What if a patient of yours with AIDS became involved with your childhood friend.

How would you handle this?



Working in retail i came across a few childhood friends that would come in for medications that had to do with STDs. I always knew better than to say anything to anyone.. but in the back of my mind i always wondered how i would deal with a situation like this as a pharmacist.

It's not safe to assume without provocation that the patient is having unprotected sex with an uninformed partner. If for some reason I knew of a specific sex partner and suspected the partner was not informed I would let the PCP know, so that he/she can ask specific questions about sexual history and discuss what needs to be told to sexual partners the next time the patient has a visit. If I knew for sure that they were having unprotected sex, for example if the other person was also a patient and she told me during a BC pill pickup that she did not use condoms with her BF, I would have to address the situation somehow. I would probably first contact a legal consultant to make sure I am doing things the way I legally ought to. My initial thoughts are to contact both the PCP and local health department, both of which should already know the patient's HIV status. I think the health department would be able to reveal HIV status if they suspected someone was having unprotected sex with an uninformed partner. There was some guy in my city with HIV who was having sex with multiple women and trying to infect him, and the health department made his case public. In any case, I am not the one to reveal the HIV status to the g/f.

 

[imprecious]

For scenario 1, yes, we would respect patient confidentiality. But since this patient is a minor, don't we have to report the patient's Rx history if the parents ask?

 

[bananaface]

For scenario 1, yes, we would respect patient confidentiality. But since this patient is a minor, don't we have to report the patient's Rx history if the parents ask?

Some states may require you to keep certain things confidential, regardless of the patient's age. You have to go by individual state law.