Death of Professional Judgment: When Fears Become Goals

June 15, 2015

More and more health care professionals err on the side of caution when it comes to making professional judgment calls.

I was in a phenomenal mood as I entered our store that Monday morning, fresh off of a wonderful 3-day weekend. But, as I walked past the cash register area towards the pharmacy, I noticed the store manager awaiting my arrival.

“I had to deliver this note to you personally," he said in a rather concerned tone of voice. I looked down at the note and read: “Doctor furious! Patient went all weekend without pain medication because pharmacist refused to fill prescription.”

Five minutes later, I was on the phone with the doctor’s assistant.

“He’s so upset!” she said. “I’ve never seen him like this!”

“I’ll be happy to hold while you get him.” I replied.

I was tremendously anxious to find out what was going on.

The next several minutes were extremely unpleasant as the doctor explained that his patient had brought a prescription for hydrocodone 5 mg/acetaminophen 500 mg to our pharmacy the previous Friday night for a fractured femur and was told that the prescribed strength was no longer available, so he would have to wait until Monday when I could call for a change.

Sure enough, as I looked through my notes, I found a request to call the doctor to ask whether the hydrocodone 5 mg/acetaminophen 325 mg would be an acceptable substitute.

“How could this possibly have happened when the solution was so obvious?” the doctor asked me point blank.

I steered clear of any commentary and apologized repeatedly, assuring the doctor that I would get the patient the medication immediately at no charge.

“Make sure you talk to the pharmacist involved and let him know the outcome of his inability to do the right thing!” he admonished as he hung up.

Throughout the day, the doctor’s question rang in my ears. How could we have let a patient go without pain medications when the obvious solution was so close at hand?

The answer bothers me more than the question.

It wasn’t that the pharmacist didn’t care, or was too busy to properly think through the situation and come up with a solution.

The answer is simple: Because of the intense amount of litigation, regulation, and corporate policy enforcement, our fears have become our goals.

When pharmacists graduate from pharmacy school, their goals are to improve patient outcomes, create world-class customer service, and make lives better. But, over time, those goals morph into not getting fined, sued, or fired.

What happened to professional judgment and common sense?

Is it logical for a pharmacist to get prosecuted for making a strength change on a pain medication in an attempt to keep the patient from suffering certain agony over the weekend? One could argue this was an isolated incident, but from my perspective, it has become the rule and not the exception.

I’ve stood by and watched pharmacists call physicians to ask if they could dispense amoxicillin capsules when the doctor wrote for tablets on several occasions. The same pharmacist then wonders why the doctor gets upset about wasting his time, and the patient even more so about how long it takes “to count 20 pills.”

I have nothing but the utmost respect for my colleagues and the challenges we all face. What we do is difficult and often overwhelming.

But, when we allow our fears to become our goals, we take valuable time away from the consultation window, and patient outcomes diminish accordingly.

As the job market tightens and competition increases, pharmacists need to ensure their reputation is to seek viable and effective solutions using professional judgment as a guide for making excellent decisions. Come layoff time, companies know who puts their fears in front of the customer’s needs.

Sadly, it is those fears that might just cause the exact outcomes pharmacists hope to avoid.