Dispensing practice and commercial interests among Maltese pharmacists : ethical issues

Abstract

Objective This dissertation presents the findings of a qualitative study that asked a sample of Maltese community pharmacists to describe their living experiences of ethical issues during dispensing and the ways they resolved or dealt with these problems. Method Semi-structured interviews were carried out with twenty-three Maltese community pharmacists. The content of these interviews was qualitatively analyzed for emerging themes. Key Findings The fear of losing customers was the central theme which emerged from the pharmacists’ interviews. Most participants were ready to bend rules to please patients. They were ready to put their professional autonomy in subordination to that of the physician in order not to irritate the doctor and lose prescriptions. The Pharmacy of Your Choice (POYC) system was an important way to retain and gain customers. Hence, the pharmacies were accepting more POYC applications than they could handle. This resulted in isolation which led to a decrease in pharmacists’ proximity to colleagues, patients and the medical profession. This daily tension of retaining and winning over new customers to increase sales created day-to-day conflicts with ethical professional behavior. The author witnessed a general lack of ethical awareness and ethical literacy in most participants. Most pharmacists relied on experience and common sense to solve these ethical problems during dispensing and participants never consulted the Code of Ethics. Conclusion Findings of this study indicated that Maltese pharmacists felt torn between maintaining professional standards and commercial interests. Also, of significance in this study was the finding that financial pressure coming from the highly competitive business environment and the pharmacies’ owners’ race for more profits, had a negative impact on ethical decision making. The primary interests of the pharmacist to seek the best interest of the patient could be unduly influenced by secondary interests of financial greed. This conflict of interest would threaten the quality of pharmaceutical care and decrease the public’s trust in the pharmacy profession.