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If ever there was an 'intense' ethical dilemma, this is it.
The pharmacist, at her wit's end, was
rushing the dispensing in a fluster. She
was clearly agitated and lost for words.
Standing there amongst a small crowd
dispersed around the pharmacy, were
two customers: one veiled woman
with an ailing child in tow, waiting for
her prescription for antibiotics and
another female waiting for her repeat
dispensing of lithium. And this woman
was in a rage; hurtling abuse, insult
and aggression at the veiled woman.
Her aggression was fully targeted
at the other woman's dress, faith
The veiled woman stood petrified,
head down, whilst the other woman
yelled at her, steadily increasing
the volume. Enjoying the tension,
she spitefully stepped up the affront.
Within seconds, the pharmacy almost
came to a standstill -- clients and staff
aghast. No one knew how to stop the
The pharmacist tried to quieten down
the abuse, but failed to be heard.
She then focused on speedy dispensing
of the lithium, and shifting the abusive
client out without further hassle. But it
did not stop. In fact, it only subsided
when the veiled woman was handed her
medicines for the child and ushered out
the side door. The yelling of swear words
continued for a while, until the woman,
by then having been asked to leave
over and again -- finally exited, leaving
everyone visibly shaken by the incident.
The ethical argument
There is no doubt that a pharmacist's
primary concern is the patient's best
interests. One might be tempted to
assume this kind of incident falls outside
this principle, it being an issue out of
the pharmacist's control. However, as
the incident happened on pharmacy
premises, and under the auspices of the
managing pharmacist, we should try
to learn from this odd but disturbing
incident. The Code of Ethics in point
7 states that the pharmacist must:
'7.4 Ensure that the working environment
and conditions are conducive to the
optimal delivery of health care services
and do not present a risk to the safety and
care of consumers or colleagues.'
In many public hospitals around the
country, there are signs attached to
almost every wall stating that abusive
behavior of clients/patients or their
carers will never be tolerated. The signs
repeat over and again the message
that hospital policies dictate respect
for others as a guiding principle and
disrespect in any shape or form triggers
immediate notification to security
entities on site and police.
Perhaps this is a place for pharmacists
to start. Clearly indicating pharmacy
policies that support mutual respect,
with a warning that police will be
contacted on any instigation of
unacceptable behavior is one way to
educate consumers. This could be a
practice that provides the pharmacist
with a platform from which to take
action. Is this sufficient? Will it stop
a mentally ill patient from behaving
erratically? Perhaps not, but again
clearly stated policies do help in
hospitals, otherwise why is the
practice still followed in hospitals
Dr Betty Chaar is Senior Lecturer and MPharm Co-
ordinator at the Faculty of Pharmacy, The University
of Sydney. Opinions expressed in this column are not
necessarily those of the Pharmaceutical Society, its
Board or staff.
Also, an apology was due to the victim
of the verbal assault. Not just hustling
her exit via the side door, even though
it was an attempt to protect her.
The victim's dignity had been damaged
badly enough already.
And, what to do about the offending
client who clearly suffers a
Our initial reaction might be anger or
sheer repulsion; however on reflection
it is not too far-fetched a scenario in a
healthcare setting, and we need to be
prepared. With a mentally ill patient,
this type of outburst could happen
at any time, place or circumstance.
Pharmacists need to be aware of mental
illness first aid. Such patients need help
before they do more damage, not only
to their victims but also to themselves.
Their physician should be contacted
and the behavior reported. Their mental
illness may not to be under control.
In summary, this is an incident that
exemplifies the need to take action to
protect staff and clients. Have policies
in place and on display relaying the
necessity for mutual respect and the
safeguarding of individuals' dignity.
No abusive behavior should be tolerated
in any pharmacy. Defense mechanisms
should also be in place, such as
emergency buttons and dedicated staff
to call police if the dispute escalates.
Call the overseeing physician of a
mentally ill patient if they get out
of hand and the situation is serious.
Make sure anyone who was hurt,
insulted or abused on the premises is
offered a sincere apology and a helping
hand if needed.
If we are to ensure a safe environment
for all in the pharmacy, we need to
Abusive behavior in the
BY DR BETTY CHAAR
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