Home' Australian Pharmacist : Australian Pharmacist July 2013 Contents 40 Australian Pharmacist July 2013 I ©Pharmaceutical Society of Australia Ltd.
Dr Betty Chaar is a Lecturer in Pharmacy
Practice and Professional Ethics at the
Faculty of Pharmacy, the University of
Jenny and the tourist
By Dr Betty Chaar
Working in a pharmacy situated in a popular tourist area, Jenny was
approached by a young backpacker with a prescription for Ciproxin 500 mg
twice daily. The client asks Jenny for a quote, adding that she is not an
Australian citizen and wanted to know the cost of the medicine she needed.
Jenny notes that the girl looks pale and clearly unwell. Upon being told the
cost, the girl pulls away from the dispensary slowly. She tells Jenny she can't
afford the medicine. Jenny asks her to sit down and wait whilst she consults her
boss. The boss is preoccupied and not at all interested. He states that he has a
business to run, not a charity.
This scenario is multifaceted, and with
some careful consideration and knowledge
of solutions available, decision making
for Jenny might be made easier. First, it is
important to recognise that this patient is
in need of the medication. The notion of
patient-centred care could not be more
essential in a case like this. The pharmacist
has a duty to ensure continuity of care -- as
denoted in the Code of Ethics for Pharmacy
Principle 2: The pharmacist should...
appropriately facilitate continuity of care for
the consumer. Nonetheless, this section of
Principle 2 is actually about conscientious
(or moral) objection, which is not quite
What is relevant is the tension between
business matters in pharmacy and
provision of healthcare to patients.
The code is silent on pro bono services in
pharmacy (as are most other codes for that
matter) -- despite some professions being
well known to provide such services, albeit
under limited circumstances (for example,
the legal profession in providing legal
aid, or the medical profession providing
some surgery pro bono to patients from
other countries, or whole organisations
such as Medicins Sans Frontier or the Fred
One could then ask: are we as pharmacists
under an obligation to donate or give
away products that come with a price-tag?
No, we are not. Are we obliged to practice
patient-centred care? Yes, we are.
The dichotomy is both professional and
personal, and quite frankly there is no
straightforward answer or solution other
than to urge all pharmacists to consider
either trying to help as much as possible,
or even consider that such situations do
happen every once in a while, and if it
doesn't affect the business too heavily,
to actually provide the medicines.
An inspiring pharmacist owner in Broken
Hill (rural NSW) was once asked about how
he collects the money owed to him by
some indigenous clients, who clearly could
not afford to pay even the co-payments
for their much needed medicines which
they pick up from the pharmacy regularly.
He shrugged, stating that he simply put
the sum owed on the last page of the
accounts book, but never expected the
debt to be paid. 'It just comes with the
territory... I can't see myself denying them
treatment. I can live with delayed payments
or bad debt. I can't live with myself denying
anyone treatment if I know they really need
it.' And his business thrives.
One aspect is not to be missed: it is crucial
that the patient in this scenario does not
walk away without treatment, no matter
what. She is obviously unwell. The boss
in this case is not behaving ethically on
two counts: his lack of respect for Jenny's
professional autonomy and his lack of
patient-centred care. However, Jenny might
still be able to help the patient.
There is the possibility, with the pharmacy
operating in a tourist area, that the tourist
might happen to come from what is known
as a 'reciprocal' country. It is good practice
to enquire of the client and of Medicare
Australia if in doubt.
Medicare Australia has policies for PBS
Safety Net eligibility for overseas visitors
from countries with reciprocal Health Care
Agreements (RHCA) with Australia. Australia
has agreements with:
• New Zealand
• the United Kingdom
• The Netherlands, and
This policy, if applicable to the scenario,
means the patient is entitled to be treated as
one would an Australian citizen. According
to Medicare Australia, people from most
RHCA countries must show a current RHCA
Medicare card or their current passport to
prove eligibility for PBS and the Safety Net.
It may not be possible for Jenny to take the
responsibility for paying for the prescription
herself, if the client is not from a reciprocate
country, but it might be possible to arrange
some contact with local charities where help
may be found. The pharmacist would at least
have provided some continuity of care.
'One aspect is not to
be missed: it is crucial
that the patient in
this scenario does not
walk away without
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