What would you do? – Tough decisions in health care

Life is usually not what you expect.

Life is usually not what you expect.

Have you realised that the things taught at school are a lot simpler than what happens in the clinical world?

In the real world, the case studies and scenarios becomes broader than just the patient, their disease and treatment plan. Sometimes we need to consider the patient’s living arrangements, family background and financial capacity.  If you’re really unlucky, the universe will find two seemingly distinct events, mash them together and present them to you as a problem to solve.

Recently I came across a situation where I had to make a decision. No class in pharmacy school prepared me for this scenario. Place yourself in my shoes and see how you’ll handle the situation. What would you do?

Case 1: – The missing script

You’re working as a pharmacist in the local community. You’re working on the Easter weekend and part of your job is to supply medicines to the local nursing home.

You’ve received a call from the nurse, she says a resident needs another supply of fentanyl patches. The old lady has used her last patch today, and she will need a new patch on Monday.

You pull up the patient’s file and find that indeed the patient is on fentanyl and so you start preparing the medicine.

Uh..oh… you realise that as you look through the patient’s script folder, she doesn’t have any fentanyl scripts left. You remember that in Australia, you MUST have a prescription or an oral permission from the doctor first before you dispense the medicine. Otherwise you’ll be breaking the law.

Secondly, you realised that it’s the Easter weekend, and the doctor is not contactable until at least Tuesday. The nurses insisted that they need it before Monday or else they’ll need to file incident reports to explain to the family why their beloved grandmother missed her patch on time.

You’re now stuck there thinking… To supply or not supply? That is the question.

If you supply, you’ll be breaking the law and placing your registration at risk. If you don’t supply, the nursing home resident will not receive her patch on time. You might jeopardize the relationship between the pharmacy and the nursing home. You don’t want that either!


How should this case end? I don’t know. I don’t think there is a right answer in these situations. Logically thinking, there will be a best solution, but I just can’t think of one that turns this lose-lose situation into a win-win.

I made a choice and stood by my decision. However I’m confident that each one of you dear readers will reach a different solution.

What I’ve learnt is that life is infinitely more complicated that what is taught in school. I have a feeling that I’ll be dealing with situations that challenge me not purely in a clinical mindset, but test my morality, legal knowledge and empathy towards the patient at the same time.

I will be faced with scenarios beyond my wildest imagination. Situations that need me to find the balance between doing best for the patient while keeping myself within moral and legal practice.

I’ll leave that for future me to worry about for now. I still need to get through second year of medicine!

What tough decisions have you come across? I would love to hear your stories!

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