Conflict at the coalface

Gary West presents at APP2020
Gary West presents at APP2020

Pharmacists are being “smashed” on the frontline serving patients during the COVID-19 crisis, says PDL Professional Officer Gary West

Even more so than usual, pharmacists need to consider how they manage conflict in their workplaces, whether with difficult and upset customers, prescribers, or colleagues, he told delegates at the APP Online conference on the weekend.

Pharmacists were reporting a rise in conflict – either from difficult customers or between staff members – even before the COVID-19 pandemic, he said.

“I think it’s pretty clear that there’s a lot of conflict out there: that complaint is increasing,” said Mr West. “We recognise that conflict is part of being a frontline health professional.”

“The pharmacist Professional Officers at PDL are aware of the increasing number of complaints and threats that pharmacists are receiving, and obviously this has escalated significantly with the COVID crisis.”

He said he and his fellow Professional Officers were receiving a growing number of calls from pharmacists worried about the threats posed to them by the general public.

Following the presentation, he told the AJP that PDL was aware that even more than usual, complaints, threats and challenges are occurring because of the COVID crisis.

“Pharmacists are being smashed, and the reports to us are that the high volumes, the challenges with stock shortages and the demands of patients are leading to exhaustion and frustration, and PDL are also concerned about not only the wellbeing of the pharmacist but the safety of the public, because of the demands on the sector.”

Staged supply is a “classic situation” for conflict, he told APP2020, as are requests for medicine without a script, as in an owing script or emergency supply; and “all too familiar at the moment to community pharmacies at the moment, these requests for multiple supplies at the one time.”

He cited a case where a patient had a script for 14 Zolpidem tablets at a time, with an 11-day interval between supplies, prescribed by a psychiatrist; when they came to their regular pharmacy with a new script – for the same medication regime and from the same prescriber – only seven days since the last dispensing, conflict ensued.

“The patient was adamant that with a new prescription that interval didn’t apply in this sort of case,” Mr West said. The pharmacist attempted to contact the prescriber to facilitate early supply, but was unable to do so; while they did this, they endorsed the back of the script with the date of last dispensing and the date of the next anticipated supply.

When they returned to the patient and said they had been unsuccessful in contacting the psychiatrist and could not dispense, the patient took back the script and said they would try to have it dispensed elsewhere.

But when they noticed the endorsement on the script, they “immediately returned back to the pharmacist at the counter, and in the words of the pharmacist we talked to, the patient absolutely lost it,” Mr West said.

“They were thumping their fist on the counter, they were pointing their finger right in the pharmacist’s face, they were verbally aggressive and threatening.”

The patient threatened to take the pharmacist to regulatory authorities and that the pharmacist must dispense, saying the script had been vandalised. The pharmacist did not supply and the patient had to be told to leave or the police would be called, though they did return later that day to try to have the script dispensed by another pharmacist.

“These things do happen, and we hear from people all the time who are being put in those very challenging situations,” Mr West said.

He said PDL supports advice from the Government and other bodies to avoid, where possible, those multiple supplies due to factors including the increased risk of error.

Dispensing of S8s, particularly without correctly completed scripts, and cases where a pharmacist attempts to validate a prescription but is unable to contact the prescriber, are also likely candidates for a conflict situation; as are the supply of medicines open to abuse or diversion, such as benzodiazepines, antipsychotics and increasingly, the gabapentinoids.

Threats are very common, including threats to go to the mainstream or social media, to involve lawyers or the regulators, Mr West said.

It’s also common for patients to tell pharmacists that if the medicine is not dispensed and the patient becomes unwell or dies, “it’s going to be on your head, you’re responsible”. It is normal for pharmacists to find such threats confronting, he said.

These threats are rarely followed through, and physical confrontation is rare.

Some patients’ expectations may not match up with the reality of pharmacists’ professional obligations, particularly if other pharmacists have done favours for them in the past; Mr West urged pharmacists not to do so, as this expectation could affect other pharmacists down the track.

Part two, Strategies for Managing Conflict, will be published on Tuesday.

For immediate advice and incident support, members can call PDL on 1300 854 838 to speak with a Professional Officers. PDL is available to support its pharmacist members 24/7, Australia-wide.

Pharmacists can also contact the Pharmacists Support Service on 1300 244 910 for peer support related to the demands of being a pharmacist in Australia during this challenging time.

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1 Comment

  1. (Mary) Kay Dunkley

    Pharmacists as healthcare professionals want to care for their patients and it is very hard to do this in these situations when patients become aggressive and threatening. There are times when saying no to supply is in the best interests of the patient. The situation is exacerbated when they are not supported by other healthcare professionals such as prescribers and also by colleagues in the workplace or in other pharmacies. This type of stress quickly leads to burnout and can result in pharmacists leaving community pharmacy and even the profession. It is important that we work together to ensure a clear message that this behaviour will not be tolerated in pharmacy. Pharmacists and staff in pharmacy have the right to feel safe at work and not to be subject to abuse. Hopefully many pharmacies are now displaying the rights and responsibilities document produced by PDL and PGA and those in charge at pharmacies are supporting staff in these situations.

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