ETHICS
PHRD 4300 Experiential Practice III
Below expectations
I “met” expectations for ethics competency, because I maintained patient confidentiality
when I measured blood pressure of the patients at the pharmacy. When I measured a
patient’s blood pressure, I made sure that no one, besides the patient was watching. I did
not keep record of the results, but I would tell the person about the results in a low,
controlled voice. My preceptor was curious about the exercise, so he asked me at the end
of my shift. I told him that except for one patient, all others had normal values. When he
asked me which person had the high blood pressure, I did not reveal the identity of the
person, nor did I tell him the values, but I simply told him that I did not remember. I
resisted the temptation to talk about this particular person with high blood pressure,
because it was not fair to the person to talk about his medical condition with others; even
though, my preceptor probably knew a lot about this person’s medical condition.
However, I revealed to him that one patient had high blood pressure, and I thought that
would be enough information to a curious person to know the identity of the person.
Perhaps it is not be a terrible idea to let the preceptor know about this person to remind
him about his hypertension when he comes back to get his refills. But I have no authority
to reveal about the person’s identity or his medical condition, unless I have a written
consent from the patient. Next time, I will be more careful not to give any information
about the patients’ medical conditions or reveal their identity without their permission.
Comment: this statement is below expectations for PHRD 4300 because the student
has mis-understood the concept of a healthcare team and, as a consequence, has
deliberately misled his/her preceptor. The statement should be returned to the
student with an explanation that his/her preceptor has responsibility for the care of
the patient and has every right to all information given by the patient. The student
should recognize that introducing him/herself to the patient as a student allows any
subsequent information provided by the patient to be shared with the preceptor.
He/she should be reminded that all patient interactions must be discussed with the
preceptor for him/her to identify any errors or omissions made by the student and
that that process must be explained to all patients.
PHRD 4300 Experiential Practice III
Meets expectations
I rated myself a “meets expectations” for ethics because I was able to explain to a patient
why he could not find pseudoephedrine on the shelves of the pharmacy. I was in the
OTC isles and approached a man that was looking at the cold medications. I introduced
myself and asked if I could help him find a product. He said that he was just looking for
Sudafed, but it seemed like the pharmacy was out. He was referring to the fact that there
were only product cards in the place of where the Sudafed boxes use to be. I told him
that we did have Sudafed and other pseudoephedrine products in stock, but we are unable
to stock them on the floor. In the past years there has been an increased demand for this
product because some people are using it to synthesize methamphetamine illegally. The
pharmacy feels that it has an ethical and moral responsibility to regulate this use by
keeping it behind the counter. I told him that I would help him select a product and then
get it from the pharmacy for him. He thanked me for my help. When I went into the
pharmacy, I told my preceptor what I had discussed and he agreed that it was valuable to
educate the patient on this issue.
This meets expectations for ethics because I was able to recognize this ethical
issue within the pharmacy field and then educated a patient about how the pharmacy is
dealing with this issue. The pharmacy field has an ethical responsibility to regulate this
product and restrict the use of it for illegal purposes. By doing this, the pharmacy
protects the community and helps to stop illegal drug manufacturing. This is an
important issue within the pharmacy field. I am becoming more interested in the issues
that will affect me as a pharmacist. As a P1, I was less motivated to educate myself on
these pertinent issues. Now that I am farther along in my pharmacy education and talking
with patients, I am taking a greater interest. Recognizing ethical issues will be very
important when I am a pharmacist.
Comment: the statement meets expectations for PHRD 4300. As described, the
student has recognized and embraced a practical application of an ethical (and
legal) issue. He/she has not addressed all the required reflective elements of a
competency statement (no “how to further improve”) and the writing preceptor, as
a minimum step, should remind the student to address all required elements in
future statements.
PHRD 4300 Experiential Practice III
Exceeds expectations
A statement that meets or exceeds expectations for PHRD 4350 or 5300 (Experiential
Practice IV or V)
PHRD 4350 Experiential Practice IV
Below expectations
A statement below or meets expectations for PHRD 4300 (Experiential Practice III)
PHRD 4350 Experiential Practice IV
Meets expectations
I rated myself as “meets expectations” for ethics when a patient approached me and
wanted to know what he could use for his congestion. I took him to a private part of the
pharmacy where we would not be overheard and I inquired about his symptoms. What he
said about his symptoms, his medication name, and his underlying illness was kept
private. I asked, “what symptoms are you experiencing?” He answered, “My nose is
congested” I asked, “How long have you had this symptoms?” He replied, “2 days”. I
asked, “ Have you had this symptoms before?” He answered, “I only have it when I have
cold but not just the congestion alone”. I asked, “Have you tried any thing?” He said, “I
turned on the humidifier in the house which helped a little”. I said, “Good”. I also asked,
“ Are you taking any medication?” He answered”, “Yes, I am taking medication for my
blood pressure” I asked”, How long have you been taking this medication?” He said,
“About a year”. This question was asked to rule out drug-induced symptoms.
I recommended Afrin No Drip because it works locally in the nasal passage for quick
relief and is not contraindicated for patients with high blood pressure. Also, Afrin is
dosed twice daily which helps with patient compliance. I met expectations for ethics
because, before giving the medication to the patient, I obtained my preceptor’s approval.
I consulted with her about the patient’s symptoms and my recommendation in accordance
with syllabus requirements. In addition, I counseled the patient in a location where we
could not be overheard and I didn’t share information with anyone other than my
preceptor. Given the same scenario, in future I honestly do not know what I can improve
upon because I followed all the rules I needed to follow.
Comment: this statement meets expectations for PHRD 4350. The student has
shown more awareness of patient confidentiality than expected of students in PHRD
4300. Students in PHRD 4300 are expected to respect patient confidentiality but,
with respect to practical application, they may limit themselves to lowering their
voices when counseling a patient in a busy pharmacy. He/she should be commended
for counseling the patient in a private area of the pharmacy but he/she should be
encouraged to think harder about how to further improve. I this instance, the
student could have educated the patient that he/she always has the right to ask to
speak to pharmacy staff in private if he/she is concerned that a conversation might
be overheard.
PHRD 4350 Experiential Practice IV
Exceeds expectations
A statement that meets or exceeds expectations for PHRD 5300 (Experiential Practice V)
PHRD 5300 Experiential Practice V
Below expectations
A statement below or meets expectations for PHRD 4350 (Experiential Practice IV)
PHRD 5300 Experiential Practice V
Meets expectations
During my sixth visit to the pharmacy, I met a woman, who was looking for a cold
product for her 5 yo daughter. She told me that the girl had had a fever for almost a week
(about 101 F). She could not take her to the doctor because the family had no health
insurance and was not eligible for Medicaid. The mother asked if I knew any antibiotic
that could help her daughter’s infection. I told her that only a doctor could decide what to
do with her daughter, because she was young and had been sick for a while. The mother
insisted that if I just gave her the name of the antibiotic, she could find it without a
prescription. (In my opinion, she might be able to get it from Mexico if she had relatives
there). It would have been unethical to give the mother the name of an antibiotic but it
would also have been unethical not do anything to help. I met the expectations for
“ethics” competency in this case by finding, and giving to the mother, the telephone
number (303 751 9021) for Child Health Plan Plus (CHP+), an extended Medicaid
program for children in Colorado. This represents improvement: as a P2 student I would
have referred the mother and her daughter’s illness to my preceptor work. To further
improve, I could have found and given information about one or more community health
centers that provide care to non-insured, low-income families to the mother.
Comment: this statement meets expectations for PHRD 5300. It’s reasonable to
expect all students in PHRD 5300 to be capable of demonstrating this level of
practice (unreasonable to expect all P2 students to show this level of competency).
Feedback to the student should recognize his/her skill in resolving the case
(demonstrates multiple competencies in addition to Ethics) and challenge him/her to
provide the names and contact information of community health centers that would
care for the family.
PHRD 5300 Experiential Practice V
Exceeds expectations
I rated myself “meets expectations” for ethics when a teenager came in to King Soopers
pharmacy with her mom to pick up her oral contraceptive and antibiotic. If you assume
someone is taking birth control pills to prevent pregnancy, you might offend your patient
and hinder patient counseling if that is not the reason. The goal of patient counseling for
this teenager was to let her know that antibiotics decrease the effectiveness of oral
contraceptives. She would need a backup method for the duration of the antibiotic
therapy plus a couple of weeks post therapy. However, my counseling would go in a
different direction if the oral contraceptive was not for preventing pregnancy. So I
started out with, “Oral contraceptives are used for various reasons such as irregular
periods, preventing pregnancy, and acne. Which indication are you using this drug for?”
She said for acne and irregular periods. Then, I told them why I asked, which was to
inform of an interaction that she doesn’t have to worry about.
This is a P3 competency because last year I would not have felt confident to discuss with
a teen and her mother the interaction between oral contraceptives and antibiotics. Last
year I might have assumed the “obvious” and made the uncomfortable mistake of
proceeding to discuss back-up methods while taking both drugs. I could have had more
patient interaction by finding out what else she was using to treat her acne. It might have
been an opportunity to suggest an appropriate over the counter medicine to help her
condition even more.
Comment: this statement exceeds expectations for PHRD 5300. Students are
expected to address non-prescription medication-related issues and, accordingly,
any encounter involving Rx medications is likely to “exceed expectations”. The
statement demonstrates multiple competencies including Ethics (i.e. it is unethical to
embarrass a patient by making unfounded assumptions or jumping too quickly to a
conclusion).