“It's about time you took some responsibility!”
How often do we hear that expression? Whether it is our parents wanting us to own up to breaking a window, our teachers encouraging us to do homework, or our partner discussing the balance of childcare.
Of course, in the pharmacy, we feel we have more than enough responsibility, thank you very much. From managing staff, ensuring that a minor illness does not become a major disease, and the clinical governance of controlled drugs, the term Responsible Pharmacist doesn't even begin to cover it. Maybe that's why failure to take responsibility is so frustrating when we see it in other people.
But is it people who choose to avoid taking responsibility, or is it the environment in which they work? Institutional disenfranchisement seems to be rife these days. When it comes to any part of care involving medication, no one is seemingly capable – or permitted – to take responsibility.
Home care staff can now only prompt someone to take the contents of a ready-prepared dosette pack, thus one original criteria for a compliance aid that used to be “absence of a carer”, seems now reversed to become “care staff involved”. And judging by the hassle we encounter, trained care home staff are no better, with requests to put glycerine and honey linctus into an administration record chart for them or constant demands to replace tablets that have been “dropped”, thereby ignoring the “five second rule” employed in all dispensaries preparing MDS trays.
Increasingly this organisational abdication of responsibility has extended to schools. Any poorly child with medication to take more than twice a day probably ends up having to take time off school.
Parents stand in the dispensary and bang their head on the desk when I explain that the flucloxacillin prescribed for their progeny is a four-times-a-day dose. “Well that's not going to happen,” is the usual response. “They won't even let him have a glass of fruit juice unless it's got his name, consent form, and risk assessment taped to the bottle!”
I get it, I really do. I discussed ‘never events’ recently, and I'm sure for schools a ‘never event’ is for Evan’s insulin to be mixed up with Aisha’s adrenaline pen. But, like every other aspect of our risk-averse society, I can’t see how or when the adults of tomorrow can grow to develop a concept of acceptable risk-benefit ratio in a society that teaches them pessimism-bias. So even though the education authority may know it’s possible for these treatments to be safely administered, it's quicker and easier to abdicate the responsibility.
Recently, a patient who visited my pharmacy wanted to discuss a back operation she’d been offered. She was worried because, as with all patient decision aids, she had read information that had listed both the pros and cons of the new treatment, meaning “they’ve said one in every five operations are unsuccessful.”
“Isn’t that great,” I responded, thinking: “They’ve got an operation with an 80% success rate!” But I understood her dilemma. After all, how can anyone take responsibility to make such a decision if they have no experience of risk?