Canadian Pharmacists Journal - May/June 2019 - 148

840055
research-article2019

CPHXXX10.1177/1715163519840055C P J / R P CC P J / R P C

COMMENTARY

COMMENTARY * PEER-REVIEWED

Professional abstinence: What does it mean for
pharmacists?
Catherine Biggs, BScPharm; Jill Hall, BScPharm, ACPR, PharmD; Theresa L. Charrois, BScPharm, ACPR, MSc

Vignette

Imagine living with a chronic medical condition, such as
rheumatoid arthritis, which requires daily medications that
have unpleasant and rare, but serious, adverse effects. Perhaps
you already do. Now imagine visiting your pharmacy to pick
up your regular medications. What if the conversation went
something like this:
Patient: I'm here to pick up my methotrexate and
hydroxychloroquine.
Assistant: Here they are. You were out of refills for the
folic acid, though, so we faxed the doctor. It will probably
take a few days.
Patient: But I'm right out of folic acid and if I don't take
it, I feel terrible. My methotrexate dose is tomorrow. Can
you ask the pharmacist if she can extend my prescription?
You can see I get my lab work done regularly.
Assistant speaks to pharmacist and pharmacist checks
the computer. . . .
Assistant: Sorry. The pharmacist isn't comfortable doing
that. . . .
There is an increasing body of evidence suggesting that pharmacists are not engaged in advanced patient care activities such as
prescription renewal, patient assessment and independent prescribing.1-4 We believe that this behaviour is apparent in both
novice and experienced pharmacists, and we fear its influence
on students, recent graduates and the profession. It is found in
all pharmacy practices and we call it "professional abstinence."

Merriam-Webster defines abstinence as "the practice of
choosing not to do something."5 We define professional abstinence as consciously choosing not to provide the full scope
of patient care activities. The aim of this article is to consider
some root causes of professional abstinence.
As professionals, pharmacists are responsible and accountable for the delivery of care to patients, communities and society.6
The professional role is not just a competency but an embodied
identity that guides pharmacists regardless of their expertise or
practice setting.6 As such, pharmacists should inherently apply
the principles of best practice, adapt to fulfill evolving roles and
seek guidance when uncertain as outlined in the competencies
for pharmacy student education and the provincial regulatory
codes of ethics and standards of practice.6-8 Given that available
knowledge is increasing every second and that scope of practice
is dynamic, what it means to be a pharmacist must continue to
change. If pharmacists are committed to their professional identity and the care of their patients, they will remain engaged in
the profession and learn what they need to know, do and be, to
embrace advanced care activities.6,9,10 On the other hand, pharmacists exhibiting professional abstinence may defer decision
making to another professional due to their unwillingness to
accept responsibility and accountability for possible outcomes.11
Researchers have endeavoured to identify barriers that limit
practice change in an attempt to facilitate pharmacists' practice
away from the status quo. Pharmacists cite lack of knowledge
as a barrier; however, continued learning and refreshing of
knowledge is paramount to maintaining the professional role
and identity. Lack of available specific patient information is
also frequently identified as a barrier, but even in cases where
pharmacists have all pertinent and available information, they
often show a reluctance to make decisions.11,12 Finally, pharmacists state a lack of remuneration as a barrier to adopting

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Canadian Pharmacists Journal - May/June 2019

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