Da ideologia à prática: percepções sobre o profissionalismo farmacêutico no mercado varejista de medicamentos do Brasil

Abstract

Introduction: Brazil's drug retailer market is one of the largest and most profitable in the world. In this scenario, with the subordination of the profession to the "laws of the market" and with the capitalist model of drug marketing mostly controlled by a lay owner, the pharmacist faces ethical dilemmas that decrease his credibility with the population, and the autonomy was weakened throughout of years. Stakeholders how managers and mentors of pharmacy chains are the links between the pharmaceutical profession and the needs of drug users, however, few studies address their opinion about Pharmacy in this scenario. Objective: To understand the perceptions of pharmaceutical retail stakeholders about what influences the pharmacist's autonomy and how to improve it in this scenario, as well as about the influences, causes, and strategies to minimize ethical dilemmas in pharmaceutical practice. Methods: Based on a script of nine questions about pharmaceutical professionalism, 19 semi-structured online interviews were conducted between August and October 2020. Sociodemographic data such as occupation, gender, age, length of professional experience, region of the country were collected and titration maximum.The interviews were transcribed and analyzed with triangulation by analysts by Categorical Content Analysis, using the ATLAS.ti software. Word clouds, a network of categories and tables were created that compared the number of categories reported between the groups of managers and mentors. Results: With an average duration of 42 minutes, interviews were conducted with nine mentors and ten managers working in the drug retail business. They reported aspects related to the guarantees and limitations of technical autonomy, limitations to managerial autonomy (being a service provider, self-devaluation and managers who do not understand their role), and strategies to improve them (ownership attitude and harmony with the code of conduct); as well as ethical aspects such as enticing drug industries, “empurroterapia”; and strategies such as “taking in that selling is not unethical”, compliance, collective goals and generating profits through services. Autonomy in general was considered limited mainly by the dependence on employability and the pharmacist's self-devaluation. Control of the market causes incongruity among authorities and exposes the weaknesses of pharmaceutical professionalism, such as the laws and the submissive and conniving attitude of the professional. Strategies on entrepreneurship and ownership attitude seem to make sense only in the micropolitical context of retail. Stakeholders assume that there is still room for pharmaceutical companies' enticement and for unethical behavior by clerks in search of financial commissions. Therefore, it is complex to demystify ethical dilemmas in retail when the current business model is centered on the product. The small diffusion of compliance programs keeps the pharmaceutical practice on the “tightrope”, and the profitability of services can balance this scenario. The variation in categories between groups was small, demonstrating that the mentors' discourse was more aligned with the interests of companies than those of the profession. Conclusion: The ideas must be aligned with the clarity of social role and the construction of a professional identity. The future of the retail profession is uncertain, and for this reason, it is necessary that the indicated strategies are aligned with the clinical purpose and construction of a stable professional identity. Future research into the application of these strategies is needed to balance and strengthen the pharmaceutical profession, as well as ensure the safety of its clients.