4.1 Introduction
Every profession in the 21st century relies on the successful communication of ideas and information. Therefore, this is an essential skill that should be learned, developed and applied in healthcare settings, including pharmacies. Communication is particularly important for pharmacy settings, because medication is a complex technology.
Pharmacy team workers can help to maximise patient outcomes by explaining the benefits, dosage and side-effects of different drugs. Pharmacy assistants play an important role in connecting the customer with the pharmacist and supporting any communication that takes place. In addition, pharmacy assistants often interact with customers and suppliers by telephone, email or face to face. Communication skills help them execute their job role to the best of their ability.
Module 4 will explain techniques that will help the pharmacy assistant communicate better with customers and the pharmacist and will also help to build better relationships with other pharmacy team members. Like other healthcare professions, the relationship between the pharmacy team and the patient must be established and maintained, in order to maximise the benefits for the public. In the absence of communication, medication therapy and pharmaceutical care cannot be provided effectively to the patient. Communication requirements
may vary across pharmacies, depending on the setting.
For example
Pharmacy assistants in retail or community pharmacy settings may be more actively involved with customer interactions compared to a hospital pharmacy set in the basement. Communication skills are particularly more relevant for long-term patient relationships and treatment of chronic ailments. However, communication skills are not restricted only to this form of medication therapy, they are useful in nearly every aspect of the pharmacy profession.
Pharmacy assistants may often face the daunting task of interacting with customers and healthcare staff, whose educational backgrounds, sensibilities and preferred modes of communication may vary. A hurried interaction or poor communication may result in a lack of understanding of medication therapy and its effects. In addition, hurried or incomplete communications may confuse the patient and hamper the treatment process.
4.2 Importance of Communication Skills in Pharmacies
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Communication skills are one of the most critical and important skills required for a successful career in the pharmacy sector. The success of medication therapy depends on the development of a valued and mutually respectful relationship between the pharmacy assistant and the patient. It is very important to view the patient or customer as a living, breathing entity, instead of perceiving a patient as a hindrance to other work.
For example
If you are in the midst of updating stocks on the computer, you may experience momentary irritation at the prospect of being disturbed. Under these circumstances, we may view the patient as an impediment to the work that we really wish to be doing. The ability to communicate effectively benefits you as a pharmacy worker, as well as the patient. It helps you to achieve your goals as a healthcare worker, striving to give your best to a patient. The patient benefits from receiving high quality pharmaceutical care and medical therapy for their requirements.
Two ways of communicating
There are two ways of communicating with people - the responsive way and the resistant way. When pharmacy team workers communicate with people in the responsive way, they treat them with respect and care and appreciate that every person has their own feelings and goals. If you recall from module 3, social orientation is an extremely crucial skill, in order to execute the job role of a pharmacy assistant. You may wish to cultivate an attitude of genuine interest in the wellbeing and improvement of others and society as a whole.
Treating people in a “resistant manner” drives us to view people in a negative light. We perceive them as obstructions to our own goals and fail to treat them as human beings with their own feelings and aspirations. This is often referred to as “objectification” of people. Objectification obstructs the process of providing comprehensive and accurate information to the patient.
A clearer understanding of the patient will help in building trust and will enable you to engage in fruitful conversations regarding health issues. As the pharmaceutical industry is experiencing rapid growth, there is a growing need for pharmacy assistants to engage with customers and understand their needs. One to one interactions with patients are often required, in order to address healthcare and pharmaceutical concerns.
For example
Patients will often have questions regarding dosage, frequency and benefits related to a specific drug. They may also have doubts regarding insurance coverage or instructions included in a prescription. Competent and friendly communication helps to establish a high quality of patient- centric relationships in community pharmacies.
4.3 Patient-Centred Communication Practices in Community Pharmacies
Let's examine the different ways in which community pharmacies can develop communication skills with regard to the reinforcement of patient-centric pharmaceutical care. The role of a pharmacy team worker involves engaging the customer in a way that helps to clarify his doubts and answers any questions. Consider a situation where a customer visits a community pharmacy in order to purchase an inhaler.
Here is an example of a typical conversation at a pharmacy counter:-
Conversation 1
Pharmacy assistant: Are you familiar with how to use the inhaler?
Customer: Well, not really, I do not really understand the instructions in the prescription.
Pharmacy assistant: Would you like for me to show you how to use it?
Customer: I don't really know.
Pharmacy assistant: Would you like to pay by cash?
If you notice, the pharmacy assistant is trying to ask relevant questions in order to ascertain if the patient is aware of how to use the inhaler. However, the assistant is unable to use the customer's answers to clarify doubts. He has also put the onus of the discussion on the customer - the customer is expected to decide if he wishes to ask for more information.
One of the biggest obstacles to communication in a pharmacy setting is preconceptions/assumptions. You may be selling a simple OTC drug, for example, Aspirin. We should avoid falling into the trap of assuming that the patient is already familiar with how to use the tablets and dosage. All dosage instructions may be clearly written on the label, but the patient may still harbour doubts. Please bear in mind that the public trusts your ability as a pharmacy worker and assumes that the advice which you provide is adequate and competent. Hence, it becomes your responsibility to provide complete, detailed and clear information regarding the medication.
Here is another example of a conversation between a patient and a pharmacy assistant:-
Conversation 2
Customer: Good morning! I would like to buy some Ibuprofen, please.
Pharmacy assistant: Shall I pack eight or 15 tablets?
Customer: The bigger strip, please.
Pharmacy assistant: Would you like tablets that can be swallowed, or those that dissolve in water?
Customer: I just want the ordinary ones, please.
Pharmacy assistant: Would you like to purchase anything else?
Customer: That will be all.
Pharmacy assistant: Your bill comes to £9.20.
On the surface, the conversation may seem to be a detailed one. However, if you observe the conversation closely, the pharmacy assistant appears to be concentrating on product facts exclusively (packet size, type of tablets and so on). There is absolutely no exchange of information regarding symptoms, beneβits and side-effects.
pharmacy worker has not even discussed alternative medication in case the patient has stomach sensitiveness and has not provided any risk assessment to the patient. In both conversations illustrated above, the pharmacy assistant appears to be asking routine questions and has not made an attempt to personalise the conversation with regard to patient requirements, symptoms and risks. The communications are repetitive (with a one-size-βits-all assumption) and the pharmacy worker has not internalised her role as a supporter of medication therapy.
This form of impersonal and rote questioning does not throw any light on the disease or symptoms and thus, does not support the concept of self-care and self-management (please refer to module 1, for more information). The evolving role of pharmacy team workers requires them to be more proactive in communications and they need to adopt the role of a pharmaceutical counsellor (without the patient having to specifically request them).
Here are the ideal ways in which conversations 1 and 2 could have been conducted:-
Conversation 1
Pharmacy assistant: Are you familiar with how to use the inhaler?
Customer: Well, not really, I do not really understand the instructions in the prescription.
Pharmacy assistant: What are your symptoms? Do you suffer from breathlessness?
Customer: Yes, occasionally.
Pharmacy assistant: Let me demonstrate how to use the inhaler. You should use the inhaler no more
three times a day.
Customer: Thanks, now I understand.
Pharmacy assistant: You must also remember to store the inhaler in a clean, dry place, away from heat. If you find this inhaler difficult to use, I can also suggest some simpler alternatives.
Customer: Thank you.
Pharmacy assistant: Is there anything else that I can help you with? Do you wish to clarify anything else?
Conversation 2
Customer: Good morning! I would like to buy some Ibuprofen, please.
Pharmacy assistant: Are you experiencing pain? Could you explain your symptoms, please?
Customer: I have a bad shoulder ache and I need to go to work.
Pharmacy assistant: In that case, Ibuprofen may help to ease the pain, but you must take care not to consume more than two tablets at a time. How long have you had the shoulder ache?
Customer: Yes, thank you. I have had it since last night.
Pharmacy assistant: I would advise you to try the tablets for two days and if the pain persists, please do visit your GP. We have Ibuprofen in packs of eight and 15 tablets. Since you need a dosage of two tablets, three times a day for two days, you will need 12 tablets. I would recommend the pack of 15.
Customer: Yes, please.
Pharmacy assistant: If you suffer from stomach sensitivity, Ibuprofen may not be right for your requirements. May I suggest some alternative painkillers that are easily digestible?
Customer: Thank you, but my stomach is not sensitive. I have consumed Ibuprofen before.
Pharmacy assistant: The tablets come in two forms, pills to swallow and pills that can dissolve. If you dislike swallowing, I can give you the ones that dissolve in water.
Customer: Yes, thank you, I would prefer the pills that dissolve.
Pharmacy assistant: Ibuprofen tablets should only be consumed after intake of food. Please do not consume them on an empty stomach.
Customer: Yes, thank you. I will be careful to take them only after I have eaten.
The difference between the former and latter set of conversations is initiative and proactive interest, on the part of the pharmacy assistant. The assistant does not wait for the patient to provide him with information. He asks incisive questions, in order to ascertain symptoms and requirements before making appropriate recommendations.
Activity
Estimated time 10-15 minutes
Put yourself in the place of the patient and think about how you would like to be treated when you visit a pharmacy.
4.4 Desirable traits
Listed below are some desirable traits in pharmacy-patient communications:-
Systematic counselling patterns: As a pharmacy assistant, you are a component of the healthcare delivery system and must adopt the role of a counsellor, whilst providing information regarding medication therapy to patients. Needs assessments: When a patient asks for medication, do not simply give him the product without sussing out the needs. Ask for symptoms and assess the needs first.
Customise the content, by using different communication techniques: Some patients may not understand with only verbal information and you may need to write down or physically demonstrate the techniques (for example, for inhalers or bandages), in order to share information.
Careful selection of content: Content should also be carefully selected, according to the patient's requirements. For example, one patient could have doubts regarding dosage, whilst another could require information on timing of drug consumption (before/after food, etc). Ensure understanding by asking relevant questions: Also, encourage the patient to clarify
any questions or doubts.
It is a good idea for pharmacy assistants to conduct the conversation in a manner that emphases the outcome. The outcome should be maximisation of benefit to the patient and achievement of your goal as a provider of pharmaceutical care. The communication styles between pharmacy workers and patients have evolved over the years. In earlier years, the communication revolved around selling medication, whilst today, the emphasis is on providing treatments and self-care.
The old style of communication unfortunately still clouds the patient-pharmacy relationship with lack of information. The pharmacy assistant should provide information regarding the use of the medicine and should be willing to clarify the patient's doubts. The pharmacy team workers should take initiative, because this communication is often asymmetric in nature - the pharmacy assistant may be required to communicate more than the patient. Lack of symptom assessment often results in lack of evidence-based decision making, thus resulting in reduced patient outcomes. The communication behaviour in pharmacy settings is often influenced by traditional beliefs and
myths.
For example
They may assume that a patient coming in for reβills (or treatment for chronic healthcare treatment) does not require any information. In other words, the patient may be regarded as a passive entity, in that you must provide information only if asked for it. On the contrary, the patient is an active entity and the pharmacy assistant must strive to establish an open relationship based on trust and mutual decision making. In addition, the pharmacy assistant must possess an enhanced understanding of the flow of information to the patient from various sources. Communication can also be improved by the βlow of electronic information. This will be discussed in detail. Fostering communication skills is an intensive learning process, which requires pharmacy workers to develop personal competency.
4.5 How to use Counselling Skills to Enhance Communication
There is some degree of emotional involvement in the communication between the patient and the pharmacy worker, even if it is brief. The patient wants something from the pharmacist and this “something” may vary across patients -some may seek reassurance, some may seek information and others may want clarification. It is up to the pharmacy assistant (it is usually pharmacy assistants who interact with the patients across the counter) to help the patient to provide information, by asking the right questions with a view to maximise benefit to the patient.
During the course of a normal working day, you may come across several types of patients. Some may be difficult, whilst others may be simpler to deal with. As a pharmacy worker, you must learnmthe art of remaining professional and cool.
Forming a relationship with the patient
When we communicate with someone, a relationship automatically starts to form. A pharmacy worker who smiles at patients, looks them in the eye and takes time to answer queries will help the patient feel better about themselves. On the other hand, a pharmacy assistant who continues to chat with his colleagues, whilst ignoring the patient, will end up making the patient feel ignored and unwanted. Patients will have a human tendency to visit the same pharmacy again, simply because they like the pharmacy assistant who takes an interest in them and their welfare. As a friendly pharmacy assistant, you may ask after the patient's health. The patient is more likely to prefer dealing with you, because of your personal attitude towards him.
Vulnerability
Many times, ill health, sickness or healthcare requirements can make it more important to develop strong and empathetic communication skills. Loss of health can make patients anxious, worried and irritable. These emotions are sometimes directed at the pharmacist, but it is sensible to remember not to perceive such behaviour as personally directed towards us. Irritability or anger caused by ill health is often fuelled by inner fears and such a reaction (of directing it towards someone else) is called “displacement”. Patients are sometimes angry at something that may be totally unrelated to you.
These are excellent opportunities to learn to hardwire your response to angry customers and to learn to keep your cool. The first inclination will always be to respond in kind, but this would be the wrong approach. It is a good idea to use the LATTE technique. LATTE stands for Listen to the patient, Acknowledge the problem, Take action towards problem resolution and lastly, Explain why the problem occurred. Do not be dismissive or condescending to the patient, as this will only exacerbate the situation even further.
Your behaviour should be aimed at calming the patient down. Demonstrate an attitude of empathy and understanding and assure the patient that you are doing all you can to rectify the situation. The patient needs to feel assured that you are on their side. You can also consider apologising, even if the complaint has nothing to do with you. Research into customer behaviour shows that a timely apology can calm down an angry person almost immediately.
Transference
Overly anxious patients may perceive the pharmacy worker as an authority figure and may become overly dependent on him or her, far beyond a professional relationship. As a pharmacy assistant, it is good to be aware of this phenomenon so that you are able to maintain a friendly professional relationship with a personal touch, but not excessively personal at the same time.
FACT
According to statistics, almost half of the adult population in the UK consumes prescription drugs.
Source: nhs.uk
4.6 Empathetic Counselling Abilities
Empathetic response helps pharmacy workers to communicate better with patients and is an effective way of gaining information regarding symptoms and the disease. Empathy is the ability to put yourself in another person's shoes. As a pharmacy assistant, you can respond empathically by listening and observing. Module 5 will explain further details about how a pharmacy worker can effectively counsel a patient.
The following conversation illustrates empathetic responding in a pharmacy setting:-
Example 1
Patient: I have been experiencing pain in the knee, in the past week.
Pharmacy assistant: I am sorry to hear that. You must have been in so much pain.
Example 2
Patient: I have been taking the medication for one week now.
Pharmacy assistant: How do you feel?
Empathetic responses indicate continuity, because your job role does not end with simply selling medication. It shows interest in the patient's wellbeing and that you are able to understand the anxiety that it is causing the patient. Some patients may not wish to admit that they have not understood the instructions and they may feel embarrassed to ask. Establishing an empathetic relationship will help to make the patient comfortable with you and they are more likely to request for guidance.
Example 3
Pharmacy assistant: This medication should be taken three times a day, with two tablets each time before meals. It should be taken along with an antacid tablet.
Patient: Yes.
Pharmacy assistant: You look a little anxious, would you like for me to go through the instructions step by step again? Don't worry, I will be glad to explain it until it's clear.
Clarity
Pharmacy workers should develop clarity in communication, not only with patients (misunderstanding medication therapy, dosage, etc can result in an increase of risk to patient wellbeing), but also with team members and other healthcare workers, such as physicians. Open-ended questions can help to clarify communication, as it gives an opportunity to the patient to express doubts or questions. For example, you could consider asking: “Am I being clear enough with the instructions?”. The patient is more likely to provide an honest response.
4.7 Communication With Other Healthcare Professionals
Efficiency and success in your job will depend on your ability to communicate clearly with other healthcare professionals. Prescriptions can sometimes be ambiguous or vague with instructions and in such cases, you may need to contact the primary care provider for clarifications. In case, you need to contact the GP or medical practitioner, make sure that you phrase your request in professional terms.
For example, you could try saying “I feel concerned that...................................A fresh prescription will help to clarify the medication for the patient, as it is important that we have understood the prescription completely”. Similarly, if you work in a hospital pharmacy, you may need to exercise more patience and empathy, as patients and caregivers are likely to feel more anxious and out of control in a hospital setting. They may not behave like their normal selves because of the feeling of dependency and it is important to understand this.
Activity
Estimated time 10-15 minutes
A patient is annoyed because the pharmacy gave him a stronger medicine, when a milder one would have done just as well. Make some notes on how you would handle the situation and calm the patient
down.
We will discuss communication and the communication of prescriptions and how pharmacies can improve care transitions for patients, in the next module.
MODULE SUMMARY
Communication skills play a pivotal role in establishing an open and mutually beneficial relationship between the pharmacy and the patient. The communication behaviour has evolved over the years and expanded to correspond with the changing role of pharmacy in healthcare. In earlier years, the emphasis was on selling medication and this has now changed to providing treatment and self-care. The patient in turn has changed from a passive user who simply paid for medication and followed instructions to an active one, who asks for information and participates in decision making.
Communication skills can drive the pharmacy-patient relationship and make it more effective. Research data indicates that although OTC drugs are available at supermarkets, customers still prefer visiting their favourite pharmacies and taking the advice of their pharmacist. Pharmacy workers are able to advise the patient regarding drug interactions and adverse effects and so on. Keeping in mind the evolving role of pharmacies in healthcare, pharmacy owners should consider implementing in-house communication training programmes that help to restructure the patient- pharmacy relationship. An increasing number of pharmacies are also introducing communication protocols and standard procedures that help re-orient treatment, based information and guidelines.
The form of information should generally vary, depending on the different patient groups that visit the pharmacy. The NHS is increasingly recognising the competence and ability of pharmacy workers to help to achieve healthcare goals. The intensive learning process needs to incorporate principles, including two-way communication, self-development, patient orientation, strategic planning, collective
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