5.1 Introduction
Communication involves the transfer of meaningful information from one person to another. Effectiveness of pharmaceutical care depends to a large extent on the quality of patient-pharmacy communication. However, it is extremely important to develop a strong set of communication skills, because the receiver does not always understand the message that the sender intended to convey. This type of misunderstanding can lead to an increase of risks for the patient.
Pharmacy assistants should focus on building an egalitarian relationship with each patient and believing that every person is entitled to the best healthcare. The relationship between a patient and the pharmacy goes beyond merely selling medicines or exchanging information. An empathetic attitude will help to establish clear and open lines of communication.
Effective communication may be distorted, due to a wide range of barriers. Some common barriers to effective communication include semantics (similar sounding words and symbols), faulty translation (usage of high flown technical language) and bad expression (incomplete sentences, or repetitive words). The content and choice of words should be suited to the understanding level of the listener.
One of the most important aspects of patient-pharmacy communication is recognising the fact that each patient is different, in terms of understanding and perception. What may seem comforting to one, may seem frightening to another. As a pharmacy assistant, you have to ensure that you curate content and select words and phrases in accordance with the patient's level of understanding.
Whilst poor communication can have a negative impact on every area of our lives, it can lead to life- altering consequences in a pharmacy. It is important for pharmacy workers to refine their communication methods, in order to ensure that patients understand and comprehend treatment information.
5.2 Pharmacy Assistant's Detailed Guide to Patient Counselling
The communication process that takes place between a pharmacy team worker and a patient serves two primary purposes:-
-To establish an ongoing and smooth relationship between the patient and the pharmacy.
-To enhance βlow and exchange of information, which helps to perform a better health needs assessment, implement suitable pharmaceutical care and evaluate the effect of the medication.
The pharmacy assistant must be able to:-
-Understand the sickness experience of each patient. In order to be able to do this, you need to be familiar with basic medical and pharmaceutical terms.
-Appreciate that each patient's experience is unique, even if the condition is similar.
-Establish and foster an egalitarian relationship with patients. This means that you should treat each patient equally and believe that everyone has a right to the best healthcare that you are able to provide. Favouritism, partiality and prejudices should have no place in your outlook and attitude towards people.
-Build a therapeutic alliance with each patient to achieve mutual goals.
Pharmaceutical care and patient counselling requires much more than exchange of information and selling of medicines. The relationship requires commitment, understanding and empathy. By demonstrating your concern for the patient's wellbeing, you are likely to elicit a more positive and open response from patients. They are more likely to express their doubts and difficulties regarding medication.
In order to foster a therapeutic response, you must develop a system of flexible response. This is because each patient is unique and what is frightening to one patient may be comforting to another. There is no right or wrong response, because you have to tailor your responses based on the requirements, beliefs and expectations of each individual patient.
Activity
Estimated time 10-15 minutes
Imagine that you work in a pharmacy located in a multi-ethnic locality, where you interact with patients from different educational, economic and cultural backgrounds. How will you regulate your behaviour, in order to provide the best services?
5.3 Developing Self-awareness of One's Personal Effects on Patients
Self-awareness will help to develop a positive interaction with the patient. A personality assessment will help us to identify our personal characteristics and we will understand how others perceive us. Patients may be intimidated or put off by your body language or tone. Becoming more self-aware helps you to foster effective relationships with patients.
As a pharmacy assistant, you should encourage patients to share their experiences. This is because patients often harbour misunderstandings regarding medication therapy, experience problems, have unanswered questions and most importantly, may not reveal information unless the pharmacy worker initiates a dialogue.
Communication during medication therapy (provided by pharmaceutical care) comprises of the following important aspects:-
-Purpose/objective of medication
-How the medication works
-Dosage, duration
-Side-effects and how to observe them
-Monitoring progress
-Goals of medication therapy
An effective communications process can maximise positive health outcomes and improve the likelihood of the patient making informed decisions, using the medication properly and meeting the desired health outcomes. It is extremely important to pay attention to non-verbal cues, such as tapping of the hands or feet, or the inability to meet your eye. This may indicate that the patient is extremely anxious and it is all the more important to ensure that he has received your message correctly.
Pharmacy assistants in the UK are likely to interact with a cross-section of patients from different ethnic, religious and economic backgrounds. It is best to avoid falling into the stereotype trap and making assumptions. For example, patients from a different ethnicity make be extremely proficient in the English language, or a person from an economically disadvantaged background may be educated. As an important component of the healthcare system, treat every patient as unique and take an interest in their wellbeing.
5.4 Barriers to Effective Patient Counselling Communication
Effective communication is a key component of patient counselling skills. The expanding role of pharmacy workers means that you will use your communication skills, whilst interacting with a wide variety of people, including patients, healthcare professionals, suppliers, other pharmacy team workers, suppliers and care facility workers, care givers and so on. Pharmacy team workers should possess good communication skills, in order to disseminate information and correct weakness in the transition of care. As a pharmacy assistant, you will often assist in the execution of clerical duties and will enjoy more opportunities to interact with patients.
However, some common barriers to patient-pharmacy team communication could include:-
Environmental/physical barriers:
The design of the pharmacy or the counter could be such that you are unable to communicate effectively. Similarly, leaning slightly towards the client indicates interest and engagement, but leaning too close may intimidate the patient.
Semantics:
Your choice of words plays a key role in how the listener perceives the message. This barrier usually arises if you have a habit of using technical or complicated jargon when you speak.
For example
You may tell a patient that he requires a certain injection “bimonthly”. However, the patient (especially non-English speaking individuals) may misconstrue this to mean “every other month”. Semantics can create serious barriers to effective communication and can result in lack of perception regarding medicine therapy.
Semantic barriers can also arise due to the following reasons (all of the reasons explained below are relevant to pharmacy work environments):-
Bad expression:
If the pharmacy assistant uses bad expressions, incomplete sentences or excessive repetition of words, the impact of the communication gets reduced.
For example
“Consume the pills first, then consume two glasses of water and consume the syrup after consuming pills” makes for confused translation. This can be much better phrased as “Please consume two pills, followed by two glasses of water and lastly, remember to take one teaspoon of syrup”.
Similar sounding symbols or words that may carry different meanings:
You must speak slowly and carefully and be particularly vigilant regarding the choice of words. If the prescription contains notations such as ml or ounces, ensure that the patient has understood exactly what they mean.
Here are a couple of examples, to illustrate the point:-
-Do wish to purchase the syrup too? This could be misunderstood as “Do you wish to purchase two syrups?”.
-Are you able to hear a buzzing sound in your ears? This could be misunderstood as “here”.
Faulty Translation:
This happens when the pharmacy worker uses technical phraseology to explain something to a patient. You have to remember to mould the message to the level of the patient/customer, so that they are able to clearly comprehend the message.
For example
“Avoid consuming concentrated solutions of amoxicillin” can be whittled down to “please consume the antibiotic amoxicillin, only after diluting it with clean drinking water”.
Technical Jargon:
As a pharmacy assistant, you will be familiar with basic (or even intermediate) medical and pharmaceutical terms. However, you must remember that the patient may not be familiar with any medical jargon and will require an explanation in simple terms.
For example
Instead of saying “non-sedative, anti-allergy”, you could explain it as “an anti-allergy medication, which does not cause sleepiness or drowsiness”. Excessive usage of technical words increases the risk of misunderstanding. Since you work in a healthcare, it may be natural for you to speak in the technical jargon with colleagues and other healthcare workers, but it may not work when it comes to communicating with patients.
Administrative barriers:
Unfortunately, many pharmacies are still managed under the old belief systems and myths, implying that the emphasis is on selling medicines exclusively. Services and treatment are often considered non-revenue generating activities. The management and supervising pharmacist must take an active interest in engaging with patients and improving overall levels of satisfaction.
Similarly, if pharmacies are short staffed and assistants are overworked, they may be left with limited time to interact with customers. This can again be categorised as an administrative barrier, because the management needs to take a closer look at staffing requirements. Counselling patients does not involve a lot of time consumption and can yield excellent results for the patient, as well as for the pharmacy. Interpersonal communication is a fragile and complex process, which can get distorted very easily.
Read on for some tips on how to improve the process of interviewing patients at the pharmacy:-
Avoid offering advice before gathering information about the patient's symptoms. This will prevent the patient from providing all of the information and will interfere with your ability to grasp the bigger picture. Please keep in mind that counselling is not restricted only to prescription medicines. An increasing number of British patients rely on a pharmacy to counsel them about the beneβits and side-effects of OTC drugs.
Pharmacy counselling services are on the rise with changing drug formulations and brand name extensions - customers want to be sure of a drug and its effects and moreover, they depend on a pharmacy assistant or technician to provide them with that information. Similarly, some OTC drugs may appear similar in appearance and packaging. A customer may inadvertently purchase a familiar looking package, which may turn out to be something completely different. This is why pharmacy workers should keep the lines of communication open and friendly. This will encourage patients to clarify doubts and difficulties and you will be able to improve the quality of pharmaceutical services.
5.5 Tips to Improve Communication in Pharmacies
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Hurried, incomplete and incomprehensible treatment information can leave patients feeling confused and frustrated. The following suggestions can help to improve communication behaviour in pharmacies:-
Adjusting Assumptions
Most of us tend to take communication for granted. Nodding of the head or a smile may be reflex actions, rather than an indication of comprehension. Pharmacy assistants must never make the mistake of assuming that the patient has understood the instructions or information. Most natural reactions, such as nodding or smiling, are simply social niceties - what you may wish to do is to ask them gently
and politely to repeat the information or ask open-ended questions, to ascertain understanding. Assumptions can also come in the way of familiarising yourself with symptoms and patient information.
For example
People are usually reluctant to share intimate details of their lives for the fear of being embarrassed. They may not tell you that they smoke too much or drink too much, for fear of judgement. Hence, if a patient has not confided these issues, avoid assuming that they do not exist. Ask gentle and incisive questions and explain that the information is important and will enable you to provide suitable guidance.
Here is a list of common assumptions that pharmacy workers often make, regarding patients:-
-Avoid assuming that the GP has explained and discussed the medications with the patient.
-Do not assume that the patient has understood all of the instructions provided. The patient may need to perform certain specific behaviour, to optimise medication outcomes. Provide full and comprehensive information. For example, the patient may need to drink adequate water or may have to avoid certain foods, etc.
-Avoid assuming that the patient will contact you in case of problems or not being able to take their medications - you need to communicate to them that they should always call you.
-Do not assume that a patient who has understood all the instructions will take his/her medications correctly - medical regimens often take time to follow.
Move your Conversation to a more Private Place
It is a good idea to move your conversation to a more private place, as this will help to reduce distractions and will prevent the patient from getting diverted by the bustle. You will also be less likely to be distracted by a co-worker or colleague during your conversation. The patient is likely to perceive this as an understanding gesture and will tend to be more forthcoming about problems, symptoms and experiences.
This will give the patient confidence to talk about private issues.
Tone and Body Language
It is extremely important to be self-aware and observe your own tone, voice and pitch, as you speak. Do not allow irritations and frustrations to interfere with your communication with patients. A louder volume, clipped tones and stiff body language can be a turnoff and the patient is unlikely to express his feelings.
Some subjects, such as unwanted pregnancy termination, end of life care, or birth control are often perceived as controversial topics. Listen, but avoid making judgmental remarks or lecturing the patient because you don't happen to agree with his/her views.
Offer to follow up Verbal Instructions with other forms of Communication
Patients are often anxious and distracted, when visiting a pharmacy. They may be worried about their health or the wellbeing of loved ones, children, financial issues, or a host of other problems. They may be hearing you, but not absorbing the communication, due to mental distractions. In such cases, you may wish to offer to write down, text or email instructions to patients. Other patients may even prefer diagrams or flowcharts.
Keep Copies of Step by Step Instructions Handy
If you find yourself repeating certain instructions on a regular basis, you can consider keeping copies handy to give out to patients. However, please do not simply hand over the copies. Make sure that you walk the customer through the steps and make sure that they have understood.
Activity
Estimated time 10-15 minutes
Take 10 minutes to read the following and write down your answers:-
Which gestures, postures and body language would you like to minimise and eliminate, if possible, in order to promote communication with patients?
5.6 Communication with Special Patients
The Elderly
Patience, understanding and courtesy are valuable traits when communicating with elderly patients. Elderly patients may experience difficulties in communication, which may include impairment with speech, hearing, or vision. Physical, mental and cognitive abilities vary significantly across elderly patients. Spend time listening to and understanding the needs of each patient.
Many elderly patients may surprise you with their adept and sharp cognitive abilities, whilst others may experience difficulties in comprehension. In such cases, you may wish to communicate with the caregiver and ensure that medication therapy recommendations are understood. Young pharmacy assistants in busy and overworked pharmacy settings (especially retail pharmacies) may deal with elderly patients brusquely or impatiently.
The following tips explain how to communicate with elderly patients:-
-Summarise what the person has said and repeat it, in order to ensure that you have understood their problem.
-If the patient suffers from a speech or hearing impairment, try communicating by writing things down.
-Gently emphasise and repeat instructions.
-Make it a point to gently guide the patient, if they sound confused.
-If you are communicating with the elderly patient as well as the caregiver, make sure that you receive feedback from both, without ignoring either one.
-Avoid using technical and discipline-specific jargon.
-Avoid using excessively familiar terms of endearment or infantilising the patient (treating the patient as a child).
-Allow the patient plenty of time to answer and avoid filling in silences for the patient. If the patient suffers from hearing impairment, consider rephrasing your words (rather than speaking louder) or consider a headset amplifier. This could be an extremely useful tool, if the pharmacy serves a significant percentage of elderly patients.
-Use a pleasant, warm and cheerful tone and infuse humour into your conversation, whenever appropriate. Senior citizens form a bulk of the clientele that visit pharmacies in the UK. It is extremely important to learn effective communication, so that you are able to provide your best services.
Children
Children will usually be accompanied by parents, guardians, or caregivers. Make eye contact and speak directly to the child. Demonstrate your willingness to answer any questions that the child has and use simple language to explain instructions. When dealing with mentally ill patients, ensure that you have obtained consent from an authorised adult before providing medication therapy.
FACT
The elderly account for 60% of the UK's population, but account for 59% of prescription drug usage and NHS costs
Source: ncbi.nlm.nih.gov
5.7 Ethical Principles and Decision-making in Patient Counselling
Autonomy:
The patient plays a significant role in self-care and has the right to participate in decisions involving medication therapy and self-care.
Beneficence:
Pharmacy assistants are healthcare professionals and should provide the best services to all patients.
Confidentiality:
Please respect a patient's right to privacy and avoid disclosing medical treatment information to third parties, without prior approval and consent.
Fidelity:
As a pharmacy team worker, your objective should be to promote the patient's wellbeing, rather than the pharmacy's own financial status.
Pharmaceutical care begins when patients accept the recommendations of the pharmacy worker, understand the instructions and attempt to sincerely follow the drug regimen. Again, the quality of your communication will determine if the patient makes intentional or unintentional deviations from the drug regimen. Regardless of medication therapy, patients understand the recommendations from their idea of perceived benefits, costs and effects.
Patients will often monitor their own response - and the pharmacist worker plays a crucial role in explaining what the patient should look out for, in order to validate the feedback from the medication therapy. When patients lack information from the pharmacy, they tend to use their own ideas in the implementation of drug therapy. Your communication skills help to elicit important perceptions and information, which can then help you make a correct assessment of the patient's needs.
For example
A patient may initiate a follow-up visit to a physician, but may fail to inform the pharmacy assistant during a follow-up visit for a reβill. The pharmacy worker is expected to take initiative, to elicit this information from the patient. Patients are more likely to conβide in you, if they feel safe and respected.
MODULE SUMMARY
Pharmacy team workers play a crucial role in enhancing patient safety in overseeing the use of medication and the implementation of medication therapy. The evolving role of pharmacy workers implies that you will communicate with a wide variety of individuals, including physicians, nurses, other healthcare professionals, patients, suppliers, insurance companies, care-givers and hospital workers.
The pharmacy team's communication skills are particularly important in patient satisfaction levels and perceptions of overall quality, service and trust. Communication behaviour consists of time, language, choice of words, understanding and listening. High quality communication skills include empathetic responses, clarity, open-ended questions, absence of distractions and verification of patient understanding. Out of these, verification of patient responses is especially crucial, as this is the factor that determines the effectiveness of your communication.
Complicated phraseology often creates roadblocks to clear communication. Similarly, bad expression, incomplete sentences, excessive repetition of words and faulty translation may result in reduced communication with the patient. In fact, the use of complicated phraseology may intimidate patients and they may feel reluctant to keep asking for clarifications. As a pharmacy assistant, you are used to working in a healthcare environment and may be habituated to conversing in technical language with colleagues and other healthcare workers. This is why you must consciously use simpler, clearer language, when communicating with a patient.
Patient counselling should ideally comprise of a two-way dialogue between the patient and the pharmacy worker. Each patient will have a different set of questions or perceptions regarding medication. You must focus on each patient as an individual with unique needs and clarify specific questions. Patient-guided counselling communication is encouraged in pharmacies, because it reinforces two-way exchange of information.
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