Download S05 Basic Communication Skills In Pharmacy Practice

SHEET L.05 SLIDE 2(Basic communication skills in pharmacy practice)
February 14, 2017
practice 2
Sheet Number : 5
Dr. Name : Eman Elayeh
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SHEET L.05 SLIDE 2(Basic communication skills in pharmacy practice)
February 14, 2017
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Last time we talked about basic communication skills and barriers of communication, we also learned
about things concerning the sender, message and the receiver. And we focused on the body
language and the possible mistakes which pharmacist can make during communication with patients.
Today we will talk in more details about the things should be done before, and during the interview
and how can we end it with the patient.
We usually make the interview with the patient for several reasons such as:
1. counseling of the patient
2. patient education or to connect with patient so that I will have an idea about the patient's
medications in case he needs an adjustment or change
3. Or if there was drug-drug interaction to modify on his care plan.
 Does the patient get benefits from the interview? HOW?
YES,
1. Better control of the disease.
2. Help the pharmacist to deal with the patient properly.
3. The patient will have higher satisfaction level and will be more comfortable taking his medications
after the interview.
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All these things will improve the relationship between the pharmacist and the patient
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What are the most important things to consider while interviewing the patient?
1) Courtesy and rapport
 As a part of courtesy and rapport, one of the most important mistakes pharmacist do is that fail to
address themselves or to identify the patient, meaning they don’t know the patient's name and
the patient doesn’t know the pharmacist's name.
 That’s why there should be a proper addressing for the patient, and it's preferable to call him by
his title if it was clear ( doctor/ engineer/sir…) or if the patient was an elderly then we can call
them )‫خالتو‬/‫(عمو‬
 Don’t speak to patients in an impolite or rude way.
EX:
an old women name (Rasmya Muhammad Fu'ad) after making sure that it's her name, I don’t call
her (Rasmya) instead I can call her )‫(خالتو ام محمد‬
 I can also use the patient's surname, anyways I should use any name the patient's is comfortable
with
 Also as a part of courtesy and rapport to use appropriatebody language
 Appearance is also important, first impression matters
 Also as a part of courtesy and rapport to respect the patient's privacy.
 BUT at the same time over respecting and totally not interfering with this privacy isn’t right when
there are important treatment-related information I should know.
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SHEET L.05 SLIDE 2(Basic communication skills in pharmacy practice)
February 14, 2017
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I should have a border line to distinguish whether the needed information is considered as only
interfering with privacy or its truly related to the case and would help me to differentiate
between different medical conditions
It's very important to determine the goal of the interview before starting.
EX:
I can tell the patient at the begging of the interview that the goal of our conversation today is for
me to know more about your medications and disease, or the purpose can be to teach the patient
how to use the inhalers prescribed to him by his doctor, or to teach the patient how to inject
insulin or to make sure the patient is adhered to his diet.
So the purpose of the interview should be clear from the beginning, why?
So the patient can determine whether he got the needed outcome or not.
EX:
If the pharmacist told me he wants to teach me how to do insulin injection but after finishing the
interview I didn’t know how to use the injection because the pharmacist was focusing on how to
safely dispose the needles or how to monitor the blood glucose while he told me that he will
teach me about insulin injection techniques.
2) Body language: Nonverbal communication:
 Body language is also important and we talked in details about the verbal and non-verbal
previously.
 There's an a acronym to remind us with communication skills which is get CLOSER:
C:
To control any distractions
 We want to reduce the number of distractions as much as possible (mobile, phones, other
patients coming in the pharmacy while I am talking with the patient)
 So we have to reduce the distractions to keep the flow of thoughts for both the pharmacist and
the patient.
 EX:
Playing with hair (especially girls), the continuous crossing and uncrossing for hands or feet,
chewing gum, all of these can irritate the patient and make the pharmacist look unprofessional
L:
Stands for lean in slightly to the conversation
 Meaning to get physically closer to the patient and make him feel that we are interest in the
conversation
 This is an important point if there wasn’t a private area, where the noise and distraction will
increase as other patients walk in the pharmacy, so I try to get closer to the patient so that our
attention and concentration are kept with the conversation.
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SHEET L.05 SLIDE 2(Basic communication skills in pharmacy practice)
February 14, 2017
O:
Keep an open posture
 Crossed legs and crossed arms give an idea that the pharmacist isn’t relaxed, so we avoid this.
S:
Smile
E:
Eye contact
 At least 75% of the interview should contain eye contact with the patient as long as the patient
is speaking, there should be no distraction and eye contact should be maintained.
R:
Relax
3) Questioning
 the type of questions asked during the interview
 The best type of questions is open-ended questions which give us more information than
expected
 YES or NO questions → the answers are very limited
 When I give the patient the chance to talk, he can give information which weren’t on my mind but
could be the core of the patient's problem
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EX:
If I want to evaluate patients compliance, if I asked him: "are you compliant or not?" he may
answer: "yes, I'm compliant". But if I asked him to tell me when is he talking his medications or at
what time of the day, I could see that the patient considered himself compliant (he takes the
medications if certain symptoms occurred, as PRN)
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EX:
Antihypertensive, diabetes medications, many patients think if there's a headache then they
should take the antihypertensive, and if there's wasn’t then there's no need to take it today. Same
thing goes for diabetes, if there's a symptom of hypertension then they take the medication but if
there wasn’t then they don’t take it.
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So if I asked the patient directly: "are you compliant to your medication?" he may say yes, but
later on during our conversation I would find out that he isn’t. This applies for pharmacological
and non-pharmacological treatments.
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When are the open-ended questions also important?
When a patient comes to the pharmacy complaining of a pain in his stomach, how do I determine
what to give him?
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SHEET L.05 SLIDE 2(Basic communication skills in pharmacy practice)
February 14, 2017
I should ask him for the questions, like how does the pain feel like?And he's the one who should
describe it for me.
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I can make him say every information he has, then if I have missing points I can ask him specifically
about them by YES/NO questions or limiting him with specific options.
We have self treated conditions the pharmacist can treat in the pharmacy.
If a patient comes complaining of a headache, red eyes or has abdominal pain, what questions should
I ask to make sure the medical condition can be treated in the pharmacy or needs referral?
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We have 2 methods:
One method (WWHAM) gives briefed questions and this usually is done by pharmacy technicians not
pharmacist. But unfortunately here the technicians can't dispense or treat in the pharmacy but he
can interview patients to make it easier and less time consuming for the pharmacist when he meets
the patient, so that he's given the final information.
Usually pharmacists use the second method (as method) because it had a larger number of
questions.
1. WWHAM
W:
Stands for whois it for?
 Patients can enter the pharmacy stating that he is in pain, or he could say I need a medication for
stomachache which could be for someone else. So I should ask: "who is it for?"
 Could be for geriatric or pediatric or adult or pregnant lady. Or there could be significant
difference in treatment for males and females.
W:
What are the symptoms?
 It should be in details, what are exactly the symptoms like? I should know the nature of the
pain(burning sensation, squeezing, pressure like)
H:
How long has it been going on?
 How long is the patient suffering from symptoms? Because it might be an acute onset or it may
have been going on for a while and this helps with the differentiation.
A:
Action taking
 What have you done to alleviate the symptoms?
 He may have taken antibiotic at home, so if I want to choose a new antibiotic what should be its
features? So that I choose different one then what he has taken because most likely he has
developed resistance for it.
 The action taken could be a visit to the doctor who gave him a medicine that didn’t resolve his
problem; therefore I should ask what medication the doctor has prescribed.
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SHEET L.05 SLIDE 2(Basic communication skills in pharmacy practice)
February 14, 2017
M:
Medicines taken
 If he has taken medications then the (action taken) is eventually the same as (medicines taken)
So these information gave me an idea about who the drug is for, what are the symptoms and how
long they've going on, what are the things done to get rid of these symptoms and if a medication
was taken or not.
2. AS METHOD
It’s the second method which is more comprehensive.
A: Age of the patient.
S: Self or for Someone else.
M:Medicines being taken.
 The technicians don’t look for interactions; the responsible for this are pharmacists.
 So the pharmacist must ask what medicines are currently taken because there might be an
OTC interaction which may result in a significant effect with the already drugs,
especiallyantiepileptic,immunosuppressant, warfarin.
 These drugs are known to have significant drug-drug interactions, so I can't give the patient
any medication without making sure there isn’t a significant interaction, which can affect the
level of those medications, such as: antiepileptic or warfarin.
 All of these may result treatment failure or toxicity, which are serious for such drugs
E: Exactly what do you mean?
 Meaning what is exactly the nature of the symptoms, describe them
 The preparation of the HPI is the physician's responsibility.
 Things the physician asks about are:
LOCATES
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L: Location
O: Other symptoms
C: Characteristics of symptoms
A: Aggravating and all alleviating factors
T: Timing( onset and for how long)
E: Environment
S: Severity
All of these can be included under (exactly what do you mean)
T:Taking an action
 What did you do to alleviate the symptoms?
 Could be nothing or he may have taken a non-prescription medication (OTC, herbal) or a
prescribed drug from someone else.
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SHEET L.05 SLIDE 2(Basic communication skills in pharmacy practice)
February 14, 2017
H: History of any disease
 The additional thing here is that we asked about other drugs he is taking and the history of any
disease whether chronic or acute.
O:Other symptoms
 This helps with the differentiation
D: Doing anything to alleviate or worsen the symptom
 Is there anything that you've done which resulted in worsening or improving the symptoms?
 If there was certain complain but no differential diagnosis, these 2 methods can help in knowing
what's going on with patient.
 So if I try to do a diagnosis in the pharmacy, I use those questions and see how the symptoms apply
on the patient (vaginal candidiasis, HF…) and decide whether I can treat in the pharmacy or needs
medical referral.
 The example in the slides shows that when the pharmacist used the AS METHOD got more answers
and therefore a better diagnosis.
4) listening
 The forth important part of the interview in listening. One of the biggest mistakes a pharmacist may do
the communication with the patient is to not give the patient a chance to ask his questions.
 So there should be a stage when the pharmacist goes silent to give a chance for the patient to either
make sure he understood or to ask questions.
 So there should be an active listener, what does it mean?
It means when he's asked he should answer, sometimes the patient may ask but the pharmacist ignores
the question because he considers it unimportant.
 Pharmacist may see the question as small or important, but it is for the patient.
EX:
A female patient came to the pharmacy prescribed with vaginal ovules, when she came back she
complained about the drug being "viscous", which means she has taken it orally!! So there must be
communication with the patient so that she understands that the drug is vaginal not oral.
5) Use of silence:
There should be times when the pharmacist goes quite to give a chance for the patient to ask
6) Talk in lay terms:
The words we use should be as short and as simple as possible, to the point, and avoid difficult and hard
terms.
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February 14, 2017
 BUT, we shouldn’t make them too simple so that the patient wouldn’t feel he's stupid. They should be
something in between, unless if it's obvious that the patient has a low level of education, then we have
to simplify to some point but not to over simply, so that he doesn’t get insulted.
 So we should try to determine patient's background from the beginning to make it easier for us to
communicate with patient.
 In the hospital, the patient's background is written in his file.
7) To develop empathy
 Theirs is a difference between empathy )‫ (تعاطف‬and sympathy )‫(شفقة‬. Nobody likes for people to feel
sad for them, this could devastate the patient, we should make him feel that we empathize but not
sympathize with him
 We have to be empathic but not sympathy
 When we see a patient we can say ),‫ سالمت‬,‫(بالسالمة هلل ششفش‬without showing that we are sad for
him.
 There are 5 stages when getting into the interview:
1. Preparation:
 Before starting the interview. This is mostly when the patient is known and has a file and his PMH
and used medications are all know.
 If a patient X wants to come and get a refill for his prescription, I prepare and get to know his
disease and medications to be ready when I meet him.
 In the hospital before entering a patient, I review his file and know his disease and why he was
administered to the hospital, what operation has he done, his symptoms, and then I review his lab
tests and check the abnormal results, check his vital signs and medication. Therefore, large parts
of information are already available, so I only need to know certain things which will take a lesser
amount of time with the patient.
 When the patient talks with someone who knows a lot about him and his disease, this will
increase patient's trust levels in the pharmacist, and the interview will become much easier and
smooth.
 There may be some information that would be more understandable if been read from the
patient's file rather than if heard from the patient himself
 For doctors, it's easier for them to hear the symptoms in Arabic directly from the patients and
write them down clearly in the file; therefore it gets easier for the pharmacist to understand them
when reading them in English.
2. Setting the stage for optimal communication
 When we start the interview, it's very important to choose a private area and try to reduce
distractions if a physical barrier exists (counter) we should remove it.
 Sometimes we have to deal with the patient with his own personal barrier, if he was angry for
example, we could try to know what's upsetting him and try to say something nice and calming to
reduce his anger and stress.
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SHEET L.05 SLIDE 2(Basic communication skills in pharmacy practice)
February 14, 2017
3. Beginning the interview:
 First I should introduce myself and get to know the patient's name, and if the drug is for him or
another person.
 So the first they is greeting the patient and identify ourselves. (The patient came with new
prescription for warfarin for example) after greeting, we take permission from the patient like:
can I have 10, 15 minuets of your time to talk to you about this medication? Then I should know if
he takes other drugs or not.
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The interview will divide into several stages:
First how to open the interview and introducing ourselves and try to be empathic with patient and
take his permission as we mentioned, then if possible take him to a private area, then start
gathering information.
What is the information I need to gather?
What medication is he taking (with prescription, or without) disease he has exercise, pregnancy,
diet, smoking. All of these plus the medical condition and medications should be gathered at the
beginning of the interview.
4. During the interview
 Note: verbal and non-verbal communication should be done together YES/NO questions are
absolutely prohibited here( I need to have as much information as possible)
 What things to mention when talking about the medication?
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Always if it was a new prescription, our reference is the physician so ask him: what did the
physician tells you about the medication? What did he tell you to expect from it? Why did he
prescribe it to you? How did he say to use it? What side effects did he say you should expect?
What did he say you should monitor? What diet did he advise?
If it was a refill prescription then we cancel on the physician because the patient now has an
experience on how to use it, so the patient becomes our reference.
EX: How do you use the drug? What side effects have you experienced? Why are you using this
drug?
Now for the new prescription:
The first question I should ask before doing (patient education) is to make the patient knows the
drug or not, so I ask him why did the physician prescribes this drug for you?
If he answered (to prevent clotting in my legs) in case of warfarin, then I am sure he knows why
he's taking it.
How did the physician say to use the drug? (We mean dose, frequency, time, duration rout of
administration)
For example: he said to take one pill daily in the morning, always in the morning or always at
night, one puff at night.
We let him speak and any gap found we fill it. For example, I tell him the drug (5mg) is taken once
daily either in the morning or at night, but should be taken at the same time everyday without
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February 14, 2017
food, you can take it until the date your physician has determined or for lifelong unless you suffer
from complication and the physician decided to cancel it.
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One of the things I should let the patient know about is when to expect improvement, especially if he
suffers from signs and symptoms
If the drug doesn’t affect the signs and symptoms like statins, I tell him you can't feel changes
happening to you while you are on this medication. So to make sure if the drug is working do a lipid
profile test after a month or two depends on what the physician has told you. I encourage him to
stick with the period determined by his physician so that he won't end up with 2 answers regarding
when to do the lipid profile.
Also emphasize on diet, exercise, avoidance of risk factors
EX:Asthmatic patients avoid smoking areas, dust, and moisture in houses, fix water leakages, and get
rid of cockroaches.
Recommendations?
For example (non-pharmacological), if the drug induces sunlight sensitivity, I advise him to avoid long
exposures to sunlight, wear long sleeves, use sun blocks and wear sunglasses.
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Then I should tell him about the side effect... What are the side effects that the physician said might
happen?
 What type of side effect I tell the patient about?
The very common ones, which happens >10%
1-10% → common
<1% → less common
 The SE can be rare BUT severe.
EX: oral contraceptives
SE which are important to say and are common: nausea, vomiting, and breakthrough bleeding
As a serious SE which are rare: DVT, and what are the signs resulting from DVT
 So I should talk about them both.
 When I talk about side effects, it's not enough to only mention them, I should have time frame when
to expect these SE.
 There SE which occurfast and other which are delayed, so I should determine when they are
expected to occur and if they do what the patient can do to relieve them.
 For example: I can say to take it with more water, or decrease fluid intake, or...Depends on the
symptoms I have.
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Warnings and precautions, how to prevent or how to deal with SE should be determined.
If severe SE occurs, the patient should see a doctor.
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Another thing I should make sure of, is the patient's expectations about the drug whether good or
bad things.
Bad things are mainly SE: I should hear it from the patient because he might have much higher
expectations; like that 100% of patients suffer from bleeding with warfarin.
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SHEET L.05 SLIDE 2(Basic communication skills in pharmacy practice)
February 14, 2017
Although the rate is much less, so I should discuss the patient's concerns about the drug with him.
 Good things: I care about hearing the patient's expectation like if he expects full cure while the drug
doesn’t cure, this should be corrected.
5. ending the interview
 At the end of the interview we have to have a verification step
 EX:To say to the patient: to make sure I didn’t forget any information, can you summarize the most
important points we said about warfarin?
 We also have to follow up at the end of the interview.
 Follow up means I have a way that permits the patient to access the pharmacy in case he has any
questions, so we can offer the patient the pharmacy's number or tell him: " you are welcome at any
time"
 Most times, when I tell a patient that a SE is very common, he expect its 65%
 Very rare → actual percentage <0.0001 while the patient expects 4%. So it's important to discuss
the SE with the patient and talk about how can they affect his life
 But we also don’t want to lie to the patient
EX:
A cancer patient receiving chemotherapy which can cause infertility, I can't let him think that he can
have children in future like saying (keep your hopes up), so we have to be honest with the patients
but without despairing him
 This is important because the patient may ask for other treatment option if it has a lower efficacy
but less SE in return, in the end we care about the patient's preference because it's his life, so we
state the advantages and disadvantages and leave the decision for him.
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SHEET L.05 SLIDE 2(Basic communication skills in pharmacy practice)
February 14, 2017
‫ إذا لم أجد ربحا فلست بخاسر وما‬..... ‫"وجدت سكوتي متجرا فلزمته‬
"‫ وتاجره شعلو على كل تاجر‬..... ‫الصمت إال في الرجال متاجر‬
‫االمام الشافعي‬
Lana Abu Khadija
Christine Haddadin
Raghad Qamareldeen
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