PHRM 3900:
Pharmacy Communications
Matthew Perri, Ph.D., R.Ph.
Professor of Pharmacy
Clinical and Administrative Pharmacy
Room 260C Ph:542-5365
mperri@mail.rx.uga.edu
Plan for today:
Course overview & introduction
– ID Cards
Name, where you are from, any prior degrees, something about
yourself that will help me remember you
– Course Web page
The pharmacy care process
OBRA 90 and Pharmacy Care
Common communication mistakes health practitioners
make
Basic communication skills
The Pharmacy Care Process
Collect and use
patient information
Follow up to assess
patient outcomes
Select and recommend
therapies
Identify patients’ drug
related problems
Develop solutions
to these problems
OBRA 90:
Three parts:
– Patient Information
– Prospective Drug Utilization Review
– Patient Counseling
Public Law 101-508, S4401, 1927(g) (November 5, 1990) and OBRA 90
Regulations. Federal Register November 2, 1992;57FR(212):49397-49401.
Patient Information
Full name
Address and phone
Date of birth (DOB) / age
Gender
Drug list (profile) including all OTC, Rx, herbal
supplements, etc.
Pharmacist comments
Chronic medical conditions (diagnoses)
Keep for 2 years
Prospective DUR
Over / underutilization
Therapeutic duplications
Drug-disease interactions
Drug-drug interactions
Incorrect dosage or duration of treatment
Drug allergy interactions
Clinical abuse - misuse
Patient Counseling
Name (generic)
Intended use and expected action
Route, dosage form, dosage and administration
schedule
Special directions for preparation, storage or
administration
Precautions to be observed while taking
Common side effects, how to avoid or action required if
they occur
Techniques for self monitoring of drug therapy
Potential interactions or therapeutic contraindications
Refills
What to do if you miss a dose
Any other information THIS patient may need to ensure
safe use
Basic Communication Skills in
Pharmacy Practice
The Communication Model
The communication model:
Communication takes two
– sender and receiver
To optimize communication we must
consider the “channel”
Two way flow of information
Potential for a breakdown to occur at any
time
Barriers will exist – minimize these when
you can
Communications Skills in Pharmacy Practice, Tindall, Beardsley and Kimberlin, third ed., 1994, Lea and Febiger,
p 15.
Barriers to communication
Pharmacy Environment
Barriers to communication
Pharmacy Environment
Barriers to communication
Basic Counseling and
Communication Skills
Courtesy and rapport:
– Quite possibly the most critical skills you will
need to develop, and includes:
How to address patients
Introducing yourself
Learning patient names
Being aware of your appearance, attitude, issues
Respecting patient privacy issues
Avoiding stereotypes
Using appropriate body language
Body Language
Message impact:
7% verbal
38% vocal
55% body movements
Often more believable than words
Composed of
Body movements
Facial expression
Gestures
Posture and breathing
Space
Basic Counseling and
Communication Skills
Body language (we will spend more time
on this later)
– Facial expression – smile
– Eye contact
– Open posture
– Distance
– Tone of voice
– Get “CLOSER”
– Control distractions, lean in, open posture, smile, make
good eye contact, relax
Some samples of facial body language….
Bringing it home to pharmacy, is this an
example of good body language for a
pharmacist?
Stereotypes
The process of attributing a set of
characteristics to all members of a group,
without regard for individual differences.
– We all react differently to different kinds of people, and even differently
at different times. Some reactions are overt, some hidden. They all can
impact how we relate to patients. We want to avoid letting stereotypes
influence how we react to and interact with our patients.
– Example statements:
“Doctors are arrogant”
“You can’t trust…(fill in with your favorite; men, women, college students, professors,
etc.)”
“Teenagers are irresponsible”
Hugman, B. Healthcare Communications, Pharmaceutical Press 2009: p50.
A stereotype in action:
I’m not feeling very well – I need a doctor immediately.
Ring the nearest golf course.
Groucho Marx
Stereotypes
Common and most everyone holds to
some degree of stereotyping
What is the impact of this on rapport?
Being aware of how you may stereotype others is
critical
Treat everyone as an individual
Rapport
A level of mutual consideration and
respect
– The “warm fuzzy” part of communication
– Paves the way for good communication
Trust is critical
– How do you build trust?
– How do you keep it?
– What happens when you break it?
Perceptions
FINISHED FILES ARE THE RESULT OF YEARS OF SCIENTIFIC STUDY COMBINED WITH THE
EXPERIENCE OF MANY YEARS
OF EXPERTS
Listening
Basic Skills: Listening
Listening Skills:
– Be aware of perceptions (F
test)
– Be non-judgmental
– Be an active listener
Summarizing,
paraphrasing, clarifying,
feedback (immediate,
honest and supportive)
– Use appropriate listening body
language
– Use silence where appropriate
Listening Skills:
–
–
–
–
–
Sit up.
Look and act interested.
Lean forward.
Actually Listen!
Nod your head to show your
attention.
– Make eye contact with the
speaker.
Basic Skills: Information
When communicating important information
to patients, be sure to:
State the purpose of your communication
Inquire about what the patient needs
Use markers for critical information
– “Now, Ms. Smith, this is really important…..I need you
to…”
Talk in lay terms, but don’t oversimplify
– Avoid technical jargon
– Avoid information overload
– Keep it short and simple, to the point
Basic Skills: Gathering
Information
When gathering information
– Ask open-ended questions
Much more information can be gained
Saves time
Provides opportunities for patients to reveal
information we might not be thinking about
– “How are you supposed to be taking this…?
– “Tell me more about this…”
Basic Skills: Assessment
The question is, did your patient learn anything
from you? In other words, did the other person
understand what you said, and meant?
To assess:
– Summarize your teaching
– Verify what your patients know
“Ms. Smith, can you tell me how you will take your
medication?
– Reinforce patient understanding when you can
“That’s right, this medication will make you sleepy…”
Basic Skills: Empathy
Seek to understand what your patients feel
Empathy is not sympathy
Realistically, may not be attainable because you
are not the other person
Empathy will help you shape your communication
so that others better understand you!
Listening and Responding Test: (p47
Tindall Book)
Basic Skills: Questions
Encourage patients to ask questions
– “Just let me know if you have any other questions, OK?
Key Point: When your patients are
comfortable asking you questions, you
know you have rapport and are doing a
good job communicating.
Basic Skills: Assertiveness and
Persuasion
Assertive versus aggressive.
Persuasive versus pushy.
– What is the difference?
Counseling Methods We Will
Learn:
Basic Counseling
– Interactive patient counseling
The Prime Questions
Counseling in challenging situations
– The PAR technique
Prepare, assess and respond
Counseling for compliance
– The RIM technique
Recognize, identify and manage
Face Reading: Art not Science
Light
Forehead
Eyebrows: shape,
position, type
Eyes: spacing, angle,
bulging, size of iris, corner
indents, pupil response,
showing stress
Eyelids
Eyelashes
Eye Puffs
Nose: size, shape, ridge,
width, nose tip angle,
Fulfer, Mac, J.D., Amazing Face Reading, 1996.
Nose tip
Nostrils
Ears: size, cups and ridges,
angle to head, placement
Cheeks
Mouth: size, angle
Lips: size and shape
Teeth
Smiles
Chins
Combinations of features
(Chin/eyebrow)
Lines
Facial hair