Five steps to better communication

with your patients

 03 Dec 2013
 ANALYSIS
Taking time to review patient communication skills can lead to better health
outcomes, free up your time and give you greater job satisfaction
 Francesca Robinson

It's one of the most important things you do in your role as a pharmacist and you've
probably been doing it all day, yet given it limited thought.

Communicating – and doing it well – is vital to building relationships with your patients,
delivering successful interventions and consultations and improving health outcomes. Yet
several studies show there is room for improvement in the way pharmacists communicate
with their patients (more of which below) and, in guidance on improving medicines
adherence, Nice1 says pharmacists should be aware of this need.

The pitfalls of poor communication are significant, says Emma Anderson, a community
pharmacist and regional tutor for the Centre for Pharmacy Postgraduate Education (CPPE)
who leads a one-day ‘Confidence in consultation skills for pharmacists' course. "When this
happens patients are less likely to voice their concerns and not take their medicines
correctly or may simply decide not to take their medication at all," she explains. "This can
result in a greater risk of complications from long-term conditions and an increased risk of
hospital admission."

And it's not just the patient who suffers, Ms Anderson adds. "For the pharmacist this can
result in poor job satisfaction and increased stress. The consultation might take longer if
patients are not able to voice their concerns early on."

So, there are plenty of incentives to improve your patient communication skills. Here's how:

1. Accept that you don't have to be a natural

First, a question: how empathetic a person are you? Answer: it doesn't matter – or at least
your starting point doesn't. "You can learn empathy," says Dr Angela Macadam, principal
lecturer at the school of pharmacy at Brighton University, who teaches communication skills
to undergraduates. "It's not necessarily something you are born with. The thing that matters
is to put the patient at the centre."

Everybody has a bad day from time to time and, when this happens, Ms Macadam says it is
crucial to take a minute to get into a frame of mind where you can focus fully on your
patients and their needs.

To help do this, she recommends her students think about treating patients in the way they
would want their own grandparents would be treated.

2. Engage with the patient as an individual

Mark Johnson is commercial director of TalkHealthTalk, an organisation that provides

support, training and approaches to pharmacists to help them engage effectively with
customers. He agrees that a first step to improving communication is to start seeing
patients as people rather than as prescriptions walking through the door. "The challenge for
pharmacists is to connect with customers and not just transact with them," he says.

The Nice adherence guidance recommends pharmacists should adapt their consultation
style to the needs of individual patients so that all patients have the opportunity to be
involved in decisions about their medicines at the level they are comfortable with.
Pharmacists should consider any factors such as physical or learning disabilities, sight or
hearing problems and difficulties with reading or speaking English, which may affect the
patient's involvement in the consultation.
Pharmacists should establish the most effective way of communicating with each patient
and, if necessary, consider ways of making information accessible and understandable (for
example, using pictures, symbols, large print, different languages, an interpreter or a patient
advocate).

3. Ask the right questions

For Mr Johnson, good communication is "about asking questions and asking questions in
the right way".

It's hardly a revelation that pharmacists should ask open questions but this is still one area
with room for improvement, according to Marjorie Weiss, professor of pharmacy practice
and medicine use at the University of Bath. Ms Weiss's research team has conducted a
number of studies of pharmacist-patient interactions and she says pharmacist prescribers
tend to use closed questions and do not always give a sufficient opening solicitation for
patients to "have the floor" to express their reasons for coming in.2

Good or bad questioning, says Mr Johnson, is "all about the patient experience". "If the
consultation is only a tick-box exercise and you are just asking repeat questions and it's a
more like a survey, the customer is not going to have a great experience," he explains. "If
you ask patients if they have missed any doses of their medication it feels like a test and
they want to give you the response they are expecting. But if you ask them about how are
they getting on and how are they feeling, the consultation is then more about the patient
than the medication."

4. Listen

Research has shown that there is room for pharmacy to improve listening skills: a 2011
analysis of pharmacist-patient communication found the profession was good at
signposting and closing sessions, but poor at listening effectively, eliciting the patient's
perspective or creating patient-centred consultations.3

"It's about being seen as a trusted adviser," says Mr Johnson. "That means listening before
telling somebody what they should be doing – that's where engagement comes in." In a
consultation, patients should also be encouraged to ask their own questions about their
condition and treatment.

5. Structure your consultations

How you structure your patient consultations is essential if they are to be effective, says Ms
Anderson. "Remember to always introduce yourself by name and role at the start of a
consultation and ask a couple of open questions to gain the patient's perspective."

In closing the consultation, she suggests summarising and, if possible, asking the patient to
tell you what they will do in the future. You should also provide a safety net for them should
they need further support. "Tell the patient that they can come back if they have further
concerns, or tell them where to go to get further advice," Ms Anderson advises.
Got it?

Off you go, then. In reality, prioritising communication is difficult, Ms Anderson concedes,
because life in pharmacies is busy. "Pharmacists are under pressure to fit everything in and
the temptation can be for them to go into a consultation considering only their own agenda
and not to listen to patients' concerns." But this is a false economy, she says: "If patients do
not feel understood they are less likely to engage with the issues that are important to
pharmacists."

She adds of her own experience: "Before I started running this course I undertook education
to improve my own consultation skills. My job satisfaction increased as I saw the difference
that I could make to the quality of patients' lives."

Case study
Michael O'Sullivan, pharmacist manager, Sharlston Pharmacy, Wakefield (a Numark
pharmacy)

Having to be at the forefront of patient-facing care can be daunting, especially when

patients, informed by ‘Dr Google', are more assertive. Pharmacy used to be an insular
profession and you could hide in the back doing prescriptions. I've made a conscious effort
to overcome my lack of confidence because, with the introduction of changes such as MURs
and the NMS, I realise I've got to go out there and communicate with patients.

I have developed my communication skills mainly by reflecting on what I've got right and
what I've got wrong. It's a bit like public speaking – once you've done it once or twice, it
becomes easier. Now I'm more proactive about sitting down and talking to – and counselling
– patients and I find it extremely rewarding. Footfall has increased in the past two years, so
this approach is having a positive effect.

Further information

● CPPE: Confidence in consultation skills for pharmacists (free full-day event) –

tinyurl.com/CDcommskills1. The CPPE also runs a consultation skills e-learning programme
and workshops for pharmacy technicians. It offers communication skills development
exercises for the whole pharmacy team – thelearningpharmacy.com. ● Guidance: Nice,
Medicines adherence: Involving patients in decisions about prescribed medicines and
supporting adherence – publications.nice.org.uk/medicines-adherence-cg76. ●
TalkHealthTalk for tools that can aid patient engagement – 07798 823250.

References

1. Nice, Medicines adherence: Involving patients in decisions about prescribed medicines

and supporting adherence, publications.nice.org.uk/medicines-adherence-cg76 2 .Weiss C,
Platt J, Riley R et al, Solicitations in GP, nurse and pharmacist prescriber consultations: an
observational study, Family Practice doi:10.1093/fampra/cmt042 3. Greenhill N, Anderson C,
Avery A, Pilnick A, Analysis of pharmacist-patient communication using the Calgary-
Cambridge guide, 2011, Patient Education and Counselling vol 83, pp 429-431