Definition

Communication is the sharing of information, ideas, thoughts and feelings. It involves not
only the spoken words but also information, which are conveyed through inflection, vocal
quality, facial expression, body posture and other behavioral responses.

 Incomplete drug information may be provided to health care

professional
 Incomplete advising for medication use to patients
 Inappropriate advising on dispensing
So pharmacists should possess good communication skills to correct weakness and
strengthen confidentiality in disseminating information.

Modes of Communication
Modes of communication can be categorized into following basic categories:
1. Verbal Communication
2. Non-Verbal Communication

1. Verbal Communication: Verbal communication includes the use of

actual words for communication. They denote the literary meanings of the actual words
and accounts for only about 10 percent of the message/theme of the communication.

2. Non-Verbal Communication: Non-verbal communication includes the

tone of voice used, the speed and volume of speech, the intonation and the whole range of
body postures and movements. It accounts for 90 percent of total communication.

Types of Non-Verbal Communication

a. Vocal communication: It includes quality and fluency of the voice. Quality

refers to the tone, pitch, volume and speed. Tone can be harsh and soft. A soft
tone is more preferable than a harsh tone, which has meaningful variations. The
volume of the tone should focus on a emphasized part of the sentence and should
be adjusted accordingly. Similarly, the speed should be considerable such that the
listeners should perfectly be able to understand things what speaker aims to say.
In gist, a preferable vocal communication should have soft tone, emphasized and
adjustable volume and maintained speed. A communication becomes effective
when spoken with warm confident tone of voice at an appropriate speed and
volume and without interruption.

b. Body language: Body language refers to the overall impression that

is perceived with whom who is talking. It is often said, "You never get a second
chance to make first impression". Hence, many neglect an unfriendly and
unhelpful person. Various components of the body language play an important
role to make understand what you ought to. These includes:
 i. Gestures: Gesture defines as the expressive movement of a part of the
body, especially, the hand or head. Appropriate use of gestures aids in
explaining things what you want. Hence, it is important not to overuse
them. Pharmacists can emphasize a point or procedures to describe y the
use of gestures,
ii. Facial expressions: A confident facial expression urges listeners to
concentrate what one says. Facial expression expresses the mood and
emotion with the eyes and mouth giving the dominant signs. It encourages
patients to motive to listen perfectly and satisfy with the information
provided by the pharmacists.
iii. Eye contact: Eye contact expresses the ongoing process of
communication. It tells about whose turn to speak and when. Avoiding eye
contact during communication clearly states avoidance for the will to
communicate.
iv. Physical contact: Physical contact is highly cultural variation. It is
one of the means of pleading to what is spoken for and often represent
much number of words spoken. However, cultural variation should be
accounted.
v. Body posture: It explains the position of different body parts. Normally,
the words spoken during communication can be controlled. But body
language is quite difficult to control. A posture of a body can also
influence the process. The intention and concentration of a speaker/listener
can be disclosed by body posture. There are several classic body postures,
which have been identified as having significant meanings.
 Closed position (arms folded): This is seen as rather
negative posture and not one likely to encourage initiation of
communication.
 Feet position: Feet position can be another checkpoint. It is
assumed that person's feet will be painting in the direction he wants to
go. This can be used to check for the listener's intention of hearing the
information provided.
 Positive body posture:Leaning towards the person who is
talking, or sitting in a relaxed fashion, are both examples of non-verbal
language, which can encourage good communication.
vi. Personal space: It is the space around which one becomes
comfortable to talk with anyone. The space during the communication
should be enough such that maximum comfort is achievable during
conversation. Adequate distance should be attained to develop a good
rapport and a meaningful dialogue to occur. The personal space is
generally divided into four major areas:
 General Area: This is approximately 3 m or more. This is the
space we would normally prefer to have around us if we are addressing
a group of people or are working alone.
 Sociable Area: This is approximately 1-3 m and is the type of
distance used when communicating with people we do not know very
well.
  Personal Area: This is approximately 0.5-1 m. This is the space we
would normally feel comfortable with, when at a business or social
meeting with people we know reasonably well. It is sufficiently close
to allow friendly and meaningful communication without any
individuals feeling threatened by having their intentions zone invaded.

Patterns of behaviour in communication

Every individual have his or her own behavior. There is infact an individualistic variation
and people behave differently. However, the behaviour during communication can be
categorized as follows:
a. Assertiveness: It is a positive attitude. It is defined as standing up for
personal rights and expressing thoughts, feelings and beliefs in direct, honest and
appropriate ways, which do not violate another person's rights. Being assertive
means listening to others and understanding their feelings. Assertive people will
deal with other people as equal.
b. Aggressiveness: Aggressiveness means violation. An aggressive
people aim to achieve their goals in the expense of others. Aggressive behaviour
is often frightening, threatening and unpredictable. It will bring out negative
feelings in the receiver and communication will be difficult.
c. Passive-aggressive behaviour: These are back talking people. They may
agree for what you are saying but may criticize at your back.
d. Submissive behaviour: These people have very little confidence in
themselves and are self-esteemed. They often allow others to violate their
personal rights and take advantage of them.

Hence, communicating as effectively as possible assertive behaviour is advantageous. It

helps in resolving the issues of conflict, in negotiation, leadership and motivation, when
giving and receiving feedback, in cooperative working and in meetings. Assertive
communication can give the user confidence, a clear self-image and leads to a feeling of
more control over situations.

Assertive behaviour shows recognition of personal rights and rights of others. Personal
rights include:
 To state one's own needs and priorities
 To be respected as an intelligent and capable equally
 To express one's feelings
 To express one's opinions and values
 To be able to say 'yes' and 'no'
 To make mistakes
 To change one's mind
 To say 'I don't understand'

Techniques in assertive communication

a. Use of I and You statements: When I is used in a statement it shows that the
speaker bears the responsibility rather than imposing the responsibility to the listener
 by using the you statements. It also approaches to minimize negative reactions such
as anger.
b. Repeating the message: It is firmly important to repeat the message provided or to
be taken, unless achieved. This should be acquainted without squeezing the outbreak
for achieving the result.
c. Clear communication: Both verbal and non-verbal communication should be
matched to avoid misunderstanding/confusion to make the communication clear.
d. Extract the truth: Impressive and affirmative communication avoids the
conversation being lousy. Anger and upset may cloud the message and one may
exaggerate during conversation. Hence, it is important to make the communication
worthful without distracting the attention of the communicator and extracting as
much as information as required to be true.

Empathy
Literally it is an ability to imagine and share another person's feelings, experiences, etc. It
is the ability to enter into the life of other people and to accurately understand both their
meanings and feelings. It involves an accurate perception and identification of both the
actual words and underlying feeling contained in what a person is saying.

Pharmacists need the skill to respond in a way that communicates this understanding
convincingly. Empathy is one of the cornerstones in communication skills and is an
essential part of assertiveness. It is needed in information gathering, when interviewing
patients and when educating and counseling.

Elements of Empathy

a. Facilitating empathy: During communication a safe and confident atmosphere

must be created to fully express the views. Pharmacist must be able to create this
environment much of which is attained by some non-verbal communications as eye
contact, tone of voice and body posture. There is also a good need to express respect
and assurance. Pharmacists should encourage people to describe their feeling at the
utmost possibility.

b. Perceiving feelings and meanings: Pharmacists should be able to make correct

identification of feelings and their meanings. Expressing information by patients
depends on their swing of mood. It is ultimately the result for how they are being
treated. Examination of both expression of feeling and its correlation with the non-
verbal communication should be matched to clearly and accurately understand what
one tries to speak. Pharmacists should also prevent the biasness of perceiving what
one tries to say by avoiding their own assumptions, as all drug addicts are the same.

c. Responding: One should try communicating by simplifying the feelings

generated by the speaker. This response shows that pharmacists could intensely
understand the feelings and is trying to help out with patient's condition. Pharmacists
 must be able to understand and focus and than be able to interpret the assessing with
positive responses.

Questioning skills
It is one of the important assets for pharmacist. An honorary and respectful questioning
aids in discloser of some hesitating reasons in a briefing manner. Normally questions are
asked to encourage for finding essential information.

Types of questions
a. Closed questions: A closed question is one, which is direct and close-ended. It
requires the respondent to give a single word reply such as yes or no. Such questions
do not include a feeling component, but do provide specific information on a subject
area. Examples
 Are you taking any medicines at present?
 Have you ever taken this medicine before?
 Do you understand how to take it?
 Do you have any questions about the medicine?
 Did the medicine work for you?

b. Open Questions: Open questions are open-ended and often allow people to respond
in their own way. They do not set any limits and generally allow the person to
provide more detailed information. Open questions encourage elaboration and help
people expand on what they have started to say. Examples:
 Describe your symptoms to me.
 What do you do when that sensation occurs?

The funneling technique

It is a method of first finding out the basic information i.e. background information by
putting open questions and then asking specific closed questions to provide specific
details and clarity. In a pharmacy setting where time can be a limiting factor, using the
funneling technique can be useful for directing and focusing a conversation to enable an
end point to be achieved more quickly.

Listening skills
For an effective communication, listening is an important component. True listening
involves eyes as well as ear. Perception of the actual description involves perfect
listening by focusing on what the speaker speaks for. Distraction by external
circumstances should be prevented and in depth meaning of the words should be
understood.

Barriers of communication
Common barriers, which can be of prime consideration in a pharmacy setting, can be
identified as follows:
a. Environment
b. Patient factors
c. The pharmacists
d. Time

a) Environment: Community pharmacies, hospital outpatient pharmacies and

hospital wards pharmacies are all areas where pharmacists use their
communication skills in a professional capacity. None of these areas are ideal and
problems may arise. Some areas of potential problem areas are illustrated as
follows:
 A busy pharmacy: This may create the impression that there appears to
be little time to discuss personal matters with patients. The pharmacist is
supervising a number of different activities at the same time and is unable to
devote his full attention to an individual matter. It is important that
pharmacists organize their work patterns in such a way as to minimize this
impression.
 Lack of privacy: Some pharmacies, both in community and hospital
outpatient departments, have counseling rooms or areas, but many may not
have. For good communication to occur and rapport to be developed ideally
the consultation should take place in a quiet environment, free of interruption.
Lack of these facilities requires additional facilities.
 Noise: Noise levels within the working environment are an
obvious barrier to good communication. People strain to hear what is said,
comprehension is made more difficult and particular problems exist for the
hearing impaired. The opposite may also be true.
 Physical Barriers: Pharmacy counters and outpatient dispensing
hatches are physical barriers and also may dictate the distance between the
pharmacists and patient. This in turn can create problems in developing
effective communication.

b) Patient Factors: Different people coming to pharmacy have different

expectations. Most of the people try to sort out the things as quickly as possible.
Their zeal of communication gets eloped because of their hectic business. Hence
they may not entertain longer communication. However, if he can be convinced
stating and explaining the necessity of communication, they may show their
willingness to communicate.
 Physical Disability: Surrogate approach of communication with
additional skills may be required in dealing with the patient with differently
capable abilities.
 Comprehensive difficulties: It is important to identify the level of
understanding of different people coming to the pharmacy. Accordingly
comprehensive adjustment should be made to make them understand what is
intended to.
 Illiteracy: To deal with these people different pictograms and verbal
communications should be adopted.

c) Pharmacists: Pharmacist must be confident and self determined to communicate

in a prefect and impressive manner. Pharmacists to develop the strength of
communication should easily overcome the following weakness:
  Lack of confidence
 Lack of interest
 Laziness
 Delegation of responsibilities to untrained staff
 A feeling of being under pressure, especially time pressure
 Being pre-occupied with other matter.

Time
Lack of time can be a major constraint on good communication. A meaningful
communication should be developed to provide or obtain concrete information.

Confidentiality
Matters related to health and illness is highly private affairs. Therefore it is important that
privacy and confidentiality are assured in the practice of pharmacy..
Private communication facilities (environment), psychological privacy, use of proper
voice, eye contact, leaning forward and concentrating on the person and their problem
helps in generating confidentiality. Ethical guidelines and privacy laws should be
followed. Without the consent of the person only information to prevent serious injury or
damage to the health of the person can be shared.

Summary
Good communication is a practice-based approach and gets developed slowly. Different
people have different personalities and skills. One should try to maximize the strengths
and minimize the weaknesses. Explaining things appropriately, listening with
understanding is essential. Good communication, however is not only needed for
pharmacists but also to others and is a life skill attitudes to be used at all times.