Review Cases CHAPTER

2
Review Case 1
A patient, Ms. Reynolds, enters a pharmacy, having just come
from her physician’s office.
Ms. Reynolds: My doctor just gave me a prescription for
methotrexate and did not tell me anything about it! What’s it
used for?
Pharmacist: I am busy right now to go into detail, but it is used
to treat various conditions, including cancer and rheumatoid
arthritis.
Ms. Reynolds: What?!! Oh my goodness!! I can’t believe this.
My doctor must think I have cancer and is waiting to tell me.

1. How could the pharmacist have handled this situation

differently to check for misperceptions?
2. What would you have said to the patient?
3. Would you call anyone else about this? If so, who?
 Review Cases CHAPTER

2
Review Case 2
You are a pharmacist in a pharmacy located in a medical
building. Cynthia Jackson, a 22-year-old college student, enters
your pharmacy. Cynthia has no prescription insurance and is on
a limited budget. She has been dealing with chronic sinusitis
and finally realized that she needed to see an ear, nose, and
throat specialist. Cynthia visited Dr. Sampson, who practices in
your building. You know Dr. Sampson to be a good physician,
but one who lacks interpersonal skills at times. He prescribed an
expensive antibiotic that would cost Cynthia $75. After you tell
her the price, Cynthia states, “Dr. Sampson didn’t help me very
much. He spends 5 minutes with me and then prescribes this
expensive antibiotic and nothing else! And how do you get off
charging me so much for just an antibiotic?”

1. What feelings do you sense coming from Cynthia?

2. How does Cynthia’s perception of Dr. Sampson influence her
behavior?
3. How would you respond to Cynthia?
4. What kind of recommendations would you give her?
 CHAPTER

3
Communication
Skills and
Interprofessional
Collaboration
 CHAPTER

3
 Pharmacist Roles in Collaborative Medication
Therapy Management
 Barriers and Facilitators to Collaborative
Partnerships
 Initial Steps to Developing Collaborative
Arrangements
 Building Trust: The Cornerstone to Successful
Collaborative Arrangements
 Using Communication Skills to Enhance
Collaborative Relationships
 Six Critical Behaviors Within Collaborative
Partnerships
 Pharmacist Roles in Collaborative CHAPTER

3
Medication
Therapy Management

Effective collaborations occurring between two

people who represent the same or different
disciplines are characterized by:

• The coordination of individual actions,

• Cooperation in planning and working together,
• Sharing of goals, planning, and problem solving, and
• Sharing of decision making and responsibility.
 Pharmacist Roles in Collaborative CHAPTER

3
Medication
Therapy Management

Additional Barriers to Collaboration

• Lack of clear definitions for these collaborations so
that effective communications among stakeholders can
occur,
• Lack of a supportive culture at the public,
institutional, professional, and agency levels so that
broad support can be gleaned among colleagues,
• Lack of a supportive regulatory and statutory system
so that clear articulation of professional responsibilities
can occur,
• Lack of economic incentives to reward collaborating
professionals who see the benefits of collaboration to
outstrip any investment in its costs,
• Lack of educational programs that encourage health
professionals to work collaboratively,
• Lack of understanding by patients about the benefit
of collaborative care, which leads to decreased
demand for collaborative care, and
• Lack of communication technology to allow partners
to easily communicate with each other.
 Pharmacist Roles in Collaborative CHAPTER

3
Medication
Therapy Management

Four Key Characteristics of Effective

Collaboration

• Sharing: includes sharing of responsibilities, philosophies of

health care, values, planning, interventions, and perspectives
such as commitment
to patient-centered care.
• Partnering: implies that two or more people will join
together in a collegial, authentic, and productive relationship
characterized by honest communication, mutual trust, and
respect. In addition, partners value the work and perspectives
of the other professionals in the partnerships, and each works
toward common goals having specific outcomes.
• Interdependency: refers to the fact that professionals are
interdependent, rather than autonomous, as they work
toward meeting patient needs.
• Power: is seen as being shared among partners with
empowerment accorded to all participants. Sharing of power
is based on knowledge and experience rather than functions
or titles (University of Toronto, 2004).
 Initial Steps to Developing CHAPTER

3
Collaborative Arrangements

Before you embark on any collaborative

practice with physicians, you should know what local
conditions support or inhibit any collaborative effort.

Learning about a community’s readiness for

expanded pharmacists’ roles begins with
talking with key stakeholders, such as patients,
hospitals, third-party administrators, and local and
state physician groups, which may be influenced by
your collaborative
efforts.
 Initial Steps to Developing CHAPTER

3
Collaborative Arrangements

When the time comes to approach physicians, it will be

much easier if you have done your homework and
have identified the following:

• Health care practitioners who have an interest in the

proposed partnership
• Patients or patient groups (broad-based and
influential) who may benefit from your partnership
• Individuals willing to share time and resources to
make your collaboration work
• Solicited the support of community agencies and
media interests who would like to see your
collaboration be successful and contribute to your
community
• Assembled examples of other collaborative
relationships that have worked with descriptions of
their structure and governance
 Building Trust: The Cornerstone to CHAPTER

3
Successful
Collaborative Arrangements

Factors that influence the development of trust

include:

• Consistent behavior over time reinforces positive or

negative feelings about trust
• Common goals or vision help strengthen trusting
relationships
• Mutual respect for each other should exist
• How the individual parties react when the
relationship is strained (for example, when a
medication error occurs) could weaken or strengthen
the relationship
• Mutual understanding of any economic gain from the
partnership
 Six Critical Behaviors Within CHAPTER

3
Collaborative Partnerships

 Relationships have long-term and short-term

agendas

 Relationships are nonhierarchical and based on

equality

 Considering patient perspectives

 Trust and shared visions are central to these

relationships

 Relationships should demonstrate respect for the

culture of each professional

 Collaborative relationships should be voluntary

 Strategies to Build Collaborative CHAPTER

3
Relationships

• Develop joint statements that support patient rights

to be involved in making informed decisions affecting
drug therapy and that articulate the value that patient
trust, safety, and relationships with caregivers always
come first.
• Host jointly sponsored professional meetings,
especially at the local level, to help develop
widespread understanding and awareness of physician
and pharmacist responsibilities in drug therapy and
why collaborative approaches to drug therapy benefit
all.
• Build effective communication, administrative, and
documentation systems that allow pharmacists to
share relevant patient information in accordance with
applicable ethical standards, accepted medical and
pharmacy practices, and state/federal statutes and
regulations to provide continuity of care for patients.
 Strategies to Build Collaborative CHAPTER

3
Relationships

• Stimulate the development of technology to enhance

communication within collaborative practices (e.g.,
shared patient databases relevant to drug therapy).
• Volunteer to work jointly on committees and projects
that enhance patient education and adherence,
investigate drug therapy issues, and promote better
practice guidelines.
• Start with a project that has a limited scope, such as
monitoring patients on warfarin or patients with
diabetes. Expand services after documenting impact
 Summary CHAPTER

3
Collaboration with other health professionals, especially
between physicians and pharmacists, provides additional
opportunities for professional growth and fulfillment for
both parties.

Professionals who participate in these collaborative relationships

combine their independent skill sets in a commitment to share
power, resources, and problem-solving talent for the
betterment of someone other than themselves. The
cornerstone of what makes all this work is shared trust and
confidence in each other.

Thus, trust is a product of many behaviors within these

relationships.