Pharmaceutical Communication Skills

Dr. Osama Abusara

Faculty of Pharmacy
Al-Zaytoonah University of Jordan

Topic 6 / Chapter 6
Assertiveness
Book: Communication Skills in Pharmacy Practice
Robert S. Beardsley - Carole L. Kimberlin - William N. Tindall
 Response Styles/Behaviors

1. Passive

2. Aggressive

3. Assertive
 Response Styles
Passive Assertive Aggressive

Can’t speak up Firm Loud

Don’t know my rights Direct Bossy
Get stepped on Honest Pushy
Meek Respect rights of others Dominating
Too accommodating Recognize the importance of Intimidating
having my needs & rights Violate others’ rights using
Talks softly respected power, position & language
Gives “cold fish” Confident
handshakes Must get my way
Realize I have choices React instantly
Don’t stand up for my
rights Effective communicator Don’t care where or when I
Avoid conflicts Can express my needs “blast” someone
People take advantage of Make good eye contact Can be abusive
me Vise-like handshake
Speak with firm voice
Trouble saying “no,” then I like to get even
I’m angry and resentful
 Passive Response
• Passive person avoids conflict at all cost
• Passive people will not say what they really think
out of fear that others may not agree
• Passive people hide from people and wait for
others to initiate conversation
• Passive people put the needs or wants of other
people above their own
• Passive people are very anxious in relationships
• Passive people worry about the response of others
 Aggressive Response
• Aggressive people seek to win
• Aggressive people promote their own interests or
point of view and hostile to the feelings, thoughts,
or needs of others
• Aggressive people respond in anger
• Aggressive response – may be beneficial in the
short term, however, it doesn’t build a trusting
relationship on the long run
 Assertive Response
• Pharmacists initiate communication with patients
rather than wait to be asked

• Assertive pharmacists convey their views on the

management of patient drug therapy to other
health care professionals

• Assertive pharmacists try to resolve conflicts with

others in a direct manner, but with respecting
others.
 Assertive Response
• Assertive behavior – direct expression of ideas,
opinions, and desires

• Conflicts are faced and solutions are discussed

• Assertive individuals respect others

• Assertive individuals stand up for oneself and

solve problems in a way that don’t damage
relationships
 Assertive Techniques
1. Providing feedback
2. Inviting feedback from others
3. Setting limits
4. Making requests
5. Being persistent
6. Ignoring provocations
7. Responding to criticism
 Assertiveness Skills
• Providing feedback:
• Responding to the behavior of others is essential to
avoid misunderstanding or to solve conflicts
• However, sometimes honest feedback – hurt feelings
on the other side. Hence, you should follow the
following criteria:
1. Feedback focuses on a person’s behavior rather than
personality.
2. Feedback is descriptive rather than evaluative.
3. Feedback focuses on your own reactions rather than
the other person’s intentions.
 Assertiveness Skills
4. Feedback uses “I” statements that take the
form “When you [do or say] _____, I feel
___.” For example, “When you are late for
work, I feel frustrated and angry” is less
damaging than “You’re irresponsible.
5. Feedback is specific rather than general.
5. Feedback focuses on problem solving.
6. Feedback is provided in a private setting.
 Assertiveness Skills
• Inviting feedback from others:
• Invite feedback from others in order to improve our
interpersonal communication skills.

• Setting limits:
• Difficulty in saying “no” to any request – feel
overwhelmed – angry at others for taking advantage.
• Being assertive – doesn’t mean to stop saying yes;
you can say no
 Assertiveness Skills
• Making request:
• Asking for what you want from others in a direct
manner – healthy relationship.

• Being persistent:
• Persistent in assuring that your rights are respected.
• Saying no and then people try to change your mind
– repeat your decision calmly – assertive without
becoming aggressive
 Assertiveness Skills

• Ignoring provocations and responding to

criticism:
• Avoid aggressive response and focus on solving the
underlying problem
• Confront the other person if you didn’t do any
wrong thing
 Assertiveness and Patients
• The most important assertive skill is your willingness to initiate
communication.

• Certain activities distinguish assertive pharmacist from passive ones:

Passive:
Passive pharmacists seem to hide behind the counter and
Avoid interaction with patients unless asked specific questions
Assertive:
Assertive pharmacists come out from behind counters,
Introduce themselves to patients,
Provide information on medications,
Assess the patient’s use of medications and problems with
therapy.
 Assertiveness and Patients
• When you hear criticism from patients, it is important to keep
in mind that their feelings of hostility may be greatly
magnified by the life stresses that are experiencing. Patients
are usually ill, sometimes seriously ill, and may be feeling
helpless and dependent on health professionals.

• It is important to keep in mind that some (not all) patient anger

arises from frustrations about being ill, and not from personal
grievances against you.

• It is most helpful for you to understand what it is like for them

and to respond empathically. e.g. saying “you are right, these
medication are expensive.”
 Assertiveness and Patients
• A useful in responding to patient criticism is to get patients to
turn criticism into useful feedback. e.g., if a patient tells you
that your pharmacy does not seem to care about the customer,
it is important to find out specifically what is causing the
problem. e.g. by asking “What specifically is it that upsets
you?” May give you feedback that would be useful in
improving your pharmacy.

• However, if a patient persists in aggressive behavior in spite of

your efforts to focus on understanding and problem
solving……limits must be set.
e.g. You can calmly say “I want to hear your point of view, but
I do not want to be called names. When you are ready to talk
without yelling and swearing, I will listen.”
Assertiveness

Case Studies
with Health Care Professionals
PHARMACIST CALLING A NURSE IN A PHYSICIAN’S
OFFICE

• Pharmacist: This is John Landers, the pharmacist at Central

Pharmacy. I’d like to speak to Dr. Stone please.

• Nurse: He’s with a patient right now. What is it you wish to

speak to him about?

• Pharmacist: I am concerned about Mrs. Raymond’s

prescription for metformin. I will need to speak to Dr. Stone
about it. Please have him call me as soon as he comes out
from the patient examination.

• Nurse: It might be quicker if you tell me what the problem

is. I could talk to Dr. Stone and get back to you.
• Pharmacist: Thank you, but in this case I
would like to talk to Dr. Stone directly.

• Nurse: He’s very busy today and we’re

running behind schedule.

• Pharmacist: I know he has a busy schedule but

I must speak with him as soon as possible.
Please ask him to call…….
 Talking to the physician – Part 1

a. Dr. Stone, this is the pharmacist at Main Street

Pharmacy. I’m sorry to bother you—I know
you’re busy—but I think there’s a problem
with Mrs. Raymond’s prescription for
metformin.
b. Dr. Stone, this is John Landers, the pharmacist
at Main Street Pharmacy. I’m calling about a
problem Mrs. Raymond is having with her
prescription for metformin.......
 Talking to the physician – Part 2

a. Did you know that Mrs. Raymond is still having

diarrhea from the metformin? Do you want to change
her prescription?

b. I spoke with Mrs. Raymond today. She reports that she

continues to have diarrhea after three months on the
medication. She has stopped her walking program and
is reluctant to leave the house because of the diarrhea.
The effect on her life is so serious that you may want
to consider switching her to a sulfonylurea such as
glyburide or one of the newer thiazolidenediones such
as Avandia® or Actos®, which are less likely to cause
diarrhea……..
with Employees
Manager: I overheard your conversation with
Mrs. Raymond this afternoon when you
became impatient with her for not
understanding instructions. I was upset
because I didn’t think you treated her with
respect. I want you to treat patients with
courtesy and not get so impatient and
judgmental with them.
Pharmacist: Well, she had been complaining
about how slow we were and then wouldn’t
pay attention when I was explaining the
directions. I just got fed up.
Manager: I know that patients can be irritating,
but I want you to treat them with respect.
Pharmacist: Well, we were so busy then that I
just didn’t have time to fool around.
Manager: I know it was hectic and you were
feeling rushed today, but even then I want you
to be more courteous.
Pharmacist: Well, it would certainly be easier to
take time to be nice if you’d get enough
pharmacists in here to cover the workload.
Furthermore, if you’d train the techs better,
they could be a lot more help to us.
Manager: Those things may be true, but right
now I want to resolve the problem in the way
you communicate with patients when you are
irritated or hurried. I want you to agree to treat
patients with respect, regardless of how busy
we get. Will you do that?

Pharmacist: That’s easier said than done.

Manager: Will you do it?.......

With Employers and dealing with criticism
If you consider the criticism you receive to be
valid, the most straightforward response is to
acknowledge the mistake……

When you acknowledge mistakes and apologize

for them, people have difficulty maintaining
their anger.

If you continue to make the same mistake and

apologize……manipulation
Avoid…….
“Yes, I am late for work a lot, but the traffic is so
bad”……. Manger can simply respond??
You came in late to work this morning and
your boss is fuming. During his attack, he
says, “You’re always late. Nobody around here
cares about the patients waiting to get
prescriptions filled.”
It is important to say to him: “You’re right, I
was late this morning, and for that I apologize.
But it is not true that I am always late. I know I
was late one day last month but that is the only
other time I can recall being late in the two
years I have worked here. And it is not true
that I do not care about our patients. I think the
way I practice shows them my concern.”
If the criticism takes you by surprise and you
are confused about how to respond, give
yourself time to think about the problem
before responding……. Delaying response
“I want time to think about what you’ve told
me, and then I’d like to sit down with you and
try to clear up this problem. Could we discuss
the situation this afternoon at the end of my
shift?”
Supervisor: You spent a lot of time talking with
that patient about a simple OTC choice.

Pharmacist: You’re right. I did.

Supervisor: The other pharmacists let clerks do a

lot of that sort of stuff.

Pharmacist: You’re probably right. They may not

spend as much time as I do on OTC
consultations……Fogging response
President: You would be perfect for the job. It is
extremely important and I must have someone
who knows the issues and stays on top of
things.

Pharmacist: I appreciate that, but I won’t be able

to chair the committee this year.

President: I’ll help with the workload. It

shouldn’t take more than an hour or so a week.
Pharmacist: That may be true, but I’m not
willing to chair the committee right now.

President: Why not? Perhaps there is something

we can do to resolve the problems you seem to
think will come up in chairing the committee.

Pharmacist: The decision is really a personal

one. I won’t be able to chair the committee at
this time.