PATIENT COUNSELLING

What is Patient Counselling?

• Patient counseling refers to the process of
providing information, advice and assistance to
help patients use their medications appropriately.
• The information and advice is given by the
pharmacist directly to the patient or to the
patient’s representative, and may also include
information about the patient’s illness or
recommended lifestyle changes.
• The information is usually given verbally, but
may be supplemented with written material.
• During counseling, the pharmacist should
assess the patient’s understanding about his
or her illness and the treatment, and provide
individualized advice and information which
will assist the patient to take their medications
in the most safe and effective manner.
• To provide accurate advice and information,
the pharmacist should be familiar with the
pathophysiology and therapeutics of the
patient’s disease.
• Good communication skills are required to
gain the patient’s confidence and to motivate
the patient to adhere to the recommended
regimen.
 Effective patient counselling aims
• Better patient understanding of their illness and the role of
medication in its treatment
• Improved medication adherence
• More effective drug treatment
• Reduced incidence of medication errors, adverse effects and
unnecessary healthcare costs
• Improved quality of life of the patients
• Better coping strategies for medication-related adverse
effects
• Improved professional rapport between the patient and
pharmacist
 Communication Skills for Effective
Counselling
• Language : When speaking to patients, use
simple language and avoid unnecessary
medical terminology.
• Tone : During counseling, the tone of our voice
has a great impact on patient understanding.
Changes in the level and range of pitch convey
information about the feelings and attitudes
of the person speaking.
• Volume : Many people speak with wide variations in
volume, depending on the situation, and where and
to whom they are speaking. Ideally, counselling
should be conducted in a quiet, private setting
where it is unnecessary to raise one’s voice.
• Speed : The clarity of our communication depends
on our rate of speech. Patients may be reluctant to
interact with a pharmacist who speaks quickly
because they may feel the pharmacist is too busy.
This may happen if the pharmacist is nervous or is
uncertain about the information being given. In
contrast, a person who speaks too slowly may lose
the interest of the listener.
 Non-verbal communication
• Proximity : This refers to the distance that
people maintain between themselves during
the counselling process. This space has been
classified into four zones: intimate (45 cm or
less), personal (45 cm to 1.2 m), social (1.2–
3.6 m) and public (>3.6 m). Generally,
counsellors and healthcare professionals use
intimate or personal proximities.
• Eye contact : The amount that people look at
one another during conversation varies
depending on whether they are speaking or
listening. Listeners look at the speaker more
often and for longer periods of time.
• Facial expression : These can be used during
counselling to demonstrate empathy towards
the patient. Head movements such as
nodding, hand gestures and body posture also
can be used to advantage.
 Qualities of a good counselor
• Be a good listener
• Be flexible
• Be empathetic
• Be non-judgemental
• Be tolerant
• Communicate confidently
 Steps of Patient Counselling

• Preparing for the session

• Opening the session
• Counselling content
• Closing the section
 Preparing for the session

• The success of counselling depends on the

knowledge and skill of the counsellor.
• The pharmacist should know as much as possible
about the patient and his/her treatment details.
• In the hospital setting, this may be accomplished by
referring to the patient’s case notes.
• In the community pharmacy setting, sources of
information include the patient and their
prescription, and in some cases, a record of
previous dispensing for the patient.
• Another issue worth considering is the mental
and physical state of the patient.
• If the patient is in a hurry, in pain or is not
communicative, it is very difficult to counsel
the patient effectively.
• In such situations, the aims of counselling may
need to be modified, or with the patient’s
agreement, the session may be postponed to
a later date.
 Opening the session
• The pharmacist should introduce him or herself
to the patient and greet them by name.
• If help is required in pronouncing the name, ask
colleagues or the patient directly.
• It is best to use titles such as Ms, Mrs and Mr
and then switch over to the first name.
• The pharmacist should identify the purpose of
the session very clearly.
• For example, ‘Hello, Mr Sreenivas! I am Vinod,
your pharmacist.
• I would like to tell you about your medication.
Do you have a few minutes to spend with me?’.
• Patients who visit community pharmacies are
often in a hurry to go home with the
medication, and this type of introduction
mentally prepares the patient to spend some
time with the pharmacist.
• Next, the pharmacist gathers information from
the patient about their understanding of the
disease they are suffering from, drug treatment
and use of alternative medications such as
ayurvedic medications or home remedies.
• Other information which may be relevant
includes previous drug allergies, past medical
history and personal habits such as chewing pan
masala, smoking cigarettes and consuming
alcohol
• Using open-ended questions is a useful technique
for gaining the confidence of the patient, and the
answers allow the pharmacist to assess the
patient’s information needs. For example, ‘What
did your doctor tell you about your illness?’, ‘What
do you know about your disease?
• Patients may be disturbed and distressed due to
their illness, and this may reduce their ability to
receive and understand information from both the
doctor and the pharmacist. In these situations, a
few kind words to demonstrate empathy and
understanding will assist the counselling process.
 Counselling content
• The counselling content is considered to be
the heart of the counselling session.
• During this step, the pharmacist explains to
the patient about his or her medications and
treatment regimen.
• Lifestyle changes such as diet or exercise may
also be discussed.
• Name and strength of the medication
• The reason why it has been prescribed (if known), or how
it works
• How to take the medication (how much and how often)
• Expected duration of treatment
• Expected benefits of treatment
• Possible adverse effects
• Possible medication or dietary interactions
• Advice on correct storage
• Minimum duration required to show therapeutic benefit
• What to do if a dose is missed
• Special monitoring requirements, for example, blood tests
• Arrangements for obtaining further supplies
 Closing the session
• Before closing the session, it is essential to
check the patient’s understanding.
• This can be assessed by feedback questions,
such as ‘Can you remember what this
medication is for?’ or ‘For how long should you
take this medication?’.
• During the discussion, some of the patient’s
information needs may have been cleared, but
the patient may have new questions or doubts.
• It is therefore advisable to finish the session
by asking the patient ‘Do you have any
questions?’.
• Before final closure and if time permits,
summarise the main points in a logical order.
• If appropriate, the pharmacist can supply their
telephone number to encourage the patient
to make contact if they need further advice or
information.
Barriers to Patient Counselling

Patient-
based
barriers

System- Provider-
based based
barriers barriers
• Patient-based barriers : In India, many
patients are unaware that pharmacists may
provide counselling and generally ask their
prescriber about medication use. Gender and
language differences may also inhibit patients
from asking the pharmacist about medication
use information.
• Provider-based barriers : Many pharmacists lack the
confidence to counsel patients due to lack of
knowledge and counselling skills. A heavy patient
load for prescription filling is also an important
barrier in many practice situations.
• System-based barriers : In India, counselling is not a
mandatory legal requirement and officially
pharmacists are not entitled to charge for dispensing
or for the information provided to patients. These
factors act as regulatory and financial disincentives
to providing a counselling service. Lack of privacy in
many busy community and hospital pharmacies can
also be a problem.