COMMUNICATION IN PHARMACY PRACTICE

CHAPTER ONE

PATIENT-CENTERED COMMUNICATION
IN
PHARMACY PRACTICE
 Chapter outline
 Introduction
Pharmacists Responsibility in Patients
centered Care?
What is Patient-Centered Care?
Importance of Communication in Patient –
centered Care
 Communication
 Elements of Interpersonal Communication
 Nonverbal Communication
 Barriers of communication
 1.1.Introduction
What is Pharmacists Responsibility in
Patient Care?
 Pharmacy practice is moving toward a model that
integrates patient-focused care and drug distribution
services

 Pharmacists can play key role in effort to deliver

improved patient care

….reduce medication errors

….cost of medication-related morbidity and

mortality
…and improve the use of medications by patients
 1.1 Introduction…
Q. How can pharmacists achieve this activities?
o by providing patient focused care

Q. What is Patient-Centered Care?

• The pharmacist must be able to:
o Understand the illness experience of the patient

o Perceive each patient’s experience as unique

o Foster a more egalitarian relationship with

patients
o Build a “therapeutic alliance” with patients to
meet mutually understood goals of therapy
 1.1 Introduction…
 Quality of Patient-centered care service
depends up on your ability..
develop trusting relationships with
patients
engage in an open exchange of
information
involve patients in the decision-
making process regarding treatment
help patients reach therapeutic goals
 1.1 Introduction…

But there are challenges…

Lack of communication skills to

effectively communicate with

patient ,caregivers and physician,…

 Importance of Communication in Patient –
centered Care
Two purposes:

 Establishes the ongoing relationship between

providers and patients
…..Positive and credible relationship is very
important

 Provides the exchange of information necessary

to;
– assess your patients’ health conditions,
– reach decisions on treatment plans,
– implement the plans, and
 Reasons to Encourage Patients to Share Their Experience with
Therapy

 They have unanswered questions

 They have misunderstandings

 They experience problems related to therapy

 They “monitor” their own response to treatment

 They make their own decisions regarding therapy

AND
 They may not reveal this information to you unless
you initiate a dialogue
Q. What is the benefit of analyzing the
medication-use process by patients?
 1.2 .Communication
 Communication is transfer of information between a
source and one or more receivers using a set of
common rules
 Communication is the art and process of creating
and sharing ideas.
 It is a complex process…….senders are often
receivers, and multiple and contradictory messages
may be being sent via different channels.
 Communication skills are the tools that we use to
remove the barriers to effective communication.
 1.2. Communication….
 Communication comes in many forms:
verbal (sounds, language, and tone of
voice)
aural (listening and hearing)
non-verbal (facial expressions, body
language, and posture)
written (journals, emails, and text
messages)
visual (signs, symbols, and pictures)
1.2 Communication….
 1.2 Communication….
 Communication encompasses a broad spectrum of
media:
Mass communication (TV, radio)
Small-group communication (committee meetings,
discussion groups)
Large-group communication (lectures, speeches)
One-to-one interpersonal communication
Interpersonal Communication
 Interpersonal Communication process

 Interpersonal communication is a common

but complex practice that is essential in
dealing with patients and other health
care providers.
 Interpersonal communication described as a
process in which messages are generated
and transmitted by one person and
subsequently received and translated by
another.
Interpersonal Communication process ….
 Interpersonal…
Sender/Source
 The source of the message is the sender.
The sender must know why the
communication is necessary and what
result is needed.

 know exactly what you want to

communicate, be sure why you are

communicating and the result you expect
 Interpersonal…
Encoding
 Encoding is the process of taking your message
and transferring it into a format that can be
shared with another party.
 In order to encode a message properly, you have
to think about what the other person will need in
order to understand the message.
 It requires knowing your audience and
ensuring that your message provides all of the
information that they need.
 Interpersonal…
Message
 Element that is transmitted from one
person to another
 Thoughts, ideas, emotions, information,
or other factors and
can be transmitted both verbally and
nonverbally
 Interpersonal…

Receiver
 The receiver receives the message from the
sender
 Each person that receives your message will
be listening to it through their own individual
expectations, opinions, and perspectives.
 Their individual experiences will influence
how your message is received.
 Interpersonal…

Decoding

 Decoding is the process of receiving the

message accurately and requires that

your audience has the means to

understand the information you are

sharing.
 Interpersonal…
Feedback

 Process whereby receivers communicate back

to senders their understanding of the
senders’ message.

 In most situations, receivers do not passively

absorb messages; they respond to them with
their own verbal and nonverbal messages

 The initial receiver becomes the sender of

feedback, and the initial sender becomes
 Interpersonal…
 Feedback can be simple, such as merely
nodding your head, or …..
 More complex, such as repeating a set of
complicated instructions to make sure
that you interpreted them correctly.
 Feedback allows communication to be a
two-way interaction rather than a one-
way monologue.
 Interpersonal…

 Verbal feedback should be: summarizing;

empathic responding

 non-verbal feedback: includes, conveying

that you have time to listen, establishing eye

contact, leaning towards person, removing

any physical barriers, nodding head

 Interpersonal…
Barriers

Environmental: high prescription counters, noisy

prescription areas, little or no privacy

Personal: lack of confidence, cross-cultural factors,

attitude

Patient: perceptions of pharmacist, perception of

illness

Administrative : reimbursement, policies that

discourage interactions

Time: both pharmacist and patient

 Personal responsibilities in the communication
process
 Sender are responsible for ensuring that the
message is transmitted in the clearest form,
In terminology understood by the other
person
In an environment conducive to clear
transmission
 ask for feedback from the receiver and clarify
any misunderstandings
 Personal responsibilities….

 As a receiver, you have the responsibility of

listening to what is being transmitted by the

sender.

 To ensure accurate communication, you should

provide feedback to the sender by describing

what you understood the message to be.

 Personal responsibilities….
Meaning of the message
 The sender delivers the message, and the
receiver assigns a meaning to that message…
receiver’s assigned meaning must be the
same as the meaning intended by the sender
 Individuals assign meaning to verbal and
nonverbal messages based on their past
experiences and previous definitions.
 Personal responsibilities….

 Speaking in medical terminology that may

have different or no meaning to our patients
will send different message.
E.g. “plenty fluid”

 People assign meanings based on the context

that they perceive the sender is using.
E.g. “Take one-half teaspoonful three times
a day for infection until all gone.”
 Personal responsibilities….

Congruence between verbal and

nonverbal messages
 Incongruence/inconsistence between the
verbal and nonverbal messages leads to
confusion
 As a sender, be aware of the nonverbal
messages as well as the verbal messages.
 As a receiver, point out to the sender that you
are receiving two different messages.
Perception of Meanings
within a Message
 Perception of Meanings…

Case 1
 A patient returned to the pharmacy complaining
of side effects apparently caused by his
medication. The patient’s records indicated he
was given 30 nitroglycerin patches. Both the
pharmacist and the physician told him to “apply
one daily.” The patient opened his shirt to reveal
27 nitroglycerin patches firmly adhered to his
chest!!
 Perception of….
 “It is not what is said, but what the receiver perceives
to have been said “
 Our individual perceptions are the filter through which
we communicate with others.
 In general, people develop their perceptions based on
their past experiences, background, and values.
 People of different backgrounds, values, and
experiences may assign meanings to messages that
are different from those intended by the sender.
Perception of….
 Perception of….

b) Language
 The different perspectives we experience
can be with language as well.
 “Words have no meaning, people have
meaning”
 “A woman without her man is nothing” Vs “A
woman. Without her, man is nothing.”
 Perception of….

c) Past experiences
 In every situations, your communication
is being affected by your past
experience.
 You enter a conversation with patients,
with certain expectations of what will
happen in that scenario, and you behave
accordingly.
 Perception of….
d) Prejudices
 We all have prejudices. They occur when we take our
past experiences with a person and assume that the
same type of experience will happen with all people
who are similar to the first.
 Prejudices are partly due to culture and partly due to
personal preference or experience.
 Not all prejudices involve a negative characteristic
either: for example. You could consider all of one
group to be smart.
 Perception of….
 Prejudices occur when we take an isolated
experience with one ‘type’ of person and then act as
if all encounters in the future with people of the
same ‘type’ or with the same characteristics will
result in the same experiences.
E.g. “People who are mentally ill do not comply with
their medication regimens.”
“Elderly people can’t hear well and always talk too
much.
 “We do not see the person as a unique individual but
as a representative of a particular group”
 Perception of….

Big Question
 What kind of perception do you expect from
patients regarding pharmacy professionals?
 How to prevent
misunderstanding?
 Try to understand and share the perceptions of
other individuals…. remember that people assign
meanings to messages based on their
background, values and experiences.
 Use lay language which is familiar to patients, rather
than medical terminology
 Determining the patient’s past experience with
medications or with the particular drugs prescribed
 Anticipate how the patients may translate the
message and need for clarity in the information
 How to prevent
misunderstanding…?
 Use feedback to verify the perceived meaning of
a message.

Questions That Elicit Feedback

 “I want to be sure I have explained things clearly.
Please summarize the most important things to
remember about this medicine.”
 “How do you intend to take the medication?”

 “Please show me how you are going to use this

nasal inhaler.”
 How to prevent
misunderstanding…?
Case 2

A young woman suffering from vaginal

candidiasis was given the usual 15 nystatin
vaginal tablets and was told by the
pharmacist to “use one tablet daily for
two weeks.” She returned to the pharmacy
after two weeks in severe discomfort with a
complaint that “those nystatin tablets
taste terrible!”
 How to prevent
misunderstanding…?
Case 3
 A patient, Ms. selam, enters a pharmacy,
having just come from her physician’s office.
 Ms. selam : 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. selam : What?!! Oh my goodness!! I
can’t believe this. My doctor must think I
have cancer and is waiting to tell me.
 How to prevent
misunderstanding…?
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?
Nonverbal Communication in
pharmacy
 Nonverbal…
 Words express ideas, whereas nonverbal
expressions convey attitudes and emotions.
 How people relate to you is not based on what is
said, but on what is not said.
 We communicate all the time…. dressing style,
facial expression, body movements, and other
aspects of your appearance and behavior… NON
VERBALLY….
 55% of communication is non verbal!
 Nonverbal…
 Medium of exchange is neither vocalized

language nor the written word.

 Nonverbal communications are unique for three
reasons;
They mirror innermost thoughts and feelings
difficult, if not impossible, to “fake” during an
interpersonal interaction
must be consistent with verbal communication
 Nonverbal…

 When analyzing nonverbal communication,

avoid focusing on just one cue.

 Look at all the nonverbal cues that you are

receiving and use verbal communication to

fully understand the meaning of the

nonverbal behavior.
 Nonverbal…
Forms of Non-verbal communication
Facial Expressions and Eye Gaze:
 Facial expressions provide a rich source of non-verbal
information, particularly in conveying emotion.
 Eye contact can indicate engagement or involvement
with the speaker and complete lack of eye contact can
suggest detachment, nervousness or that the person
is hiding something.
 However, a constant or fixed eye gaze can be
frighten.
 Nonverbal…
Posture and Gesture

 The way you sit or stand can convey your attitude or

feelings about what you are doing or thinking.
– a slumped posture can indicate despondency or
boredom;
– a relaxed posture may suggest …a person is calm and
unnerved;
– a shifting posture might be associated with
uneasiness or discomfort.
 Nonverbal…
Voice
 A great deal of information can be communicated with
voice .
– Timbre/speech sound quality
– Inflection/change in tone of speech
– Speech rate, pitch
– pauses emphasis and volume
– vocalizations such as ‘ahhh’ or sighing
 Nonverbal…
Personal space and distance
 The extent to which people will keep out of or
encroach upon our personal space, depends on a
multitude of factors including culture,
personality, age, sex, status

Personal appearance
 This plays a significant role in determining how a
message that we send or receive; will be
interpreted and understood
 Nonverbal…
Elements of Nonverbal Communication
Kinesics

Proxemics,

Physical environment, and

Distracting elements
 Nonverbal…

Kinesics
 Body movement… the manner in which you use
your arms, hands, legs…
 Individuals from various societies use different body
movements to communicate certain messages!
 An open stance can nonverbally communicate
sincerity, respect, and empathy for another
person…. standing (or sitting) with a full frontal
appearance to the other person
 Nonverbal…
 legs and arms comfortably apart (not crossed), and a facial
expression that expresses interest and a desire to listen as
well as speak

Key components of kinesics

Varied eye contact (consistent, but not a stare)

Relaxed posture

Appropriate comfortable gestures

Frontal appearance (shoulders square to other person)

Slight lean toward the other person

Erect body position (head up, shoulders back)

 Nonverbal…
Proxemics
 distance between two interacting persons and structure
and use of space
 Less than 18 inches… intimate relationships

 distance of 18 inches to 48 inches is maintained … for

interpersonal communication
 distances of more than 4 to 6 feet…. for public
communication.
 The type of instructions that you need to give to the
patient will also affect the distance
 Nonverbal…

Physical Environmental

 Colors used in the pharmacy’s decor, the

lighting, and the uses of space all

 Physical characteristics of pharmacy

employees also send nonverbal messages

to patients
 Nonverbal…
Distracting Factors
 lack of eye contact
 facial expression…rolling eyes as a
patient explains something to you, may
communicate a feeling of disinterest or
lack of concern toward the patient.
 body position …. closed stance with
folded arms or a body position that is
slouched forward or tilted to one side
may be communicating reluctance on
your part to talk with them
 tone of voice
Nonverbal…
 Nonverbal…
Detecting Nonverbal Cues in Others
 Assessing the meaning behind the nonverbal
messages of others is difficult, because we
tend to interpret nonverbal cues based on our
own personal backgrounds and experiences
Some clues;
 Elderly patients move closer to you or may
put a hand to their ears
 when patients are reluctant to speak to
pharmacists …. Sensitive issues incontinence,
sexual dysfunction, depression, menopause,
hemorrhoids, contraception, and breast or
prostate cancer
1.6 . Barriers of communication
Barriers of….
 Barriers of….
Potential environmental barriers
 Is the pharmacist visible?, is it easy to get the
pharmacist’s attention?
 Does it appear that the pharmacist wants to talk to
patients?
 Is the prescription area conducive to private
conversation?
 Is there a lot of background noise or are there other
distractions
 Barriers of…

II. Personal Barriers

Potential pharmacist-related personal barriers
– Low self-confidence
– Shyness
– Dysfunctional internal monologue
– Lack of objectivity/emotional objectivity
– Cultural differences
– Discomfort in sensitive situations
– Negative perceptions about the value of patient
interaction
 Barriers of…
Patient-related personal barriers
 patient perceptions of pharmacists (knowledge or
trust) are critical in establishing communication
relationship.
 their belief that the health care system is
impersonal/not concerned about them as
individuals but rather as cases or disease states.
 Patient perceptions of their medical conditions may
also inhibit communication.
 Barriers of…

III. Administrative Barriers

Staffing polices

Lack of reward for pharmacy services like

counselling
Pharmacy setting

IV. Time Barriers

The timing of the interaction is critical
Any Question?