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The Practitioners Guide to Effective The Practitioners Guide to Effective Communication in Pharmacy Practice: Communication in Pharmacy Practice:
The Basic SkillsThe Basic Skills
Matthew Perri III, Bs. Pharm., Ph.D., R.Ph.Matthew Perri III, Bs. Pharm., Ph.D., R.Ph.Professor and Associate HeadProfessor and Associate Head
Clinical and Administrative PharmacyClinical and Administrative Pharmacy
[email protected]@uga.edu
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DisclosuresDisclosures
Financial:Financial:– Consultant for the US Department of Justice, Consultant for the US Department of Justice,
multiple states Attorney’s General and other multiple states Attorney’s General and other law practices, Pharma, State Medicaid.law practices, Pharma, State Medicaid.
Nonfinancial:Nonfinancial:– Consultant, GA Department of Community Consultant, GA Department of Community
Health, Medicaid data and policy analysis.Health, Medicaid data and policy analysis.
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Topics for Today:Topics for Today:
Create a model of ideal pharmacy care. Create a model of ideal pharmacy care. Use basic communication skills to improve patient care. Use basic communication skills to improve patient care. Improve rapport and understanding with customers. Improve rapport and understanding with customers. Have some fun developing and implementing some new Have some fun developing and implementing some new
and some familiar skills.and some familiar skills.
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Current EventCurrent Event
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http://www.pharmacist.com/rise-credentialing-and-privileging-all-settings-kaiser-s-price-meets-criteria-patients#.VgKlV4Lu6KA.email
The Pharmacy Care ProcessThe Pharmacy Care Process
Collect and use patient information
Identify patients’ drug related problems
Develop solutions to these problems
Select and recommend therapies
Follow up to assess patient outcomes
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OBRA 90:OBRA 90:
Three parts:Three parts:– Patient InformationPatient Information– Prospective Drug Utilization ReviewProspective Drug Utilization Review– Patient CounselingPatient Counseling
Public Law 101-508, S4401, 1927(g) (November 5, 1990) and OBRA 90 Regulations. Federal Register November 2, 1992;57FR(212):49397-49401.
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Patient InformationPatient Information
Full nameFull nameAddress and phoneAddress and phoneDate of birth (DOB) / ageDate of birth (DOB) / ageGenderGenderDrug list (profile) including all OTC, Rx, herbal Drug list (profile) including all OTC, Rx, herbal supplements, etc.supplements, etc.Pharmacist commentsPharmacist commentsChronic medical conditions (diagnoses)Chronic medical conditions (diagnoses)Keep for 2 yearsKeep for 2 years
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Prospective DURProspective DUR
Over / underutilizationOver / underutilization
Therapeutic duplicationsTherapeutic duplications
Drug-disease interactionsDrug-disease interactions
Drug-drug interactionsDrug-drug interactions
Incorrect dosage or duration of treatmentIncorrect dosage or duration of treatment
Drug allergy interactionsDrug allergy interactions
Clinical abuse - misuseClinical abuse - misuse
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Patient CounselingPatient Counseling
Name (generic), intended use and expected actionName (generic), intended use and expected actionRoute, dosage form, dosage and administration scheduleRoute, dosage form, dosage and administration scheduleSpecial directions for preparation, storage or administrationSpecial directions for preparation, storage or administrationPrecautions to be observed while taking along with Precautions to be observed while taking along with common side effects, how to avoid or action required if they common side effects, how to avoid or action required if they occuroccurTechniques for self monitoring of drug therapyTechniques for self monitoring of drug therapyPotential interactions or therapeutic contraindicationsPotential interactions or therapeutic contraindicationsWhat to do if you miss a dose and refill informationWhat to do if you miss a dose and refill informationAny other information THIS patient may need to ensure Any other information THIS patient may need to ensure safe usesafe use
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Basic Communication Skills in Basic Communication Skills in Pharmacy PracticePharmacy Practice
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The Communication ModelThe Communication Model
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The communication model:The communication model:
Communication takes two Communication takes two – sender and receiversender and receiver
Two way flow of informationTwo way flow of informationPotential for a breakdown to occur at any timePotential for a breakdown to occur at any timeBarriers will exist – minimize these when you Barriers will exist – minimize these when you cancan
Communications Skills in Pharmacy Practice, Tindall, Beardsley and Kimberlin, third ed., 1994, Lea and Febiger, p 15.
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Barriers to communicationBarriers to communication
Pharmacy EnvironmentPharmacy Environment
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Barriers to communicationBarriers to communication
Pharmacy EnvironmentPharmacy Environment
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Basic Counseling and Basic Counseling and Communication SkillsCommunication Skills
Courtesy and rapport: Courtesy and rapport: – Quite possibly the most critical skills you will Quite possibly the most critical skills you will
need to develop, and includes:need to develop, and includes:How to address patients How to address patients Introducing yourselfIntroducing yourselfLearning patient namesLearning patient names
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Basic Counseling and Basic Counseling and Communication SkillsCommunication Skills
Courtesy and rapport: Courtesy and rapport: – Quite possibly the most critical skills you will Quite possibly the most critical skills you will
need to develop, and includes:need to develop, and includes:How to address patients How to address patients Introducing yourselfIntroducing yourselfLearning patient namesLearning patient namesBeing aware of your appearance, attitude, issuesBeing aware of your appearance, attitude, issuesRespecting patient privacy issuesRespecting patient privacy issuesAvoiding stereotypesAvoiding stereotypesUsing appropriate body languageUsing appropriate body language
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Body LanguageBody LanguageMessage impact:Message impact:11
7% verbal7% verbal
38% vocal38% vocal
55% body movements55% body movements
Depends on context – incongruence:Depends on context – incongruence:– When attitudes and posture disagree, posture winsWhen attitudes and posture disagree, posture wins
Composed ofComposed ofBody movementsBody movements
Facial expressionFacial expression
Gestures Gestures
Posture and breathingPosture and breathing
SpaceSpace
04/21/2304/21/23 (1) Mehrabian & Wiener, 1967 and Mehrabian & Ferris 1967
Basic Counseling and Basic Counseling and Communication SkillsCommunication Skills
Body languageBody language– Your most powerful tool is Your most powerful tool is
your smile – or more your smile – or more generally your facial generally your facial expression. expression.
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Basic Counseling and Basic Counseling and Communication SkillsCommunication Skills
Body languageBody language– Facial expression – smile. Facial expression – smile. – Eye contactEye contact– Open postureOpen posture– DistanceDistance– Tone of voiceTone of voice– Get Get ““CLOSERCLOSER””
– Control distractions, lean in, open posture, smile, make good Control distractions, lean in, open posture, smile, make good eye contact, relaxeye contact, relax
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Some samples of facial body language….Some samples of facial body language….
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How is Andy’s body language? How is Andy’s body language?
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StereotypesStereotypes
The process of attributing a set of The process of attributing a set of characteristics to all members of a group, characteristics to all members of a group, without regard for individual differences.without regard for individual differences.– We all react differently to different kinds of people, and even differently We all react differently to different kinds of people, and even differently
at different times. Some reactions are overt, some hidden. They all can at different times. Some reactions are overt, some hidden. They all can impact how we relate to patients. We want to avoid letting stereotypes impact how we relate to patients. We want to avoid letting stereotypes influence how we react to and interact with our patients.influence how we react to and interact with our patients.
– Example statements:Example statements:““Doctors are arrogantDoctors are arrogant””
““You canYou can’’t trust…(fill in with your favorite; men, women, college students, professors, t trust…(fill in with your favorite; men, women, college students, professors, etc.)etc.)””
““Teenagers are irresponsibleTeenagers are irresponsible””
Hugman, B. Healthcare Communications, Pharmaceutical Press 2009: p50.04/21/2304/21/23
StereotypesStereotypes
Are common Are common
Most everyone holds to some degree of Most everyone holds to some degree of stereotyping stereotyping
What is the impact of this on rapport? What is the impact of this on rapport?
Being aware of how you may stereotype others is Being aware of how you may stereotype others is criticalcritical
Treat everyone as an individualTreat everyone as an individual
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RapportRapport
A level of mutual consideration and A level of mutual consideration and respectrespect
– The The ““warm fuzzywarm fuzzy”” part of communication part of communication– Paves the way for good communicationPaves the way for good communication
Trust is criticalTrust is critical– How do you build trust?How do you build trust?– How do you keep it?How do you keep it?– What happens when you break it?What happens when you break it?
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PerceptionsPerceptions
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FINISHED FILES ARE THE RE-FINISHED FILES ARE THE RE-
SULT OF YEARS OF SCIENTIF-SULT OF YEARS OF SCIENTIF-
IC STUDY COMBINED WITH THE IC STUDY COMBINED WITH THE
EXPERIENCE OF MANY YEARSEXPERIENCE OF MANY YEARS
OF EXPERTSOF EXPERTS
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ListeningListening
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Basic Skills: ListeningBasic Skills: Listening
Listening Skills:Listening Skills:– Be aware of perceptions (F Be aware of perceptions (F
test) test)
– Be non-judgmentalBe non-judgmental
– Be an active listenerBe an active listener
Summarizing, Summarizing, paraphrasing, clarifying, paraphrasing, clarifying, feedback (immediate, feedback (immediate, honest and supportive)honest and supportive)
– Use appropriate listening body Use appropriate listening body languagelanguage
– Use silence where appropriateUse silence where appropriate
Listening Skills:Listening Skills:– Sit up.Sit up.
– Look and act interested.Look and act interested.
– Lean forward.Lean forward.
– Actually Listen!Actually Listen!
– Nod your head to show your Nod your head to show your attention.attention.
– Make eye contact with the Make eye contact with the speaker.speaker.
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Basic Skills: InformationBasic Skills: InformationWhen communicating important information When communicating important information to patients, be sure to: to patients, be sure to:
State the purpose of your communicationState the purpose of your communication
Inquire about what the patient needsInquire about what the patient needs
Use markers for critical informationUse markers for critical information– ““Now, Ms. Smith, this is really important…..I need you toNow, Ms. Smith, this is really important…..I need you to
……””
Talk in lay terms, but donTalk in lay terms, but don’’t oversimplifyt oversimplify– Avoid technical jargonAvoid technical jargon– Avoid information overloadAvoid information overload– Keep it short and simple, to the pointKeep it short and simple, to the point
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Basic Skills: Gathering Basic Skills: Gathering InformationInformation
When gathering informationWhen gathering information– Ask open-ended questionsAsk open-ended questions
Much more information can be gainedMuch more information can be gained
Saves timeSaves time
Provides opportunities for patients to reveal Provides opportunities for patients to reveal information we might not be thinking about information we might not be thinking about
– ““How are you supposed to be taking this…?How are you supposed to be taking this…?– ““Tell me more about this…Tell me more about this…””
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Basic Skills: AssessmentBasic Skills: Assessment
The question is, did your patient learn anything The question is, did your patient learn anything from you? In other words, did the other person from you? In other words, did the other person understand what you said, and meant?understand what you said, and meant?
To assess:To assess:– Summarize your teachingSummarize your teaching– Verify what your patients knowVerify what your patients know
““Ms. Smith, can you tell me how you will take your Ms. Smith, can you tell me how you will take your medication?medication?
– Reinforce patient understanding when you canReinforce patient understanding when you can““ThatThat’’s right, this medication will make you sleepy…s right, this medication will make you sleepy…””
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Basic Skills: EmpathyBasic Skills: Empathy
Seek to understand what your patients feel Seek to understand what your patients feel Empathy is not sympathyEmpathy is not sympathy
Realistically, may not be attainable because you Realistically, may not be attainable because you are not the other personare not the other person
Empathy will help you shape your communication Empathy will help you shape your communication so that others better understand you!so that others better understand you!
Listening and Responding Listening and Responding
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Scenario:Scenario:
I’ve been to Dr. Johnson several times I’ve been to Dr. Johnson several times because I heard he was a good doctor. But because I heard he was a good doctor. But he just doesn’t seem to care. I have to wait he just doesn’t seem to care. I have to wait for hours even with an appointment. Then for hours even with an appointment. Then when I do get to see him, he whips in and when I do get to see him, he whips in and out so fast I don’t have a chance to talk to out so fast I don’t have a chance to talk to him. Oh, he’s pleasant enough. I just get him. Oh, he’s pleasant enough. I just get the feeling he doesn’t care.the feeling he doesn’t care.
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Possible Response:Possible Response:
“You have to understand. Dr. Johnson is a “You have to understand. Dr. Johnson is a very busy man. He probably doesn’t mean very busy man. He probably doesn’t mean to be abrupt.”to be abrupt.”
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Possible Response:Possible Response:
“I don’t blame you for being upset. You “I don’t blame you for being upset. You shouldn’t have to wait that long when you shouldn’t have to wait that long when you have an appointment.”have an appointment.”
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Possible Response:Possible Response:
“Dr. Johnson is a very good physician. I am “Dr. Johnson is a very good physician. I am sure he gives his patients the best care sure he gives his patients the best care possible.”possible.”
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Possible Response:Possible Response:
“I know how you feel. I hate to wait in “I know how you feel. I hate to wait in doctors offices too.”doctors offices too.”
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Possible Response:Possible Response:
“Let me talk with you about the new “Let me talk with you about the new prescription you are getting.” prescription you are getting.”
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Possible Response:Possible Response:
“You seem to feel there is something “You seem to feel there is something missing in your relationship with Dr. Johnson missing in your relationship with Dr. Johnson – that there isn’t the caring you would like.” – that there isn’t the caring you would like.”
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Basic Skills: QuestionsBasic Skills: Questions
Encourage patients to ask questionsEncourage patients to ask questions
– ““Now, do you have any questions for me..?”Now, do you have any questions for me..?”– ““Just let me know if you have any other questions, OK?Just let me know if you have any other questions, OK?
Key Point: Key Point: When your patients are When your patients are comfortable asking you questions, you comfortable asking you questions, you know you have rapport and are doing a know you have rapport and are doing a good job communicating.good job communicating.
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Basic Skills: Assertive, Persuasive and Basic Skills: Assertive, Persuasive and Aggressive Aggressive
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Pushy
Persuasive
Assertive I don’t care what yousay I am not jumpingoff this roof! Thanks
for convincing me to jump!
Counseling Methods:Counseling Methods:
Basic CounselingBasic Counseling– Interactive patient counselingInteractive patient counseling
The Prime QuestionsThe Prime Questions
Counseling in challenging situationsCounseling in challenging situations– The PAR techniqueThe PAR technique
Prepare, assess and respondPrepare, assess and respond
Counseling for complianceCounseling for compliance– The RIM techniqueThe RIM technique
Recognize, identify and manageRecognize, identify and manage
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Body LanguageBody Language
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We’ve talked a little about this. We’ve talked a little about this. Many aspects, the important Many aspects, the important ones, we’ve reviewed. There ones, we’ve reviewed. There
is also some art to this.is also some art to this.
The Art (Science) of The Art (Science) of Face ReadingFace Reading
LightLight
ForeheadForehead
Eyebrows: shape, Eyebrows: shape, position, typeposition, type
Eyes: spacing, angle, Eyes: spacing, angle, bulging, size of iris, corner bulging, size of iris, corner indents, pupil response, indents, pupil response, showing stressshowing stress
EyelidsEyelids
EyelashesEyelashes
Eye PuffsEye Puffs
Nose: size, shape, ridge, Nose: size, shape, ridge, width, nose tip angle,width, nose tip angle,
Nose tipNose tip
NostrilsNostrils
Ears: size, cups and ridges, Ears: size, cups and ridges, angle to head, placementangle to head, placement
CheeksCheeks
Mouth: size, angleMouth: size, angle
Lips: size and shapeLips: size and shape
TeethTeeth
SmilesSmiles
ChinsChins
Combinations of features Combinations of features
(Chin/eyebrow(Chin/eyebrow))LinesLines
Facial hairFacial hair
Fulfer, Mac, J.D., Amazing Face Reading, 1996.
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Exercise: Building a FaceExercise: Building a Face
Lets put together a face composed of the Lets put together a face composed of the features we features we leastleast want to see in our want to see in our patients/customers. patients/customers.
This will help us to identify potential This will help us to identify potential problem customers so we can be problem customers so we can be prepared.prepared.
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Self Will PadSelf Will Pad
Fleshy pad or Fleshy pad or bump between bump between eyebrows.…let eyebrows.…let nothing stand in nothing stand in your way of your way of getting what you getting what you want.want.
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Angled Eye BrowsAngled Eye Brows
Is always right – wants to be in control. Is always right – wants to be in control.
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Stressed Eyes: White shows Stressed Eyes: White shows above pupilsabove pupils
This shows stress and that an individual This shows stress and that an individual could react in a violent manner. could react in a violent manner.
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Nose: Nose:
Bump on Bump on bridge….feisty when bridge….feisty when cornered.cornered.
Points down…ruthlessPoints down…ruthless
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Jaw/ChinJaw/Chin
Ripples in jaw = Ripples in jaw = repressed angerrepressed anger
Chin sticks out = Chin sticks out = formidable adversary.formidable adversary.
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Head TypeHead Type
High crown, High crown, low forehead: low forehead: dominatingdominating
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LipsLips
Stretched tight (upper lip tight across Stretched tight (upper lip tight across teeth)…false sincerity, hidden agenda.teeth)…false sincerity, hidden agenda.
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Now with the help of some sophisticated software and your Now with the help of some sophisticated software and your imaginations …we will meld these facial features…to form a imaginations …we will meld these facial features…to form a mental picture of a customer with which to avoid confrontation…a mental picture of a customer with which to avoid confrontation…a customer who is better left to the competition…customer who is better left to the competition…
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Watch out for this one!
Thank you, George, for all you do for our Thank you, George, for all you do for our students and profession and for being a good students and profession and for being a good sport! sport!
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