This fast-paced environment seems at odds with what the word “counseling” means to many pharmacists.
Historically, counselors have been portrayed as Sigmund Freud clones, devoting hour after hour to sorting through a client’s problems. However, pharmacist counseling obviously can’t look like this. There’s not enough time to sit quietly with a patient to identify and discuss key issues.
Instead, interactions are usually brief and concise, with few wasted words and one question always in mind: Do you understand? Unless a particularly assertive patient demands some of your time, counseling often gets sacrificed for other pressing concerns.
Pharmacy practice is becoming more reliant on interactions, evolving into a point-of-care service from a product delivery service. As a result, pharmacists will need to interact with patients more meaningfully and frequently.
As medications have become more plentiful and frequently used, informing patients about their medication therapies has become more critical. For some time now, pharmacists have been trained to speak with patients about their medications in order to make sure that the drug is understood, from mechanism of action, to dosage instructions, to indications.
In my opinion, this isn’t counseling; it’s consulting. Although this distinction may seem semantic, it has important implications for pharmacy practice.
Ultimately, counselors are advice-givers. They tell patients what they should do, and patients simply obeys orders. Counselors reflect back to patients (“What I heard you say was…”) and force them to find answers on their own. Counselors assume that the patient is unable to function effectively and must be retrained to do so.
Consultants, on the other hand, are behavioral facilitators. They provide information and guidance to patients about taking medications without telling them how to do it. They gather important data by asking questions and listening, and then share it with patients to enhance their understanding of the important facts. They prepare patients to be responsible for their own behavior by understanding their health situations and offering ideas about how to handle them.
Pharmacists are experts in drugs, so training them to ask patients if they have any questions about their medications isn’t effective. Why would they have questions, anyway? They probably know next to nothing about what they’re taking or the condition that makes it necessary.
Pharmacists are trained to ask to cover liability, to say that “patients were counseled,” but we can do better.
Pharmacists are in a great position to be helpful to their patients. Patients don’t know what they don’t know, and a few good questions can go a long way in making them aware of that. They’re also very unlikely to admit that they’re worried, scared, overwhelmed, or confused.
Asking for help puts an individual in a vulnerable and humble position. Few of us enjoy admitting that we need someone else to do something that we can’t do on our own. Pharmacists must give advice and counsel without making the patient feel badly about asking, and the consultant model is perfect for this task.
Here are some ideas for consulting with your patients. They’re admittedly quite general and will need to be customized for your practice environment.
1. Access your ignorance.
Don’t make assumptions about why patients are noncompliant, why they may have a certain condition, or how much they care about their own health. The fewer inferences you make about why a patient behaves in some way, the less often you’ll stick your foot in your mouth.
2. Ask a specific question and listen.
Instead asking patients if they have any questions, be more exact. Ask things like:
- “Do you understand how this medication works?”
- “This medication may cause ______. Will these possible side effects cause significant problems for you?”
- “When you take this medication, there are things you shouldn’t do or take (list them). Will this cause a problem for you?”
This may help with adherence and compliance issues. Consider questions like:
- “What makes it hard to remember to take your medications?”
- “When you forget to take your medications, why does that usually happen?”
- “Is there someone in your life who can help you remember?”
- “Do you understand why it’s so important to take this medication as instructed?”
If patients resist your efforts, make it clear that you can be ed later.
Even if you can’t do all of this in a single interaction, attempting some of it is better than asking, “Do you have any questions?” As many of you would probably agree, the answer to that is almost invariably “no.”
So much more can potentially be accomplished with just a small change in focus. Now, go and build those relationships with your patients!
Kraig Schell, PhD
Kraig Schell, PhD, is a Professor of Psychology and Director of the Consultation and Research Institute at Angelo State University in Texas, and also Affiliate Professor of Pharmaceutical Outcomes and Policy at the University of Florida School of Pharmacy. He has taught, consulted, and authored dozens of continuing education articles for pharmacists on patient safety and engagement, as well as the application of psychological principles to safer and more effective care.