CHAPTER 2

ESTABLISHING THE PHARMACIST–PATIENT

RELATIONSHIP
1
By: Minimize Hassen
(MSc in Clinical
Pharmacy)

03/17/2025
PATIENT COUNSELING

Patient counseling is defined as providing

medication information orally or in written form to the

patients or their representatives.

 On directions of use,

 On side effects,

 Precautions,

 Storage,

 Diet and life style modifications.

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PATIENT COUNSELING OBJECTIVES

Better patients understanding of their illness and the role of medication

in its treatment.

Improved medication adherence.

More effective drug treatment.

Reduced incidence of adverse effects and unnecessary healthcare costs.

Improved quality of life for the patient.

Better coping strategies to deal with medication related adverse effects.

Improved professional rapport between the patient and pharmacist.

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 PATIENT
COUNSELING…
 Patient counseling consists of three stages:

 Introduction

 Process Content and Issues regarding manner

 Conclusion

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COUNSELING TIPS
Review the patient's record.

Introduce yourself.

Explain purpose of counseling.

Obtain drug related information such as allergies, use of

herbals.

Assess the patients understanding of the reasons for therapy.

Assess any actual and/or potential concerns or problems of

importance to the patient.

Use language that the patient understands.

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 COUNSELING

TIPS…
Use appropriate counseling aids.

 Present facts and concepts in simple words and in logical

order.

 Use open ended questions.

 Verify the patient's understanding by means of feedback.

 Summarize by emphasizing key points.

 Give an opportunity to the patient to put forward any

concerns.

 Help the patient to plan follow-up.

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 PATIENT COUNSELING…
 The amount and type of information provided to the

patient will vary based on the patient’s needs, and

practice setting.

 Ideally, the pharmacist counsels patients on all new and

refill prescriptions.
 Patients receiving more than a specified number of

medications.
 Patients known to have visual, hearing or literacy
problems.
 Pediatric patients.
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 Patients on anticoagulants.
ENVIRONMENT FOR PATIENT COUNSELING

 The patient should be counseled in a semi-private, or

private, area depending on the medication(s).

 The patient should perceive the counseling area as

confidential, secure and conducive to learning.

 This helps ensure both parties are focused on the

discussion, and minimizes interruptions and distractions.

 It provides an opportunity for patients to ask questions they

may be hesitant to ask in public.

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 PATIENT COUNSELING…
The counselling process uses verbal and non-

verbal communication skills.

Verbal communication skills:

Language

Tone

Volume

Speed

Non-verbal communication skills:

Proximity

Facial expression
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 PATIENT
COUNSELING…
 Counselling is a two-way communication process.

 Interaction between the patient and the pharmacist is

essential for counselling to be effective.
 Preparing for the session.

 Opening the session.

 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 [diet or exercise] may also be discussed.

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 PATIENT
COUNSELING…
 Topics commonly covered:
 Name and strength of the medication.
 Reason why it has been prescribed or how it works.
 How to take the medication.
 Expected duration of treatment.
 Expected benefits of treatment.
 Possible adverse effects.
 Possible medication or dietary interaction.
 Advice on correct storage.
 Minimum time duration required to show therapeutic
benefit.
 What to do if a dose is missed.
 Special monitoring requirements (e.g. blood tests).
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 Arrangements for obtaining further supplies. 03/17/2025
PATIENTS EDUCATION
Empowering clients on proper use of medicines through

patient education is essential to improve treatment outcome.

Principles to guide public education

 Should address important drug use issues with special

focus on rational use of medicines.

 Should encourage informed decision-making and cover

basic concepts of medicine use, like:

 How to choose when to self-medicate and when to seek medical

advice,
 Which conditions that do not require medication,

 How to read a drug label or patient information 03/17/2025 12

PRINCIPLES…

Should recognize and consider the cultural

diversity and the influence of social factors.

Should have clear and measurable objectives.

 To change deep-rooted beliefs and

practices, it requires a sustained effort and
a stepwise process which moves from
creating awareness, to acquiring knowledge
and finally changing behavior.
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PHASES OF ORGANIZING MEDICINE USE
EDUCATION
Preparatory phase:
Perform needs assessment

Prepare well-structured patient education material

Get well prepared on the selected topic

Consider socio-cultural aspects of the audience

Medicine use education session:

Introduce yourself

Explain the objective of the day’s session

Respect clients and be supportive

Make it interactive

Summarize

Post-event phase:
Record

Documentation and 03/17/2025 14

 APPLY EFFECTIVE COMMUNICATION SKILLS

 Ask questions and listen (use open-ended questions).

 Make interaction with the patient’s positive experience.

 Speak clearly and simply.

 Encourage patient to ask questions.

 Ask checking questions to determine understanding.

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ASK QUESTIONS AND LISTEN: OPEN-
ENDED QUESTIONS
 Cannot be answered with “yes” or

“no”.

 Usually start with:

 What?

 Why?

 Who?

 When?

 How?
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 Explain or describe to me…..
 Make Interaction with the Patients
Positive Experience
 Demonstrate a caring, respectful attitude.
 Actions
 Words
 Body language
 Tone of voice
 Eye contact

 Praise and encourage patient.

 Motivate the patient to continue treatment.
 Be non-judgmental if patients’ views or lifestyles
differ from your own.

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 SPEAK CLEARLY AND SIMPLY
 Use simple non-medical terms.

 Use words that are familiar to the

patient.

 Use appropriate language level &

visual cues.
Image source: WHO

 Repeat important information.

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SPEAK CLEARLY AND SIMPLY…
Example:

Difficult to understand

“This drug, isoniazid is a bactericidal agent that is

highly active against Mycobacterium tuberculosis”.

Simple to understand

“This isoniazid pill will help fight TB and help

you get better”.

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ENCOURAGE PATIENT TO ASK
QUESTIONS

 Ask patients “Do you have any questions”.

 Praise patients for asking questions.

 “I am glad that you asked that question…”

 “Good question…”

 Answer all questions thoughtfully and carefully.

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COMMUNICATION ABOUT MEDICINES WITH SPECIAL
PATIENTS & CHILDREN
Applying communication skills to pharmacy practice

situations is not always easy.

Especially in situations where patients have special

communication needs.
 Hearing problem,

 Visual problem

Before communicating with individuals with unique

problem one shall check his/her perception.

We should try to avoid stereotyping individuals and make

sure to check our perceptions. 03/17/2025 21

COMMUNICATION ABOUT MEDICINES WITH SPECIAL
PATIENTS AND CHILDREN…
Older Adults

A. Learning
 In certain individuals aging process affects the learning process, but

not the ability to learn.

 Some older persons process information at a slower rate.

 Ability to process new and innovative solutions to problems might

also be slower in some older adults.

 Solution

 Set reasonable short-term goals, approach long-term goals in stages,

and break down learning tasks into smaller components.

 Encourage feedback from patients as to whether they received your

intended message. 03/17/2025 22

B. VALUE AND PERCEPTUAL DIFFERENCES
 Generation gap

 Some older adults may perceive things differently from those in

different age groups since people typically adhere to values

learned and accepted in their younger years.
Hoarding and sharing medication

 The image of the pharmacist and the pharmacy profession.

 Perception of authority

Some may be receptive to being told what to do.

On the other hand, many patients want to be more independent

and may feel the need to assert themselves.

They may be somewhat more demanding, may want additional
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information
OLDER…
C. PSYCHOSOCIAL FACTORS

Several psychosocial factors may influence your relationship

with older adults.

Some older adults may be experiencing a significant amount

of loss compared with people of other age groups.

 Their friends may be dying at an increased rate, they may have

retired from their jobs, or they may have had to slow down or cease
certain activities due to the aging process.
 All these situations involve loss and subsequent grieving.

 Thus, their reaction to certain medical situations may be different.

Such as ignoring your directions or complaining about the price of

their medications. 03/17/2025 24

PATIENTS WITH DISABILITIES

“Don’t treat me as a disability, treat me as an individual with

a disability; in other words, treat me as an individual first.”

WHEEL CHAIR BOUND PATIENTS

LEARNING DISABLED PATIENTS

Patients with Mental Health Problems

Use open-ended questions to determine the level of patient

understanding before you counsel them about their medications.

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TERMINALLY ILL PATIENTS
Communicating with terminally ill patients and their

families is extremely important.

You should not avoid talking with them unless you

sense
that they do not want to talk about their illness.

Not interacting with them only contributes further to

their isolation and may reaffirm the idea that talking

about death is uncomfortable.

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Patients with HIV or AIDS
 How do we need to treat them?

 Special needs

 Many patients do not have an adequate support system.

 Dealing with HIV or AIDS has a physical component (i.e.,

weight loss, lack of energy), psychological and sociological

aspects (fear of dying, fear of pain).
 Deal with misinformation and inaccurate perceptions about

HIV and AIDS.

 Identify what the patient’s needs are and what services

you can provide or referrals you can make to best meet

these needs. 03/17/2025 27
COMMUNICATING WITH CHILDREN
ABOUT MEDICINES…
Communicating with children is different from communicating

with adults in two distinct ways.

 Communication with children typically involves three
people:
 The pharmacist, the child, and the parent of the child.

 When educating children about medicines, one needs to

communicate at a level that is appropriate for the cognitive

developmental level of the child.

Pharmacists need to assess what parents know about their

child’s prescription and OTC medicines by using open-ended

questions and then filling in the gaps with education. 03/17/2025 28
 SEVEN KEY PRINCIPLES GUIDING ETHICAL CONDUCT

I. Nonmaleficence: “above all else do no harm.”

II. Beneficence: behave in the best interest of their
patients.
III. Autonomy vs paternalism: establish a patient’s
rights to self-determination.
IV. Honesty and truth telling

V. Informed consent: the way in which patient

preferences become expressed and are applied out of
respect for that patient’s autonomy
VI. Confidentiality: protect patients information.

VII. Fidelity 03/17/2025 30

 STEPS IN ETHICAL DECISION-MAKING
Recognize the moral dimensions.

Identify all stakeholders and interested parties.

Think through the shared values or principles involved.

Weigh the benefits and burdens.

Look for analogous cases.

Discuss the case with relevant parties and gather

opinions.

Consider the legal and organizational rules involved.

Reflect on how comfortable you are with the decision.

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 CASE ON ETHICAL DILEMMA
You are working as a relief pharmacist in a community pharmacy. You

notice that Megan, the 17-year-old daughter of a very close family

friend, is receiving prescriptions for oral contraceptives and for the
treatment of a STD. Apparently, Megan has been hanging out with a
group of students whom her parents disapprove of and have
forbidden her to see. You are very concerned about Megan and
wonder whether her use of oral contraceptives may lead her to forego
the use of condoms that could offer protection from STDs. When
Megan enters the pharmacy to pick up her prescriptions, she becomes
upset at seeing you and hurries out, refusing to talk to you. You know
that if you were in her parents’ shoes, you would want to know about
the prescriptions. You are convinced that Megan is in trouble and
needs the help of her family.
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 CASE ON ETHICAL DILEMMA…
When reviewing Megan’s case, consider the following
questions:
 What is the ethical dilemma?

 What additional facts may be needed to help you reach a

decision in this case?

 What alternatives do you consider in resolving this dilemma?

 What ethical principles are involved in the decision?

 What alternative would you choose and why?

 How would you proceed in carrying out your decision?

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