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Potential challenges in patient counselling

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Leading questions are those that suggest a particular answer. For example “You do not miss any doses of your medication, do you?” By phrasing the question in this manner the patient feels obliged to say, “No, I Don’t.” because the question implies that the patient should not missing doses. Therefore, to obtain an accurate response to your questions, leading questions should be avoided. The role of silence during your interaction with the patient is more significant than you may realize. By allowing moments of silence after asking a question, the patient is able to reflect on your question and provide a more thoughtful and accurate response.
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In general, the silence should be long enough to provide the patient a chance to gather his or her thoughts but not so long as to make the patient feel uncomfortable. As you are interviewing your patient, avoiding why questions may prevent the patient from feeling as though he needs to defend his choices and actions. For example, if you desire to learn why a patient missing dose of amlodipine, instead of asking “Why do you miss your doses?” you might ask “What causes you to miss your doses?” With the why method the patient may feel the need to defend him or herself, whereas using “what” method allows the patient to reflect their reasons without feeling as you are offering judgement.
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Nonverbal communication is the sending of message to or from your patient without the use of words. This type of communication plays an important role in your interaction with your patients because it can be as powerful as the words that are spoken. Nonverbal communication includes tone of voice, choice of language, facial expressions, body posture and position, gestures, eye contact, appearance, and overall behavior. A patient’s perception of nonverbal communication may be influenced by individual and cultural differences. Therefore, you should be sensitive to cultural differences prior to making inferences about the patient based on nonverbal communication. The pharmacist faces many challenges in providing patient counseling within the inpatient, ambulatory care and community setting. Workload is the most commonly reported challenge by pharmacists.
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Although some pharmacists find workload demands to be a barrier to offering counseling, others do not. A patient with a terminal illness has an incurable disease that often results in the death of the patient in a relatively short period of time. Hospice care focuses on the palliation of a terminally ill patient’s symptoms, which can be physical, emotional, spiritual or social in nature. It also focuses on bringing comfort and self-respect to the dying patients. Conditions such as HIV, certain cancers, or other chronic illnesses, such as renal failure, heart failure, or diabetes are considered incurable but treatable diseases. They are usually on an aggressive treatment regimen to manage the disease state.
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They are also often very involving in the self-management of their disease states. The nature of these treatment regimens has led to increased pharmacist interaction with patients. The pharmacist-patient relationship that is built through the pharmacotherapy management counseling session is very important. Here are some strategies to accomplish this including an active listener and provider of information, identify the patient’s need, provide motivational counseling. Continue to reinforce adherence due to lengthy nature of treatment. Offer follow-up phone calls or home visits when appropriate. And provide support to the patient and caregivers. Consider the patient’s emotional stage. And tell the patient that you understand the fact that he or she is not feeling well and that it might be better to reschedule for a later time.
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Many geriatric patients have limitations and disabilities, such as hearing loss or vision impairment. Identify patient-specific barriers and implement strategies to overcome these barriers. For example, if a patient is hearing impaired, write down the information. If a patient has a hard time with cutting pills in half, offer to cut the pills or show the patient how to use a pill cutter. Anger is an emotion of grievance or displeasure. It is human nature to feel anger, but lack of understanding of one’s anger can lead to inappropriate expression of anger, and thus nonproductive or destructive behavior. Sometimes, anger is a secondary response to another emotion, such as pain or fear. Anger is also used to express frustration or general injustice.
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Anger may mask the core emotion at the root of problem and lead to further problems if suppressed. In the last part of this section, I’ll briefly introduce medication consultation and education services system in the Taipei Veterans General hospital. It provides our patients and medical staffs to ask medication related questions online. This service is only for our hospital patients because it’s hard to give an appropriate answer without seeing the medical records and every medication they took. Before asking question, the requestors have to write down their basic information, including name, gender, relation to patients and contact details. The system can recognize if the patient has visited our hospital before by checking medical record number or ID number and birthday.
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In order to limit the question to medication related problems, instead of medical conditions or other situations, the requestor must at least write a specific drug name, and then describe what they want to ask.

Ms Chen covers the remaining communication skills, before addressing the potential challenge. She also explains how to provide counselling to certain patient groups.

Key points

Essential communication skills:

  • Avoid leading questions

  • Moderate silence

  • Avoid “why”

  • Notice nonverbal cues

The pharmacist faces many challenges in providing patient counselling, such as:

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Good Pharmacy Practice: Medication Management

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  • High workload

  • Lack of privacy setting

  • Language barriers

  • Lack of effective communication skills

When counseling terminally ill patients, focus on palliative care and pain relief.

When counselling patients with incurable but treatable conditions, focus on building a pharmacist-patient relationship through the pharmacotherapy management counseling session.

When counselling geriatric patients, it is important to cater to potential limitations and disabilities, such as hearing loss or vision impairment. Identify patient-specific barriers and implement strategies to overcome them.

When counselling angry patients, pharmacists should unveil the core problem behind strong emotions.

TVGH strategies:

The medication consultation and education services system provides patients and medical staff a platform to ask medication-related questions online. It is reserved for TVGH patients because it is difficult to address questions without access to medical records. Requestors must have their name, gender, relation to patients, and contact details. To limit the question to medication-related problems, requestors must include a specific drug name in their question.

Share and learn:

Have you received communication skills training before?

Which patient groups do you think are difficult to counsel? How so?

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This content is taken from Taipei Medical University online course
Good Pharmacy Practice: Medication Management
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