Optimizing Patient Experience With Immunization Counseling


Using inclusive questions, preferred terms, and language etiquette can turn the simple task of immunizing into a fulfilling patient-centered opportunity for both pharmacists and patients.

Pharmacists and pharmacies are on the frontline of vaccinating citizens of the United States with the COVID-19 vaccines.1 With this unique opportunity, pharmacists are in a position to change public perception of the pharmacy profession as a whole, in addition to increasing their own pharmacy’s reputation in the community by optimizing patient’s immunization experience.

Studies have shown that one of the best ways to improve a patient’s experience is by engaging with good communication skills.2 The Center for Advancement of Pharmacy Education Educational Outcomes 20133 and the Accreditation Council for Pharmacy Education4 have also identified the public health need for improved communication for pharmacists.

Communication skills such as self-awareness, building rapport, impression management, audience-focused messaging, reflective listening, and using inclusive stigma-free language are a top priority for patients.5,6

Patient Perceptions and Immunization

The initial steps to optimizing a patient’s immunization experiences are immersed in the patient’s perception of your overall pharmacy. For a positive perception, ensure you have a good workflow with your staff, place employees in tasks that are based on their strengths and knowledge base, and know your eligibility to administer vaccines.7

Being efficient with a dedicated and reliable pharmacy team safeguards you and your pharmacy’s reputation. Also, be prepared with an emergency plan or back-up staff positions to accommodate for breaks, illness, and absence of members of the pharmacy team to keep operations running smoothly.

The next step is ensuring you and your staff are using good communication skills. In good communication, self-awareness is a key component in the construct of resilience among health care providers.8

In health care’s busy multitasking atmosphere, it is easy to forget that verbal and nonverbal communication is crucial impression management (Millie A. Harrison, 2018). Nonverbal communication includes body language, which encompasses everything from posture to use of personal space.

Utilizing S.U.R.E.T.Y (T., 2011) can help keep a positive and open body language by: Sitting at an angle, Uncrossing legs and arms, Relaxed posture, Eye contact, appropriate Touch, and using Your Intuition. The use of face masks also increases the need for maximizing body language and verbal communication.

When speaking, always remember the voice carries a lot of emotion and can change the interpretation based on tone or pitch, cadence or rate, and volume. Tone or pitch can convey meaning or intensity of the message while cadence or rate, and volume can lead to a variety of emotional implications (Brommel, 1972).

Counseling While You Immunize

Immunizing patients is an excellent way to build rapport, engage patients, learn more about their medical history, and to ultimately educate patients on their health and what pharmacists can do to make a difference. While you are preparing for administration, try using the vaccination prime questions (Figure 1), augmented from the original 3 prime questions of the Indian Health Services counseling technique to elicit a counseling session about the vaccine.9

These questions serve as a framework or lead to further discuss other required and recommended counseling points.10 While using these questions and counseling points, try to focus on giving an audience-centered message while using reflective listening to tailor the conversation to the patient and display empathy.

Audience-centered messaging evaluates the patient to determine the content and language usage needed to have the most effective communication (Lombardo, 2014). Reflective listening re-states or reflects what the patient expressed so they can hear it in a new way and know the immunizer is actively engaged in the conversation (Katz & McNult, 1994).

Language Etiquettes To Utilize While Immunizing

Language etiquette in health care is when a provider shows consideration for a patient by using preferred terms to reduce stigma and improve the patient’s perceptions.11 When thinking of preferred terms, use simple terms and practice plain language in lieu of clinical or medical terminology to ensure clarity and understanding of the patient. 

Plain language removes jargon, acronyms, abbreviations, and any other technical terms that may be less known outside of a health care field (The Plain Language Action and Information Network, 2011).

Whenever potentially sensitive topics arise in a patient discussion, the use of language etiquette will help keep the conversation comfortable and open. Language etiquette is available for discussing mental health, suicide, substance use, HIV, age, weight, sexual orientation, grief, and many other topics.

An integral part of any language etiquette in sensitive subjects centers around utilizing person-first language. During an immunization person-first language, such as “Susan, are you living with HIV?” or “Jackson, have you experienced any conditions that could involve your immune system like cancer?” This approach can help reduce stigma by not defining the patient by their condition.

Choosing sensitive terminology, such as “John, since you experience allergies, have you ever had a reaction to a vaccine?” or sensitive question framing, such as “For the purpose of the vaccine, are you looking to become pregnant, are pregnant, or breastfeeding at this time?”

Framing questions in a sensitive and inclusive manner while using person-first language can lead to not only an optimal experience for a patient but a rewarding experience for the practitioner.

Along with preferred etiquette, phrasing, and terminology, further tailor your language and use other inclusive questions to improve the patient’s experience. Adding questions such as “How would you like to be addressed?” and “Do you have any lifestyle, work-related, or religious observances coming up that we need to keep in mind?’” (Figure 2)

Allow patients to express their individual needs and inclinations.

Asking a patient how they would like to be addressed is great for eliciting preferred names, titles, and pronouns from your patients. The second question can cover any topics such as exercise, social events, job-related tasks, and personal beliefs that are always beneficial to know when practicing patient-centered care.12

Communication is the key when trying to optimize a patient’s immunization experience and shape the public’s opinion of the profession of pharmacy. Using the vaccination opportunity to get to know more about your patients by discussing their lifestyles, allergies, and conditions can aid not only in upcoming discussions, but also assist in health care situations with that patient in the future.

Utilizing inclusive questions, preferred terms, and language etiquette can turn the simple task of immunizing into a fulfilling patient-centered opportunity for both pharmacists and patients. The COVID-19 pandemic is not only giving pharmacists the opportunity to help protect our patients, but it is giving us the opportunity to communicate what a large impact pharmacists can make in the world.

Ryan Hoffart, Doctor of Pharmacy Candidate 2023, contributed to this article.

About the Author

Dr. K. Ashley Garling, PharmD

Clinical Assistant Professor

Op-Ed Project National Public Voices Fellow

The University of Texas at Austin College of Pharmacy


  1. Center of Disease Control and Prevention. (2021, February 12). CDC.gov. Retrieved from Center of Disease Control and Prevention: https://www.cdc.gov/vaccines/covid-19/retail-pharmacy-program/index.html
  2. Boissy A, W. A. (2016, July 31). Communication Skills Training for Physicians Improves Patient Satisfaction. J Gen Intern Med, 755-61. Retrieved from J Gen Intern Med: https://pubmed.ncbi.nlm.nih.gov/26921153/
  3. Medina, M. S. (2013). Center for the Advancement of Pharmacy Education 2013 educational outcomes. Am J Pharm Educ, 77(8), 162.
  4. The Accreditation Council for Pharmacy Education. (2011). Accreditation standards and guidelines for the professional program in pharmacy leading to the doctor of pharmacy degree. Retrieved from The Accreditation Council for Pharmacy Education: https://www.acpe-accredit.org/pdf/FinalS2007Guidelines2.0.pdf.
  5. Grice, G. R. (2017). Design and Validation of Patient-Centered Communication Tools (PaCT) to Measure Students' Communication Skills. Am. J Pharm Educ, 42(5_supp):22S-26S.
  6. Kumar MS, K. S. (2020). Telepsychiatry Netiquette: Connect, Communicate, and Consult. Indian J Psychol Med, 42(5_supp): 22S-26S.
  7. American Pharmacist Association. (2020, December 9). Pharmacists.com. Retrieved from American Pharmacists Association: https://www.pharmacist.com/sites/default/files/audience/APhACOVIDAuthoritytoImmunize_1220_web.pdf
  8. Rippstein-Leuenberger K, M. O. (2017). A qualitative analysis of the Three Good Things intervention in healthcare workers. BMJ Open , :e015826. doi:doi: 10.1136/bmjopen-2017-01582
  9. Lam N, M. S. (2015, Sept). Retrieved from PubMed: https://pubmed.ncbi.nlm.nih.gov/26359960/
  10. American Society of Health-System Pharmacists. (1997, February 15). ashp.org. Retrieved from American Society of Health-System Pharmacists: https://www.ashp.org/-/media/assets/policy-guidelines/docs/guidelines/pharmacist-conducted-patient-education-counseling.ashx
  11. Lydecker, J. G. (2016). Words will never hurt me? Preferred terms for describing obesity and binge eating. Int J Clin Pract, 70, 682-690. doi:https://doi.org/10.1111/ijcp.12835
  12. Joint Commission of Pharmacy Practitioners. (2014, May 29). Joint Commission of Pharmacy Practitioners. Retrieved from jcpp.net: https://jcpp.net/wp-content/uploads/2016/03/PatientCareProcess-with-supporting-organizations.pdf.
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