Overcoming Common Barriers to Effective Patient Counseling

Pharmacists have taken on the responsibility of effectively educating patients about their medications. This process serves 2 functions: it makes patients more likely to achieve positive outcomes through their drug therapy, and it helps avoid medication misadventures.

In order to be effective medication counselors, pharmacists first need to identify the barriers to effective medication counseling. We need to go beyond the minimum legal requirements of simply offering to counsel a patient.

First, we need to educate patients about why they need medication counseling. Let them know taking the initiative to understand their medication will help them achieve a better therapeutic outcome. Then, we need to go the extra mile and help patients understand all of the important aspects about their medications.

We’re currently required to counsel every patient with a new prescription and any time the dosage or directions change. All we need to do is offer this consultation; patients have the right to decline it at any time.

I’m not going to list off all the items to cover in a complete counseling session. Rather, my goal is to help you overcome the following barriers to effective patient counseling.

Face-to-Face Contact

Far too often, a patient may pick up a prescription and decline counseling before the pharmacist ever gets to see the patient. Or worse, the patient receives the prescription in the mail and avoids visiting the pharmacy altogether.

Here’s a common situation. A physician takes 60 seconds to let a patient know how to take a prescribed medication. The patient visits the pharmacy and sees 7 individuals in line waiting for their prescriptions. After spending 15 minutes in line, the patient gets to the counter and picks up the prescription. The patient then looks over and sees there’s another line to speak with the pharmacist, prompting the patient to decline the counseling session.

Many things could go wrong in this situation. What about drug interactions with medications from other physicians? Should the medication be taken with food? How can the patient know if the medication is working? Which adverse reactions should be expected, and which of them should the prescriber be told about? What does the patient do when a dose is missed?

This is a difficult situation for the pharmacist. Fortunately, I work in a setting that always have 2 pharmacists on duty, so we can counsel patients in a timely fashion. When I’m checking or filling a prescription, and I want to make sure the patient gets counseled, I’ll write a note on the receipt so the technician knows the patient shouldn’t decline the counseling session.

I also make a point to acknowledge every patient who walks into our store. Just eye contact or a simple hello is a great step toward building relationships with patients because it shows them you’re available.

Prejudice

We all have some sort of preconceived thoughts about certain patients just by looking at them. I’m not saying it’s right; I’m simply acknowledging this is a fact.

Pharmacists need to be acutely aware of preconceived prejudices so we leave them at the door when we come to work. Each patient who approaches us deserves just as much counseling and attention as the next. By being honest with ourselves and identifying our own prejudices, we’re able to put them aside and treat each patient with concern and understanding. Take a moment to identify your own prejudices, so you’ll be aware of them the next time you step behind the counter.

Age Gap

Does the little old lady with her Parkinson’s medication trust the 26-year-old pharmacist who looks like her grandson to counsel her? Or, does the 17-year-old girl getting birth control for the first time trust the 58-year-old pharmacist who looks like her dad to counsel her? It takes practice, but it can be done.

The most important factor is to initially understand the patient you’re going to counsel may have some preconceived notion about who you are and what you do or don’t know. If you’re able to recognize this as you’re moving into the counseling session, you’ll be able to create a sense of understanding or empathy with the patient. At that point, you may be in a better position to move forward with the medication education.

Patients need to trust you aren’t going to judge them because of the medication they’re taking, while also trust you’re knowledgeable enough to understand their specific needs.

Language Gap

Quite a few patients who come to my pharmacy are Spanish speakers. I have a very limited grasp of Spanish, but just enough to tell patients how to take their medications and a few side effects to watch for. I’m fortunate to have a couple Spanish-speaking technicians who do a tremendous job interpreting, but it’s difficult when one isn’t present or we have someone who speaks another language altogether.

The hospital where I work subscribes to a translation service, so I can call in and get a 3-way call going. I’ve used this a couple times and although it takes a bit of time to arrange the entire event, it’s quite helpful. The point is, be prepared to translate.

Barriers to effective counseling can make or break a patient’s therapy. If you’re limited in your time to consult patients who need it, take a moment and speak with your supervisors. Find out how they’d like you to deal with patient counseling. Do they support appropriate patient care and counseling, or are they there just to get the prescription filled and out the door?

Remember, without appropriate knowledge of their medications, patients won’t be able to achieve their best possible therapeutic outcome. The consequences of inappropriate medication use are high financial and human cost. With your help, your patients may be effective partners in managing their own drug therapy.