Listen to the patient. In the preceding case study, neither the physician nor the pharmacist took time to listen. Pharmacists should listen to and understand patients’ perceptions of their conditions. Ask open-ended questions. Elicit feedback from the patient. Let the patient tell his or her story. Sarah should have asked Paula some probing questions, such as “Are you interested in herbals because you’re concerned that medicine may not work?” “Why do you think your blood pressure is high?”

         Explain your perception of the problem and your strategy for treatment. Often, strategies for treatment and the reasons for choosing them are not explained to the patient, or are explained in a way that is too technical. Pharmacists should make a concerted effort to explain the treatment and the decision-making process in a way that is easy for the patient to comprehend.

         Acknowledge the patient’s perspective and discuss similarities to and differences from the health care provider’s perspective. The pharmacist–patient relationship should be collaborative, rather than prescriptive. The patient must be acknowledged and respected. In case study 3, both health care providers missed the opportunity to compare herbal remedies with the patient’s prescription drug. When patients are educated about their options, they can make better decisions regarding their health.

         Recommend treatment while remembering the patient’s cultural background. Do not force your own attitudes, beliefs, and values on the patient. Sarah needs to realize that many of her patients value alternative forms of medicine. Rather than dismissing or ignoring patients’ beliefs about alternative medicine, pharmacists should take the opportunity to work with patients on a drug regimen that meets their specific needs.

         Negotiate an agreement. Remember that the patient’s health is ultimately in the patient’s hands. Acknowledging the patient’s attitudes, beliefs, and values is essential in tailoring effective drug therapy. In case study 3, Paula never “bought into” the treatment prescribed for her; she ended up going to a faith healer. For any medication to work, pharmacists must partner with patients and elicit their cooperation and compliance.

Sarah, from case study 3, admits that her first impulse would have been to dismiss seeing a faith healer as a total waste of time. She realizes that if she had used a narrative approach, rather than a biomedical approach, she would have learned valuable information about the patient that would have influenced the quality of care she provided. Sarah believes the narrative approach would have revealed (1) why the patient’s blood pressure was high, (2) that the patient had decided to reject the dosage increase, (3) that the patient valued nontraditional remedies, and (4) that simply listening to this patient would have been a therapeutic intervention. If Sarah had used this approach, Paula might not have gone to a faith healer.

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