Dealing With Patients and Health Care Professionals

LEARNING OBJECTIVES

• INTRODUCTION

As the profession of pharmacy moves toward more active involvement in direct patient care, pharmacists will face new practice environments such as health care teams, which will require learning new methods to communicate with other health professionals. Pharmacists will also enter new roles as a provider with primary responsibility to help patients manage their chronic diseases. In those roles, developing effective pharmacist-patient relationships is essential to be successful in helping patients optimize their health. Finally, pharmacists in new roles will now be a primary educator of patients about their chronic disease and the medications to treat them, rather than just verifying that patients understand how to properly use their prescription medication.

• DEVELOPING EFFECTIVE PATIENT RELATIONSHIPS

Changing Patient Attitudes

In previous decades, health care providers were the sole owners of the knowledge regarding health, diagnosis, and medicines. They were perceived as an “all-knowing” authority figure whose recommendations were to be followed. Today, that model of patient-provider relationship has all but disappeared. Patients currently have a wide variety and depth of information regarding health issues available at their fingertips through the Internet. Scandals involving politicians, businessmen, and other traditional authority figures have eroded patient trust and respect of authority figures. Research has shown that patients rely more on peers and the Internet than health professionals for information about diseases and medication. Finally, most patients want a more active role in decisions about their health care.

Changing Provider Roles and Patient-Provider Relationships

Inter- and intraprofessional language still reflects those golden decades, where providers were the knowledgeable authority figures. Comments such as “That diabetic patient in bed 3B” or “I manage Mrs. Jones diabetes” are still heard today in hallway conversations. In reality, the only time a provider manages a patient’s chronic disease is during the 20-minute office visit, two to four times a year. For the remainder of the time, the patient manages their chronic disease. The patient follows the diet, exercises regularly, and remembers to take medications in a timely fashion. Today’s patients want to be considered by health care providers as a person, not as a disease, and tend to view approaches of past decades as noncaring attitudes. Patients want to be active participants in their care and view the preferred patient-provider relationship as a partnership. In this partnership, the provider’s role is to facilitate optimal patient self-care of both acute and chronic illnesses and serve as the patient’s advocate. Also, remember that the patient’s desire for participation is dynamic. During times of severe illness, patients, not feeling well, may prefer to temporarily defer to the provider’s judgment.

Changing Pharmacist Skill Requirements

To operate effectively in these new partnership roles, the pharmacist will likely need to augment his/her current skill set. Newer skills include enhanced communication skills, including reflecting responses, motivational interviewing, “I” messages, opened-ended questions; patient assessment skills including history taking; limited physical examination skills; primary patient education skills, e.g., teach-back methods; improved cultural sensitivity; and adherence support skills, which include enhanced knowledge of human behavior, effective communication skills, and interventions to improve adherence with prescribed therapy. The content of the textbook attempts to provide many of the important new skills and knowledge pharmacists require to effectively perform in newer patient-centered roles.

• PRIMARY PATIENT EDUCATION

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