Patient: I thought I just had some allergies. Now I find out I have asthma. Doc says I have to give up smoking. It’s one of the few things that relaxes me.

Pharmacist: It sounds like finding out about asthma has been difficult for you. It could be very hard to stop smoking, since it’s so relaxing for you. That would certainly help your asthma, though.

Patient: Yeah, I know. It’s just tough.

Pharmacist: It sounds difficult.

Note that this pharmacist does not try to make everything better. The pharmacist doesn’t try to cheer up the patient and point out all the benefits of not smoking and all the good things in the patient’s life. It’s too soon for that. That may be useful at some point, but not now.

Becoming ill also evokes fear and anxiety in patients. These two emotions occur because the patient experiences ambivalence, circumstances seem uncontrollable, or there is a perceived or real threat to the patient. The same illness that produces sadness in one patient may produce fear or anxiety in another patient. Therefore, pharmacists must be sensitive to how each patient uniquely processes the illness and its treatment. For patients who are fearful or anxious, supportive communication focuses on legitimizing the feelings of the patient, “reducing the individual’s uncertainty about the situation, enhancing the individual’s sense of efficacy or control, modifying judgments about the harmfulness of a perceived threat, or identifying ways to escape from the threat.”¹ Here’s an example:

Patient: The doctor told me I have high blood pressure. Am I gonna have a heart attack?

Pharmacist: This must be very frightening for you. It’s true that patients who have uncontrolled high blood pressure for a sustained period of time are at a higher risk for a heart attack, but the medicine your doctor has prescribed is very effective at controlling blood pressure if it’s taken once a day as prescribed.

Patient: So, if I take this, I won’t have a heart attack?

Pharmacist: I feel very confident that if you take this medicine properly, cut down on salt in your diet, and get some moderate exercise on a regular basis you will greatly reduce the risk of a heart attack. It really is up to you. I know these are things that you can handle without a problem.

Patient: I hope so.

The pharmacist in this situation legitimized the patient’s concern, then gave the patient a realistic appraisal of the risks of a heart attack. The pharmacist helped to reduce uncertainty by letting the patient know about those things that are under his control, then supported the self-efficacy of the patient by letting him know that he could do what is necessary to escape the threat of a heart attack.

Shame, embarrassment, and guilt are other emotions that are evoked by one’s own illness and the illness of loved ones. Shame and embarrassment result from feeling “caught” when you don’t want to be caught. Shame or embarrassment occurs when a person’s character or competence is questioned (either privately or publicly)—when the person’s self-image is either challenged or confirmed (some people already believe they are not competent or worthy of respect). If a patient is treated like a child and shamed by a physician for not following her treatment plan correctly (in the eyes of the physician), that shame may have been converted to anger or intolerance by the time she reaches the pharmacy. This is a very difficult situation. Supportive communication is needed to let the patient know that she still deserves to be treated with respect, regardless of whether she followed the treatment regimen. But the patient’s anger or intolerance may be met with far less than supportive communication by the pharmacist. The key for the pharmacist is to stay separate from the patient—that is, to not be taken in by the patient’s anger. Here is an example:

Patient: Here, fill this! (tosses prescription on the counter angrily)

Pharmacist: Sounds like this has been a difficult day.

Patient: Hmmf. Difficult day…you people think it’s so easy to take all of this medicine and change your whole life when you get ill!

Pharmacist: I hope I haven’t given you that impression. I know that keeping your diabetes under control takes a lot of effort and hard work.

Patient: You’re darn right it does. Tell that to Dr. Harris.

Pharmacist: You don’t think he understands that?

Patient: Not a bit. I don’t deserve to be belittled like a child because my weight isn’t where he thinks it ought to be.

Pharmacist: Sounds like you had a very difficult time with Dr. Harris today.

Patient: He has no idea how hard I’ve tried.

Pharmacist: You really have tried hard.

Patient: Yes, I have.

In this situation, the pharmacist does not take the patient’s anger personally. He supports the patient without taking sides and without assuming that the patient’s story about Dr. Harris is accurate or inaccurate. The pharmacist simply responds to what the patient is having difficulty with and supports her character.

Guilt arises when people believe they did something they should not have done or didn’t do something they should have done. A feeling of helplessness goes with guilt. The goal of supportive communication in dealing with another’s guilt feelings is to first acknowledge the feeling and then ask what the other person thinks he or she can do to change those feelings of guilt. Finally, support and encourage the action steps the person identifies.

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