ARK O.

PAROJINOG
CLINICAL JOURNAL 1
1. Think about the reasons behind patient counseling as a service
a. List some benefits of patient counseling to your patients
i. Patients could obtain important information regarding their medications that
require special attention including but not limited to proper scheduling,
adverse effects, missed doses, storage instructions, etc.
ii. Patients can be trained regarding medical devices, home health products,
and discuss the importance of self-monitoring on some cases.
iii. The pharmacist can identify complex drug-related problems that may arise
and adjust the medications accordingly.
iv. The pharmacist can identy changes in the patient’s health status that
require special medical attention that require intervention and additionial
communication with the patient and the prescriber.
v. Some patients may require specific-condition related needs that require
more in-depth consultation that could take up more than 30 minutes and
couldn’t be done over the counter due to time restrictions or privacy issues.
Some examples are smoking cessation, drug addiction management,
contraception and other reproductive health oriented discussion.
vi. Patients with chronic condtions such as allergies, asthma, hypertension,
diabetes, STDs, etc., may benefit from a better understanding of their
conditions and nondrug treatments.
vii. Enables the personalization of medication therapy
b. List some benefits of patient counseling to the pharmacy
i. Counselling services provides an opportunity to build a connection with the
community that encourages the patients to return to the pharmacy
providing more business opportunity.
ii. Enable better patient medication profile tracking that provides essential
information for the better management of a patient’s condition or provides
important data for research.
iii. Helpful in painting the image of a modern pharmacy that is more patient-
focused rather than product-focused when it comes to medication
management.
c. Are the existing standards/ laws that mandate us to provide patient care serves
such as counseling?
i. RA 10918 Article I. Section 3
Render services, such as clinical pharmacy services, drug information services, regulatory
services, pharmaceutical marketing medication management, or whenever the expertise and
technical knowledge of the pharmacist is required.
ii. Philippine Pharmacy Standards of Practice, Practice Area No.4:
Community, Hospital and Institutional Pharmacy Competnecy Standard
No. 3
Counsels client/patient on the safe and judicious use of medicine and other health products

2. What system challenge/ considerations exist in PGH?

a. Lack of time to be able to provide counselling to all patients in need.
b. Lack of incentives in providing additional pharmacy services
c. Pharmacists are not in direct contact with most of the patients in need other than
in the dispencing area
d. Lack of policy change that accomodates the change in the needs of patients
e. Lack of acceptance by the public and other health care professionals
f. Lack of places that is conducive for a private counselling session
g. Overworked pharmacists
3. Make a priority list of strategies to overcome these challenges/ considerations. Briefly
describe each.
a. Prepare for the change by conducting researches on feasibilty, cost-benefit,
perception, and other important parameters that could measure the preparedness
of the system and the individuals themeselves to adapt to a change in types of
services.
b. Selection of appropriate services to be offered depending on the demand of the
general public and the capacity of the workers.
c. Developing of goals and building a protocol around those goals to standardize
these services allowing for easier tracking and evaluation.
d. Providing and investing resources to the program that could be used for the
improvement of the counseling area, providing incentives for the pharmacists,
giving appropriate trainings, and other factors that would require fund allocation.
e. Promoting the service through recommendations, media, or word of mouth must
be done to keep the service alive and ensure that both the patients and
pharmacists are benefiting from the exchange.
f. Monitoring and evaluation of the program to ensure that it is functioning on a
satisfactory level and allows for adjustment on any aspect of the program if
problems are detected.
CLINICAL JOURNAL 2
The following things are the most noteworthy observations from our previous exercise that I know
I could work on to become a better communicator.

 When it comes to one-on-one talks, specially those with a personal connection, I could
say that I am a good listener but has slight troubles as a responder.

 I tend to give too much eye contact when listening making it a bit uncomfortable for other
people or the complete opposite would happen if I am not comfortable.

 Most of the things that I say in response are usually in a form of an advice or fact that is
sometimes unsolicited. Often times these responses come out when the topic is very usual
for me and that I have encountered before in the past.

 I get carried away by the discussion that I tend to stray the topic away from the current
matter either unintentionally or intentionally to avoid tackling an awkward topic.

 I fidget a lot when I speak and tend to distract myself if I have less confidence on a certain
topic. I have this habit of putting my hands in my front pockets or under my jacket and play
with coins or spin around a pen to feel less anxious.
Following the Medication-related Consultation Framework as a guide, I have the following
personal goals to reach in order to keep on improving my communication skills for the purpose of
becoming a better counselor.

 Have a better way of opening up a conversation and introducing myself and the purpose
of the counseling to patients to establish a good starting ground for the session.

 Allow the patient to talk more about themselves and their concerns and cut my advising
responses to each statement.

 Try to encourage the patients to share more information by asking the right follow-up
questions.

 Organize my thoughts well before talking so that the session has a certain flow rather than
jumping from one subject to another.

 Be more emphatic in responding by trying to connect emotionally with the patient rather
than taking all the information as mere facts that I need to note in order to give a proper
advise.

 Have a good set of questions that is ready to ask when a specific topic comes into the
session so that both me and the patient could build a common understanding on the
situation at hand.

 Reduce or eliminate judging or stereotyping responses.

 Say “Sorry” less often.

 Be wary of the time that I am taking on a certain topic and learn to prioritize on what
information is important to know and to give out. Minimize unnecessary facts and opinions.
  Speak with more volume and confidence.
CLINICAL JOURNAL 3
11/19/18
Patient A is a 76-year-old female patient with diabetes mellitus that is taking several drugs with
different indications. She’s concerned that her medications would negatively affect her kidney
function. Minor concerns include basic information about the drugs, concern regarding her blurring
vision even after laser surgery and the use of Healing Galing, a naturophatic approach to manage
her diabetes, that the physician abruptly recommended to stop. Upon reviewing her medications
before probing, I gathered the following information:

 The physician prescribed ketoanalogues and amino acids (Ketolog) indicated for the
prevention and therapy of damages due to faulty/deficient protein metabolism in chronic
renal insufficiency in connection with limited protein food. Upon probing, the patient is
currently in PGH to undergo renal function tests as recommended by her physician. Based
on her story, the physician stopped her from using Healing Galing because it has negative
side effects on her kidney. No additional information regarding the medicine and its
indication was provided and positive reinforcement was given because she stopped using
Healing Galing as soon as the doctor told her to.
 The patient is also taking simvastatin and atorvastatin for hyperlipidemia. No monitoring
was performed to obtain her cholesterol level, so degree of control wasn’t determined
because of that no additional information was given.
 The patient is also taking insulin and sitagliptin for diabetes for several years now. Based
on her random blood glucose test of approximately 200mg/dL taken outside the PGH
premises, her diabetes isn’t well controlled despite her religious taking of the medications.
I suggested that she raise this concern to her physician immediately so that adjustments
to the medication to properly control her diabetes since most of her issues on the eyes
and kidney can be attributed to her high blood glucose level. Despite her lon g
experience with the drug, the patient isn’t informed about hypoglycemia as she’s been
complaining of light headedness and fatigue on several occasions and assumed that it is
a normal effect of the drug. I provided her with methods on what is hypoglycemia and how
it was managed.
 She is also taking losartan for hypertension and possibly diabetic nephropathy. Her blood
pressure is normal, so no additional information was provided.
 Based on her prescription and her story, she experienced painful and swollen kidney in
the previous week before the encounter. She claims that she is no longer experiencing
said symptoms and is almost done with her antibiotic therapy using cefuroxime for
pyelonephritis. A quick reminder regarding antimicrobial resistance and the importance of
finishing her medications was given.
The patient is very compliant on her medications and consultations and is doing well despite
all the circumstances. She provides information quick and is well-informed regarding her
health status. Without any further concern and questions, a quick summary of the sessions
was given before leaving the counselling table with the drug information leaflets that we
provided. The patient seems to be thankful and satisfied with the information that I provided.
 After the first patient, I realized that I should probe the patients thoroughly before handing out
information since I discovered her concern her history of using Healing Galing even though I
asked about her use of alternative or herbal medicine during the earlier parts. Providing a
more logical and structural breakdown for the session should be done on future counselling
sessions. Summarizing the discussion on key sections of the session should also be kept in
mind to remind the patient and/or test their understanding.
Patient B is a 56-year-old male patient that suffered from a stroke that lead to dysarthria, difficulty
or unclear articulation of speech making him unable to communicate verbally. This experience
proves to be difficult since I am communicating to him and his wife simultaneously while trying to
interpret his non-verbal motions to convey a massage and often vague keywords that he types
on his phone. Their main concern is the safety of taking Vitamin-B complex supplements together
with his other medications. Minor concerns involve additional information regarding the indication
of the medications, pathophysiology of stroke, and his mother-in-law experiencing pamamanas
or edema after taking Myra-E. Upon probing, I discovered that he is currently undergoing speech
therapy in PGH, his limbs haven’t been affected by the stroke, and is taking the following
medications:

 Atorvastatin for dyslipidemia

 Losartan and amlodipine for hypertension
 Vitamin-B complex which is their main concern
The patient is compliant with the medication and is routinely monitored to check for the degree of
control which, according to the wife, is well-managed as per their last check-up. Upon checking
the references, studies have shown that Vitamin-B complex is commonly used for stroke survivors
to reduce post-stroke associated functional declines. No major interaction with the medications
and no undesired side-effects has been recorded, so I told them that it is safe to take the
medications. I provided them handouts for their medications and explained to them how it helps
in managing his conditions and pointed out some important notes to remind including storage and
missed dose. I briefly explained to them the pathophysiology of stroke in which there is a sudden
loss of blood flow in a certain part of the brain resulting to a damage in that area with
corresponding loss of neurologic function, relating to his speech impairment and other stroke
victims losing control over their body. After summarizing the important points, I shifted the
discussion towards their other concern.
I probed separately for their mother-in-law and found out that she is hesitant to go see a doctor
even after they tried convincing her. Upon checking the information, did not see anything close or
related to their complaint regarding Myra-E and relayed this to them. I reminded them of what
Myra-E, being only a supplement, and suggested to stop taking the supplement and observe if
there are changes in the condition. I advised them that if the symptoms persist it is valuable to
get her checked-up to be properly diagnosed since various conditions could result in pamamanas
and it is hard to point which one with minor information.
The family is doing well despite the challenges that they are facing. When her wife left to attend
to the counter, I tried communicating to Patient B to the best of my abilities and gathered that they
are trying their best for him to regain his speech, but regardless of his temporary inability to
communicate, they are still very thankful that he survived the stroke.
The session proved really challenging to me because I never anticipated that I would encounter
this type of communication barrier during this counselling session.