COMMUNICATION SKILLS FOR

PHARMACISTS
Eyob Alemayehu
BPharm, MSc

1
 Course description
This course introduces students with
the basic concepts of communications
establishing pharmacist-patient relationship
collaborative working relationship with other
healthcare professionals
written communication skills.

2
 Introduction
Definition:
Interpersonal communication is described as a
process in which message is generated and
transmitted by one person and subsequently
received and translated by another.

3
Why relationship matter?
pharmaceutical care “the responsible provision
of drug therapy for the purpose of achieving
definite outcomes that improve a patient’s
quality of life” and stated that,
– the provider must be able to develop the
relationships with the patient and other health
care professionals needed to provide
pharmaceutical care.

4
 1. Patient centered communication
• The incidence of preventable ADEs and the
cost to society associated with medication
related morbidity and mortality is of growing
concern.
• Over 770,000 people are injured or die each
year in hospitals from ADEs in USA.
• The national hospital expenses to treat
patients who suffer ADEs during
hospitalization are estimated at between
$1.56 and 5.6$ million annually.

5
Cont…
The potential of pharmacists playing a pivotal
role in reducing the incidence drug-related
illness is also received increased attention.
Hence pharmacists are accepting increased
responsibility in ensuring that patients reach
desired outcomes with their medication
therapy.

6
Cont….
This changing role requires pharmacists to
switch from a medication-centered, task -
centered or practitioner-centered to patient-
centered practice.
‘Practitioner-centered’
Primarily focuses on decisions made and
actions taken by physicians and other health
care providers.
The patient is acted upon rather than seen as an
active participant.
7
Cont….
‘Patient centered’
• Focuses on the patient’s role in the process.
• the patient make certain decisions to seek
help from a health professional.

8
Cont…
• In providing patient centered care pharmacists
must be able to:
– Understand the illness experience of the
patient
– Foster a more egalitarian relationship with
patients
– Assume the patient unique.
• consider the patient as a person
• do not generalize like the following: Older persons as
talkative or obese individuals as happy.

9
Cont….
– Build a ‘ therapeutic alliance’ with patients
to meet mutually understood goals of
therapy
– Develop self-awareness of personal effects
on patients

10
Cont….
Generally the communication process between
you and your patients serves two functions:
It establishes the ongoing relationship
between you and your patients and
It provides the exchange of information
necessary to assess your patients condition

11
2. PRINCIPLES AND ELEMENTS
OF INTERPERSONAL
COMMUNICATION

12
Components of interpersonal communication

Interpersonal communication includes the

following important components/elements:
Sender
Message
Receiver
Feedback
Barriers

13
Cont….
Case 1:
Samson Abebe, a 29 years old naïve HIV-AIDS
patient, comes to your dispensary with a
prescription that calls for Nevirapine,
Lamivudine and Stavudine. He is your relative
and you don’t know still whether he got HIV-
AIDS. After a hand shake with you he looks
down to the ground and told you “the doctor
called in a new prescription for me, and can I
also have a refill of my heart medication?”
14
Cont…
• Sender
Transmits message to another person (Samson,
in the above example)
• Message
Is the element that is transmitted from one
person to another.
Messages can be thought, emotions,
information
It is transmitted in different ways
15
Cont….
• Receiver
Receives message from sender (you in the
above case)
In receiving and translating the message, it is
crucial to consider both the verbal and non-
verbal components to the message.

16
Cont…
• Feedback
Is the process where by receivers
communicate back to senders their
understanding of the sender’s message
 In the feedback loop, the initial receiver
becomes the sender of feedback
 the initial sender becomes the receiver of
feedback

17
Cont….
• Barriers
Interpersonal communication is usually
affected by a number of interferences or
barriers.
 These barriers affect the accuracy of the
communication exchange

18
Importance of perception and
personal responsibilities in
the communication model
 Cont…
• The interpersonal communication model
shows how messages originate from a
sender and are received by a receiver.
• The sender delivers the message, and the
receiver assigns a meaning to that message.
 Cont…
• The critical component in this process is
that the receiver’s assigned meaning must
be the same as the meaning intended by
the sender.
But one may or may not interpret the
meaning of the various verbal and
nonverbal messages in the same way as
the sender intended.
 Cont…
This is because individuals assign meaning to
verbal and nonverbal messages based on:
 their past experiences and previous definitions
of these verbal and nonverbal elements or
“This medication should be taken with plenty of
fluids.”
 the context that they perceive the sender is
using.
“Take one-half teaspoonful three times a day for
infection until all gone.”
 Cont…

• Our perception of the message is also

influenced by our perception of the
individual sending the message.
 Cont…
• Case 2.1
A patient returned to the pharmacy
complaining of side effects apparently
caused by his medication. The patient’s
indicated he was given 30 nitroglycerin
patches. Both the pharmacist and the
physician told him to “apply one daily”.
The patient opened his shirt to reveal 27
nitroglycerin patches firmly adhered to his
chest.
 Cont…
• Case 2.2
A young woman suffering from vaginal
Candidiasis was given the usual 15
nystatin vaginal tablets and was told by
the pharmacist to use “one tablet daily for
two weeks”. She returned to the pharmacy
after two weeks in sever discomfort with a
complaint that “those nystatin tablets
taste terrible”.
 Cont…
Hence the following points are important in
preventing misunderstanding:
anticipating how other peoples may
translate your message
transmitting messages as clear as possible
and
finally asking receivers to share their
interpretation of the message (feedback)
27
 Cont…
Examples of statements or questions that
elicit feedback:
• ‘How do you intend to take the
medication?’
• ‘Now when you get home, how are you
going to take this medication’
• ‘ Describe in your own words how you are
going to take this medication’
 Cont…

The receiver can also alleviate some

misunderstanding by offering feedback to
the sender.
After receiving the message, the receiver
should indicate in some way what he/she
understands the message to be.
 Cont…
The meaning of the message may also be
somewhat unclear if the receiver senses
incongruence between the verbal and
nonverbal messages
– i.e. the meaning of a verbal message is not
consistent with the meaning of a nonverbal
message
Example of incongruence
• A patient hands a pharmacist a prescription
for a tranquilizer, then bursts into tears. The
pharmacist asks if there is any problem, and
the patient responds, “No, I’m okay, it’s
nothing at all.”

31
 Cont…
To avoid this incongruence:
• As a sender, you must be aware of the
nonverbal messages as well as verbal
messages.
• As a receiver, you must point out to the
sender that you are receiving two
different messages.
 Cont…

In general, pharmacists have their own

responsibilities in ensuring accurate
communication both as a sender and
receiver.
 Cont…
As a sender:
You are responsible:
 for ensuring that the message is
transmitted in the clearest form, in
terminology understood by the other
person, and in an environment conducive
to clear transmission.
to ask for feedback from the receiver and
clarify any misunderstandings.
 Cont…
As a receiver:
You are responsible:
to listen to what is being transmitted by
the sender.
to provide feedback to the sender by
describing what you understood the
message to be.
3. Nonverbal Communication
Overview
• interpersonal communication involves both
verbal and nonverbal expression
• Words normally express ideas, whereas
nonverbal expressions convey attitudes and
emotions.
• Behavioral scientists, who have reported that
approximately, 55% to 95% of all
communication can be attributed to
nonverbal sources.
Cont…
Nonverbal communications are unique for two
reasons:
They mirror innermost thoughts and feelings
Are difficult, to ‘fake’ during an interpersonal
interaction
Cont…
• In nonverbal communication, we perceive and
interpret a given nonverbal message or ‘cue’
in a personal manner

• This divergence of interpretations stems from

a variety of social, psychological, economic,
cultural and other background variables found
throughout the human race.
Cont…

• However ‘cue clusters’ occur within a given

society.

• clusters are combinations of nonverbal acts

• We have to avoid misinterpretation of these

cues while communicating with patients
 Case study
• During his first externship experience in a community
pharmacy, a pharmacy student (Yohannes) was
assigned the task of receiving new prescriptions from
patients. John wanted to help the patients and was
looking forward to the opportunity of talking with
them about their problems. One day, Mr. Setegn
approached the prescription counter to have his
prescription for levodopa refilled. Yohannes, who did
not realize that Mr. Setegn had Parkinson’s disease,
noticed that his hands were shaking and
commented, “I see you are a bit nervous today, Mr.
Setegn. What’s the matter?”
41
Elements of nonverbal communication
Important elements of nonverbal
communication include:
• Kinesics
• Proxemics
• Environment
• Distracting factors
Cont…
Kinesics
• The manner in which you use you arms,
legs, hands, head, face and torso may have a
dramatic impact on the messages that you
send.
• In general individuals from various societies
use different body movements to
communicate certain messages.
Cont…

• Kinesics can be breakdown into several

component parts which include gestures,
facial expression, eye contact, physical contact
and body posture.
Cont…
Gestures
• Gestures are expressive movements or
actions.
• Hand gestures in particular are used in
communication.
• They are useful when emphasizing a point or
to help describe something.
Cont…

• If used appropriately, they can enhance

communication and improve the listener’s
understanding.
• However, it is important not to overuse them
Cont…
Facial expression
• This is of vital importance in any
communication.
• Patients may register strong feelings like
anger, sadness or joy through facial
expression.
Cont…

• The facial expression of the pharmacist

specially at the start of the conversation may
very well determine how receptive the patient
will be to any advice or information offered.
Cont…
Eye contact
• The maintenance of eye contact during a
conversation is vital to ensure the
continuation of the process.
• Eye contact can indicate interest in the subject
and is also useful as a means of determining
whose turn it is to speak.
• However uninterrupted stare should be
avoided
Cont…
Physical contact
• Physical contact is usually expressed by
shaking hands and hugging.
• it can be used to greatly enhance verbal
communication.
• However, physical contact is governed by
broad social rules and inappropriate use may
cause problems.
Cont…
Body posture
• Body posture can have a major influence on
how well a communication progresses or even
if it gets started at all.
• There are several classic body postures which
have been identified as having significant
meanings.
Cont…
Open posture:
– Standing or sitting with a full frontal
appearance to the other person
– Legs comfortably apart, not crossed
– Arms uncrossed
– Palms of hands facing front
Cont…
Closed posture:
• Arms folded in front of your chest
• Legs crossed at knees
• Head facing downward
• Eyes looking at the floor
Cont…
• Communication from a closed posture may
shorten or halt further productive
interactions.
• Sometimes it appropriate to use a closed
posture, for example, when you want to limit
the interaction with an overly talkative person.
Cont…
Generally the key components of kinesics that can
improve communication include:
• Varied eye contact (consistent, but not a stare)
• Relaxed posture
• Appropriate comfortable gestures
• Frontal appearance
• Slight lean toward the other person
• Erect body position
• Facial expressions that expresses interest and desire
to listen as well as speak
56
 Proximecs

• The distance between two interacting persons

• Use of space, is a powerful nonverbal tool.
The different space zones are generally divided
into four main areas.
1. General space (3m or more)
2. Sociable area (1-3m )
3. Personal area (0.5-1m)
4. Intimate area (15-50cm)
• The type of instruction affect the distance.
 Environmental nonverbal factors

• General appearance within the pharmacy setting

(colors used in the pharmacy decor, the lighting, use
of prescription counter, untidiness, e.t.c)
• the physical characteristics of pharmacy employees
• The presence of a private consulting area
 Distracting factors

Some of the distracting nonverbal elements

include:
Lack of eye contact
Inappropriate facial expression
Inconsistence or incongruence of nonverbal
cues (e.g. facial expressions) with verbal
expressions
Closed posture
Inappropriate tone of voice
 Continued ……Distracting factors
• Self awareness of the distractive nonverbal is
important in improving interpersonal
communication.
Example:
• if you have a soft voice and you sense that the
patient cannot hear you, then you should:
– lean towards the patient
– raise your voice, or
– move the patient into a quieter section of the
pharmacy
 4. Barriers to communication
1. Environmental barriers
2. Personal barriers
3. Administrative barriers
4. Time
 1. Environmental barriers

Some of the examples of environmental barriers

are:

Physical barriers
A busy pharmacy
Noise
Lack of privacy
points to identify environmental barriers

• Is the pharmacist visible?

• Is it easy to get the pharmacists attention?
• Does it appear that the pharmacist wants to talk to
patients?
• Is the prescription area conducive to private
conversation?
• Is there a lot of background or are there other
distractions?
 2. Personal barriers
I. Pharmacist related personal barriers
• Lack of confidence
• Shyness
• Lack of objectivity
• Cultural differences
• Discomfort in sensitive issues
• Negative perceptions about the value of patient
interaction
• laziness
 II. Patient related personal barriers

patient perceptions:
– of the pharmacist
– Of the health care system
– Of their medical conditions

Physical disabilities
Illiteracy
 3. Administrative barriers

• Counseling services are not included as part of

pharmacies business plans.

• Staffing policies
 4. Time barriers

The timing of the interaction is critical

Generally minimizing such communication

barriers typically requires a two stage process:
You must be aware that they exist

You need to take appropriate action to overcome

them
5. Questioning skills, listening and
emphatic responding

68
 I. Questioning skills
• Questioning is one of the most widely used
social skills
• In a pharmacy setting questions are normally
asked to encourage the listener to provide
information.
• However questioning in itself is not enough.
– Reinforcement, together with questioning is
required to build up interaction between two
people.

69
 Types of questions
Closed questions
• By definition a closed question is one which
is direct and closed-ended.
• It requires the respondent to give a single
word reply such as ‘yes’ or ‘no’.
• Such questions do not include a ‘feeling’
component, but do provide specific
information on a subject area.

70
Cont…
• Examples of closed questions used in a
pharmacy setting include:
– Are you taking any medication at present?
– Have you ever taken this medication
before?
– Do you understand how to take it?
– Do you have any questions about the
medicine?

71
Cont..
Open questions
• Open questions are open-ended and often
allow peoples to respond in their own way
with a particular reply.
• They do not set any ‘limits’ and generally
allow the person to provide more detailed
information.
• Open questions encourage elaboration and
help people expand on what they have
started to say.
72
Cont…
Examples of open questions include:
• Describe your symptoms to me
• Tell me about any over-the counter
medicines you are taking just now
• How do you relieve the symptoms of
headache
• What do you do when that sensation occurs?

73
Cont…

• Pharmacists can be inclined to use too many

closed questions, but
• In many pharmacy situations a balanced
combinations of both open and closed
questions is more beneficial

74
Cont…
The funneling technique
• A funneling technique can be used to allow
directions and focusing of ideas on a specific
topic.
• The idea behind this technique is to direct
the questions to a particular subject area.

75
Cont…
It is possible during any one conversation to
use more than one funneling technique,
• Example:
 establishing a patient’s current medical
condition
then going to suggest appropriate action or
medication available.

76
Cont…
Example:
• Conversation between a hospital clinical pharmacist
and a patient:
‘please tell about the insulin products you have used
in the past’
(Background open question)
‘What type of insulin do you currently use?’
(Specific closed question)
‘How long have you been using this?’
(Specific closed question)

77
Cont…
• ‘So we have established a little about your
medication, now can we discuss what action
we will take in the future to prevent
problems with your medication?
(This starts another funneling technique)

78
Cont…
Application
• questioning skill do not only apply to the
communication between pharmacists and
patients but also in dealing with health care
professionals, in ordering and supplying
goods, staff training, e.t.c.

79
 II. Listening and emphatic responding
• Probably no other skills are more valuable in
developing trust than listening and emphatic
responding.
• Trust is essential in developing a therapeutic
alliance and effective therapeutic
relationships

80
 Listening well
• Listening to patients, trying to understand
their thoughts and feelings is crucial to
effective communication
• perhaps the most difficult to learn, is the
ability to be a good listener.

81
Cont…
• The process of active listening starts with an
act of will.
– We must will ourselves to listen
• Next we must give someone our complete
and undivided attention.
• In addition, to truly listen, we must
temporarily give-up
our need to judge
the perspective that our frame of reference is the
correct one (bracketing)
82
Cont…
Some communication habits can interfere with
your ability to listen well:
• Trying to do another while communicating
with patients
• Planning ahead to what you will say next
• Jumping to conclusions before patients have
completed their messages
• Judging the person or the message as it is
being conveyed (right or wrong)
• Communicating in stereotype ways

83
Cont…
• Generally listening well involves understanding
both the content of the information being provided
and the feelings being conveyed:
• and skills that are useful in effective listening
include:
Summarizing
paraphrasing and
empathic responding.

84
 Empathic responding
• A well known psychologist Carl Rogers
defined empathy as the “sensitive ability and
willingness to understand the client’s
thoughts, feelings, and struggles from the
clients’ point of view
• it means entering to the private conceptual
world of the other.
• Empathy is an objective identification with
the effective state of an individual

85
Cont…
• One can be empathic without responding
empathically.
• But it is through the empathic response that
the other feels understood.
• Reflecting your empathic understanding back
to the other is always transforming or growth
producing.

86
Cont…

Empathic response VS Paraphrase ?

87
Cont…
Example:
• Patient: I don’t know about my doctor. One time I
go to him and he’s as nice he can be. The next time
he’s so rude I swear I won’t go back again.
• Pharmacist:
Paraphrase- He seems to be very inconsistent
Emphatic response- you must feel
uncomfortable
going to see him if you never
Know what to expect

88
Cont…
• Patient: I’m so glad I moved to the retirement
village. Everyday there is something new to
do. There are always lots of things going on,
I’m never bored.
• Pharmacist:
Paraphrase- so there are a lot of activities to
choose from
Empathic response- you seem to love living
there

89
 Activities

• Case 1: I live with my illness for ten years.

Every time I come to the pharmacy for refill,
they always ask me how to take my routine
medications. I am wasting my time listening
repeated instructions.
• Case 2: my son suffers from chronic cough.
Every morning when he wakes up he has to
take his syrup. Now, he is not able to get to
school without taking his medications. I am
the only family member supporting him. 90
• Case 3: my neighbors has intermittent
wheezing at night. While feeling this
discomfort, he borrows my puff for his
temporary relieve. I always face run out of the
medication before my appointment.
• Case 4: my doctor prescribed me this tablet
for seven days for back pain. Now it is the
fourth day since I started the medication. it
tastes very bitter. I should discontinue right
now. 91
• Case 5:I was diagnosed for DM ten years ago.
My insulin injection was painful when I just
begin for the first time. Now I adapt the skill
well. I can inject it without sever feeling.
• Case 6: I am having difficulties with frequent
attack of tonsilophrnigits since my childhood.
Now my heart also beats to much when I am
on exertion.

92
• Case 7: My daughter reported me 4 episodes of
diarrhea three days before. We visited the local
pharmacy to collect ORS. The diarrhea still remain
despite replacement with reconstitution fluid. She is
showing sunken eyes.
• Case 8: my blood pressure was controlled with diet.
But, recent record revealed that there is slight
elevation in spite of my good adherence to my diet.

93
• Case 9: My belly becomes so big in recent days. I was
told to lose weight by my home physician. I do not
adhere with his counseling in fact. I should be
embarrassed to see him for the next
appointment.

94
 Activities

• I live with my illness for ten years. Every time I

come to the pharmacy for refill, they always
ask me how to take my routine medications. I
am wasting my time listening repeated
instructions.
• Paraphrasing: you take same medication with
identical instruction for long time
• Empathic responding: you seem exhausted
with same instructions
95
• Case 2: my son suffers from chronic cough.
Every morning when he wakes up he has to
take his syrup. Now, he is not able to get to
school without taking his medications. I am
the only family member supporting him.
• Paraphrasing: your child is taking daily
medication for the cough
• Empathic responding: it seems that you are
overwhelmed caring your child.
96
• Case 3: my neighbor has intermittent
wheezing at night. While feeling this
discomfort, he borrowed my puff for his
relieve. I always face run out of the
medication before my appointment.

97
• Paraphrasing: you give your inhalation for
your neighbor
• Empathic responding: it seems that you are
suffering from lack of medication at the end of
he month.

98
• Case 4: my doctor prescribed me this tablet
for seven days for back pain. Now it is the
fourth day since I started the medication. it
tastes very bitter. I should discontinue right
now.
• Paraphrasing: you take the tablet for a week
for your back pain
• Empathic responding: it seems that you are
feeling upset with unpleasant tast.
99
• Case 5:I was diagnosed for DM ten years ago.
My insulin injection was painful when I just
begin for the first time. Now I adapt the skill
well. I can inject it without significant feeling.
• Paraphraisng: your insulin was painful while
taking ten years ago unlike today.
• Empathic responding: it seems that you
tolerate the pain due to the injection

100
• Case 6: I am having difficulties with frequent
attack of tonsilophrnigits since my childhood.
Now my heart also beats to much when I am
on exertion.
• Paraphrasing: you have longstanding tonsilits
with new onset heart problem.
• E.Respondng : it seems that you are worried
about the recent palpitations.

101
• Case 7: My daughter reported me 4 episodes of
diarrhea three days before. We visited the local
pharmacy to collect ORS. The diarrhea still remain
despite replacement with reconstitution fluid. She is
showing sunken eyes.
• Paraphrasing: the diarrhea last long despite the fluid
replacement
• It seems that you are worried about its
complications.

102
• Case 8: my blood pressure was controlled with
diet. But, recent record revealed that there is
slight elevation in spite of my good adherence
to my diet.
• Paraphrasing: your BP was controlled on diet
despite the current rise.
• E.responding: it seems that you are seeking
for additional therapy.

103
• Case 9: My belly becomes so big in recent
days. I was told to lose weight by my home
physician. I do not adhere with his counseling
in fact. I am afraid to see him for the next
appointment.
• Paraphrasing: you gain weight due to lack of
physical activity.
• E.responding: you should be embarrassed to
talk to him again.
104
Cont…

105
Cont…
• Generally an empathic person:
• want to listen and try to understand a
person’s feelings and point of view
• accept feelings as they exist without
trying to change them, stop them or
judge them
• is not afraid of a patient’s emotion and is
able to just be with the person and not
necessarily do anything except listen.

106
Cont…

• Trust that people can cope with their

own feelings and problems
• Effectively convey to the person he/she
understands

107
Cont…
• Nonverbal aspects of listening and empathy
– establish good eye contact
– slightly leaning towards the person
– removing any physical barriers
– nodding head
– conveying that you have time to listen
– relaxed posture
– moving to an area that ensures privacy

108
Cont…
Problems in establishing helping relationships
• Stereotyping
Images towards different groups of patients:
What comes in to your mind when you encounter?
“AIDS” patients
Illiterate patients
Terminally ill patients or dying patients
Psychiatric patients
109
Cont…
• Depersonalizing
Ex. focusing all communication on ‘problems’ and
‘cases’
• Controlling
 in patient- practitioner relationships: the provider
adopts a “I know what is best” attitude
 Unequal relationship: provider is often
“authoritarian”; patients are told what they should
or shouldn’t do.
 Pharmacists must understand that treatment
decisions are inevitably shared decisions.

110
 .

Thank you!!!!
 Quiz
1.Mention at least four components of kinesis
2.List at least three components of verbal communications
3.Describe three skills that are useful in effective listening
4. paraphrase and emphatically respond for the following story.
Story
• My heart is palpating! I was told to take my medication
regularly. But, I missed the monthly injection due to
unaffordable cost. I am now seeking your help to lower my
beat.
• Paraphrase:
• Emphatic responding: