Ask me! I’m a pharmacist
Jonathan Silcock is a research
practitioner in pharmacy practice and medicines management at the
University of Leeds
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Jonathan Silcock says Ask About Medicines Week is an appropriate time to review how pharmacists ask questions and how they answer their customers' questions
How do we ask questions? In our day-to-day business, we usually ask customers
questions to confirm or obtain some important piece of information. In
this situation, “important” means that we need the information
to help give appropriate advice or dispense safely. The agenda is mainly
professional and is often narrow. Typically, questions are direct, require
simple answers and are of the WWHAM type: Who is the patient? What is
the problem? How long has it been a problem? What action has been taken?
What other medicines are taken?
Problem with closed questions
I recently requested some over-the-counter ibuprofen at a local pharmacy
and was asked: Is it for you? Have you taken it before? Do you have
asthma? Have you ever had an allergic reaction to this? My revealing
answers were “yes”, “yes”, “no” and “no”.
Mutual understanding to promote health it was not. Curiously, the assistant
missed out “Do you have any stomach problems?”. Luckily
I do not, but this illustrates one problem with simple closed questions:
the danger of forgetting something or missing a piece of important
information.
Without a preamble like “I just need to ask a couple of questions
to make sure this medicine is right for you. Would that be OK?”,
these questions also feel like interrogation. I instantly felt uncomfortable
and unable to say, simply, “I’ve taken these lots of times
before for occasional bad headaches and none of the warnings on the pack
apply to me”.
Perhaps, given the chance, I would have said: “I’m a pharmacist.
Leave me alone.” I hope not, but we should be sensitive to particular
customer needs and remember that some will have health or medical training.
The Government is also encouraging many people with chronic diseases
to become “expert patients”. When time is short, direct questions
may be the only way to do business. However, direct questions often do
not help us understand things from a customer’s point of view and
they rarely give the impression of caring (even when we do passionately
care).
Patients notice how health professionals ask questions as this quote
(regarding a hospital consultant) from a lay person I interviewed recently
illustrates: “He is a very understanding man. He wants to know
the answers, he needs the answers and he goes in depth, but his manner
is excellent, he encourages you to respond you know, and he brings out
the best, in other words. He knows the right questions and his person-to-person
manner is very good.”
This may be typical of customers who view us, at our best, as not necessarily
want-ing to understand them better but “knowing the right questions
to ask”.
Ask About Medicines
Week, of course, puts the boot on the other foot.
Let us consider the issue of how best to answer our customers’ questions.
An initial customer question might be fairly short and specific, but
we usually need some context to help us frame an appropriate response.
Let us suppose, for example, that a customer asks: “Does paroxetine
have any side effects?” The simplest answer is: “Yes.” To
which you might add: “But so do all medicines, and it depends on
the individual.”
For top marks you might also seek out a list of common side effects and
their incidence. However, suppose your first response is another question: “Why
do you ask?”
The customer might reply in a number of ways:
“I’ve found these tablets in my husband’s wardrobe and
he’s
acting a bit strangely.”
“I’ve just started taking these and I have a really bad headache.”
“I’ve just been prescribed these and I’m not sure that
I want to take them.”
The key is understanding
In each case a different answer is appropriate, which might include some
or all of the scientific details. The key to pharmacist and customer
satisfaction is understanding why the customer needs or wants the information
and tailoring an appropriate response. Customers rarely ask questions
for their own sake; there is usually a particular reason and a unique
situation. This is why internet searching can be frustrating, but chat
rooms and news groups that offer “real” experience are
popular. A good customer-pharmacist relationship is mutually rewarding
because (i) the pharmacist can help the customer understand freely
available raw information and apply it confidently to their own situation
and (ii) the pharmacist learns something about the customer and pharmacy
in the process.
Giving a good answer that is appropriate for the individual customer,
at that particular time and in that particular place, is more difficult
than providing the standard “correct” answer. In any case,
pharmacists have three main sources of information: scientific data from
papers and books, their own training and practical experience, and customers
themselves.
The main difficulties in synthesising an appropriate answer are understanding
customers’ demands, needs and values, time, access to scientific
data and understanding the validity of personal experience.
A practical solution to these problems may be to ask customers a few
more questions before you answer theirs, and “Why do you ask?” is
one way to start a more meaningful dialogue, although we can hardly blame
customers for following the bad examples we often set them and assuming
we only have time for a short, sharp answer.
Another useful question is “What do you know already?”, which
might elicit:
“Nothing, that’s why I’m asking you.”
“What I’ve read in the patient information leaflet — will
I get all these problems?”
“What my friend told me.”
“I’ve accessed the company’s US web site, but I’m
still not sure about some things.”
The customer’s prior knowledge is an excellent aid to giving an
appropriate answer. You also guard against wasting time providing unnecessary
information. In a busy working environment you might also ask “Is
it urgent?” or “When would you like an answer?”. This
encourages the customer to think about it and can allow more time to
produce a good answer. You may, for example, choose to:
• Do your own web-searching
• Speak to a colleague
• Telephone a medicines information department (NHS or commercial)
Community pharmacy in particular is highly demand-led (and sometimes
professionally isolated) and it is easy to assume that the customer needs
an answer (any answer) straight away. If you can negotiate some breathing
space you also gain time to reflect on whether your personal experience
matches the scientific data and the opinion of others.
Earning respect
The experience of being asked more questions, clarifying, negotiating
and responding should be a stimulating one. Encourage your customers
well and you may gain their trust or respect. Learn the lessons yourself,
apply them daily and you should build valuable relationships that improve
care and build business. We need above all to move away from a narrow
professional agenda. When we are seen to treat customers and their
problems with the respect they deserve, then customers will treat us
and their medicines with the respect we have earned.
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