Tomorrow's Pharmacist October 1999 p64-66
Edited by Pamela Mason

Communication

How to communicate effectively with patients

By Kathryn Wisner, BPharm, MRPharmS

Effective communication is a skill. Some of us find it easier to communicate than others, but, as with any skill, we can all improve and build upon what we do already.

Communication is an essential part of all our lives. Throughout university you will have been communicating with a limited range of people in terms of age, lifestyle and background. However, in the "real world" of pharmacy we see an enormous range of different people on a daily basis. Being able to communicate effectively is vital to the benefit of both patients and the business.

Patients

communication Some of you will have worked in pharmacy during your university breaks and so may be used to dealing with patients. However, you will soon become pharmacists, and as such, patients will think of you differently. Most will hold you in high regard, and you will have all the responsibility that goes with being a respected healthcare professional.
We need to remember that patients are people and that they are all individuals. In your academic life you probably studied diseases separately with the pharmacology of the drugs used to treat each of them. As you are probably aware, patients quite often have more than one clinical condition, especially the elderly, and so are taking various classes of drugs. Therefore, they may not fit the classic stereotype of a patient on particular medication or with a specific disease.
When we see patients in the pharmacy they may be feeling ill and experiencing a range of different emotions. They may have already seen their doctor but might not be happy with the outcome, or they may be frightened or confused. They may not have understood what the doctor told them or know why their medication has been prescribed. They may have waited a long time to see the doctor for a consultation that lasted just a few minutes. If you try and put yourself in their shoes you can get an idea of all the different ways patients might be feeling when they see you. This will enable you to empathise and so communicate more effectively.

Listening

communicating with patients Listening is a major aspect of effective communication. You need to listen actively to patients before you can respond appropriately. It is crucial in identifying their needs and being able to pitch your response at the right level. You should let patients say all they want to, without interrupting, before you respond. Let them know you are listening by looking at them and making reassuring "uh-huh" or "mmm" noises. Ensure that you have understood what they have said by paraphrasing. This is repeating back what they have told you using different words, which gives the patient a chance to correct you if you have said something wrong. Do not be afraid to ask questions if you need further clarification. Most patients will not mind answering questions if you explain that you need to have all the necessary facts before you can help them.
Communication is made up of three basic components:

Words - 10 per cent
Paralinguistics (the way in which the words are spoken) - 40 per cent
Non-verbal features (or body language) - 50 per cent

The actual words we use only make up about 10 per cent of the communication process. The paralinguistics, or the way we say the words, make up a further 40 per cent. However, it is the non-verbal features which make up the remaining 50 per cent. So what we say is not actually as important as how we say it and what we do with our face, body and hands while we are saying it! This also confirms the saying that "actions speak louder than words".

Non-verbal communication

medicine Non-verbal communication is also sometimes referred to as body language. It includes how close we stand to the other person, eye contact, facial expressions, touch, body posture and hand gestures. In everyday life these are aspects we change all the time without even realising it. As individuals we may also have characteristic features, for example, most people stand in a particular way. In pharmacy we need to pay particular attention to our body language and may need to alter it depending on to whom we are talking.
For example, you may have a patient who always pats your hand or touches your arm and stands quite close when talking to you. In this case you are more likely to stand nearer to them and may touch them reassuringly. There may be another patient who never maintains eye contact or always has their arms crossed in front of them. This patient may feel extremely uncomfortable if you patted their hand or tried to prolong eye contact.
You can usually predict how a person would like to be treated by using your instincts and experience to judge what is appropriate. But remember that a person's gender and cultural background will also affect non-verbal communication. For instance, there will be differences between cultures on the amount of eye contact that is acceptable.
Facial expressions reflect emotions and will enable you to assess how a patient is feeling. But be aware that your face will be telling them how you are feeling and even what you are thinking. You should try to keep your facial expression neutral when possible or make sure that it is not giving a different message from the one you are saying.
The gestures that we make with our body and head can have both positive and negative effects. Nodding your head when speaking to a patient shows that you are listening and paying attention. Everyone tends to have a characteristic stance, but you can appear more friendly and inviting if you adopt an open posture. This means facing the other person, whether standing or sitting, without folding or crossing your arms and legs.
Another topic linked to non-verbal communication is first impressions. When you first meet someone their appearance and non-verbal behaviour can have an enormous impact even before they speak. Be wary of first impressions and try not to make generalisations about people. Don't assume anything! Remember that you will also make first impressions on patients, too. So make sure your appearance and behaviour are making the impression that you wish to portray.
The paralinguistic features, or the way we speak, also make up a significant part of communication. These include the tone, pitch and volume of our voices, as well as the rate at which we speak. The tone is particularly important as it can send out a different message from what is being said. The pitch can also greatly alter the meaning if we emphasise particular words. The rate of speech determines the clarity of what we say; so remember to speak slowly and clearly.

Words

Although the actual words we use when communicating only make up a small part of the message that is received by the other person, it is important to remember that in pharmacy, the words are important if we expect the patient to understand what we are saying. We have to change a lot of the medical and pharmaceutical jargon into layman's terms; this becomes easier with experience. You need to ensure that the information you provide is at the right level. It is essential not to confuse the patient, although you do not want to patronise people who may know a lot about their condition or medication.
Patients are most likely to remember three or four key pieces of information. Be prepared to repeat these several times if necessary, especially with elderly patients and those that speak a different language. It is important to make sure the patient has understood what you have told them. You can do this using the features of communication that we have looked at. Their facial expressions, tone of voice, and what they say will give you the main clues.

Summary

A good way to improve your communication is to observe other people dealing with patients. You can pick up some good tips and also find out what not to do! Do not try to improve every aspect of your communication all at once. Try to pick a couple of points to work on first. For example, if you know you are not very good at keeping eye contact, concentrate on this first and maybe practice with a friend.

Effective communication

Listen to the patient
Keep your message clear and simple
Try to be yourself
Do not forget to smile

Ms Wisner is a pharmacist from New Southgate, North London

Tomorrow's Pharmacist October 1999 p64-66 Edited by Pamela Mason