1. COMMUNICATION SKILLS
FOR DISPENSERS AT RDVs
March 2, 2012
Milano Hotel, Mekele

2. Case I
• A 1 year old baby is admitted to a clinic with a severe infection.
The mother came to a nearby rural drug vendor and while the
dispenser was speaking to her, he leant that about 1 wk ago,
her son had developed a minor bacterial infection and received
an antibiotic, which she gave him for 4 days until the infection
appeared to be cleared up.

3. Case 1, contd.
• When asked why she stopped the antibiotic, the mother
stated that she was just following the directions on the label
of the container which reads:
• “Take one-half of teaspoonful three times a day
for infection until all gone”.
2. What went wrong with this communication?
3. Was it possible to avoid the misunderstanding and how?

4. Say true or false to the following statements
based on Case 1
A The dispenser didn’t have a good communication skill T F
B Communication barrier is a hindrance to therapeutic T F
success
C “Until all gone” is the wrong term in this T F
communication that made the mother stop giving the
antibiotic prematurely
D When advising clients, simple to remember terms have T F
to be used (avoid medical jargons)
E Such terms as “take a tablet; apply an eye drop; insert a T F
suppository; apply a cream” have to be used in
communication

5. Objectives
 Describe the basic principles and/or processes of
communication
 Explain the various means of communication
 Identify the different barriers to communication
 Review the basic skills to effective communication
 Describe the best approaches to communicating with
health care providers
 Demonstrate effective communication with patients
and between providers

6. uUM¡ƒ ¾S Ó vvƒ Úª

• My mother loves me.
• ÑödÃÁ g— M
” pKgM ::
• ’w u? Ñ::
ƒ v

7. Patient-oriented pharmaceutical services
• Clinical pharmacy services are patient-oriented
services developed to promote the rational use of
medicines, and more specifically,
• to maximize therapeutic benefits (optimize treatment
outcomes),
• minimize risk, reduce cost, and
• support patient choice and decisions
• there by ensuring safe, effective and economic use of
drug treatment in individual patients.
• Effective communication is the key to successful
patient-oriented pharmaceutical services

8. Pharmaceutical Care
• is the responsible provision of medicine therapy for the
purpose of a definite outcome that improves a
patient’s quality of life.
• is based on a relationship between the patient and the
healthcare providers who accept responsibility for the
patient.
• it implies the active participation of the patient in
medicine therapy decisions, the cooperation of
healthcare providers across disciplines, and gives
priority to the direct benefit of the patient.

9. THE COMMUNICATION PROCESS
 Three parts of communication process
Sender
Message
Receiver
 The goal of all communication is understanding
 Effective communication occurs only when the
meaning of a message is held in common by the
participants.

10. THE COMMUNICATION PROCESS (2)
• Flow of communication

11. VERBAL AND NONVERBAL COMMUNICATION
 Verbal Communication
Involves the words which are spoken
Actual words convey about 10% of the message
 Non verbal communication
Involves the use of body languages:
Gestures, facial expression, eye contact
physical contact, body posture
body space and proximity

12. Challenges of Communication for Patients
 Inferiority
 Low-literacy
 Anxiety
 Conflicting information
 Forgetfulness
 Prefer not to disclose their concerns
 Impaired faculties of communication
 Blind, deaf, etc.

13. BARRIERS TO COMMUNICATION IN DISPENSARIES
1. The Environment
Physical barriers
Lack of privacy
Noise
A busy rural drug vendor

14. Inside View of a Dispensing Unit - small dispensing window

15. Outside View of a Dispensing Unit - no privacy when counseling

16. Counseling: before renovation
(privacy???)

17. Counseling: After renovation

18. Dispensing/Counseling Unit – Before Renovation

19. Dispensing/Counseling Unit – After Renovation

20. BARRIERS TO COMMUNICATION IN DISPENSING SETTINGS (2)
1. The Patient Factors
• Physical disabilities
• Illiteracy
2. The Dispenser
Lack of adequate knowledge
Lack of confidence
Lack of interest
Laziness
Delegating responsibilities to untrained staff
• Time: suitable timing of information

21. Case II
• A young woman suffering from vaginal candidiasis was
given the usual 15 nystatin vaginal tablets and was told
by the dispenser to “use one tablet daily for two
weeks.”
• She returned to the pharmacy after two weeks in
severe discomfort with a complaint that “those nystatin
tablets taste terrible!”
• What was the problem with this communication?

22. LISTENING AND QUESTIONING SKILLS
Listening
Listening is extremely important to effective communication
Good Listening Poor Listening
Helps to get better information Creates misunderstandings
Saves time Wastes time
Solves problems Creates problems
Reduces errors Allows for mistakes

23. LISTENING AND QUESTIONING SKILLS (2)
Keys to Effective Listening:
 Take personal responsibility for understanding what you hear
 Concentrate and make a good effort to focus on the person speaking
 Listen without interrupting, disagreeing, or offering explanations
 Use body language (nonverbal gestures) to show that you are involved in
the conversation.
 Example: nod your head, keep eye contact, keep hands at side
 Ask questions to be certain you are interpreting the message correctly.
Example: summarize and paraphrase what you heard
 Take notes as necessary. This will help you remember or document what
was said

24. Sharing experiences
• Share your experience to the participants where
mistakes were made because of poor listening.

25. LISTENING AND QUESTIONING SKILLS (3)
Questioning
 ‘Questioning’ is one of the most widely used social skills
 In a health setting, questions are normally asked to
encourage the listener to provide information
 The type of question asked and the way in which it is
asked will dictate the level of response given
 Health care providers can use two types of questions
• Close ended questions: Did you take your doses correctly?
• Open ended questions: How did you take your doses last
month?

26. STRATEGIES TO IMPROVE COMMUNICATION
 Explain things clearly in plain language
 Focus on key messages and repeat
 Use a “teach back” or “show me” technique to check
understanding
 Effectively solicit questions
 Use patient-friendly educational materials to enhance
interaction
 Together, these strategies and others will help ensure the environment is
patient-friendly and shame-free for ALL patients.

27. 1. Explain Things Clearly in Plain Language
 Slow down the pace of your speech
 Use plain, non-medical language
• “Blood pressure pill” instead of “antihypertensive”
• Pay attention to patient’s own terms and use them
back
 Avoid vague terms
“Take 1 hour before you eat breakfast” instead of
“Take on an empty stomach”

28. Using Plain Language: What could we say instead of…
 Adverse reaction Side effect
 Hypoglycemia Low sugar
 PRN When you need it
 Topical On skin
 Angina Chest pain
 Your H.I.V. test was negative You don’t have
H.I.V

29. 2. Focus on Key Messages and Repeat
 Limit information
Focus on 1-3 key points
 Develop short explanations for common medical
conditions and side effects
 Discuss specific behaviors rather than general
concepts
What the patient needs to do
 Review each point at the end

30. 3. Use a “Teach Back” to Check Understanding
Teach Back Scripts:
 I want to make sure I explained everything clearly. If
you were trying to explain to your husband how to
take this medicine, what would you say?
 Let’s review the main side effects of this new
medicine. What are the 2 things that I asked you to
watch out for?
 Show me how you would use this inhaler.

31. 4. Effectively Solicit Questions
 Don’t say:
Do you have any questions?
Did you take your doses correctly?
 Instead say:
What questions do you have?
How did you take your doses last month?”

32. COMMUNICATION B/N DISPENSERS AND PRESCRIBERS
 The provision of pharmaceutical care requires a
collaborative relationship with the physician (Prescriber)
 With rare exceptions, the primary reason dispensers call
physicians is that something is wrong or a problem needs
to be resolved.
 Because these calls so often begin with a problem, they
can start off in a negative or adversarial way and trigger
defensiveness in the physician.
 But skillful and sensitive dispensers can turn these
negatives into pluses.

33. Reasons for Communication
 Untreated condition(s)
 Improper drug selection
 Dosage too high
 Subtherapeutic dosage
 Adverse drug reactions and side effects that cannot be
tolerated or won’t go away
 Drug interactions
 Unnecessary drug therapy
 Compliance problems
 Request for additional information about the patient

34. Preparation Before Communication
 Have the necessary facts ready, including your
recommendation and rationale
 Have a literature citation ready, if possible
 Get sufficient information from the patient
 Be prepared to the SOAP approach
 Always have an alternative recommendation ready in
case your initial recommendation is not accepted

35. Communication Considerations
 The entire focus should be on attacking problems or issues, not
people or personalities
There is a big difference between the following:
• Dr. Solomon, Ato Samson can’t use those tablets you prescribed. I would like
to recommend ….) and
• Dr. Solomon, Ato Samson has trouble of swallowing. I would like to
recommend ….)
 Make sure professional boundaries are respected
 Make sure that you listen completely to the physician’s
rationale for the decisions made
 Use 4F communication: “I know how you feel. I felt the same
way, too. But found in the literature….,” and stay focused on the
problem

36. Handling the Communication
 Begin by identifying yourself
 Identify the patient whom you are to discuss
 Present the issue or concern that you have identified
Do not be judgmental
Use professional rapport to gain respect
 Be prepared to discuss the issue on a professional level
 Propose a solution
 Await feedback

37. Handling the Communication (2)
 You may not always have all of the answers to the
questions that follow
 Be comfortable saying that you do not know the answer
at the moment, that you will look into it and get back to
the provider as soon as you can
 The provider will respect that you provide only
information about which you are confident
 Over time, you will build a working relationship with the
physicians and nurses that you work with

38. Outcome of the Communication
 Preparation, focus, and interpersonal skills can make
a great deal of difference in the outcome of the
dispenser-physician interaction
 Scenarios of pharmacist-physician interaction:
same problem but different communication style
affecting the final outcome

39. Dialogue 1
 Dispenser: Hi Doctor, the amoxicillin you prescribed for Ms. Kidist’s kid is not
working. We need to get her something else.
 Physician: Who is this?
 Dispenser: Zewdu at Lions rural drug vendor – the dispenser
 Physician: What do you mean it’s not working? Did she give it to the child correctly?
He’s only been taking it for 5 or 6 days. She has a 10 days supply. Is the child still
running fever?
 Dispenser : I guess she’s giving it to him right. She says he is not feeling good and
she wants to give him something else. I didn’t ask about a fever.
 Physician: Tell her to call me. I will take care of it.
 Dispenser : You got it, Doctor!
 Discussion

40. Dialogue 2
 Dispenser: Hi Doctor Kamil. This is Zewdu Kassa at Lions rural
drug vender. I just got off the phone with Kidist Bikila, Tedy’s
mother. She called because she was concerned about Tedy. His
fever is 38 0C and he has been taking the amoxicillin for 6 days
now, three times a day as you prescribed. She said he is still in
a miserable condition. I assumed Tedy has otitis because she
talked about his ear infection and I saw from his medication
records that he was treated for otitis once before, about 3
months ago. I think it might be time to go to trimethoprim-
sulfamethoxazole twice a day.

41. Dialogue 2 Contd…
 Physician: So he is still running a fever. From what you
said it sounds like he is not responding to the amoxicillin.
Ok, give him the trimethoprim-sulfamethoxazole twice a
day. Do you have his weight?
 Dispenser: Sure Doctor.
 Physician: Good. Let’s keep him on it for 10 days.
 Dispenser: Ok, I’ll let Mss. Kidist know.
 Physician: Thanks for calling.
 Dispenser: You’re welcome. Thanks for getting back to me so
quickly.
 Discussion

42. Lessons Learnt from this Dialogue
 Well-prepared and skilled dispensers who focus on patient
problems rather than on prescribing problems can turn these
interactions into opportunities for professional collaboration
and cooperation, rather than conflict there by saving the
patient from unnecessary drug related problems which is the
ultimate goal of the communication.

43. Role Play
 Demis came to your rural drug vendor and tells you that he has
been suffering from itching. He pulls up his shirt and shows you
a rash on his skin.
 When you look at his medicine envelope, you realized that he
was taking cotrimoxazole.
 Trying to gather more information from the patient to
determine if he is having a mild or severe rash, you established
that the patient has severe rash.
 Contact the prescribing nurse or physician to change the
medication.

44. Role play
• Negus, a 24 year old daily laborer, comes to your
RDV with a prescription for Amoxicillin for
community acquired mild pneumonia:
Amoxicillin 500 mg capsule
P.O. TID for 7 days
• Provide him with the necessary information to
enable him take the drug correctly

45. Role Play
• A patient comes to your RDV with a prescription for Fansidar
stat and Chloroquine for 3 days.
• Contact the physician and propose a change of his/her
medication.

46. KEY POINTS
 Successful communication of information, ideas, and concepts
is an integral skill that must be learned, developed, and used
by all dispensers.
 Relationship between patients and dispensers provide the
basis for effective and valued communications.
 Understanding feelings properly and empathic responding
strengthens the therapeutic alliance between the patient and
the dispenser.
 Good communication with providers and patients is essential
for successful care and treatment.
 The provision of pharmaceutical care requires a collaborative
relationship and team work with providers

47. THANK YOU!!!