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Ethics CHAPTER 12
good pharmacist (Wingfield 2007a, b, c). The code is
intended to promote professional judgment and support professional discretion.
Health care requires a multidisciplinary approach
and healthcare professionals can be expected to share
some common ethical rules. A shared code of ethics
has been advocated and principles identified based on
the Tavistock principles (Berwick et al 2001; Smith
et al 1999a, b):
*
Rights – people have a right to health and health
care
*
Balance – care of individual patients is central, but
the health of populations is also our concern
*
Comprehensiveness – in addition to treating illness,
we have an obligation to ease suffering, minimize
disability, prevent disease and promote health
*
Cooperation – health care succeeds only if we
cooperate with those we serve, each other and
those in other sectors
*
Improvement – improving health care is a serious
and continuing responsibility
*
Safety – do no harm
*
Openness – being open, honest and trustworthy is
vital in health care.
There has been a resurgence of interest in medical
oaths in recent years (Hurwitz & Richardson 1997;
Sritharan et al 2001) and such a personal professional
pledge has been advocated in pharmacy (Hawksworth
2003, 2004). This could take the form of a personal
affirmation encompassing the four ethical principles,
some of the virtues such as integrity, honesty, compassion and other key obligations concerned with
working practice such as confidentiality and consent.
Ethical decision making
In making ethical decisions, healthcare professionals
can refer to law, professional codes and guidelines and
to the principles and theories of ethics. Common
sense, beliefs and values, intuition and experience also
all play a role in influencing the decision. The first step
in the process is to recognize that an ethical issue is
involved and it is not purely a matter of law or professional etiquette. Ethical issues arise when there is
confusion about competing alternatives for action,
when interests compete and when none of the alternatives is entirely satisfactory. It typically prompts the
question: ‘What should I do?’ or ‘ What ought I to do?’
This requires a moral awareness or sensitivity. The
next stage requires critical thinking and an ability to
make ethical judgments. Typically this benefits from
following a structured approach such as:
*
Obtaining knowledge of all the pertinent facts
*
Identifying the specific ethical issue(s)
*
Framing these issues in the context of ethical
theories and principles
*
Considering – weighing up all available information
in order to identify options
*
Choosing an option
*
Justifying the reasoning behind the decisions
*
Reviewing and reflecting.
Wingfield & Badcott (2007) have set out in detail a
methodology for ethical decision making, based on a
four-stage approach:
*
Gather relevant facts
*
Prioritize and ascribe values
*
Generate options
*
Choose an option.
Gathering relevant facts includes ascertaining what
law (criminal, civil, NHS) applies and what guidance
(codes and guidelines) is available. The second stage is
identifying all the individual parties involved and
attempting to balance their disparate interests. The
third stage involves asking the question ‘What
COULD I do in this situation?’ and the final stage,
asking the question ‘What SHOULD I do in this
situation?’ – recognizing that decisions may have to
be justified. Finally, so as to develop decision-making
skills, professional judgment and practice experience,
once the decision has been made and any consequences realized, reflection is required (Wingfield &
Badcott 2007).
When applying ethical principles, the principles
involved should be identified, asking whether any of
these are in competition, and whether one principle
should take priority over another. The ethically correct option is typically one that fulfils the most principles. There may not always be right and wrong
answers to situations, but there are better and worse
ways of dealing with them. The better way would be
to analyse an ethical problem by following a structured framework that enables the theories and principles to be critically reviewed and applied.
The importance of reflection cannot be emphasized enough. Most people make decisions at great
speed and with little reflection. Experienced pharmacists often do not recognize the processes they use
when making difficult choices. By slowing down the
process, and breaking it up into stages and steps, it is
possible to analyse how decisions were reached. An
119
SECTION TWO Governance and good professional pharmaceutical practice
analysis of what was done, and why, can prove helpful
the next time a situation presents with a difficult
decision to make.
The virtuous pharmacist
Ethical principles do not in themselves solve ethical
dilemmas but merely act as starting points to help
identify the issues and concerns. Principles need to
be supplemented with compassion, empathy and
common sense.
At its simplest, the ethical principles become
merely a checklist. Beauchamp & Childress (2001)
were keen to assert that the principles-based approach was not designed to provide simple solutions
to complex ethical dilemmas:
Principles do not provide precise or specific
guidelines for every conceivable set of
circumstances. Principles require judgement,
which in turn depends on the character, moral
discernment, and a person’s sense of
responsibility and accountability... Often what
counts most in the moral life is not consistent
adherence to principles and rules, but reliable
character, moral good sense, and emotional
responsiveness.
(Beauchamp & Childress 2001, p. 462)
Mapping of values associated with pharmacy (Benson
2006, Benson et al 2007, BMA 1995) have been un-
dertaken in recent years and have identified some of
the basic and ancient virtues.
Being a professional is concerned with personal
development and striving for professional and moral
excellence. In response to the question ‘What is a
good doctor?’, Tonks (2002) identified the following
qualities:
*
Compassion
*
Understanding
*
Empathy
*
Honesty
*
Competence
*
Commitment
*
Humanity.
The education of a healthcare professional is more
than the acquisition of knowledge and skills. There
is the need to learn professional behaviour and to
acquire a new identity – a professional identity. From
entering a professional programme, professionalism,
the development of character traits and behaviours
associated with professionalism, and the development
of a commitment to ethical principles must be nurtured. This process continues throughout professional
life.
The four focal virtues
One or two virtuous traits do not amount to a virtuous
person. A virtuous professional requires a virtuous
character, according to Beauchamp & Childress. To
that end, they identified four focal virtues:
*
Compassion – ‘regard for the welfare of others. It
combines an attitude of active regard for another’s
welfare with an imaginative awareness and
emotional response of deep sympathy and
discomfort at the other person’s misfortune or
suffering’
*
Discernment – ‘includes the ability to make
judgements and reach decisions without being
unduly influenced by extraneous considerations,
fears, or personal attachments’
*
Trustworthiness – ‘Trust is a confident belief in and
reliance upon the ability and moral character of
another person’
*
Integrity – ‘means soundness, reliability, wholeness,
and integration of moral character ...[it] means
fidelity in adherence to moral norms’.
120
Conclusion
Why is ethics important and why do healthcare professionals need to study ethics? Because it helps us to
consider different perspectives, to respect others and
the different needs of others. It helps us to take note
of a patient’s wishes. It helps personal and professional
development. Autonomous professionals are required
to make judgments and take decisions and it helps us
to analyse these actions and their consequences.
Healthcare professionals have a responsibility to
work ethically and personal standards, competence
and high ethical standards are essential. Individual
reflection on personal standards and ethics is vital.
Excellence is not a state but a journey. It requires
constant effort and never quite reaching the final
destination. Aristotle recognized that it was not easy
to be virtuous – otherwise we would not praise it.
KEY POINTS
*
Ethics is associated with choices, judgments and
decisions, encompassing concepts such as right
and wrong, values, duty and obligation.
Importantly, ethics is critically reflective and
analytical
*
Three main ethical theories inform biomedical
ethics: utilitarianism, deontology and virtue
theory
*
Utilitarianism is the most prominent
consequentialist theory and actions are judged by
their usefulness
*
Deontology emphasizes duty and motives
Ethics CHAPTER 12
*
Virtue theory stresses the importance of the actor’s
character
*
The four key ethical principles in medical ethics are
autonomy, non-maleficence, beneficence and
justice
*
Ethical principles serve as a stimulus to identify
ethical conflicts and aid decision making
*
A coherent and consistent approach to ethical
decision making is needed and requires critical
analysis and reflective thinking
121
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Chapter Thirteen
Communication skills for the
pharmacist
Judith A. Rees and Isobel J. Featherstone
13
STUDY POINTS
*
Elements of communication
*
Assumptions and expectations
*
What is communication?
*
Listening skills
*
Questioning skills
*
The Calgary–Cambridge model
*
Patterns of behaviour in communication
*
Empathy and its facilitation
*
Barriers to communication in the pharmacy
*
Confidentiality
*
Communicating with those with special needs
*
Handling difficult situations
Introduction
Joan is a community pharmacist. At the end of the
working day she thinks back to what has happened
that day. She has discussed with customers their
choice of over the counter (OTC) medicines, advised patients how to use their prescription medicines, conducted a medicines use review, phoned
the local GP about a potential drug interaction,
supervised a methadone addict, spoken briefly to
the d istrict nurse, who popped in to pick up some
dressings for a patie nt, explained to a patient who
needed to fill in a prescription exempt payment
form, negotiated with her boss about a day off,
interviewed a potential sales as sistant, disciplined
a sales assistant, exchanged pleasantries with the
delivery person and had been introduced to the
new chairman of the local pharmaceutical committee at lunchtime.
Ravi, a hospital pharmacist, similarly looked back
at his working day. He had spent time on the wards
discussing drug-related matters with junior doctors
and nurses, as well as undertaking medication histories with a couple of patients and talking to a
patient about their discharge medication. The latter
task involved him phoning the patient’sGPand
local pharmacist to arrange a continuity of medicine
supply. He had helped run an induction course for
pre-registration students and given a seminar at the
lunchtime journal club for fellow pharmacists. Later in the day he had attended a committee meeting
on developing policies for the safe use of medicines
in the hospital. Representatives of other healthcare
professionals and administr ators in the hospital
attended this meeting. He had finished off his
day with a brief spell supervising the dispensary,
when he had to deal with a complaint from a prescriber about an alleged aggressive phone call from
pharmacy earlier in the day.
From the above descriptions of two pharmacists’
very different working days, it can be seen that
while each is performing pharmaceutical tasks, all
of these tasks required the use of communication
skills. In fact, almost everything we do in life
depends on communication. Pharmacists spend a
large proportion of each working day communicating with other people – patients, doctors, other
healthcare professionals, staff and others. Poor
communication has the potential to cause a range
of problems, from misunderstandings with healthcare professionals and others caused by incomplete/
poor communication to inappropriate or incomplete
advice on the use of medication causing potential
harm to a patient/customer.
SECTION TWO Governance and good professional pharmaceutical practice
Thus there is a need for effective communication
skills for pharmacists. But how effective is our communication? Many are able to talk at length, but do
our listeners benefit from our words? Others may find
talking to strangers difficult. Good communication
demands effort, thought, time and a willingness to
learn how to make the process effective. Some people
find that good communication is difficult to achieve
and an awareness of this fact is an important first step
to improvement.
This chapter considers some of the elements of
successful communication, looking first at the ways
in which we assume things about other people and
how this can influence our attitudes and then at the
processes involved in communication, listening and
questioning skills. A tot al model for an effective
pharmacist–patient consultation is outlined, followed by t he barriers to effective communication
in pharmacy. The importance of confidentiality and
the needs of special groups are considered. Finally
there are some difficult situations to consider and
practise.
Assumptions and expectations
It is said that you never get a second chance to make a
first impression. When we meet somebody for the
first time we make assumptions about that person.
We often put people into categories and the assumptions lead to expectations of their behaviour, jobs and
character.
This initial judgment of a person is often based
purely on what we see and hear and includes appearance, dress, age, gender, race and physical disabilities.
It is important that we are aware of these assumptions
in order to avoid stereotyping people. For example,
the impression we have of a person wearing a hooded
jacket, baseball cap and jeans may be very different
from that of the same person wearing a designer shirt
and smart trousers. Conversely, people will make
assumptions about us based on initial impressions;
e.g. a pharmacist wearing a smart suit in a clean, clinical environment may inspire more confidence than a
pharmacist wearing a scruffy jumper and working in a
cluttered, untidy environment.
It is well documented that age and gender may
affect how we communicate with people because of
assumptions and expectations. We should not assume
that people in wheelchairs cannot communicate effectively. Likewise, we must ensure that we direct our
communication at an appropriate physical level and to
the appropriate person (that is, to the patient in the
wheelchair, not the person pushing it!).
Demeanour
The way in which people present themselves will lead
to certain judgments being made. For example, people who stride aggressively towards someone else may
make the person being approached feel defensive because the assumption may be made that they have
come to make a complaint. However, people who
approach hesitantly may lead to the assumption that
this person needs help and advice, perhaps on a potentially embarrassing matter. Both assumptions may
be wrong but will affect our behaviour and attitude in
subsequent communication with this person.
Tone of speech, accents and
common expressions
All of these have an impact on communication. Our
response to a person speaking with a whining, complaining tone will differ from our response to someone
who greets us in a friendly welcoming manner. Similarly, a cultured, ‘BBC’ English accent may invoke a
different response from that to someone with a strong
local accent.
No one experiences the same situation in the same
way. While people may appear to be doing similar
things, they will have different feelings about them.
We can only guess what people are thinking or feeling
from how they look and from their behaviour. For
example, we may think that people are nervous if they
move restlessly or twitch, but that may not be the
case. It is also useful for us to consider how aware
we are of our own behaviour and appearance and what
message this may give to other people.
What is communication?
Communication is more than just talking. It is generally agreed that in any communication the actual
words (the talking) convey only about 10% of the
message. This is called verbal communication. The
other 90% is transmitted by non-verbal communication which consists of how it is said (about 40%) and
body language (about 50%). Non-verbal communication is well described in Chapters 22 and 44 and so is
not discussed here, but see Example 13.1.
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Communication skills for the pharmacist CHAPTER 13
Example 13.1
To test your awareness of communication and
assumptions there is a simple exercise. To be effective,
you must not read the questions which follow just yet.
Spend about 5 minutes talking to a person who you do not
know very well – there is no particular topic, just let the
conversation flow. After this time, turn away from each
other and each write down your answers to the following
questions:
1. What did you notice about your partner? What type of
facial expression did he/she have? What was his/her
posture (or gestures) like? How did he/shespeak – tone,
speed, volume? What does this tell you about him/her?
2. How aware were you of your own non-verbal
communication? What was your facial expression?
How were you sitting (posture, position in relation
to your partner), gesturing and speaking?
3. What assumptions did you make about your partner?
For example, what is his/her taste in food, political
persuasion, favourite TV programmes, family
background?
4. How accurate were the assumptions that you made?
Ask your partner.
5. Do these assumptions say anything about you and the
initial judgments you make of people based on sex,
age, class, dress, etc.?
Now come back together and share your answers
about ea ch other – do t hey surprise you? If you
complete this exercise without ‘cheating’ you will realize
just how many assumptions we make about other
people with no evidence for them – and how wrong
some of them are!
The communication process
Argyle (1983) describes the message process as a
sender encoding a message which is then decoded
by the receiver:
Mistakes can be made by both sender and receiver.
The sender may not send the message they wished to
send or they may sometimes intentionally seek to
deceive. At the receiving end the message may not
be decoded correctly. Poor communication skills contribute to these mistakes in encoding and decoding.
Messages are not normally one way and if we send a
message then we generally expect a reply, and so in
replying the receiver becomes the sender and the
sender becomes the receiver. While the messages
may be going backwards and forwards between two
people, effective communication becomes a helical
model. In other words, what one person says influences how the other person responds in a spiral fash-
ion with reiteration and repetition, coming back
around the spiral at a different level each time.
Pharmacists tend to see contact with patients/
customers as either getting information out of, or
imparting advice to them. However this ignores the
vital purpose of communication, which is to initiate
and enhance the relationship with their patients/
customers. If this can be achieved, then pharmacists
will be perceived as more ‘patient friendly’ and more
supportive of patients. Indeed good communication
skills will make it easier for a pharmacist to seek
information and advise patients.
Listening skills
Communication is not just about saying the right
words; it involves listening correctly. If we do not listen
properly, then it means we are not decoding the message that is being sent to us. In other words, however
good the patientis at telling thepharmacisttheir symptoms, if the pharmacist does not listen correctly then
the patient may be given the wrong diagnosis or the
wrong medicine or the wrong advice. Listening and
hearing are different.Hearing is a physical ability while
listening is a skill. Listening skills enable a person to
make sense of and understand what another person is
saying. The listening process is an active one that consists of three basic steps, namely hearing, understanding and judging. The hearing stage means listening
enough to catch what the person is saying. The understanding stage takes the listener from hearing to
125
SECTION TWO Governance and good professional pharmaceutical practice
understanding the message in his or her own way (this
may not be what was intended by the speaker). The
judging stage takes the understanding stage and questions whether it makes sense. Do I believe what I have
heard? Is it credible? Have I really understood what I
have been told or have I misinterpreted the meaning?
How to be a good listener
Listening, like other skills, takes practice. Tips for
developing good listening skills are shown in Box 13.1.
Box 13.1
Tips for being a good listener
*
Always look attentive to the person who is
speaking. Maintain eye contact and stand/sit
facing them. Try not to fidget or move around too
much. Do not stare at the floor or look at some
other object in the room
*
Focus your mind on what is being said. Do not
let your mind wander, even if you think you know
what is going to be said or you think you have
heard it all before
*
Always let the speaker finish what they are saying.
Do not interrupt – speakers prefer to finish what
they were trying to say. In addition, interruption
tends to imply that you were not listening
*
Let yourself finish listening before you start to talk.
Listening is an active process and you cannot
really listen if you are busy thinking how to reply
*
Listen for the main ideas of the message. The main
ideas may be repeated several times by the
speaker
*
Ask appropriate questions or repeat what has been
said in your own words if you are not sure that your
understanding is correct
*
Give feedback to the speaker by nodding to show
you understand (but only if you do). It may be
helpful to smile, laugh, grimace or just be silent to
let the speaker know that you are listening. Leaning
towards the speaker may show you are interested
in what the speaker has to say and give them
encouragement
*
Do not forget the non-verbal side of
communication. The speaker may be
demonstrating many non-verbal clues and
gestures, which may indicate their true feelings. So
in the listening process use your eyes as well as
your ears
In a pharmacy, avoid listening across a barrier such as
a counter or desk, or getting too close and invading a
patient’s ‘intimate zone’
Questioning skills
Pharmacists need effective questioning skills to obtain
information from patients/customers. Examples of
situations in which questioning skills are used include:
*
Drug history taking
*
Requests for treatment of minor ailments
*
Probing a patient’s knowledge of how they take/
use their medicines
*
Determining the need for an emergency supply.
Effective questioning skills involve the use of different
types of questions, namely open and closed questions.
These are explained fully in Chapter 44 and their use
is discussed in the questioning of patients in the treatment of minor ailments (Ch. 22).
Effective questioning can also be used in symptom
analysis, which is another approach to assessing a
patient’s presenting symptoms. The mnemonic PQRST
provides key questions which will help pharmacists to
obtain an overview of symptoms, although additional
questions can be added, for example ‘Is the patient
taking any concurrent medication?’ The PQRST
approach to symptom analysis is shown in Box 13.2.
However, questioning skills do not apply only to
pharmacist–patient/customer situations. Good questioning skills are required in staff training, implementing
procedures and other management tasks, as well as
Box 13.2
PQRST symptom analysis
*
P = Precipitating/palliative factors
Ask: What were you doing when the problem
started? Does anything make it better/worse, such
as medicine or change in position?
*
Q = Quality/quantity
Ask: Can you describe the symptom? How often
are you experiencing it? What does it feel/look like
or sound like?
*
R = Region/radiation/related symptoms
Ask: Can you point to where the problem is? Does
it occur or spread anywhere else? Do you have any
other symptoms? (These symptoms may be
related to the presenting symptoms)
*
S = Severity
Ask: Is the symptom mild, moderate or severe?
Asking the patient to grade on a scale 0–10 may
help
*
T = Timing
Ask: When did the symptom start? How often does
it occur? How long does it last?
126
Communication skills for the pharmacist CHAPTER 13
dealing with other healthcare professionals and administrative staff.
On many occasions questioning skills may not be
in a face-to-face situation. Often a pharmacist has
to communicate by telephone with, for example, a
GP, a dentist, a district nurse, nursing home staff,
hospital staff or patients’ relatives. The major
drawback of this type of communication is that
reliance is put solely on good verbal communication
skills and not on the non-verbal aspect of c ommunication. In these circumstances, it is vital to obtain
the information as quickly and efficiently as possible. At the same time, the pharmacist must remain
professional, give out accurate advice and offer reassurance if necessary. For example, when a GP
phones to order a prescription medicine for a patient, the pharmacist is required to ask specific
questio ns to ensure that all information is accurate.
As another example, a patient phones to ask about a
prescription item that may have been incorrectly
dispensed, and, using good questioning skills, the
pharmacist would check the prescription information, identify the patient’sconcernsandbeableto
take appropriate action.
A model for guiding the pharmacist–patient interview
The Calgary–Cambridge model was developed in
1996 to aid the teaching of communication training
programmes for medical students. Since that time it
has been adopted widely by medical schools and has
been used in other related disciplines (see Ch. 46 in
which its use is described for the development of a
concordance model for pharmacy, involving patients
in decisions about their medicines). The Calgary–
Cambridge model is designed to specifically integrate
communication skills with the content skills of traditional medical history and thus the approach can be
used by pharmacists for their core tasks, such as drug
history taking and the interviewing of patients to determine the best treatment of presenting minor ailments.
The Calgary–Cambridge model has five main
stages, namely:
*
Initiating the session
*
Gathering information
*
Physical examination
*
Explanation and planning
*
Closing the session.
Concomitantly and alongside these stages, the model
provides for two further ongoing stages:
*
Providing structure to the interview
*
Building the relationship.
Providing the structure to the interview involves:
*
Summarizing at the end of a line of enquiry to make
sure there is mutual understanding between the
pharmacist/prescriber and the patient/customer,
before continuing
*
Signposting – in other words indicating to the
patient when moving from one section to the next,
e.g. gathering information and explaining
*
Sequencing – this means developing a logical
sequence which is apparent to the patient, in other
words do not interrupt information gathering to
explain and then go back to information gathering
*
Timing – this means keeping to time and not
being able to close the session or closing abruptly
because the time has run out.
Building the relationship during the interview
involves:
*
Developing rapport – being aware of non-verbal
behaviour clues and involving the patient in the
interviewprocess.Developingrapporthas four areas:
T Acceptance of the patient, their views and
feelings and being non-judgmental
T Empathy with the patient by showing an
understanding and appreciation of the patient’s
feelings or predicament (see later in this
chapter, p. 131)
T Support which expresses itself as concern for the
patient, a willingness to help, an
acknowledgement of their coping efforts and selfcare, e.g. use of OTC medicines, and offering a
partnership approach (see Chs 44 and 46)
T Sensitivity, which includes dealing sensitively
with embarrassing and disturbing topics.
Some sensitive areas can be seen in Table 13.1.
An awareness of non-verbal behaviour is the next
step in building the relationship. The awareness
relates to the interviewers themselves – are they demonstrating good eye contact and other features of positive non-verbal behaviour? Are they picking up on any
cues displayed by the patient’s non-verbal behaviour?
Any note taking or reading (or use of computers these
days) should not interrupt or affect the dialogue.
In building the relationship it is important to
involve the patient and to share thoughts with them
(e.g. ‘I think we are looking for a medicine that
doesn’t cause drowsiness’), to provide a rationale
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SECTION TWO Governance and good professional pharmaceutical practice
Table 13.1 Types of patients’ problems and the communication difficulties which they present
Problem type Examples Communication difficulties
Embarrassing
problems
Emotional/
psychological
Problems of handicap
Sensory Blindness, deafness Making inaccurate judgments regarding personality, intellect, etc.
Physical Paralysis, congenital deformity
Communicative Speech impairment
Mental Educationally subnormal
Psychological Personality disorders
Social Introversion
Terminal illness Knowing what to say and how to say it. Establishing patient’s
Financial problems Interpreting cues given off by patient. Not embarrassing the
for questions (e.g. explain why you need to know
about concurrent prescribed medicines when recommending an OTC cough medicine), and to explain and
ask permission if a physical examination is necessary.
We will now consider in more detail the stages of
the interview process relevant to current pharmacy
practice according to the Calgary–Cambridge model
in order.
Contraception; disorders of the
reproductive system;
hyperhydrosis; skin conditions
Anxiety; depression; marital
problems; drug abuse and
dependence; stress
Obtaining privacy in the pharmacy. Establishing a common
language of understanding. Demonstrating empathy and
understanding. Establishing trust and confidentiality. Not
exhibiting negative non-verbal behaviour
Demonstrating empathy and understanding. Insufficient time for
counselling. Evaluating patient’s immediate needs. Establishing
the nature and amount of advice to be given. Establishing two-way
listening
Providing effective explanations. Listening and taking sufficient
time with patient. Overcoming social barriers
feelings
patient regarding cost of medicines
like to speak to me – how can I help?’ The patient’s
answer must be listened to attentively and then the
pharmacist needs to check and confirm the list of problems/queries/issues with the patient. During this
stage the pharmacist should pick up on any verbal
and non-verbal behaviour cues and help facilitate the
patient’s responses. To complete this stage an agenda
for the interview is negotiated (e.g. ‘so you would like
me to recommend a medicine to help relieve your
Initiating the session
cough that doesn’t make you drowsy? Is that right?’).
Preparation involves the interviewer (the pharmacist)
preparing him- or herself and focusing on the session.
Forexample, in communitypharmacy, a customermay
request to see the pharmacist. The pharmacist will
need to finish off at an appropriate point whatever task
they were doing, probably take a few breaths and then
focus on meeting the patient. At this moment it is
important to establish initial rapport by greeting the
patient,introducing yourself,the roleand natureof the
interview (e.g. a pharmacist conducting a drug medication history) and obtain consent, if necessary. The
next step is to identify the reasons for the consultation
by anopening question such as, for a patient requesting
to see the pharmacist, ‘I understand that you would
128
Gathering information
An initial exploration of the patient’s problems, either
disease or illness, is necessary and the patient should
be encouraged to ‘tell their tale’ in their own words.
Clearly the pharmacist needs to listen attentively and
question appropriately using different types of question (open and closed) and suitable use of language
(e.g. avoiding jargon and very technical language but
not in a patronizing way). The pharmacist needs to be
aware of verbal and non-verbal cues and the possible
need to facilitate responses. It may be necessary to
clarify what the person is saying (e.g. ‘What do you
exactly mean by a stomach cold?’). Certainly it will be