FEATURE

Using Personal Selling Skills to

Promote Pharmacy Services
Everyday encounters with patients offer valuable
opportunities to build demand for pharmacy services
and impart the value of pharmaceutical care.
Randal P. McDonough and William R. Doucette

To take the CE test for this article online, go to:

http://www.pharmacist.com/gateway.cfm?redirType=cecity&courseID=6305

Program Preview comfortable and proficient with personal selling activities. These
strategies have been used by one of the authors (McDonough) in
Marketing pharmaceutical care is not the responsibility of the promoting pharmacy services at Main at Locust Pharmacy in
few innovative pharmacists who try it first. Rather, it is the respon- Davenport, Iowa.
sibility of everyone in the profession.
—Charles D. Hepler1
Personal Selling: An Overlooked
In recent years, pharmacists have made significant progress in Promotional Strategy
building the supply of pharmaceutical care services. Pharmacists
in a variety of practice settings are developing new clinical ser- A number of recent articles and other publications have
vices and disease management programs to help patients achieve reviewed basic marketing principles and their application to phar-
desired health outcomes. These services range from blood lipid macy practice.6–8 Traditionally, the general framework for mar-
management and diabetes education to smoking cessation pro- keting has followed a set of basic principles called the five Ps,
grams and cancer risk assessment.2–5 briefly described as follows:
As pharmaceutical care pioneer Charles D. Hepler has noted, n Product (or service)—the item marketed, such as a pharmacy
however, the pharmacy profession has put far less focus on build- service.
ing demand for these same services. Because many patients and n Price—the fee paid by the patient, insurer, or other third party
physicians may not yet recognize the value of pharmacy-based payer, such as an employer.
patient services, the demand for pharmaceutical care remains lim- n Promotion—activities to raise awareness of the service, such as
ited. Although some pharmacies have developed and implement- advertising or public relations.
ed effective marketing strategies to build demand for new services, n Place—the site at which the service is offered, such as the phar-
many others have experienced difficulty in this regard.6 macy, a health fair, or work-
Creating and maintaining mutually beneficial relationships with place.
“Using Personal Selling
patients, physicians, and other stakeholders is essential for suc- n Positioning—a term that Skills to Promote Pharmacy
cessful marketing of pharmacy-based services. This approach, describes how the service Services” is part of the continuing
education program The Dynamics
known as relationship marketing, depends on effective use of per- will likely be viewed by of Pharmaceutical Care: Enriching
sonal (one-on-one) selling skills.6 By combining personal selling prospective patients. Patients’ Health appearing in
skills with a sound marketing plan, pharmacists can more effec- Personal selling is a compo- the Journal of the American
Pharmacists Association. The
tively promote and generate demand for their patient services. This nent of promotional activities, series is developed by the
article reviews techniques that help pharmacists become more but it is often overlooked in American Pharmacists Association,
and supported by an educational
daily practice or dismissed by grant from Merck & Co., Inc.
Continuing education credits: See page 373 for learning objectives and pharmacists as unnecessary or
test questions for this article, which is number 202-000-03-231-H04 in
too hard to implement.
APhA’s educational programs. CE answer sheets are located inside the
back cover of this issue.To take the CE test for this article online, go to Although considered a form of
http://www.pharmacist.com/gateway.cfm?redirType=cecity&courseID=6305 promotion, personal selling dif-

Vol. 43, No. 3 May/June 2003 Journal of the American Pharmacists Association (www.japha.org) 363
FEATURE Personal Selling Skills
fers from traditional promotional strategies because it involves
interpersonal communication between the pharmacist and the
patient (or between the pharmacist and the physician or other
stakeholder). Unlike mass media approaches to pharmacy promo-
tion (e.g., newspaper advertisements), which tend to be broad-
based and impersonal, personal selling requires the pharmacist to
initiate a dialogue with the patient, use effective questioning and
listening skills to identify the individual’s unmet health needs, and
persuasively present a service that meets explicitly stated and
mutually agreed-upon goals.
Applying the techniques of personal selling to everyday
encounters with patients can help pharmacists attract and retain
patients for pharmacy services and programs. Although some
practitioners may recoil at the concept of selling their services to
patients, it is important to remember that these same techniques
can improve the provision and quality of pharmaceutical care.
Through effective use of personal selling skills, pharmacists can
become more adept at uncovering patients’ unmet health needs,
offering services that meet those needs and identifying ways to
improve service quality.
Personal selling strategies are best viewed as one integral com-
ponent of a comprehensive pharmacy marketing plan.7–12 The plan
should be based on a careful market analysis to ensure that pro-
posed or existing pharmacy services can fulfill unmet health needs
in the community. A mission statement that communicates the
goals and purpose of the service to patients and other stakeholders
is also recommended.
Businesses that adopt a personal selling approach tend to have a
greater organizational commitment to marketing than do those that
depend almost exclusively on advertising.13 This observation is
likely to hold true for pharmacy as well, even though most phar-
macists have not yet embraced personal selling.
Stages of Consumer Purchasing
Decisions
Pharmacists who want to build patients’ awareness and demand
for their services can benefit from understanding the cognitive
processes consumers go through when deciding to purchase a
product or service. Although these models have been developed to
explain and predict purchasing behavior for consumer products
and services, they can provide insight into how patients make deci-
sions about using pharmacy services.14,15
Before purchasing a product or service, consumers typically go
through four contemplative stages: awareness, interpretation, inte-
gration, and decision.
n Awareness. In this preliminary stage, an individual becomes
aware of a product or service through one or more means, such
as an advertisement or word of mouth. In the pharmacy setting,
patrons usually become aware of new patient care services
through newspaper or radio advertisements, bag stuffers,
brochures, or in-store signage. Another less utilized but highly
364 Journal of the American Pharmacists Association (www.japha.org)
effective way to build awareness is through one-on-one dia-
logue between the pharmacist and patient (a personal selling
strategy). For example, a pharmacy might promote its asthma
management program through advertisements on local radio
and cable television outlets. To increase the effectiveness of
these promotions, the pharmacists and other staff may use per-
sonal selling skills to inform appropriate patients about the pro-
gram.
n Interpretation. In this stage, the individual considers the mean-
ing of the service with respect to his or her situation, drawing
on prior knowledge and beliefs. For example, if a woman with
asthma becomes aware of a pharmacy’s new asthma manage-
ment program, she may begin to recall her recent episodes of
wheezing and shortness of breath. She may worry that acute
asthma attacks are keeping her from participating in usual daily
activities and wonder whether she could improve her health by
asking the pharmacist for more information. These thought pro-
cesses lead into the next stage: integration.
n Integration. In this stage, the individual synthesizes informa-
tion about the product or service to form an evaluation or opin-
ion. In the pharmacy setting, patients base their evaluation of
services on their health needs and such factors as convenience,
cost, and past experiences. Using the previous example, if the
patient with asthma has recently experienced acute symptoms,
she may be inclined to try a new asthma management service
or at least learn more about it. Conversely, if her illness is well
controlled or if she does not understand how the service could
help her manage her disease better, she may form a neutral (or,
possibly, negative) attitude about the service.
n Decision. Based on their initial evaluation, consumers decide
whether to purchase a new product or service. In the pharmacy,
patients are more likely to purchase a service if they believe it
will help them solve a health problem (e.g., pain or discomfort)
or achieve a desired health outcome (e.g., improved disease
management or risk reduction). For example, the patient who is
experiencing acute asthma symptoms may believe that the
pharmacy service will help her regain control of her condition
through improved medication management. In this situation,
she recognizes the value of the service and may wish to pur-
chase it.
Typically, patrons go through the cognitive processing cycle
more than once before deciding to use a service. Pharmacists need
to keep in mind that people’s health needs may change over time
for many reasons, such as worsening of a medical condition, onset
of medication adverse effects, or the occurrence of a major life
event (e.g., pregnancy, menopause, or the natural process of
aging).
Instead of becoming discouraged when patients choose not to
use a service after the initial encounter, pharmacists need to con-
tinue to help them identify their unmet health needs and offer ser-
vices that can aid them in reaching desired outcomes. For exam-
ple, a woman who has previously declined to enroll in a pharma-
cy-based smoking cessation program may decide to participate
May/June 2003 Vol. 43, No. 3
 Personal Selling Skills FEATURE

after she learns she is pregnant and realizes the potential harm to
her fetus. Similarly, a man with diabetes who has been reluctant to Figure 1. M odel for Personal Selling of
enroll in a diabetes education program may change his mind if he Pharm acy Services
experiences a serious complication, such as a diabetic foot ulcer or
erectile dysfunction.

Prelim inary Stage:

A Model for Personal Selling in
Pharmacy Practice G athering Patient Inform ation

Conventional promotional strategies, such as fliers, posters,

direct mail, and advertisements, play an important role in raising
public awareness of pharmacy services. However, to encourage
patrons to move beyond the awareness stage and toward a decision
to use a service, pharmacists need to make greater use of their per-
Step 1:
sonal selling skills.
Figure 1 shows a 5-step model that illustrates how pharmacists Assessing Inform ation
can use personal selling skills to identify patients’ unmet health
needs, present pharmacy programs to fulfill these needs, and fol-
low through to obtain an agreement to use the service. The dia-
gram is funnel-shaped because the exchange of information
between the pharmacist and patient is initially general, then
becomes more specific as the patient’s health needs are identified.
Step 2:
Asking Probing Q uestions
Prelim inary Stage
The preliminary stage of the personal selling model provides a
“warming up” period between the pharmacist and patient. Most
pharmacists enter this stage many times during the day as they
encounter new patients or perform routine duties, such as dispens-
ing prescriptions or providing clinical services. Many ordinary Step 3:
daily activities provide opportunities to uncover patients’ needs
and acquaint them with pharmacy services. These include dis- Presenting Features and
pensing new prescriptions or refills, advising patients on over-the- Benefits
counter products, performing routine health screenings (e.g., blood
pressure or blood glucose checks), and providing services at health
fairs or other off-site locations (e.g., workplaces).

Step 1: Assessing Inform ation Step 4:

During the preliminary stage, the pharmacist is gathering infor-
Addressing Concerns
mation about the patient’s health care needs. In step 1, the phar-
macist asks the patient for more information to clarify possible
problems and concerns. The pharmacist needs to be attentive to
the patient, use active listening skills, and ask open-ended ques-
tions. The goal is to help the patient explicitly recognize his or her
health needs. That is, the patient (not just the pharmacist) needs to
be aware of having a health problem that could be improved Step 5:
through a pharmacy service. O ffering the
Service

Step 2: Asking Probing Q uestions

As the pharmacist listens to the patient and begins to identify

Vol. 43, No. 3 May/June 2003 Journal of the American Pharmacists Association (www.japha.org) 365
FEATURE Personal Selling Skills
concerns about his or her medications or health condition, it is
important to ask focused, probing questions to clarify the prob-
lem.16 Usually, a sensible approach is to begin by asking more
general questions about the problem and then proceed with more
specific questions as the concern becomes clearer.
Neil Rackham, a sales consultant and author of several top-sell-
ing books on marketing, has developed a research-based strategy
to improve sales performance through critical questioning behav-
iors called the SPIN model.17 Originally developed for use in
improving sales force effectiveness, the SPIN model offers a use-
ful paradigm for identifying patients’ needs in pharmacy practice.
The SPIN model prompts pharmacists to ask a series of questions,
the goal of which is to help the patient identify his or her explicit
needs for pharmacy services. In other words, through answering
the pharmacist’s questions, the patient becomes more fully aware
of a health concern that has substantial implications for well-being
and that could be improved through participation in a pharmacy
service.
In the SPIN model, the salesperson uses four different types of
probes to uncover the needs of customers: situation, problem,
implication, and need–payoff questions. Figure 2 shows how this
model was used at Main at Locust Pharmacy to identify a patient’s
explicit needs for a pharmacy service.
Situation Questions
Asking these questions is useful in the preliminary stage of the
patient encounter, when the pharmacist is trying to gather back-
ground information about the patient. During this stage, the phar-
macist may initially have little or no idea of the patient’s concerns
or problems. Examples of situation questions include:
n How are you feeling?
n What are your current complaints related to your health?
n What medications are you taking?
n What over-the-counter products do you take?
n What current medical conditions do you have?
n Have you had your cholesterol or blood pressure checked
recently? If yes, what are your numbers?
Problem Q uestions
These questions probe for dissatisfaction or concerns the patient
may have with his or her current situation. The goal is to uncover
problems the patient may have with his or her medications, self-
care behaviors, or other health issues. The problems identified up
to this point are considered to be the patient’s implicit needs
because he or she may not fully realize the impact on his or her
health or quality of life. Examples of problem questions include:
n Have you experienced any drowsiness or other side effects with
this nonprescription antihistamine?
n How have your blood glucose readings been since you started
this new insulin therapy?
n How much money do you estimate you spend each month on
your nutritional supplements?
366 Journal of the American Pharmacists Association (www.japha.org)
Im plication Questions
Answering these questions helps the patient become aware of
the true impact of a health concern on larger issues, such as over-
all well-being, relationships, work productivity, or personal
finances. In answering these questions, patients may realize that
their problem or dissatisfaction has significant implications and
may require some action to resolve. Examples of implication ques-
tions include:
n Has the drowsiness associated with your antihistamine made it
hard for you to concentrate at work?
n Did your doctor explain that taking too much insulin may cause
low blood sugar, which can be dangerous?
n Did you know that second-hand smoke can increase your chil-
dren’s risk of developing ear infections and other health prob-
lems?
N eed–Payoff Q uestions
The objective of these questions is to help patients articulate
their explicit needs with regard to the problem or dissatisfaction.
Answers to these questions help the patient to focus on possible
solutions to the problem. This dialogue often leads naturally to a
discussion about the features and benefits of a pharmacy service to
address the patient’s stated needs. Examples of need–payoff ques-
tions include:
n Would it be helpful for you to learn to monitor your blood pres-
sure at home, so you could make fewer trips to the doctor’s
office or pharmacy?
n Do you think your family would be pleased if you enrolled in a
smoking cessation program and quit for good?
n Did you know that keeping your blood glucose in the target
range will substantially reduce your risk of long-term diabetes-
related problems?
n Would your finances be easier to manage if we could eliminate
or reduce some of the prescription and nonprescription medica-
tions you are taking?
Step 3: Presenting the Service’s Features
and B enefits
Once the patient’s needs have been uncovered and the pharma-
cist has identified an appropriate service to address those needs,
the next step is to explain how the service can help the individual
reach his or her goals. The presentation should be tailored to the
patient’s specific needs and briefly describe the service’s features
(i.e., its specific components) and benefits (how it solves the
patient’s problems). This step requires pharmacists to use verbal
presentation skills. Specifically, pharmacists need to be prepared
to succinctly describe how the service can help the patient address
an unmet health care need. It is important to remember that the
benefits of the service need to be matched to the needs and con-
cerns of the patient.
For example, at Main at Locust Pharmacy, a medication review
service (the Pharmacy Check-Up Program) offers a complete
May/June 2003 Vol. 43, No. 3
 Personal Selling Skills FEATURE

Figure 2. Using Personal Selling Skills at M ain at Locust Pharm acy: A Case Example

For the past several years, one of the authors (McDonough) has been integrating personal selling skills into the marketing mix
at Main at Locust Pharmacy. The following case example illustrates each step in the model for personal selling of pharmacy
services, using a case from the Pharmacy Check-Up Program. This medication review service is offered to patients who have
problems with or questions about their drug therapy. To provide the service, the pharmacist takes a comprehensive medical and
medication history, reviews the patient’s medications, identifies any drug therapy issues, and develops a written action plan to
resolve the problems. The pharmacist’s recommendations are provided verbally and in writing. If approved by the patient, a
summary is sent to the physician.
Preliminary Stage: Gathering Patient Information
A woman who appears to be in her early 60s enters the pharmacy and asks to speak with the pharmacist. W hen the pharmacist
inquires how he can help her, the woman mentions she would like to get her blood pressure checked. The pharmacist begins by
asking several situation questions:
Pharmacist: W hat are your current medical problems?
Patient: Right now, my only problem is high blood pressure.
Pharmacist: Are you taking any medications?
Patient: Yes. I’m taking this expensive blood pressure medication. [She hands a prescription vial to the pharmacist, who
identifies the medication as an angiotensin receptor antagonist, 50 mg daily.]
Pharmacist: Are you taking any over-the-counter products, such as a vitamin or herbal supplement?
Patient: Yes. I take several vitamin and herbal supplements that I get through the mail. They are supposed to give me more
energy and slow down aging, but I’m not sure what the actual ingredients are. I take about 8 to 10 tablets every day.
At this point, the pharmacist does not know if the patient’s blood pressure is well controlled or to what extent her supplement
use represents a drug therapy problem. However, the groundwork has been laid to move to Step 1 (assessing information) and
Step 2 (probing for clarification). As the pharmacist walks the patient back to the counseling area to measure her blood pressure,
he begins to ask problem questions to determine potential issues with the patient’s drug therapy or medical condition.
Steps 1 and 2: Assessing Information and Asking Probing Questions
Pharmacist: How has your blood pressure been running?
Patient: It’s been too high the last few times I went to my doctor. She suggested I start monitoring more frequently on my own.
That’s why I came in today.
Pharmacist: Do you know the target goal for your blood pressure?
Patient: Well, I’m not exactly sure.
Pharmacist: I also wanted to ask about your supplements. Have you thought about what may be in them—and if they could be
affecting your blood pressure?
Patient: Now that you mention it, I realize I don’t know what’s in some of them. And they sure do cost me a lot of money each
month.
These probing questions have identified two potential problems, or implied needs, for this patient. First, she mentions that her
blood pressure readings have been elevated and she needs to monitor them more frequently. Second, she acknowledges she
knows little about her supplements, which are financially burdensome. At this point, the pharmacist has identified the patient’s
implied needs, but he has not determined whether the patient fully realizes the implications for her health and well-being. This
leads the pharmacist to ask implication questions to assess how much impact the patient’s concerns have on her life.
Pharmacist: You mentioned you want to monitor your blood pressure more frequently. Do you have any specific concerns
about your blood pressure?
Patient: My mother died of a stroke at about my age. I worry the same thing will happen to me if I don’t get this condition under
control.
Pharmacist: You also have some concerns about how much you’re spending on supplements, right?
Patient: Yes, my husband and I are retired and living on a fixed income. I’ve been wondering if I might be taking supplements
that are making my blood pressure worse or not doing me any good.
The patient’s answers to these questions indicate she has more issues than just getting her blood pressure measured. By
explicitly stating her needs, she has set the stage for the pharmacist to describe a service that may help her address these issues.
At this point, the pharmacist is ready to ask need– payoff questions. The patient’s responses to these questions can help her
recognize some solutions to her problems or concerns.
Pharmacist: It sounds like you want to get your blood pressure under better control and determine if you need to take so many
supplements. Is that right?
Patient: Yes, and I would like to ask you some questions about them.
Pharmacist: W ould it be helpful if we scheduled a time for you to come in and get your blood pressures checked? We can fax
this information to your doctor so she stays up to date with your measurements. We can also share any recommendations we
may make with your doctor.
Patient: Yes, that would be really helpful.
Pharmacist: Also, since you have questions about your supplements, would you be interested in a service to help you sort
through them all? That way, you could be sure that none are worsening your blood pressure. The pharmacist also can answer
any questions that you might have.
Patient: Actually, I would appreciate if someone could do that for me.
As illustrated in this case, the need– payoff questions help the patient to recognize her explicit needs and identify solutions to
them.

Continued on next page

Vol. 43, No. 3 May/June 2003 Journal of the American Pharmacists Association (www.japha.org) 367
FEATURE Personal Selling Skills

Figure 2. Using Personal Selling Skills at M ain at Locust Pharm acy: A Case Example
(Continued)

Steps 3 and 4: Presenting the Service’s Features and Benefits and Addressing Patient Concerns
Now that the patient’s needs have been identified, the pharmacist can provide her with a brief presentation on the service’s
features and benefits. The pharmacist can also address any concerns or questions the patient may have.
Pharmacist: W e have a service called the Pharmacy Check-Up Program that includes a complete review of your medications
and any supplements you’re taking. After I meet with you and review your medications, we’ll set up a follow-up appointment to
discuss my recommendations. I’ll answer your questions about your supplements and identify any that may be worsening your
blood pressure. I’ll also see if you’re taking some products you may not need, which will lower your expenses.
Patient: That sounds good, but how much is this service?
Pharmacist: The service costs $75.00 for the initial medication review and a follow-up appointment.
Patient: Oh. That sounds expensive. I’m not sure that I can afford it.
Pharmacist: I understand this may seem expensive. But after talking with you, it sounds like you have some concerns about the
number of supplements you’re taking and their cost. Is this correct?
Patient: Yes, I do want to get my blood pressure controlled and be sure I’m taking the right supplements.
Pharmacist: Our Pharmacy Check-Up Program can help you make the right choices with your supplements and identify
strategies to get your blood pressure under better control. Also, we have a payment installment plan to help you budget the
cost of the service.
Patient: Hmm. That sounds good.
Step 5: Offering the Service
Now that the pharmacist has addressed the patient’s objections, he is ready to offer the service.
Pharmacist: May I schedule a time for you to come in later this week so we can review your supplements?
Patient: Yes, I think that will work, but how long will it take?
Pharmacist: If you bring all your supplements at the time of the appointment, we can probably finish in about 30 minutes. Then
we can schedule a follow-up appointment to go over my recommendations.
Patient: Okay. Do you have any openings for this Thursday morning?
Pharmacist: Yes, I can put you down at 10:00 a.m.
Case Conclusion
This patient chose to schedule the medication review session, which revealed that none of her supplements adversely affected
her blood pressure. However, she was taking several supplements that were therapeutic duplications. The pharmacist reduced her
use to just two supplements daily, which met her desire to continue using these products while reducing the cost. Also, after
reviewing her medications, the patient expressed concern about the cost of her prescription antihypertensive medication. After
consultation with the physician, she was switched to a generic b-blocker and hydrochlorothiazide.
As a result of using the Pharmacy Check-Up Program, the patient’s blood pressure is better controlled, and her expenses have
been reduced. She and her husband subsequently transferred their prescriptions to Main at Locust Pharmacy, and she has enrolled
in the pharmacy’s Hypertension Clinic Program.

patient history, comprehensive assessment of the patient’s drug
therapy, a set of recommendations for the patient, and copies of the
pharmacist’s work-up and recommendations for the patient and his
or her physician. The benefits of this program include improved
control of the patient’s medical condition and, possibly, medica-
tion dose reductions or other changes and more cost-effective
therapy.
To take advantage of brief encounters with prospective patients,
pharmacists need to be able to describe their services quickly and
clearly. Indeed, A Practical Guide to Pharmaceutical Care8 rec-
ommends that pharmacists learn to describe each patient care ser-
vice in just 15 seconds—the estimated time that most customers
listen with attention. Although it may not always be necessary (or
feasible) to describe a pharmacy service in 15 seconds, the ability
to present services succinctly and confidently is an important skill.
To become adept at describing services to prospective cus-
tomers, pharmacists may find it helpful to rehearse with a col-
league or family member. Ask for honest feedback. Have you
expressed yourself clearly and confidently? Have you succinctly
conveyed the benefit? Another useful technique is to write down
the features and benefits of the service on paper or in the comput-
er. The presentation then can be practiced until the pharmacist
feels comfortable explaining the service to a patient.
Step 4: Addressing Patient Concerns
Inevitably, pharmacists will hear objections from patients when
attempting to sell a pharmacy service.8 Keep in mind that objec-
tions are the patient’s way of indicating that he or she is listening
but need additional information before making a purchase deci-
sion. An initial “no” may simply mean that more dialogue is need-
ed. For example, if a patient states that the service seems too
expensive, the pharmacist may not have made a strong enough
case as to how the service will address the individual’s needs.
Perhaps an explicit need was never identified, or, possibly, the
pharmacist did not demonstrate how the service provides a solu-
tion to the patient’s problem.
It is important not to give up when objections are raised.

368 Journal of the American Pharmacists Association (www.japha.org) May/June 2003 Vol. 43, No. 3
 Personal Selling Skills FEATURE

Regardless of the reason for the objection, most can be effectively
managed using a three-part process:8
1. Acknowledge the objection. This simple feedback mechanism
assures the patient that the pharmacist has heard and understood
the objection. The acknowledgment should be neither apologetic
(“Gee, I’m sorry I have to charge you for this service”), nor defen-
sive (“Well! Other pharmacies charge a lot more for this service
than we do”), nor unnecessarily lengthy. Often, simply stating: “I
understand how you might feel that way” is sufficient.
2. Probe for more information. Politely ask for more informa-
tion about the reason for the objection to ensure a clear under-
standing and help formulate an accurate response.
3. Respond to the objection. Think about the features and bene-
fits of the service as well as the patient’s unique situation. Explain
how the service can address the patient’s needs in a way that
resolves his or her objection and overcomes his or her reluctance
to use the service. Figure 3 shows examples of common objections
to pharmacy services and ways to respond to them.
Rackham17 has suggested that objections can be minimized by
more thoroughly identifying the patient’s explicit needs earlier in
the sales process. Often, objections are raised because the sales-
person has not built a strong enough recognition of need in the cus-
tomer’s mind. Applied to pharmacy practice, this means that dur-
ing the probing stage, the pharmacist may have uncovered the
implied need of the patient but did not use implication and need–
payoff probes to create a strong enough recognition in the patient’s
mind of a need to use a service. By developing their questioning
skills, pharmacists can become more effective at identifying
patients’ explicit needs, a skill that, in turn, may reduce the num-
ber of objections to using their services.
Step 5: O ffering the S ervice
Once all of the patient’s questions or objections have been sat-
isfactorily addressed, the pharmacist can move to the final (fifth)
step in the model—offering the service. In this last step, the phar-
macist tries to obtain a commitment from the patient to use or fur-
ther consider the service. The commitment may consist of the
patient’s agreement to enroll in the service or a request for more
information and some additional time to make a decision. In some
cases, the patient may not see a current need for the service but
may be willing to use it in the future if his or her situation changes.
Developing Effective Listening Skills
Active listening is important for all steps of the personal selling
model. In the context of personal selling, this skill has been
described as “actively sensing, interpreting, evaluating, and
responding to the verbal and nonverbal messages of present or
potential customers.”18
As the term implies, active listening requires work or effort on
the part of the pharmacist, who must remain attentive throughout
the communication process and tune out surrounding distractions.
The pharmacist is advised to listen nonjudgmentally to the content
of what a patient says and ask open-ended questions to clarify con-
tent. The pharmacist should avoid interrupting and allow time for
natural pauses in the conversation. Active listening includes atten-
tion to both verbal and nonverbal cues, because more than half of
all interpersonal communication is estimated to occur through
nonverbal means, such as facial expressions, eye contact, and body
positioning.19

Figure 3. Overcom ing Objections: Som e Comm on Exam ples

Objection I think my doctor should be taking care of this for me.

Acknowledge You’re right to see your doctor for your condition.
Probe Does your doctor have time to educate you about your medications and the lifestyle changes that can help
improve your condition?
Respond As a pharmacist, I’m trained to teach people about using their medications more safely and effectively. Our
service also will help you learn how to make lifestyle changes that may help relieve your symptoms (or
improve your long-term health).

Objection I can’t afford this service.

Acknowledge Many people are having difficulty with health care expenses.
Probe Have you thought about the value of your time and the fact that you may be more productive if your
medications work more effectively and you feel better?
Respond This service may save you money by reducing or eliminating some unnecessary medications. Also, we have
several payment plans that make it easier to purchase this service, such as … .

Objection I’m just too busy.

Acknowledge I understand you have a lot to do.
Probe Have you thought about the possible consequences of not taking care of this problem?
Respond Taking steps to stay healthy and use your medications more effectively can help save time in the long run,
such as by avoiding emergency medical visits. Also, we have some flexibility about when we could schedule
you for the service.

Source: Adapted from Reference 8.

Vol. 43, No. 3 May/June 2003 Journal of the American Pharmacists Association (www.japha.org) 369
FEATURE Personal Selling Skills
Of equal importance, pharmacists need to be conscious of their
own nonverbal cues and convey empathy and concern for the
patient through gestures as well as words.16 When patients sense
that the pharmacist sincerely cares about their situation, they are
more likely to disclose personal information, which, in turn, can
help pharmacists better understand their health needs. This is espe-
cially true when patients are dealing with sensitive health issues,
such as contraception or incontinence, or conditions that can evoke
fear and anxiety, such as cancer or heart disease.
Another essential component of active listening is feedback
between the pharmacist and patient to demonstrate mutual respect
and show sustained interest in the conversation. Pharmacists
should guard against responding to patients mindlessly or auto-
matically. It is especially important to avoid “pseudolistening,” in
which one displays cues that indicate active listening (such as peri-
odically nodding the head or saying “uh-huh”) while, in fact, one’s
mind has wandered from the discussion.
Pharmacists who pseudolisten may miss crucial patient infor-
mation, such as disclosure of a health need that could be met
through a pharmacy service.20 Also, patients may sense that the
pharmacist is not truly interested in what they have to say, reduc-
ing their own interest in the dialogue. Attentive and genuine feed-
back is an important component of the communication process,
helping to establish and continue the relationship between the
pharmacist and patient.21
Active listening means paying attention to the emotions, not just
the words the patient is communicating. A technique called
“empathetic responding” can help pharmacists demonstrate they
have understood not only the content of the patient’s message but
also the feelings that are being communicated. For example, a
frightened patient at Main at Locust recently revealed that his
brother had undergone a diabetes-related leg amputation. The con-
cerned pharmacist responded: “That would be a scary thing to go
through.” Empathetic responding helps put patients at ease
because it lets them know the pharmacist has heard the true mean-
ing of what they have to say—both the content of their words and
the emotions that underlie them.
Mastering the skill of active listening requires practice, espe-
cially given the frenetic pace in most pharmacies, where distrac-
tions can be difficult to tune out. A private or semiprivate coun-
seling area can be invaluable in helping to reduce distractions and
facilitate active listening.
Elements of Success in
Personal Selling
The literature on personal selling identifies a number of profes-
sional and organizational qualities that are antecedents for superi-
or sales performance. The primary elements for successful sales
are customer orientation, service orientation, and adaptability of
the salesperson.22–24
370 Journal of the American Pharmacists Association (www.japha.org)
Custom er O rientation
Customer-oriented salespeople are those who take time to fully
understand and meet their customers’ needs and goals. In the phar-
macy setting, this means being attentive to and empathetic with
patients, taking time to identify their problems and concerns, and
measuring long-term patient satisfaction with services. Research
suggests that customer orientation is the most important element
for developing and maintaining buyer–seller relationships.24
Pharmacists who want to improve their customer orientation
must ensure that they have sufficient time to interact with current
and prospective patients. A useful starting point is to assess the
pharmacy’s workflow to determine what modifications may be
needed to free pharmacists’ time for personal selling and provision
of patient services. Pharmacists also should evaluate the pharma-
cy’s use of computers and other automation to determine whether
updated technology could help to streamline operations and
improve efficiency.
The pharmacy layout should be designed with customer orien-
tation in mind. Pharmacists are advised to walk through the phar-
macy and view it through their customers’ eyes. Does the pharma-
cy convey the impression of a professional health care setting with
visible evidence of the staff’s commitment to health and wellness?
Are employees courteous, attentive to customers, and dressed in
professional attire? Does the pharmacist appear accessible rather
than blockaded within the prescription dispensing area?
As mentioned previously, a customer-oriented pharmacy needs
a semiprivate or private area for patient consultations. The specif-
ic design of the counseling area depends on the scope of services
to be offered and the expected volume of patients. However, phar-
macy redesign need not be expensive, and many resources, such as
A Practical Guide to Pharmaceutical Care,8 offer guidance on
reengineering the layout.
Service O rientation
The second element of successful sales performance is service
orientation, or an emphasis on ensuring service quality. Service-
oriented individuals and organizations take steps to regularly eval-
uate and improve service quality, including using continuous qual-
ity improvement and total quality management techniques. To
measure the quality of their services, pharmacists can evaluate
patients’ health outcomes over time (e.g., changes in glycosylated
hemoglobin levels among patients enrolled in a diabetes care ser-
vice), the rate of patient retention in a service, and/or the quality of
employees’ performance in providing the service.
Main at Locust recently began using report cards to evaluate
employee proficiency in service delivery. For example, if a phar-
macy offers a diabetes care program, a series of patient charts
could be checked to ensure that pharmacy staff routinely per-
formed blood glucose checks, provided patient education materi-
als, and scheduled follow-up appointments. Using this feedback,
service shortcomings can be identified and improved.
Pharmacy managers can use a variety of tools to assess patient
May/June 2003 Vol. 43, No. 3

satisfaction with pharmacy services. For example, a patient satis-
faction survey might be used to solicit participants’ feedback about
a service they have used. To improve the usefulness and quality of
the collected data, pharmacists may want to use a validated patient
satisfaction survey.25 Examples of patient satisfaction surveys
have recently been published elsewhere.6,25
Adaptability
The last element in successful personal selling is the adaptabil-
ity of salespeople—that is, their ability to adjust their communica-
tion styles or the service itself to fit customers’ needs.22,23 Many
pharmacists already are proficient in tailoring their communication
styles to match the needs of specific patient populations, such as
young children, seriously ill patients, or patients with sensory dis-
abilities.
Because of the increasingly multicultural composition of the
United States, pharmacists also need to be attuned to cultural influ-
ences that can affect their own communication styles and those of
their patients.26 Communication styles and nonverbal expressions
vary markedly among cultures. For example, some people may
consider friendly hugging and touching to be signs of warmth
and regard, whereas others find these gestures inappropriate and
intrusive.
Pharmacists who serve patients who speak only (or primarily)
Spanish or a language other than English also may need to adapt
their services to meet the needs of these populations.27 In particu-
lar, strategies need to be in place to overcome language barriers,
such as hiring bilingual or bicultural pharmacy staff (usually the
preferred option) or providing language skills training for existing
employees.
Training Pharmacy Staff to Use and
Improve Their Personal Selling Skills
One issue that commonly arises in pharmacy practice is a nega-
tive attitude among pharmacists and support staff toward personal
selling.28 In the authors’ experience, it can be a daily struggle to
get the pharmacy staff to actively promote services to patients.
Although the reasons for this reticence vary, many pharmacists
feel uncomfortable in their role as service marketers. Others lack
experience with personal selling or have not yet developed suffi-
cient confidence in their questioning or presentation skills.
To help overcome these attitudinal obstacles, Main at Locust
Pharmacy has implemented training programs to help employees
learn to effectively promote the various services. As part of this
training, staff meetings are held to discuss a particular service, dur-
ing which employees are given a one-page summary of its features
and benefits. One of the authors (McDonough) demonstrates how
he promotes the services to patients. Then he assesses how well
other staff members present the service while he plays the role of
a patient.
Vol. 43, No. 3 May/June 2003
Personal Selling Skills FEATURE
It is worth noting that technicians and clerks have played a
major role in promoting pharmacy services to patients at Main at
Locust. In fact, these employees are often the first to pique
patients’ interest in a service. These leads are passed to the phar-
macist, who then provides the patient with more information about
the service and responds to the patient’s objections and concerns.
This team approach to sales (an underused strategy in most phar-
macies) has been shown to be a valuable way to promote services
in other businesses.29,30 Pharmacists are therefore encouraged to
involve all staff members in the promotion of pharmacy services.
Using Personal Selling Skills With
Physicians and Other Stakeholders
Developing collaborative relationships with physicians and
other stakeholders, such as allied health care providers (e.g., dieti-
tians, nurses) or employers, is another critical component of suc-
cessful marketing of pharmacy services.6 Pharmacists can use per-
sonal selling skills to develop these important relationships.
As they do with patients, pharmacists need to succinctly convey
the features and benefits of their services to each stakeholder and
explain how a particular service fills an unmet need. While the fea-
tures of the service remain the same, the benefits that are high-
lighted in the presentation stage may differ from one stakeholder
to the next. For example, when Main at Locust pharmacists pro-
mote the Pharmacy Check-Up Program to physicians, the key ben-
efit emphasized is the provision of an updated patient medication
list that includes prescriptions from other physicians as well as
nonprescription drugs, herbal products, and other dietary supple-
ments. In contrast, when the same service is presented to area
employers, the pharmacist shifts the emphasis to such benefits as
reduced health care costs, improved health care quality, and
increased employee productivity.
Usually, pharmacists need to invest more time in preparing to
call on physicians than they typically do with patients. Unlike
patients, whose visits to the pharmacy are usually unscheduled,
physician meetings can be planned well in advance of the appoint-
ment. The more the pharmacist knows about the physician’s prac-
tice, the more efficiently he or she can use the time with the physi-
cian. Before the meeting, the pharmacist should gather information
about the types of patients seen in the practice, their main demo-
graphic characteristics (e.g., age, sex, income), and the size of the
practice. Becoming acquainted with key support staff in the physi-
cian’s office, such as a receptionist or nurse, also can be helpful for
making appointments with busy physicians and establishing long-
term relationships with them.
If the physician sees value in the pharmacy service and agrees
to refer patients, it is important to send periodic reminders (such as
follow-up letters, fliers, or arranging in-person visits) to the prac-
tice. In the authors’ experience, it often takes some time before
busy physicians remember to begin referring patients to the phar-
macy after they have indicated their intention to do so.
Journal of the American Pharmacists Association (www.japha.org) 371
FEATURE Personal Selling Skills
Conclusion
Although personal selling is a valuable component of success-
ful implementation of pharmacy services, many pharmacists do
not yet feel comfortable in this role. By following the steps in the
personal selling model, pharmacists can use a staged approach to
promote their services to patients. This strategy focuses on identi-
fying patients’ explicit needs and demonstrating how pharmacy
services can effectively address these needs. The skills needed by
pharmacists to implement personal selling—good listening skills,
the ability to ask probing questions, and a relationship orientation
with the patient—are consistent with the principles of pharmaceu-
tical care. By combining personal selling skills with a sound mar-
keting plan, pharmacists can successfully generate demand for
their patient services.
Keywords: Marketing, promotion, personal selling, relationships,
communication skills, listening skills.
Randal P. McDonough, PharmD, MSPharm, and William R.
Doucette, PhD, are both associate professors, College of Pharmacy,
University of Iowa, Iowa City.
Randal P. McDonough is a pharmacist at Main at Locust Pharmacy.
Other than this, the authors declare no financial interests or conflicts of
interest in any product or service mentioned in the article, including
grants, employment, gifts, stock holdings, or honoraria.
Correspondence: Randal P. McDonough, PharmD, MSPharm,
College of Pharmacy, University of Iowa, S513PHAR Pharmacy
Building, 115 S. Grand Street, Iowa City, IA 52242. Fax: 319-353-5646.
E-mail: randal-mcdonough@uiowa.edu.
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1. Hepler CD, Strand LM, Tromp D, et al. Critically examining pharmaceu-
tical care. Presented at: American Pharmaceutical Association Annual
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2. Bluml BM, McKenney JM, Cziraky MJ. Pharmaceutical care services
and results in Project ImPACT: Hyperlipidemia. J Am Pharm Assoc.
2000;40:157–65.
3. Rodriguez de Bittner M, Haines ST. Pharmacy-based diabetes manage-
ment. J Am Pharm Assoc. 1997; NS37:443–55.
4. Kennedy DT, Small RE. Development and implementation of a smoking
cessation clinic in community pharmacy practice. J Am Pharm Assoc.
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5. Giles JT, Kennedy DT, Dunn EC, et al. Results of a pharmacy-based
breast cancer risk-assessment and education program. Pharmacother-
apy. 2001;21:243–55.
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6. Doucette WR, McDonough RP. Beyond the 4Ps: using relationship mar-
keting to build value and demand for pharmacy services. J Am Pharm
Assoc. 2002;42:183–94.
7. McDonough RP, Pithan ES, Doucette WR, Brownlee MJ. Marketing
pharmaceutical care services. J Am Pharm Assoc. 1998;38:667–81.
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9. Schwartz A, Sogol E. The marketing of pharmaceutical services, part 2:
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10. Kotler P, Armstrong G. Principles of Marketing. Upper Saddle River, NJ:
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11. Berkowitz EN. Essentials of Healthcare Marketing. Gaithersburg, Md:
Aspen Publishers, Inc; 1996:6–8.
12. Kotler P. Marketing Management. Upper Saddle River, NJ: Prentice
Hall; 1997.
13. Powers TL, Bowers MR. Challenges and opportunities for personal sell-
ing. J Health Care Mark. 1992;12(4):26–32.
14. McGuire WJ. Some internal psychological factors influencing con-
sumer choice. J Consum Res. 1976;2:302–19.
15. Peter JP, Olson JC. Consumer Behavior: Marketing Strategy
Perspectives. Homewood, Ill: Irwin; 1987.
16. Rantucci MJ. Pharmacists Talking With Patients. Baltimore, Md:
Williams & Wilkins; 1997.
17. Rackham N. SPIN Selling. New York, NY: McGraw-Hill; 1988.
18. Shepherd CD, Castleberry SB, Ridnour RE. Linking effective listening
skills with salesperson performance: an exploratory investigation. J Bus
Ind Mark. 1997;12:315–22.
19. Knapp M. The effects of territory and personal space. In: Essentials of
Nonverbal Communication. New York, NY: Holt, Rhinehart, & Winston;
1980.
20. Meldrum H. Interpersonal Communication in Pharmaceutical Care.
New York, NY: Haworth Press Inc; 1994.
21. Van Servellen G. Communication Skills for the Health Care
Professional: Concepts and Techniques. Gaithersburg, Md: Aspen
Publishers, Inc; 1997.
22. Keilor BD, Parker RS, Pettijohn CE. Relationship-oriented characteristics
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23. Pettijohn CE, Pettijohn LS, Taylor AJ, Keilor BD. Adaptive selling and
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24. Williams MR. The influence of salespersons’ customer orientation on
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25. Larson LN, Rovers JP, MacKeigan LD. Patient satisfaction with pharma-
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2002;42:44–50.
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28. Nigon D. Sales skills for health care professionals: the emotional side of
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May/June 2003 Vol. 43, No. 3

CE Credit
CE Credit
To obtain 1.5 hours of continuing education credit (0.15
CEU) for completing “Using Personal Selling Skills to
Promote Pharmacy Services,” complete the assessment
exercise and CE registration form and return them to APhA.
To take the CE test for this article online, go to
http://www.pharmacist.com/gateway.cfm?redirType=cecity&courseID=6305
A statement of credit will be awarded to respondents
achieving a grade of 70% or better. APhA continuing edu-
cation policy provides you with two opportunities to suc-
cessfully complete this continuing education examination.
Please note that you will not be permitted to submit the
examination a third time. Individuals completing this exer-
cise successfully by May 31, 2006, can receive credit.
The American Pharmacists Association is approved by
the American Council on Pharmaceutical Education as
®
a provider of continuing pharmaceutical education.
APhA provider number for this program is:
202-000-03-231-H04.
Learning Objectives
After reading this article, the pharmacist should be able to:
n Describe the stages of consumer purchasing decisions.
n Review the five-step model for personal selling of pharmacy
services.
n Discuss effective listening skills needed for personal selling.
n Demonstrate the use of personal selling skills through a case
example.
n Cite three common objections to the use of pharmacy services
and demonstrate effective responses.
Assessment Questions
Instructions: CE answer sheets are located inside the back cover of this
issue. For each question, blacken the letter on the answer sheet corre-
sponding to the answer you select as being the correct one. There is only
one correct answer to each question. Please review all your answers to be
sure that you have blackened the proper spaces. To take the CE test for
this article online, go to www.pharmacist.com/education.cfm
1. Which of the following is not one of the five traditional “Ps” of
marketing?
a. Product.
b. Price.
c. Personal selling.
d. Promotion.
Vol. 43, No. 3 May/June 2003
Personal Selling Skills FEATURE
2. Within the marketing plan, personal selling is an integral component of:
a. Product development.
b. Programming.
c. Promotional activities.
d. Positioning.
3. Personal selling includes all of the following except:
a. Initiating dialogue with patients.
b. Pushing a particular service to all patients.
c. Using effective questioning and listening skills.
d. Persuasively presenting a service that meets an explicitly
stated patient need.
4. Which of the following statements is false?
a. Businesses that undertake massive advertising campaigns
tend to have greater organizational commitment to marketing
than those that rely on personal selling.
b. Through effective use of personal selling skills, pharmacists
can become more adept at uncovering patients’ unmet needs.
c. Effective personal selling strategies use probing questions to
identify the explicit and implied needs of the patient.
d. Applying techniques of personal selling to everyday encoun-
ters with patients can help pharmacists attract and retain
patients for pharmacy services.
5. Identify the appropriate order of stages that a consumer typically
goes through before purchasing a product or service.
a. InterpretationÕAwarenessÕIntegrationÕDecision.
b. DecisionÕAwarenessÕInterpretationÕIntegration.
c. AwarenessÕInterpretationÕIntegrationÕDecision.
d. IntegrationÕAwarenessÕInterpretationÕDecision.
6. In which stage does an individual consider the meaning of a service
in regard to his or her situation?
a. Interpretation.
b. Integration.
c. Awareness.
d. Decision.
7. In which stage does an individual synthesize information about the
product or service to form an evaluation or opinion?
a. Interpretation.
b. Integration.
c. Awareness.
d. Decision.
8. Which of the following statements is true?
a. Patients will feel like they are being badgered if pharmacists
continue to remind them of a service that they have declined
in the past.
b. The interpretation stage is when the individual becomes
aware of a product or service through one or more means,
such as advertisement or word of mouth.
c. Typically, patrons go through the cognitive processing cycle
more than once before deciding to use a service.
d. Research has demonstrated that patients’ decisions regarding
purchase of a product or service is relatively stable over time
and that they seldom change their minds.
9. The five steps of the personal selling model are:
a. Assessing information, asking probing questions, asking
need–payoff questions, presenting the service, and address-
ing concerns.
b. Preliminary stage, assessing information, asking probing
questions, presenting the service, and handling objections.
c. Preliminary stage, then asking situation questions, problem
questions, implication questions, and need–payoff questions.
d. Assessing information, asking probing questions, presenting
features and benefits of the service, handling objections, and
offering the service.
Journal of the American Pharmacists Association (www.japha.org) 373
FEATURE Personal Selling Skills
10. The SPIN model includes which of the following types of questions?
a. Situation, problem, implication, and need–payoff.
b. Situation, personal selling, implication, and need–payoff.
c. Service, problem, implication, and need–payoff.
d. Situation, problem, explicit, and need–payoff.
11. “What current medical conditions do you have?” This query is an
example of a _____ question.
a. Situation.
b. Problem.
c. Implication.
d. Need–payoff.
12. Which type of question helps the patient become aware of the true
impact of a health concern on larger issues, such as its effect on over-
all well-being?
a. Situation.
b. Problem.
c. Implication.
d. Need–payoff.
13. The objective of _____ questions is to help patients articulate their
explicit needs with regard to a health problem and focus on possible
solutions.
a. Situation.
b. Problem.
c. Implication.
d. Need–payoff.
14. Which of the following statements is false?
a. Once the patient’s needs have been uncovered and the phar-
macist has identified an appropriate service to address those
needs, the next step is to present the service.
b. Presentation of services should be tailored to the patient’s
specific needs and briefly describe the service’s features.
c. In most cases, it is not necessary to establish the benefit
when promoting a service as long as the features of the ser-
vice have been adequately described.
d. Practicing personal selling skills will help pharmacists to bet-
ter implement their pharmacy services.
15. An effective strategy to respond to objections includes all of the fol-
lowing except:
a. Acknowledging the objection.
b. Probing for more information.
c. Responding to the objection by describing the features and
benefits of a service.
d. Pointing out the fallacy of the patient’s opinion.
374 Journal of the American Pharmacists Association (www.japha.org)
16. Which of the following statements is false?
a. Pharmacists need to pay attention to nonverbal cues when
communicating with patients.
b. Active listening requires the pharmacist to remain attentive
throughout the dialogue with the patient.
c. Approximately one-tenth of all communication occurs
through nonverbal communication, such as facial expres-
sions, eye contact, and body positioning.
d. Feedback is an essential component of interpersonal commu-
nication.
17. Which of the following elements of personal selling seems to be the
most important for developing and maintaining buyer–seller rela-
tionships?
a. Customer orientation.
b. Persuasiveness.
c. Service orientation.
d. Adaptability.
18. Which element of personal selling refers to pharmacists’ ability to
adjust their communication styles or service to fit the customer’s
needs?
a. Empathetic responding.
b. Adaptability.
c. Customer orientation.
d. Service orientation.
19. If a patient objects to the fee for a pharmacy service, which of the fol-
lowing responses is recommended?
a. Apologize for having to charge for the service.
b. Offer a detailed explanation of the numerous reasons the
pharmacy charges a fee for the service.
c. Vigorously defend the pharmacy’s pricing policies and point
out that competitors are much more expensive.
d. None of the above acknowledgments is recommended when
responding to this objection.
20. A technique called _______ can help pharmacists demonstrate they
have heard not only the patient’s words but also his or her underly-
ing feelings.
a. Emotive therapy.
b. Empathetic responding.
c. Pseudolistening.
d. Culturally competent counseling.
May/June 2003 Vol. 43, No. 3