COUNSELLING

Communication skills-role of the

pharmacists in giving advice and
information

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 State true or false
1. Counselling is not a lecture
2. Patients should not be given the opportunity
to ask questions.
3. As such counseling can be done in any way.
4. A busy setting is a barrier to effective
communication.
5. The extent to which patients should be told
about side effects will vary from one patient to
another.
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 Communication skills
• 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.

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 Communication skills
• Elements of successful communication:

assumptions and expectations

Demeanour
Tone of speech, accents and common expressions
Listening skills
Questioning skills
Patterns of behaviour in communication
Empathy
Barriers to communication
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 Objectives
• The rationale and need for counselling
• What is counselling
• Assessing the need for counselling
• How to decide on the content and method of
counselling
• Aids to counselling
• How to counsel
• Stages in the counselling process
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 Definition
• “Counseling is the process of giving and
receiving information in a way that is
meaningful, memorable and usable, changes
behavior and facilitates a successful
rehabilitative outcome.”

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 Definition
• The sympathetic interaction between
pharmacists and patients, which may go
beyond conveyance of straightforward
information about the medicine and how and
when to use it.

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 Definition; BNF
• Counselling needs to be related to the age, experience,
background, and understanding of the individual patient. The
pharmacist should ensure that the patient understands how
to take or use the medicine and how to follow the correct
dosage schedule. Any effects of the medicine on driving or
work, any foods or medicines to be avoided, and what to do
if a dose is missed should also be explained. Other matters,
such as the possibility of staining of the clothes, or skin by a
medicine should also be mentioned. For some preparations
there is a special need for counselling, such as an unusual
method or time of administration or a potential interaction
with a common food or domestic remedy.
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 The need for counselling
Slides (8-13)

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 What do Patients Remember?

• Patients and family members remember unimportant

details such as the color of the doctor’s shirt or the
kind of glasses he or she wore. They always vividly
remember the date and can describe the trip to the
hospital in explicit detail, but they usually fail to retain
any of the important information.

• Luterman DM (2001). Counseling Persons with Communication Disorders and their

Families. (4th ed.) Austin: Pro-Ed
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 What do Patients Remember?
• Physicians’ impressions of what patients would
remember were not correlated with measures of
patients’ actual recall (Anderson et al., 1979). This
finding reinforces the need to provide information in
writing even for patients who appear to be absorbing
everything.
• Anderson JL, Dodman S, Kopelman M, Fleming A (1979). Patient information recall
in a rheumatology clinic. Rheumatol Rehabil 18:18-22.

• Of the information that is recalled, about half is

remembered incorrectly
• Anderson JL, Dodman S, Kopelman M, Fleming A (1979). Patient information recall
in a rheumatology clinic. Rheumatol Rehabil 18:18-22
• Kessels RPC (2003). Patients’ memory for medical information. J Roy Soc Med
96:219-222.

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 What do Patients Remember?
• Overall studies indicate that about 50% of
information provided by healthcare providers is
retained
• Shapiro DE, Boggs SR, Melamed BG, Graham-Pole J (1992). The effect of varied
physician affect on recall, anziety, and perceptions in women at risk for breast
cancer:an analogue study. Health Psychol 11:61-66.

• Depending on conditions, 40-80% can be forgotten

immediately
• Kessels RPC (2003). Patients’ memory for medical information. J Roy Soc Med
96:219-222.

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 What do Patients Remember?
• A study of recall of information presented during an
informed consent process preceding elective surgery
found that 25% of the information was correctly
recalled

• Godwin Y (2000). Do they listen? A review of information retained by patients

following consent for reduction mammoplasty. Br J Plast Surg 53:121-125

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 What do Patients Remember?
• Thompson, Cunningham, & Hunt (2001) concluded
from their study of information retention following
an orthodontic consultation “that verbal information
should not be given to patients unless supplemented
by written and/or visual information” (p. 169).
• Thomson AM, Cunningham SJ, Hunt NP (2001). A comparison of information
retention at an initial orthodontic consultation. Eur J Orthod 23:169-178.

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 The aims of counselling
• Provision of advice
• Encourage patients to identify any problems they
perceive with medicines and also any solutions to
these problems.
• Encourage patients to develop their own action
plan for taking/using medicines correctly.
• Gain an understanding of the patient’s perspective.
• Respect the patient’s beliefs and be non-
judgemental of their use (non-use) of medicines.
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 Opportunities for counselling
• On admission
• Needs assessment
• Pharmacist-often the last health care professional
whom patient sees before starting drug therapy
(discharge).
• At the end of dispensing process
• Sale of medicine
• Community pharmacy
• Hospital pharmacist – adv is have more patient
information
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 How to counsel
• Thoughtful and structured way
• Both knowledge and communication skills
• Use patients language
• Know which questions to ask and how
• A two-way process
• Create ample opportunity for patient to ask
questions
• Be a good listener
• Use comprehension aid
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 How to counsel:
Stages in the counselling process
• Recognizing the need for counselling
• Assessing and prioritizing the needs
• Specifying the assessment methods to be used
• Implementation
• Assessing the success of the process

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 Stages in the counselling process
Recognizing the need for counselling
• Has the medicine been prescribed before for
the patient?
• Are the instructions clear?
• Is the prescription for drugs that have a
complicated or unusual regimen?
• For e.g. Antacid and enteric coated tablet

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 Assessing and prioritizing the needs:
• counsel only those who require
Illiterate: pictogram

• The average number of facts which can be

retained at any one time by most individuals is
three.

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 Specifying the assessment methods to be used

• Check that the patient can read the label, use

an inhaler device or open a container with a
child-resistant cap
• Follow-up

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 Implementation :
• appearance of pharmacy
• How the pharmacist appears is also of importance.
• An organized, calm person is more likely to instil
confidence in the patient than a pharmacist who
appears distracted, harassed and unsure of
himself.
• Patients should be given an indication of why you
wish to speak to them and you should always
check that they have the time to listen.

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 Assessing the success of the process

• Just telling things non-stop is just a waste of

time if patient does not understand.
• Watching the patient’ body language and
maintaining eye contact can give useful clues
as to whether the message is being
understood and whether compliance is likely.

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 Class work:
Case: stages in counselling process
• Mrs Koirala, a lady of about 70 years, presents
a prescription for diclofenac sodium 25 mg
tablets. She has lived alone since the death of
her husband, 2 years ago. When she is signing
the back of her prescription she has difficulty
holding the pen and complains that her hands
and fingers are rather sore and stiff and hopes
that the prescription will help. This is the first
time she had these tablets.
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 What information to include in counselling

• How to take
• When to take
• How long to continue
• What to expect, e.g. immediate relief, no effect for
several days
• What to do if something goes wrong, e.g. if a dose is
missed
• How to recognize side-effects and minimize their
incidence
• Lifestyle and dietary changes that need to me made
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 Some drugs and the type of side-effects
that can occur
• Manage
Drug Side-effect precaution
Biphosphonates Oesophageal Stand or sit upright for 30
reactions minutes after taking the tablet
NSAID’s GI disturbance Take after food
chlorpromazine photosensitivity Use sunscreen

• Warn patient
Drug Side-effect precaution
CNS Drug’s Drowsiness
Co-beneldopa colour urine
chlorpromazine photosensitivity Use sunscreen

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 Some drugs and the type of side-effects
that can occur
• Monitor
Drug Side-effect precaution
chlorquine Ocular Ocular tests

• Needs immediate reporting

Drug Side-effect
Aminisalicylates bleeding
Gold therapy Sore throat, breathlessness, rashes

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 Who to counsel
• Not every body. Pharmacist need to identify the patient
requiring it. On the basis of :
• Consideration of the medicine
- If the prescription has multiple medicines, multiple
dosage forms, cmplex dosage regimen
- With narrow therapeutic index
- Has potential side effects
- Durgs with potentiality of interaction with other drugs
or food
- Drugs mentioned in BNF that requires counselling.
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• Consideration of the patient
- Elderly requires special advice
- If patient is child den the parents need to be counselled
- Patient with physical disability like hearing, vision problem
- Anxity
- Level of comprehension., pictogram for illiterate.
- Level of support
- Forgetful
- Pregnant or breast feeding
- The level of advice the patient has received earlier
- Patient asking prescription item not to be dispensed.
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 Privacy and confidentiality
• Respect peoples private life
• Separate counseling room

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 Aids to counselling
• Patient information leaflets, warning cards and placebo
devices.
• Placebo devices: inert medication. Eg. Placebo inhalers,
patches to demonstrate the technique of using the device
• Warning cards for anticoagulant therapy, lithium,
monoamine oxidase inhibitors and steroids
• Patient information leaflet:
on how to use eye drops, ointment, suppositories are
available.
Should be available in all pharmacies, hospital and any other
counselling places.
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 Minimum requirement for label
• Generic name & strength of medicine
• Dose, frequency & duration of course, if applicable
• Date of dispensing
• Name of patient
• Name/address of supplier
• Child safety warning

“Good pharmacy practice in community and hospital pharmacy settings”,

FIP, 1992

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 Benefits of Dispensing Labels
 Fast and correct counseling with less skilled staffs.

 Uniformity in counseling

 Information read immediately before administration.

This increases compliance and reduces errors.

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