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Overview • Within the communication process, numerous barriers exist that may disrupt or even eliminate interpersonal interaction. Given the large number of potential barriers that exist in pharmacy practice settings. Some barriers are rather obvious, while others are more subtle. The key is to identify when barriers exist and then develop strategies that minimize them.
Introduction • As indicated before, the communication process involves five essential elements: the sender, the message, the receiver, feedback, and barriers. Deficiencies in any of these essential elements may cause a breakdown in communication. The message must be clearly sent by the sender and received accurately by the receiver. Feedback that verifies understanding must be related in a clear manner.
The fifth element, barriers, is often overlooked. • Unfortunately, many things seem to get in the way when you try to communicate with someone else. Some issues are rather obvious, while others are not. Some are easily removed, while others are more complex and require multiple strategies to minimize their impact.
Minimizing communication barriers typically requires a two-stage process: • first, you must be aware that they exist. • Second, you need to take appropriate action to overcome them.
A-Environmental Barriers • The environment in which communication takes place is critical in pharmacy practice, and distractions within the environment often interfere with this process. The most barriers in most community practice settings is :
1-The height of the prescription counter separating patients from pharmacy personnel.
These prescription counters exist for three primary reasons: • (1) They provide an opportunity for patients to identify where the pharmacy is located. • (2) They provide an opportunity for pharmacy staff to look over the store area periodically. • (3) They provide a private area in which the staff can work.
Unfortunately, in some situations, patients cannot see pharmacy personnel behind these placed partitions or counters. It is difficult for patients to talk with individuals they cannot even see. These counters may intimidate some patients and inhibit communication because the pharmacist is standing over them. This type of environment may also give patients the impression that the pharmacist does not want to talk to them.
Many pharmacies provide areas where the counter is lower to facilitate pharmacist–patient interaction. Ideally, you and the patient should both be at eye level to enhance verbal and nonverbal communication. This will also help counteract patient perceptions that you are not approachable.
2-Crowd noisy environments: Crowded, noisy prescription areas also inhibit one-to-one communication in many practice settings. Many pharmacies tend to have significant background noise, such as people talking or music playing. These noises interfere with pharmacist’s ability to communicate with patients. In addition, other people may be within hearing range of conversation, which limits the level of perceived privacy for the interaction. Privacy is especially important when patients want to talk about personal matters.
Many community pharmacists have tried to increase the amount of privacy by: A- Use glass partitions or dividers to create the feeling of a private conversation area that is away from common traffic areas. B-Some have installed private or semiprivate counseling areas or rooms. C- Privacy can be enhanced by moving to the end of the prescription counter or by turning away from a busy prescription area and lowering your voice to achieve a more private environment and communicate more effectively.
D-Conversations between pharmacist and colleagues should take place in relatively private environments. pharmacists need to find ways to discuss patient-specific issues about the medication therapy or the general treatment of patients with colleagues out of hearing range of family members due to the sensitive nature of these discussions .
B-Personal Barriers 1-Pharmacist-Related Personal Barriers 2-Patient-Related Personal Barriers
1-Pharmacist-Related Personal Barriers 1• Low self-confidence 2• Shyness: pharmacists with high levels of shyness and anxiety tend to avoid interpersonal communication in most situations, including interactions with patients, physicians, or other health care providers.
3• Dysfunctional internal monologue : Pharmacist may have within himself while talking with others. For example, while you are listening to someone, you may be thinking to yourself about how you want to deal with this situation. You might be thinking, “What in the world is she talking about?”, “How can I get rid of this person?”, or “I’m too busy to deal with her right now.” This internal conversation may limit your ability to listen effectively as you focus on your own thoughts rather than on what the other person is saying.
4• Lack of objectivity: while taking care of patients, pharmacist may be tempted to take on the emotional problems of patients. Pharmacists should separate his role in treating both and they should remain empathetic towards his patients, but not get so involved that he carries their emotional burdens as well.
5• Cultural differences 6• Discomfort in sensitive situations 7• Negative perceptions about the value of patient interaction
2-Patient-Related Personal Barriers 1-Patient perceptions of pharmacists : This is a critical in establishing communication . If patients sense pharmacist as not being knowledgeable or trustworthy, they will tend not to ask questions or listen to the advice being offered. Also, if they perceive that pharmacists do not want to talk with them, they will not approach them and vice versa. • Therefore, pharmacists may need to alter negative patient perceptions by informing patients that they want to communicate with them, and by actually counseling them effectively.
2-Patients’ believes about health care system providers: Patients perceive about health care providers are impersonal and are not concerned about them as individuals but rather as cases or disease states especially if patients may have been treated poorly in the past . If patients have positive feelings toward health staff environment, they will be more willing to talk with them.
3-Patients’ perceptions of their medical conditions: This may also inhibit communication. A-Some patients may believe that their conditions are relatively minor requiring no further discussion with the pharmacists. Thus, they may not seek out information from the pharmacist. B-Some patients may be overly anxious about their conditions and therefore will avoid talking about . Some patients may feel that their physicians would have told them everything about their conditions and their medications. Therefore, there is no need to talk with pharmacists.
C-Many patients think that all the important information is stated on the prescription label. Pharmacists may need to convince some patients that they need to learn more about their medications and that the few moments spent with the pharmacists will be valuable to them later on.
C-Administrative Barriers Most community practitioners are not paid directly for educating or communicating with patients. Counseling services are not included as part of pharmacies’ business plans. Therefore, many pharmacy managers perceive the task of talking with patients as an expensive service and not a high priority. However, studies have shown that many consumers are willing to pay for such services.
Case study A pediatrician phoned two different antibiotic prescriptions into a pharmacy—one for Brian Bentley and one for Brandon Bentley. Unfortunately, the pharmacy assistant did not recognize that two different names were given and did not realize that they were twins. She subsequently typed both prescriptions for Brian (Brandon sounded like Brian to her). The father picked up both prescriptions and gave them both to Brian. Unfortunately, the mother was attending a PTA meeting that night and did not discover the error until the next day. She called the pharmacy and clarified the issue. Fortunately, Brian was not injured by taking a few doses of both antibiotics
- Staffing policies may also inhibit patient counseling. Many pharmacies have reduced the number of staff members who can assist pharmacists. Sufficient staff support should provide more time for the pharmacist to offer enhanced patient care, including patient counseling. Often, when patients need to talk with the pharmacist, they must first mention it to the assistant, who then relays the message to the pharmacist. In some situations, the pharmacist then responds to the assistant (rather than directly to the patient), who then passes the answer on to the patient.
Obviously, this is not the best method of communication, because both the question and answer can be misinterpreted by any of the three parties. Mechanisms that allow patients to have ready access to the pharmacist need to exist. Support staff needs to be aware of situations where patients need to talk with the pharmacist. Training of staff is a crucial component to enhancing patient care. Case study describes an actual pharmacy practice experience resulting from a breakdown in administrative policies resulting in the assistant and the pharmacist not double checking the name of the intended patient or checking the identity of the patient when the prescription was picked up.
D-Time Barriers • Choosing an inappropriate time to initiate conversation may lead to communication failure. • Many pharmacists make efficient use of time during brief counseling encounters by “highlighting” information within the written information to emphasize key points before the patient leaves the pharmacy.
The timing of the interaction is critical, since both parties must be ready to communicate at a given time. • For example, a woman who just came from a physician’s office after waiting for three hours with two sick children may not be interested in talking with you or anyone else. The most important thing on her mind is to go home, get her kids to bed, and then relax. She is probably not in the best frame of mind to sit down and have a meaningful conversation about her children’s medications.
By the same token, you may not be in the best frame of mind to interact with this mother. You may be dealing with multiple issues: A physician is waiting on the phone, a large number of prescriptions need to be filled in the next hour, and you need to go to the rest room. You may feel that this is not a convenient time to talk to the mother and only give the mother basic information to get the therapy started or to have written information that can reinforce a short message during busy situations.
In addition to the communication barriers discussed, some communication habits can interfere with your ability to listen well. • 1-Trying to do two things at once makes it evident that patients do not have your full attention. • 2-Planning ahead to what you will say next interferes with actively trying to understand the meaning of patients’ communication. • 3-Jumping to conclusions before patients have completed their messages can lead to only hearing parts of messages—often pieces that fit into preconceived ideas you have. • 4-Focusing only on content, judging the person or the message as it is being conveyed, faking interest, communicating in stereotyped ways—all cause us to miss much of the meaning in the messages people send us.
