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Published on 16 October 2015

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Bedside manner: not just for doctors any more*

 

 

Pharmacists’ unique role in healthcare is vital for proper communication, exchange of information, trust and respect among other healthcare professionals and patients; forming what is referred to as a Triad Relationship
Mindy Cormier PharmD RPh
Compounding Pharmacist Medisca Network, Las Vegas, USA
The term ‘bedside manner’ is one that is surely very familiar with each and every one of us. However, historically this term has only been used to reference a doctor’s ability to engage and communicate with their patients. While a doctor’s capability to effectively connect with their patients is extremely important, it is not the only relationship that benefits from this ideology; a pharmacist’s communicable skills among both patients and prescribers are not only important but are essential in developing and maintaining a trusting relationship.1–4
Unfortunately, the only guidance pertaining to communication skills that most pharmacists receive is in regards to patient counselling. The idea of being able to use “Layman’s terms” when counselling patients is highly stressed; nothing beyond this notion seems to be addressed. Instead, what needs to be emphasised is the importance of being able to know your audience, effectively tailor the conversation and develop interprofessional relationships. Pharmacists are one of the most accessible health professionals and are also quickly becoming a primary source of information for both prescribers and patients.5,6 With the rapidly evolving role in healthcare, pharmacists have the ability to serve as an important mediator, not only between patients and prescribers, but other health professionals as well.7 It is imperative now, more than ever, for pharmacists to realise the need for proper communication skills in order to successfully develop and maintain these primary relationships.2
Triad Relationship 
Forming and securing relationships among pharmacists, patients, and other heathcare professionals are of the utmost importance, and the Triad Relationship is the linking of all three together (Figure 1). This relationship allows for channels of communication to be open based on trust and respect.3,7 In order to get there, pharmacists have the opportunity to create the foundation to the triad and close the loop. This requires active participation and initiation on the pharmacist’s part in order to successfully engage all involved parties to deliver the highest quality of healthcare.8
Healthcare professional connection 
When questions regarding prescription dosing or therapeutic concerns arise, it is becoming standard practice for faxes or emails to be exchanged instead of a personal phone call. As advances in technology provide conveniences, it undoubtedly has aided in the loss of a personal connection. Loss of personal connection can sometimes be even greater for those pharmacists working in institutional pharmacies such as hospitals, long-term care facilities, etc.  More often than not, the pharmacists work in the basements or other areas remote from the main hospital floors or in a separate closed-door facility further isolating pharmacists from face-to-face communications other than those by pharmacy personnel. As roles in healthcare in general are consistently changing, in addition to prescriber connections, affiliated healthcare professionals would also benefit from personal relationships with pharmacists, such as those in the institutional environment; nurses, dieticians, physical and respiratory therapists, for example, all interact with patients. Personal connections with other healthcare professionals’ aid in building positive reputations, strengthens the ties of communication and forms a mutually beneficial relationship for the wellbeing of the patient.2 The following key aspects are crucial to establishing a connection and forming a professional relationship between the prescriber and affiliated healthcare professionals:
  • Get to know the prescribers in your area
  • Relate and establish trust
  • Provide accessibility
  • Exhibit best practices
Get to know other healthcare professionals for enhanced pharmaceutical care 
Pharmaceutical care, at its most efficient, is the active cooperation by a variety of hospital and community pharmacists, physicians, nurses and other professionals.9 Not only do pharmacists have to communicate with one another but, they need to communicate and establish relationships with prescribers and other healthcare professionals, in order to provide the most enhanced pharmaceutical care to the patient.
Getting to know prescribers starts with those you most commonly fill prescriptions or hospital orders for but also needs to extend beyond that. Identify the type of prescriber they are, as prescribing privileges are not exclusive to doctors any  more – nurse practitioners, physician assistants, naturopaths etc. also are prescribers that need to be recognised and addressed. Researching the prescribing practices and specialties of the prescribers will aid pharmacists in initiating any needs of the practice that can benefit from pharmacist assistance as well as help to guide conversations.
In addition to getting to know and establish relationships with prescribers, knowing other healthcare professionals and their roles in patient care are also crucial, especially in institutional care, where interprofessional relationships are imperative for enhanced collaborative care.10
It is also important for pharmacists to inform prescribers and other healthcare professionals of any specialties or certifications that they hold. This helps identify niches specific to a prescriber’s practices and aids pharmacists to determine how to customise services to better form a mutual, beneficial relationship. Informing prescribers and other healthcare professionals of your specialty services and certifications, such as the following, engages conversation and an exchange of information:
  • Diabetes management
  • Infectious disease
  • Immunisation services
  • Medication therapy management (MTM) services
  • Compounding services
Healthcare is an ever-changing field and by showing prescribers and other healthcare professionals you play an active role to the changing needs, of not only their practice but their patients as well, shows a desire to adapt and relate, thereby setting the stage for establishing trust.11
Relate and establish trust 
Relating to and establishing trust is often easier said than done. So, how can pharmacists successfully achieve this notion? It has been mentioned that pharmacists are becoming a primary resource; one reason is that a professional relationship and trust has been established.5 Pharmacists need to remember the importance of the vast amount of knowledge that they possess; not just the ability to recite information off the top of their head, but the ability to know where to find sources of information for answers unknown. Ensuring validity behind recommendations needs to be based on findings from scientific literature that can be easily cited and or provided to prescribers as warranted.12 If there is a lack of scientific studies or literature, it is important for pharmacists to use their pharmacological, physiological, and therapeutic knowledge in assessing anecdotal recommendations and information.13 It is also not only important but crucial to explain the rationale and reasoning for your recommendations as opposed to just simply giving an answer, as most will appreciate the train of thought used. This not only highlights expertise but the ability for critical thinking and reasoning skills, which further reinforces validity behind all information and recommendations.
Provide accessibility
It is very important for pharmacists to be accessible to other healthcare professionals and to make their accessibility known. It is also crucial to prioritise and instil the notion of professionalism and courtesy. Timely responses back to questions or inquiries, visits to prescribers and other healthcare professionals in person such as co-attendance during rounds or visits to pertinent departments, as well as shortened phone hold times, shows respect, which is mutually reciprocated.14 Pharmacists need to reassure prescribers that they are there to work with them – not against them – for a collaborative practice approach.2,9,11
Exhibit best practices
As it has been mentioned before, word spreads very quickly in the healthcare community, both negative and positive. Exhibiting best practices is ensuring that you hold yourself to the highest standards as it relates to your practice and making it known. By sharing with prescribers the standards you hold yourself to and follow, as well as the measures you take to ensure quality and validity of therapeutic care, not only strengthens trust and reliability in your services but also aids in establishing and reinforcing a positive reputation in the healthcare community.
Patient connection 
Pharmacists see several patients a day, even as high as in the hundreds. Institutional pharmacists may see hundreds of prescription orders but may have a lack in face-to-face contact with patients. Times have changed, but patient connection shouldn’t be one of them. Personal attention, no matter how little, really does go a long way.7 One way of initiating and executing personal attention, no matter how brief or extensive, is the notion of PLAE:
  • Privacy
  • Listen
  • Ask
  • Educate
Provide privacy for the patient 
Privacy is extremely important for patients. While it may seem some patients have no issue in disclosing their personal medical history or conditions to all in earshot, the majority of patients are very private and may even be too shy to openly discuss all their concerns. Pharmacists can help alleviate patients initial reservations by establishing an area for privacy – whether it is a designated area or a private counselling room in an outpatient pharmacy or by assisting in bedside rounds or visiting patients in their hospital rooms prior to discharge.10 By clearly demonstrating that patient privacy is valued and respected, the initial foundations for trust have been set.15
Listen to the patient 
Pharmacists have the ability to greatly influence medication adherence and educate patients.16 Counselling extends far beyond simply informing patients on how to take their prescribed medication. Counselling involves listening to the patient – their needs, concerns, and questions – and the ability to address all that are expressed.17 Pharmacists need to remember that every patient has different needs. Some are very independent and need little guidance, while others may require more attention. Some patients may be overwhelmed with medical jargon and, yes, this is where Layman’s terms will come into play. Remember, however, that some of your patients may also be a healthcare professional themselves. After all, we are all patients at one time or another.
Ask the patient pertinent questions 
After listening to your patients, you must ask pertinent questions that weren’t discussed. Details that might seem irrelevant to the patient may very well be extremely important and crucial for determining proper care, identifying possible interactions, or recommending lifestyle modifications. Asking if they have sought any medical attention/information from other healthcare professionals, as well as relevant personal history such as job or educational background, will aid in determining how to alter the conversation to best suit the patient and better relate to their needs. Asking questions and explaining to patients the necessity of the questions helps to educate the patient.
Educate the patient 
As mentioned before, patient education extends beyond prescribed medication counselling. Education is also informing patients of the importance of open lines of communication between themselves, pharmacists, physicians and other healthcare professionals; patients need to disclose all pertinent information to all practitioners for proper safety and efficacy of treatment.17
Conclusions
Pharmacists indeed play a unique role in healthcare; one that is integral for proper communication and exchange of information among prescribers, other healthcare professionals and patients to form the Triad Relationship. The success of the Triad Relationship is largely based on the pharmacist’s ability to adapt and effectively tailor lines of communication, reinforce validity behind information and recommendations, maintain privacy, and establish reputation based on trust. Word spreads quickly in the healthcare community; those pharmacists that reach to achieve and maintain Triad Relationships help to ensure that pharmacists will continue to remain among the most trusted professionals.18
*Originally published in full length in the International Journal of Pharmaceutical Compounding Mar/Apr 2015;19(2):115–8.
Key points
• A pharmacist’s communicable skills among both patients and prescribers are not only important but are essential in developing and maintaining a trusting relationship.
• With the rapidly evolving role in healthcare, pharmacists have the ability to serve as an important mediator, not only between patients and prescribers, but other healthcare professionals as well.
• Forming and securing relationships among pharmacists, patients, and other healthcare professionals are important, and the Triad Relationship is the linking of all three together.
• Healthcare is an ever-changing field and by showing prescribers and other healthcare professionals you play an active role to the changing needs of their patients, shows a desire to adapt and relate, thereby setting the stage for establishing trust.
• Pharmacists need to remember the importance of the vast amount of knowledge that they possess.
References
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  3. Ozawa S, Sripad P. How do you measure trust in the health system? A systematic review of the literature. Soc Sci Med 2013;91:10–14.
  4. Dueñas GG, Pringle JL. Physician perceptions of pharmacist-provided medication therapy management: qualitative analysis. J Am Pharm Assoc 2010;50:67–71.
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  9. Hepler CD. Clinical pharmacy, pharmaceutical care, and the quality of drug therapy. J Human Pharmacol Drug Ther 2004;24(11):1491–8.
  10. Makowsky MJ et al. Collaboration between pharmacists, physcians and nurse practitioners: a qualitiative investigation of working relationships in the inpatient medical setting. J Interprofess Care 2009;23(2):169–84.
  11. 10Rubio-Valera M et al. Factors affecting collaboration between general practitioners and community pharmacists: a qualitative study. BMC Health Serv Res 2012;12(1):188.
  12. Hojat M et al. Psychometrics of the scale of attitudes toward physician–pharmacist collaboration: A study with medical students. Med Teach 2012;34(12):e833–e837.
  13. Byrd GD. Can the profession of pharmacy serve as a model for health informationist professionals? J Med Libr Assoc 2002;90(1):68.
  14. Thomas EJ, Sexton B, Helmreich RL. Discrepant attitudes about teamwork among critical care nurses and physcians. Crit Care Med 2003;31(3):956–9.
  15. Gidman W, Ward P, McGregor L. Understanding public trust in services provided by community pharmacists relative to those provided by general practitioners: a qualitative study. BMJ Open 2012;2(3):e000939.
  16. Mansoor SM, Aslani P, Krass I. Pharmacists’ attitudes and perceived barriers to provision of adherence support in Australia. IJCP 2014;36(1):136–44.
  17. Vermeire E et al. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther 2001;26(5):331–42.
  18. Pharmacists Ranked as Second Most Trusted Profession in Annual Gallup Poll. – News. National Association Boards of Pharmacy, 31 Dec. 2014. Web. 20 July 2015.


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