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Making our patients feel cared for

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By Nina Barnett, Lesley Grimes and Barry Jubraj

“People don’t care how much you know until they know how much you care”. This is a quote from the former American President, Theodore Roosevelt. You will see it quoted many times by doctors, but if you search for it online together with the word ‘pharmacist’, a single result pops up. What does this say about our profession? Are we focused on demonstrating what we do rather than how much we care? 

While pharmacists are not alone in not being able to understand what their patients are thinking[1], are we living up to the narrative in the press about providing patient-centred care? Sadly, each one of us has had experiences where our concerns and circumstances have been glossed over. How did it make us feel? Sometimes under-valued, often patronised and mostly, not cared for. For all our professional efforts, our experiences are that care certainly wasn’t centred on our needs.

You might say that, as health professionals, we are empowered to work out what we need for effective care anyway but where does that leave other patients? So, how can we improve what we do, especially given the time constraints of many of our jobs? We must find a way to embed empathy in every pharmacist’s practice in order to improve the way we care for patients.

If you take a moment now, do you think we are any more patient-centred than, say, 10 years ago? Are we really moving away from the notion that we are simply responsible for ‘telling’ the patient everything they need to know about their medicine?

If the quote from President Roosevelt is true, then our experience as patients suggests that we have a long way to go, and an urgent change in attitude is needed. Think about the recent high profile campaign by Kate Granger - the ‘Hello, my name is’ work is a shocking indictment of how little health professionals demonstrate common civility to patients. 

So, what’s the solution? The first is to tackle that recurring elephant in the room; “I haven’t got time”, the perceived barrier to being empathic. It’s easy to understand how our advice-giving role has evolved. We are concerned about medicines safety. What if we forget to tell a patient something and it all goes wrong? Whose fault is that?

We contend that the “telling” approach, even if it is quicker, simply no longer cuts it with many patients and the research supports this. Patients don’t always get an opportunity to ask questions and pharmacists can often sidestep the deeper issues raised by patients[2]. If we move into the advice-giving role this can show a disregard of the patient’s perspective and may lead to patient’s feeling patronised and unaccepting of advice[3]. Worse, still, patients might ‘switch off’ and then ignore our safety messages.

If time is a barrier to changing the things, we have to act differently in consultations and that starts by changing how we are. Patients are people with lives, homes, concerns, celebrations and illnesses, where medicines, if fitted into their lives, can improve their health and well-being. Once we acknowledge this we can start to build rapport with patients through listening, which we appear to do poorly[4], rather just speaking. By asking patients what they want to know, we can support them to be better equipped to manage their medicines because they’ve had the conversation they needed with us.

When we hear the word empathy what usually springs to mind is responding to a piece of sad or difficult news from a patient. This is one example of empathic behaviour but it can also be more subtle. It is about putting yourself in the patient’s shoes, trying the see the world through their eyes. It means that you can start to see what medicines taking means for them, so you can support them in incorporating it into their lives on their terms. It’s about facilitating a conversation that enables disclosure, so they can ask what really matters to them about medicines and this will help to support better health outcomes. When we, or the patient, are short of time, we can demonstrate empathy by just sharing our name and a smile and through a simple enquiry after the patient’s well-being.

In the same time you would normally use to give instructions, which many can read or be signposted to read later, try asking:

“how are you getting on with your medicines?”

“what would you like to ask me about your medicines?”

“is there anything that worries you or concerns you about them that you want to chat about now”?

Some conversations will take longer, but not all. For some patients we will be giving them their first opportunity to volunteer and share their information. Surely that is what we call patient-centred care, where we can still maintain our responsibility to make sure medicines are safe for patients but take a different approach to offer patients the opportunity to tell us what they want from us.

What can you do to put yourself in the patient’s shoes? NHS England has reported that “the compassion in care campaign hits new milestones” citing the “hello my name is” campaign as an example. Patient-centred care and in particular empathy is under the microscope for medicine and pharmacy. To address this, the forthcoming update of the Centre for Pharmacy Postgraduate Education package on consultation skills will support our profession in exploring empathy in more detail. We encourage every pharmacy professional to take a look.  We have nothing to lose and our patients have everything to gain: let’s show them that we care so they can gain from what we know.

Nina Barnett is a consultant pharmacist for older people, London North West Hospitals NHS Trust & NHS Specialist Pharmacy Services. Lesley Grimes is a lead pharmacist, Learning Development Centre for Postgraduate Pharmacy Education. Barry Jubraj is an honorary associate professor, Chelsea & Westminster Hospital NHS Foundation Trust & UCL School of Pharmacy.  

References                                   

[1] Snow, R. Editor’s Choice. Do you know what your patient is thinking? British Medical Journal. 2015; 350;1.

[2] Latif A, Pollock K, Boardman HF. The contribution of the Medicines Use Review (MUR) consultation to counseling practice in community pharmacies. Patient Education and Counseling. 2011; 83:336–44

[3]Salter C, Holland R, Harvey I et al . ‘I haven’t even phoned my doctor yet.’ The advice giving role of the pharmacist during consultations for medication review with patients aged 80 or more: qualitative disclosure analysis.

[4] Greenhill N, Anderson C, Avery A, Pilnick A. Analysis of pharmacist-patient communication using the Calgary-Cambridge guide. Patient Education and Counseling. 2011; 83:423–31.

Readers' comments (7)

  • Thank you for a thought provoking blog. I agree whoeheartedly about the importance of empathy in the patient consultation. It's a way of being, not restricted to sad or distressful situations but in helping individuals to feel like a person rather than patient. There's something in it for use too! Remembering to say "Hello, my name is.. and my role is..and I'm here to help you with... " can transform the patient's attitude towards us and make them more helpful and friendly. Encouraging dialogue and disclosure facilitates patients playing their part in managing their care and solving medicines related issues. Two heads are better than one as the saying goes. So the return on investment of a little empathy is having nicer people to talk with, a helper in our consultations and better patient outcomes in the same time it takes to talk at the patient rather than with. Empathy - it's a yes from me.

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  • I remember some wise advice I was offered early in my career, that a patient will always remember how you made them feel, even if they don't always remember all the details of the conversation. I have found this to be true in work and in life in general.

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  • It is interesting that it took a health care professional experiencing healthcare as a patient to highlight how important care is, and how easy it is to show care saying hello my name is ... but also how easy it is to be lacking in empathy and belittle or ignor patients needs. I was 'patient' this week trying to get eczema cream for my son following a delay at the surgery, I was told that he only needed a cream, that it was not a medicine and that it was not important. I felt angry and uncared for. What is needed to change this? Appropiate skill mix, motivated teams, education of staff ... and empathy ...treating everyone with repect.

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  • The 'short of time' argument that I hear a lot is interesting. As healthcare professionals we will always be short of time - so surely we would prefer to use the time that we do have achieving the best outcomes possible from the consultation. Why then waste time 'telling' a person what they already know and switching them off? By demonstrating empathy and showing interest in finding out what the person already knows, you will engage them in the consultation, so that the 'short time' you do have results in transference of the most useful and effective information possible - for both parties. After all, whose consultation is it anyway?

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  • I'm frequently moved to grumble about poor service in a restaurant when the wait staff appear to know little about the menu, being all but ignored at a supermarket checkout, or being patronised by the mechanic when my car needs a repair. I've consciously changed my choice of restaurant / supermarket / garage as a result of poor service and sometimes wondered about those industries as a whole on the basis of one of their ambassadors. It isn't hard to imagine that our patients (and their carers) might feel the same about our profession unless we take time to care.
    Time is often cited as a barrier, and often with justification, but a little investment in time can pay dividends in the long run. Patients I've spent time talking with in the past have phoned to ask advice or for another medication review, rather than just stop taking their medicines. Having said that, resourcing of services does need to take some account of the additional time that's required to provide good patient-centred care, particularly where that time might generate system-wide benefits.
    In the meantime we must do what we can with what we've got and ensure that we take an interest in our patients' wants, needs and understanding to lay the foundations of a powerful relationship in the long run.

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  • Great stuff, Nina (as always!)
    I think we're singing from the same song sheet:
    www.health.org.uk/blog/patient-engagement-we-need-to-live-it-not-talk-it
    Excerpt: "It’s simply about becoming people again. It starts with basic things like ‘Hello, my name is...’ (hats off to Kate Granger). Names are part of what make us human. The most successful encounters over my past six days as a carer/parent/patient started when the staff members introduced themselves. When you say your name, you usually smile. This personal information and associated positive body language gets the whole conversation off to a great start."

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  • I find this 'conversation' really interesting, especially considering patient-centred care with childred (child-centred care maybe?!).
    I often find it difficult to overcome the parent at the bedside in order to include the child who is in the bed.
    I have found children more receptive since I changed my practice by not standing at the end of the bed and actually approaching the child and asking them the questions. It's not true what they say, children should be seen AND heard.

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