Posted by: Nina Barnett12 FEB 2015
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, 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. 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. 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, 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.
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