Mind the gap between your clinical perspective and the patient’s perspective

At university, we were taught which counselling points were important to highlight to patients during consultations. However, little consideration was given to patient perceptions and beliefs about their medications. I believed patient adherence was improved solely through medicines information — if a patient received education from a drug expert, they would listen and obey as instructed. But this is rarely the case!

Regardless, I carried this belief with me into my preregistration training. When handing out prescriptions, I would undertake what I thought was the standard way of working. I would begin with the necessary safety checks, clarify whether the patient had taken the medication before, counsel them on the dose and frequency, and inform them of any serious side effects to be aware of and when to seek medical help. I would give the patient an opportunity to ask questions and end the consultation. On the wards, I would follow a similar process for taking drug histories.

However, a couple of months into my preregistration year, I met Nina Barnett, a consultant pharmacist working with older people who introduced me to the concept of ‘health coaching’. I wasn’t familiar with the term or what a coaching approach entailed, but I discovered a method that encourages patients to be active participants in their own health through goal setting and behavioural change techniques. The coaching approach focuses on reducing health risks, and improving patient self-management and health-related quality of life. It utilises professional practices and health psychology to optimise the management of conditions. I was intrigued, and with support from Nina, I identified a number of opportunities to develop skills in this area.

I reflected on how I approached patient consultations and identified gaps in my practice. In particular, the divide between clinical and patient perceptions. I recognised the need to manage the gap by better understanding the patient’s perspective to provide holistic care.

I made simple changes to determine what patients wanted from pharmacist interactions and how I could best help them. I recognised that building rapport was crucial when encouraging patients to make fully informed medication-related decisions to maximise health outcomes.

The benefit became evident while eliciting a drug history from an elderly patient. Previously, I would ask for a list of his medicines and check the summary care records, which required little patient input. Instead, we engaged in an open discussion where I asked him how he would like to go about the consultation, explaining that I wanted to confirm my list was accurate. He chose to list each medicine, using his own to demonstrate. I realised that my initial assumptions about him being unable to provide an accurate list were misguided. I realised how independent he was with his medicines and his wellbeing in general. He was very happy to be given that control and thanked me many times. This has now encouraged me to ‘mind the gap’ when speaking to all patients. Interestingly, the consultation took the same amount of time as before.

Through this experience I have identified a gap in my practice that I was previously unaware of. I strongly encourage universities to introduce undergraduates to health coaching in order to equip them with the skills to manage patient perceptions, which may differ from their own.