Dr.Merrin,Joseph,Department of pharmacy practice,Community Pharmacy , Pharm D Second year, patient counseling,definition,outcome/scope of patient counseling,steps in patient counseling,communication skill in patient couseling,verbal skills and non-verbal skills.

1. PATIENT
COUNSELLING
Dr. Merrin Joseph
Department of
Pharmacy Practice

2. DEFINITION
 It is the professional counselling given by a practicing
pharmacist to his patient or the patients representative
on layman language on matters related to the
prescribed medication, health care and life style with
the objective of increasing patient compliance to the
prescribed medication and promoting rational ,
scientific and prudent use of medications.

3. AIMS/OUTCOMES
 Better patient understanding
 Reinforcement of advice from primary health care
team.
 Improves medication adherence.
 More effective drug treatment
 Reduced incidence of adverse effects and unnecessary
healthcare costs.
 Those patients most in need are given more attention.
 Improved job satisfaction for pharmacists
 Rapport with patient and pharmacist.

4. STEPS IN COUNSELLING
 Preparing for the session
 Introduction/opening of the session
 Content of the counselling
 Closing the session

5. 1.PREPARATION FOR THE COUNSELING
 The pharmacist should make a quick mental
preparation for the counseling before the actual
encounter.
 The pharmacist should know as much as possible about
the patient and about his/her treatment details.This will
be possible in the hospital setting through reference to
the patient case notes.
 The sources of information include the patient and their
prescription and in some cases the record of previous
dispensing of patient.

6.  Mental and physical state of the patient should be
considered.Observation of the patient prior to
counselling can reveal many clues about the
patients physical and mental state.
 If the patient is in hurry,in pain or is non-
communicative,it is very difficult to counsel the
patient effectively.In such situations, the aims of
counselling may be modified or with the patients
agreement, the session may be postponed to a
later date.

7. 2.INTRODUCTION/OPENING OF THE SESSION
 The first phase of counselling is used for information gathering.
 Conduct appropriate counselling introduction by identifying self
and the patient or patients agent.
 The pharmacist should introduce himself to the patient and greet
them by name.
 Always put on a friendly face with a pleasant smile and good
behaviour and extend hands.
 Explain the purpose of the counselling session.It is very important
to tell patients the importance of the counselling session from their
point of view.
 Review patient records prior to counselling .The pharmacist should
review patients records before the counselling session,if available
inorder to familiarise himself with the patient before actually
meeting the patients.In this way,the pharmacist can think of what
questions are needed to be asked and what needs to be said.

8.  Obtain pertinent initial drug related information. Ask the
patient whether he/she has some allergies or whether
he/she is currently using other medications ,about age
and other drug related information .This is important as
sometimes these issues can cause undesirable activity in
the patients instead of the desired therapeutic action.
 Determine if the patient use any other medication
including OTCs , herbals/botanicals and alcohol which
could interact or inhibit the prescribed medication.
 Determine if the patient has any other medical
conditions which could influence the effects of this
medication or enhance the likelihood of an ADR.

9.  Assess the patients understanding of the reason for the
therapy.This will help to save time in the counselling
session and reinforces learned information in
addition,any incorrect information could be corrected at
the time.
 Assess the actual and/or potential concerns or problems
of importance to the patient.The patient should be
prompted and encouraged to share with the harmacist his
concerns or doubts.Pharmacists have to respond with
appropriate empathy,listening,and paying attention to the
doubts.

10. 3.CONTENT OF COUNSELLING
 The content of counselling is considered to be the heart of the
session. During this step the pharmacist explains to the patient
about his or her medication and treatment regimen.Lifestyle
changes may also be discussed.
 Topics commenly covered include the information listed below.
 The medications trade name,generic name,common synonym or
other descriptive names ,therapeutic class and efficacy.
 The medications use and expected benefits and action.This may
include whether the medication is intended to cure a
disease,elimination,decrease symptoms,arrest or slow disease
process or prevent the disease or symptoms.
 The medications expected onset of action and what to do if the
action does not occur.
 The medications route,dosage and administration schedule.This
helps in accurate dose and ensures the desirable action.

11.  Directions for preparing and using or administering the
medications.For instance,directions for using and preparing
dry syrups must be given for the correct
usage.Similarly,administration of suppositories,enemas,ear
drops,eye drops,ointments,lotions,liniments must be given.
 Action to be taen in case of a missed dose.Advise the patient
if a dose is missed never double the dose as it can cause
toxicity and also tell them to continue with the schedule.
 Precautions to be observed during the medications use or
administration and the medications potential ADRs in
relation to the benefits.
 Potential common and severe adverse effects that may occur
,actions to prevent or minimize their occurence and actions to
take if they occur,including notifying the prescriber or
pharmacist/other health care provider.
 Techniques for self monitoring of the pharmacotherapy.

12.  Potential drug-drug (including non-prescription),drug-food
and drug-drug interactions or contraindications.
 The medications relationship to radiologic and laboratory
procedures and timing of doses and potential interferenes
with interpretation of results.
 Prescription refill authorizations and the process for
obtainin refills
 Instructions for 24hrs access to a pharmacist.
 Proper storage of the medication Eg.Insulin pen
 Proper disposal of contaminated or discontinued
medications and used administration devices.
 Any other information unique to an individual patient or
medication.

13. 4.CONCLUSION OF THE SESSION
 Before closing the session ,it is essential to check the
patients understanding . This can be assessed by
feedback questioning such as Can you remember what
this medication is for?
 Conclude the counselling covering the following area
 Verify patients understanding via feedback.
 Summarize main points in a logical order and
emphasize the key points.
 Tell the patient when he is due back to a refill

14.  Provide an oppurtunity for final concerns and questions
 Help the patient to plan follow up and next steps. Give
if appropriate,the pharmacists telephone number and
other details to encourage patients to make contact if
they need further advice/information.
 Thank the patient
 Documentation of the session which can help in future

15. Communication Skills Needed For
Effective Counselling
The counselling process uses basically 2 types of
communication skills.
1)Verbal Communication Skill
2)Non-Verbal Communication Skill

16. Verbal Communication Skills
→Language
 Use simple language.
 Avoid unneccessary medical words.
 If possible speak’s in patient’s own language.

17. →Tone
 Changes in the level and range of pitch convey
information about the feelings and attitude of
person speaking.
 Tone of voice should be caring and reassuring.

18. →Volume
 Counselling should be conducted in a quiet
private setting where it is unneccessary to raise
one’s voice.
 Speak more loudly –patient with hearing problem.
 Speak in wide variation of volume depending upon
where and whom you are speaking to.

19. →Speed
 The pharmacist should present clear,relevant
messages in a logical sequence and at a
speed which gives the patient to think about
what is being said.
 Clarity of our communication depends upon
our rate of speed.

20. →Use of open ended questions
 Open ended question starts with who,
what,where,when,while,how.
 The answer to a closed ended question will not reveal
anything about the understanding and recollection of
information.
 A yes/no question tells you whether the patient thinks
she /he know the information ,but doesn’t allow you to
access the accuracy of information.

21. →Use of paraphrasing (Active listening)
 Pharmacist attempt to reframe in his own word
what the patient has just said to him.
 Thus pharmacist convey to patient that he/she has
listened to the message of the patient.

22. →Assertiveness
 The intent of assertive behaviour is to
communicate in an atmosphere of trust.
 Assertive indivituals initiate communication in a
way that conveys their concern and respect to
others.

23. Non-Verbal Skills
→Eye contact
 The best a pharmacist can offeris the fequent and
attentive eye contact,avoiding blank starer.
 Some people with depression or due to cultural
differences should not maintain eye contact.

24. →Facial Expression
 This can beused during counselling to demonstrate
empathytowards patient.
 Head movements such as nodding,hand gestures
and body postures also can be used to advantage.

25. →Proximity
 This refers to the distance that people maintain between
themselfes during the counselling process.
 Counsellers or healthcare professionals use intimate or
personal proximities.
☺Intimate (45 cm or less)
☺Personal (45cm-1.2m)
☺Social (1.2m-3.6m)
☺Public (more than 3.6)

26. →Mannerisms
 The pharmacist needs to make patient seat
comfortable by enhancing physical and
psychological privacy.
 Gesture ,clothing,hygiene can provide information
about interviewer.

27. →Listening
 Listening to the patient is important to effective
communication.
 Must allow the patient tospeak without
interruption and concentrate on the words.
 The pharmacist should rid him/herself of
distraction.
 Ask clarifying questions where appropriate and
avoid jumping to conclusion.

28. →Touch
 It can enhance the verbal communication facilitate
the interaction with the patient.

29. COUNSELLING AREA
 It should be a private area away from other people
and distractions.
 The patient should perceive the counselling area as
confidential and secure so that they will ask
questions which they hesitate to ask in public.