Research & Reviews: Journal of Medical and Health Sciences
MenuISSN: 2319-9865
ISSN: 2319-9865
1Department of Pharmacy, National Hospital Abuja, Central District, Federal Capital Territory (FCT), Nigeria
2Department of Pharmacology, College of Medicine and Health Sciences, Federal University Dutse, Jigawa State, Nigeria
Received date: 19/11/2018; Accepted date: 14/01/2019; Published date: 21/01/2019
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As varied as are different shades of colours we find, so also the kinds of people we meet and interact with. As professionals however, we have to handle and manage them all appropriately.
The key is in finding techniques that help you disarm unhappy and/or uncooperative patients and maintain the sanity of the work environment to keep the patients satisfied by providing stellar professional pharmaceutical service. Also, understanding what the most appropriate and acceptable behaviour is in any given situation accounts for ease in effective Pharmacist- Patient relationship.
Therefore, being intuitive and adaptive is an effective and applicable strategy in managing different types of patients. That way, Pharmacists can keep all patients happy and relatively satisfied. With each Pharmacist-Patient interaction being unique, it requires a great level of common sense, the application of diplomacy, tact, good judgment and constant practice to master. Always keep in mind; every patient is someone else's loved one and should be treated as human as possible.
Diplomacy, Fidelity, Good judgment, Pharmacist-Patient relationship, Pharmaceutical service, Tact
Though the patient is always “king”, but that does not mean all patients are easy to interact with or are correct. As Pharmacists, who have constant interaction with diverse and almost all kinds of patients on daily basis; we can testify that certain patients can be downright uncooperative. Still, as professionals, we have to handle our interactions with them all appropriately.
Finding techniques that help you disarm unhappy and/or uncooperative patients in order to maintain the sanity of the work environment as well as keep the patients satisfied is the key to providing stellar professional pharmaceutical service – even when the human reaction tends to almost drive one to really want to kick certain extremely uncooperative patients to the curb. We never do [1,2].
The Paternalistic relationship - High Pharmacist and low Patient control
In this relationship, the patient is the “yes-man” where the interventions are precipitated by the pharmacist with little or no input from the concerns of the patient.
Consumeristic relationship - High Patient and low Pharmacist control
In this relationship, the pharmacist tends to be the “yes-man” where the interventions are precipitated by the patient with little or no input from the concerns of the pharmacist.
Unengaged relationship - Low Pharmacist and low Client control
In this relationship, there is little or no input from either the pharmacist or the patient here, there the interventions are nonrealistic and nonexistent; as concerns of both partners are not easily aired.
Collaborative relationship - High Pharmacist and high Client control
This is the most ideal relationship control. Here, both the concerns of the pharmacist and the patient are equally and easily aired and the course of intervention mutually agreed upon and adopted.
The dynamic Nigerian pharmacy practice and the kind of patient mannerisms with their expectations as encountered by Nigerian pharmacists in effort to provide a stellar pharmaceutical service resulted in the idea to write this commentary. Despite the unique demands of respective patients, responsible provision of drug therapy in Nigeria set us apart from other pharmacy practices around the world. This commentary was written in order to:
•To give insight on the ways to achieve effective Pharmacist-Patient relationship
•To show that certain communication skills can be learned and adopted
•To highlight ways to surmount challenging interpersonal interactions faced by health professionals.
Tact and diplomacy are vital communication tools needed to aid effective and efficient communication during pharmacistpatient interactions. While attempting to be persuasive or assertive especially during patient interaction, the act of negotiation and the appropriate application of tact and diplomacy can lead to an improved relationship and interpersonal interaction with patients. This is a way to build and develop mutual respect, which in turn can lead to more beneficial outcomes with less difficulty or stress in these interactions and communication [3,4].
Tact means a “keen sense of what to do or say in order to maintain good relations with others or avoid offense” or “skill and sensitivity in dealing with others or with difficult issues” [3-5].
In the words of Sir Isaac Newton, “Tact is the art of making a point without making an enemy.”
Diplomacy refers to the “skill in handling affairs without arousing hostility” or “the art of dealing with people in a sensitive and tactful way” [3-5].
According to David Frost, “Diplomacy is the art of letting somebody else have your way” [3].
Tact and diplomacy are skills used in interpersonal interactions and they are centered on a good understanding of other people and their situations. Also, using them requires being sensitive to the opinions of people, their beliefs, concerns, ideas and most importantly their feelings [3].
In effort to be assertive or reflect your own ideas in communication, effective use of these skills demands that the communicator is able to convey information in a delicate and well-meaning manner without arousing an ill feeling or awkwardness. This is achieved in the manner the communicator accurately perceives the emotions and thoughts of the listener and responds to the concerns or objections of the listener at any given time [3,4].
"All people and all communication situations are unique and require a level of common sense, good judgment and constant practice". In diverse situations, the following added skills are employed to make use of tact and diplomacy effective [3].
•Listening attentively: The Pharmacist does not need to just talk all through an interaction, there is need to be able to listen to not just the response from the patient but also how the response is conveyed in order to understand, and react in the most appropriate manner [3,4,6].
•Having emotional intelligence: It usually requires people with a higher level of emotional intelligence to more naturally apply tact and diplomacy in a communication session. Emotional intelligence being a measure of how well one partner (in this case the Pharmacist) understands the emotions of the patient and the emotions of others [3,4].
•Showing empathy: To further buttress emotional intelligence, showing empathy is the Pharmacist's ability to see the world or situation from the perspective of the patient [3,4].
•Being assertive: The act of assertion while applying tact and diplomacy is often to influence or persuade others to think, behave or act in a certain way, in some cases even to come to an agreement about a point of view [3,4].
•Building rapport: When it comes to rapport building, it is closely related to tact and diplomacy as well as good manners and emotional intelligence are. Being able to communicate well with patients and having a great sense of understanding of their persona [3,4].
•Being polite: Professionalism considers that the cultural differences, view-points and choices of the patient and others are kindly respected. It also requires as a matter of importance that courtesy is shown in interpersonal relationships and being [3,4].
Understanding what the most appropriate behaviour is in any given situation can be dicey or problematic; as a result of the generally unpredictable nature human relations, interaction and communication [2-4].
Sometimes in Pharmacist-patient relationships, the most appropriate course of action may be to withhold your opinion. It may also be relevant to introduce an idea, or favored outcome, in such a manner that the other patient can take ownership of it. Furthermore, it may be best to take a direct stance about a vital decision, stating exactly what you want and how you intend to achieve it in partnership with the patient without compromising the fidelity of the intended message [3,4,6].
• To improve the quality of care
• To improve clinical outcomes
• To improve medication adherence
• To reduce occurrence of drug therapy problems especially adverse drug reaction
• When you are planning a potentially difficult conversation or interaction you should first focus on the end gain; keeping in mind what you want to achieve; always think about the reasons for your actions. Try to set aside your personal opinions and think about the valid facts surrounding the intervention or situation at hand [4,6].
• Anticipate what and where the objections may arise from patient; carefully think over your answers to their valid concerns; the Pharmacist should demonstrate that the opinions or arguments of the patient have been duly considered [4].
•Do not take anger, aggression or stress into an interaction: As much as you can, Pharmacist should try to remain calm keeping an open mind in all patient interactions. Find out the facts, and reasons behind such patient actions. Also, try to clarify why such reactions were made possible or not before putting forth a reaction [4].
• Once again, while communicating make effort to listen to what the patient has to say; Look out for non-verbal communication signals as can be detected in their body language and their tone of voice. This can help the Pharmacist understand their concerns and message been passed. With hold your own opinions and ideas until you have had opportunities to understand and make sense of the patient's point-of-view. Then carefully plan your responses to address properly the feedback been received [4,6].
• Learn to Negotiate: If what the intervention seeks is in conflict with the patient’s expectations and ideas, then discussions on how sacrifices can be made should result. This is to achieve a better outcome for both of you moving forward, as mutual sacrifice is usually perceived more favourably and acceptable than one-sided sacrifice. As such, Pharmacist should aim for a "win-win" situation where both the Pharmacist and patient are happier [4].
• Strengthen your points by offering time-lines to when the beneficial effects of the intervention you propose would most likely be being reached; Here, Pharmacist has to be precise in giving dates, facts and figures. Favouring fact and logic over personal opinion. Have something drawn out or written in advance, if it helps gain patient conviction [4,6].
•Instead of directly voicing your opinion, turn your statements into questions if possible. Transform your statement into questions for the patient to think about: This simple act not only leads patients to discuss the benefits of the interests you may have, it also gives room for the patient to think along the same line as the Pharmacist. This is an effective approach that helps your partnership and collaboration overcome problems and achieve much more. This is particularly useful in cases where you are not entirely certain of the outcome. In this strategy, both partners should make room for beneficial changes and surprising positive results would usually emanate from it [4,6].
•It is important to note that if the interaction or conversation gets too heated than expected, try to give yourself room to respond in a manner that help rather than inflame or escalate the situation: If you notice yourself at some intense moments giving in to confrontation or negative reaction: take a breather and give yourself time you cool off. Kindly excuse yourself from the situation or call on another colleague to take over the interaction when possible. Again, inform the patient that you would need to think about what they have just said, rather than feel obliged to respond immediately [4].
Individuals have different personalities, though there may be similarities among some. Pharmacists must therefore know how to identify each patient’s personality and adapt accordingly to ensure and maintain a smooth interaction [4].
This article identifies and classifies certain different types of patient’s personalities a Pharmacist might encounter and gives some tips on ways of effectively communicating or interacting with them.
The irate/aggressive patient
Known for their anger they most likely explode and start fuming on or even before your interaction or encounter with them. Irate patients are among the most common patients you will encounter. This is because the Pharmacy gets to be the one the last (if not last) points of call for each patient. While some only get aggressive at the start of an interaction, others are only aggravated with every unanswered query and can get more increasingly annoyed and easily transfer their aggression [1,4]. Added to their aggression and quick temper, these types of patients are highly critical, rude, arrogant and impatient. In some cases they can become both verbally and/or physically abusive.
The irate/aggressive patient believes that their demands and needs supersede everybody else’s. Little wonder; they do not appreciate been kept waiting. Thus, they demand to be served NOW! Irrespective of their gender, they scream, complain and use intimidation tactics to get what they want [1,4].
How to manage the irate/aggressive patient
The best key to interacting with this kind of patient is to remain calm throughout the interaction. Do not let your own irritation and impatience take over the conversation, always respond in a manner that soothes the patient. Also, assure the patient that you know how best to solve the problem, and then provide a solution as soon as you can [1,7].
Sometimes your explanations do not really matter to these type patients, please save it for another. And they do not bother themselves about who is right or wrong because they have a sense of entitlement. They come across most times as arrogant, rude and impatience making it impossible for them to listen or comprehend what others has to say; listening to the sound of their voice alone. Always try to avoid actions that tend to escalate the situation [1,7].
Furthermore, another good way to handle an irate patient, especially when there is a wrong doing on their part, is to calmly and confidently apologize for the ‘confusion’ or ‘misconception’, point out the said error they have committed and tell them that you are willing to solve the problem if they calms down and tells you exactly how you can help.
In all cases, always maintain eye contact with the aggressive patient at all times. It shows them that you are not buying into their antics.
Do not ever join an irate patient in a shouting match or try to match their aggression. Respond politely to them without raising your voice and never take their insults and criticisms too seriously or personally. It is your responsibility to remain calm and ‘sane’ while the “bully” rages on [1,7].
If in the end, your attempts to manage the situation fail, politely declare your exit from the situation or call on another colleague if any to take over and move on for the time been. The Pharmacist can try to reach out to them at another time, when they may have calmed down. ‘Converted irate patients’ usually become very loyal ambassadors of your services [1,7].
The talkative patient
Talkative patients are one of the frustrations and one of the causes of time-wastage of a service point’s efficiency and productivity, as they tend to slow down interactions. These types of patients tend to buzz on about topics unrelated to the issues they have come to tackle. This is because conversations with them take too long; that you may have to keep other queued patients on hold for far longer than expected. Consequently, the Pharmacist would most likely delay and even loose the opportunity to help other patients [1,7].
How to manage the talkative patient
There is a need to always maintain control over interactions with chatty patients, focus on the reason(s) why these patients have come. Should the conversation digress in either way from the topic, politely redirect the discussion back to the main issue(s) being tackled, quickly attend to them and move on to other patients. Don't forget to bid them good bye [1,7].
Mr & Mrs ‘No boundaries
These are patients who would call you up on a ‘Sunday morning’, while you are on vacation or at a seemingly ‘ungodly’ hours to discuss a matter that is neither very important nor an emergency [1,7].
This type of clients does not respect boundaries of any kind and expects the Pharmacist to respond to their requests immediately and at any time. It does not matter what time of the day it is or over the holidays, they just have to contact the Pharmacist. They would call at the oddest of times if that does not suffice they would result to sending the Pharmacist email or texts messages [1,7].
Mr & Mrs ‘No Boundaries’ is the type of patient that intrudes and invades your personal space, private life and leaving you feeling all overwhelmed and swarmed [1,7].
How to manage the ‘No boundaries
When you suspect that a patient falls into this category, it is usually best to clearly explain and define your boundaries [1,7].
Take for example, the Pharmacist could state clearly and politely while giving out his/her contact when he/she is available to be contacted and when he/she is not available, always never forget to give room for an emergency.
Many a times, these types of patients may ignore and flout the stated boundaries and try to contact you; never mind, do not take it personal and keep calm. When this happens, learn to enforce the boundaries by your behaviour rather than with direct confrontation – only respond to that text or email by time you have stated [1,7].
Also when they eventually call, intelligently and politely calm their agitations and give them whatever feedback by the time you have stated especially when it is not an emergency. If not done this way, they would swarm and tend to overwhelm you with requests from all corners [1,7].
The “know it all”/mistaken patient
This type of patient always insists that they know more than you do, chances are there that they seem to know something thing about everything, including the service you render but in fact, they may be misinformed. So be careful to avoid being misled. When a solution is given to them, they might not believe you immediately. This makes it harder for the Pharmacist to manage them [1,7].
This type of patient can be especially difficult to deal with because you cannot really tell what they want. In their effort to showcase their knowledge and centralize attention on themselves, they could come off as highly critical and rude; they also, like the sound of their own voice and can be egotistic. They tend to talk a lot and always want to dominate the interpersonal interactions and conversations [1,7]. Please don’t fall for it.
How to manage the “know it all”/mistaken patient
Managing this type of patient can be especially easy and interesting, if the Pharmacist knows how to.
Be careful not to come off as high handed, superior and mighty. Also, never argue with this type of patient as you may end up having extended arguments or resultant talks. And worse still, you may end up easily annoying them and/or hurting their ego [1,7].
Ordinarily customer service would advocate "an ego massage" Instead, understanding the gravity of an act of misinformation in pharmaceuticals, these patients need to be corrected and provided correct facts and information when there is need to; you may adopt a line like: "I understand your point, but (then give your own view)" Or "Wow, your knowledge has been insightful, however (then make your point)" [1,7].
Always be polite and sincere as you explain to this patient how the interventions you recommend can help them especially achieve better outcomes.
As long as we try to keep their egos intact and give them the correct information, this kind of patient can become loyal and trusting in you as well [1,7].
The elitist/aristocratic patient
Elitist patients do not like interfacing with the front-line staff of an establishment, because they believe that the problem(s) they are encountering or their concerns are too complex, delicate or too special for the front-line employees to manage. They also exhibit a sense of entitlement as shown when they insist to be attended to in a certain manner or by the supervisors or Chief- Pharmacists. Often time, after explaining things to them, you may hear them say, "I want to talk to your boss, supervisor or person in-charge or" instead of giving your recommended intervention a trial [1,7].
How to manage the elitist/aristocratic patient
In managing this type of patient, always assert that you are qualified to help resolve their concerns; doing so in a polite manner. Especially where there is absolutely no need to solve a problem with a superior's or supervisor's intervention, inform them that it is not advisable to escalate the matter to a superior as you are able to appropriately handle it. Make sure, however, that you can thoroughly and appropriately address their concerns and issues and move on [1,7].
It is important to always know when to call on a superior [1,7]. When in doubt; always ask.
The nagging patient/"habitual complainer"
Patients in general complain. And this can be a good thing because complaints can serve as a very rich source of constructive feedback for an establishment [1,7].
However, when a Pharmacist finds a particular patient who complains at every interaction – even about the pettiest of things – the Pharmacist may have a ‘habitual complainer’ on hand [1,7].
These kind patients complain and nag about anything and everything. They can nag about your prices, the colour of your shirt, the layout of your office, and even the day’s weather is not spared [1,7].
For this patient type, nothing is ever good enough or going to ever be. That is why it can be almost impossible if not totally impossible to satisfy them [1,7].
How to manage the nagging patient/"habitual complainer"
Though their complaints may seem to be harmless, the Pharmacist still needs to be very careful with the nagging patient/ habitual complainer because their attitude can exhaust and totally stress the Pharmacist out especially on a busy day [1,7].
Firstly, the Pharmacist needs to accept the fact that you cannot satisfy or please everyone. And our nagging patient/"habitual complainer" is one of those. Coming to terms with this fact will help the Pharmacist learn to limit himself/herself from going all out of their way to seek interventions in order to satisfy these types of patients every time [1,7].
This does not mean however that the agitations or concerns of the nagging patient/habitual complainer should be ignored. All the Pharmacist can do each time is to give the very best possible service [1,7].
The Pharmacist should give them attention and let them know that they have been listened to. Never try to give in to the temptation of making excuses or finding an explanation to offer to their complaints. Simply assure them that their concerns and complains would be looked into and resolved as need be [1,7].
No matter what they say and how they say it, always respond calmly and nicely, and with a smile (if you can find one) [1,7].
Again, when there are valid concerns, complaints and points that the Pharmacist thinks can/should be resolve; then action must be taken to do something about it. Finally, it is always a good strategy to make a quick note of all the valid concerns they ask for at a go and handle them at once. That way, the Pharmacist does not have to interface with them multiple times [1,7].
The positive/pragmatic patient
This patient personality type is the best one there is. These are genuinely friendly patients who just want to get their problems, queries and concerns fixed or resolved. Patients with a sincere positive mindset often can be beneficial for any establishment. They usually serve as a valid source of feedback and can provide you genuine insights regarding your services and products. Their suggestions can help an establishment grow [1,7].
These patients can be your brand's ambassadors as well. Just continually give the best service you can to them, take vital note of their concerns when aired and they would always appreciate that you did [1,7].
It's important for Pharmacists to know how to manage patients with varying personalities efficiently and in varying situations, in order to ensure that interactions will go smoothly and effectively. Therefore, being intuitive and adaptive is an effective and applicable strategy in managing different types of patients. That way, the Pharmacist can keep all patients happy and relatively satisfied [1,6,7].
Bearing in mind that each Pharmacist-Patient interaction and situation is unique, Pharmacists require a great level of common sense, the application of diplomacy, tact, good judgment and constant practice to master them [1,7].
Attributes to build good pharmacist-patient relationship
•Being an expert/professional
•Being collaborative (with both patients and other professional colleagues)
•Show solid work ethic
•Exhibit strong moral character
•Being patient oriented
Being intuitive and adaptive is an effective and applicable strategy in managing different types of patients. That way, the Pharmacist can keep all patients happy and relatively satisfied.
Though there is room for improvement in our various pharmacy practices in Nigeria, always being professional in the responsible provision of pharmaceutical services would help us score even higher and achieve better outcomes subsequently.
With each Pharmacist-Patient interaction being unique, it requires a great level of common sense, the application of diplomacy, tact, good judgment and constant practice to master them. Always keep in mind; every patient is someone else's loved one and should always be treated as human as possible.