Amanda Seeto – Community Pharmacist and Pharmacy Owner; Branch Committee Member and Professional Practice Pharmacist, The Pharmacy Guild of Australia, Queensland Branch
Glenn Guilfoyle – Principal, The Next Level
From conversation to conversion: Seamlessly linking the supply of advice to the supply of medication
In the first article of this two part series we looked at how a pharmacist can change their conversation with Mr She’ll be Right (aka Mr SbR) from telling him when to take his tablets and ringing it up at the till, to engaging him in a meaningful discussion about his health and lifestyle. By relating the symptoms of Mr SbR’s condition to how it affected his ability to do his job, we gained his trust to delve further into what changes he could make to improve the symptoms of his Type 2 diabetes. You will recall that Mr SbR, not the pharmacist, was the one who made the suggestion of more exercise, putting him in control of the changes he needs to make to his lifestyle.
At the end of this first conversation, we invited Mr SbR back to the pharmacy for a MedsCheck, as his diabetes is poorly controlled, and here we are going to take advantage of this 30 minute private consultation to further encourage him to exercise more, as he really does need to lose some weight. Mr SbR said last conversation that taking the dog for a walk each night could be a way for him to exercise, as his wife is ‘always nagging him’ to do that. However, on his return to the pharmacy, Mr SbR admits he’s done it twice in the few weeks since then.
Enter, Glenn Guilfoyle, Principal of The Next Level, and industry thought leader on the conversation skills required in pharmacy for the provision of a complete customer solution.
Glenn says that this admission of infrequent exercise is a good confirmation that you are dealing with a condition, or set of co-morbidities, that are intrinsically associated with long-standing poor personal health and care behaviours and mindset. He reiterates that this is a brilliant opportunity to shine and differentiate from what would happen next if he were to go to the vast majority of any other pharmacies. Think of it this way: the conversation we role played in part 1 was focussed on providing a more complete solution than what would otherwise have been crafted. The key features were the inclusion into the consultation of 5 critical “complete solution” elements:
- Treating the condition
- Relieving symptoms of the condition
- Alleviating side effects of the treatment
- Preventing the condition/recurrence
- Supporting the patient in regards to the specific condition
Mr SbR re-presenting the way he has, means you need to take the conversation to the next level. You need to help him determine his willingness to change habits and lifestyle. This is a very personal conversation since you are inviting Mr SbR to engage with you, even bare his soul about change. One of the most difficult human endeavours.
So what are the signals you should be vigilant for? Glenn suggests you do not leap into motivational interview mode too early, even if Mr SbR is a long-standing patient of yours. Earn your trust credits in accordance with the bullet point principles above, over a series of visits. Intuitively you know when motivational interviewing is likely to add value, such as the abovementioned lack of exercise, but also if you see signs of poor diet, inadequate blood sugar control or lack of compliance to taking medication.
The behavioural signs to look for in your discourse include ambivalence, procrastination, resistance to change and/or your advice. Once you pick up these cues, and you switch conversational mode, following the guiding principles and “PACE” yourself:
- Partner – rather than be the expert
- “what ideas do you have about what WE may be able to do together to help you”
- Acceptance of the patient – not judgement
- “I understand where you are coming from”
- Compassion for their perspective
- “I hear what you are saying”
- Evocation – encourage your patient to generate ideas, rather than provide yours
- “can you think of any other people like you and what they have done in a similar situation”
What are the conversation tools and techniques? Get paddling with your “OARS”:
- Open questions – get the patient talking more than you
- “how does it make you feel when that happens?”
- Affirmations – in listening to the answers provide affirmation when you hear about past successes
- “that’s great – so you have had some successes after all”
- Reflections – the power of paraphrasing can be truly amazing
- “I think you are trying to tell me…………”
- Summaries – distill the essence of ideas and actions
- “let me see if I can summarise the last 10 minutes………….”
What are the processes to work through? Make your patient “FEEL” really listened to:
- Focus – set clear direction and goals
- “how about we write down some of this now into your goals”
- Evoke – questions to encourage patient to describe why they want to change in their own words
- “What difference do you think it would make to YOU, if you could lose that 15kg?”
- Engage – don’t assess or tell how
- “so it sounds like we are talking about some specific changes to your grocery shopping list?”
- List – actions and plans.
- “how about we write some of this down into a bit of an action plan?”
A final note: don’t try to boil the ocean in one visit. Take a long-term, chip-chip approach. By all means, conduct this conversation in the privacy of the consulting room, but don’t be afraid to do so at the service counter too. And it does not necessarily need to be an impractically long conversation. The agreed action plan should reinforce and link back to your earlier recommendations of relevant products and services (refer back part 1 of this story). How do you eat an elephant? One mouthful at a time.