We have all seen a surfeit of advice punctuating the trade press recently as Feb 1 approaches.  We want to add to the chorus, but trust we can reward you finding the 5 minutes to read this, due to the different angle from which we are coming at the issue.  Many of the pundits have beseeched pharmacists to be prepared.  But how do you prepare for the cranky customer?


Due to the significant change up-scheduling of codeine containing medicines will present, and the potential for some patients to be unfamiliar or uncomfortable with the changes due to the sudden lack of accessibility of these medicines, there will likely be patients who will be irate and unhappy at the changes. Pain can commonly be a complex, subjective and emotive issue which can sometimes result in aggressive behaviour. The pharmacist’s role in assisting patients with their pain management and diffusing potentially difficult situations will be critical after February 1. Effective communication skills, remaining calm and not dismissing their concerns will assist in ultimately delivering the best solution for that patient.


Firstly, you know who they are likely to be.  Convene your team to come up with a list.  Then run some in –house scripting and role plays. Completing the Guild and PSA’s online learning modules will also help pharmacists and staff to be well prepared, with some useful case study scenarios and examples.  Seriously.  It is that important.  Use one of the tried and tested variations on the theme of conversation models to handle objections.  Here is one that is easy to learn and simple to execute.  LARF!


L – listen.  I mean REALLY listen.  Silence is golden.  Give your customer “psychological air”.  Shut your mouth for at least 2 seconds … as you FULLY digest what the customer says.  Regardless of how inane it may have been. Ensure that the environment within the pharmacy is conducive to having an effective conversation, with minimal distractions. Utilising a private consulting area or room will help with this as well as considering workflow adjustments, and ideally situating a pharmacist at the front counter. Making an appointment to ensure you have the time to devote to the patient can be another useful option. Open body language is also essential in showing that you care.


A – acknowledge.  Let the customer know that you have REALLY listened. Throw your customer the “velvet cushion”.  Choose your own words, but anything that impresses “I hear what you are saying” or ‘I understand how difficult it is to manage pain, but with the right medicines and support you will be able to find relief’.  You will be amazed at how you can connect with the hitherto disconnected customer, if you say it and REALLY mean it.  Very disarming.  Empathy – not sympathy.


R – respond.  Only now should you respond.  Don’t cave in.  Support your original position, and explain why.  Otherwise you will undermine your own credibility. Take the opportunity to discuss health and safety risks based on factual information and evidence. e.g. ‘Evidence suggests that codeine is not safe or effective in treating long term pain.’ Patients may appreciate that you are protecting them from any harm related to codeine containing medicines. But be prepared to offer an alternative that goes some way toward addressing the customer’s objection.  Let the customer choose.  Your job is to provide professional alternatives.  Let the customer take control of the choice. Alternatives could include ibuprofen, liniments, heat packs or tens machines. It may be that a referral to a GP may be most appropriate, for instance if there is chronic pain. Or it could be an opportunity to provide a MedsCheck if the patient is eligible.


F – feedback.   Ask for it.  Lead the customer into speaking more than you at this point.  Use an open question.  Something as simple as “how does that sound”?  Again, puts the customer in control.  Be prepared to loop back and repeat the process if there is still an appreciable gap between you and the customer.


Take the opportunity to record the interaction as a clinical intervention, as well as documenting any referrals you have made to follow up with the patient and GP at a later.


The up-scheduling of codeine medicines will provide an opportunity to genuinely engage, build relationships and provide ongoing support for patients. It will also allow you to further collaborate with other clinicians such as GP’s, practice nurses, physiotherapists, occupational therapists, and addiction specialists. Remember that a cranky customer can be a key opportunity to improve their pain management strategy if the pharmacy is prepared and it’s handled in the right way.