Dr. Hiwa K. Saaed
School of Pharmacy
University of Sulaimani
ref. Communication Skills in Pharmacy practice, Chapter 4, p 43-53
Barriers to Communication
• Environmental Barriers
Discovering Potential Environmental barriers
• Personal Barriers
Potential pharmacist-related personal barriers
Patient-related personal barriers
• Administrative Barriers
• Time Barriers
Barriers to communication
What are barriers to communication that exist in any work setting?
Take a few moments to write down some of…. your thoughts…
Barriers to Effective Communication
Barriers can disrupt the accurate transmission of information. These
barriers take different forms:
Barriers to effective Communication
or time conflict.
Such conflicts prevent effective
communication from being established.
Physical/ Channel Barrier
Physical/ Environmental barriers
• The venue, (place, space):
lack of privacy
• The effect of noise:
• Physical factors:
voice & visual quality
• Closed office doors,
• barrier screens
• and separate areas for people of different status results in
creating a barrier to effective communication.
The place or the location where a communication process takes
place can degenerate into a barrier to effective communication.
Crowded, noisy prescription areas also inhibit one-to-one
communication in many practice settings.
Noise may have its origin from an external source or may exist
even in the communication loop.
Discovering Environmental barriers
One approach might be to view things from the other person’s
• What images do others have when they enter your practice site?
• How easy is it for them to access you to have a meaningful dialogue?
• How many steps does it take you to reach a private area within your
Paying attention to the amount of privacy can help create an
atmosphere that causes both parties to communicate more
Potential Environmental Barriers
The next time you enter a community pharmacy, check for the
• Is the pharmacist visible?
• Is it easy to get the pharmacist’s attention?
• Does it appear that the pharmacist wants to talk to patients?
• Is the prescription area conducive to private conversation?
• Do you have to speak to the pharmacist through a third
• Is there a lot of background noise or other distractions?
Potential Pharmacist-Related Personal Barriers
• Low self-confidence
• Dysfunctional internal monologue
• Lack of objectivity
• Cultural differences
• Discomfort in sensitive situations
• Negative perceptions about the
value of patient interaction
Potential Pharmacist-Related Personal
• Lack of confidence, if you believe that
• you do not have the ability to communicate well.
• or are rather shy,
you may avoid talking with others.
• Negative experiences: what might happen
• if you get into a heated argument with a patient who appears to
be unreasonable and rude? Would you be excited to talk to the
next patient? Probably not.
• if you felt you were taken advantage of by a colleague when you
agreed to do something that you really didn’t want to do? Would
you feel like avoiding this individual in the future?
Probably, the negative experiences may influence your
• personal desire to communicate
• Self-esteem regarding interactions with others
PHARMACIST-RELATED PERSONAL BARRIERS-Emotional
• Another potential personal barrier involves emotional
• Although physical and emotional issues are often related to
each other, you should separate your role in treating both.
• It may be appropriate for you to assist with physical issues,
but probably not patient emotional needs.
• You should remain empathetic towards your patients, but
not get so involved that you carry their emotional burdens
• It is probably more appropriate to refer patients to
professionals who can assist them with these issues.
PHARMACIST-RELATED PERSONAL BARRIERS/
For example, in some cultures it is not proper to engage in eye
contact during communication.
Other barriers related to culture include the following:
• Definitions of illness (some patients may not perceive
themselves to be ill).
• Perceptions of what to do when ill (some cultures stress self-reliance
rather than seeking help):
• Health-related habits or customs (eating habits).
• Health-seeking behavior (some cultures place more reliance on folk
• Perceptions of health care providers (based on possible
distrust of the health care system or past negative
PHARMACIST-RELATED PERSONAL BARRIERS-other
Other personal barriers exist in:
• Situations: where you may not be completely sure how to respond;
For example, you may not know exactly what to say when a cancer
patient expresses a fear of dying.
• The pharmacist’s personal perception of the value of patient
communication. Many pharmacists believe that talking with patients
is not a high-priority activity.
PATIENT-RELATED PERSONAL BARRIERS
If patients perceive you
as not being knowledgeable or trustworthy,
that you do not want to talk with them,
On the other hand, if patients perceive you
as being knowledgeable and have had positive experiences in the
past, they will tend to seek out information.
• Impersonal: Another patient perception that hinders
communication is their belief that the health care system is
impersonal. Some patients sense that health care providers
are not concerned about them as individuals but rather as
cases or disease states.
PATIENT-RELATED PERSONAL BARRIERS
• Patient perceptions of their medical conditions :
• Some may believe that their condition is a relatively minor one
requiring no further discussion with you.
• In contrast, some patients may be overly anxious about their
condition and therefore will avoid talking about it because they feel
• Some patients may feel that their physicians would have already told
them all the important information about their condition and their
medication. Therefore, there is no need to talk with you.
• In addition, many patients think that all the important information is
stated on the prescription label or in the patient education leaflet.
• You may need to convince some patients that they need to learn more
about their medications and that the few moments spent with you will
be valuable to them later on.
We all see the world differently !
We all have our own
preferences, values, attitudes,
origins and life experiences that
act as ‘filters’ on our
experiences of people, events
• management: may view the lack of money compensated for
communication as a reason not to communicate. More
money is made by prescribing medication, not caring for
• Time barriers are interlinked with administrative barriers
because management is responsible for staffing levels as
well as allocation of work duties.
• Time limits are very common when it comes to pharmacists
and patients. Time restraints are often excuses not to
counsel, though it often does not take very long.
Choosing an inappropriate time to initiate conversation may
lead to communication failure.
For example, a woman who just came from a physician’s office
after waiting for 3 hours with two sick children may not be
interested in talking with you or anyone else.
The most important thing on her mind is to go home, get her
kids to bed, and then relax. She is probably not in the best
frame of mind to sit down and have a meaningful
conversation about her children’s medications.
• By the same token, you may not be in the best frame of mind to
interact with others. You may be dealing with multiple issues: a
physician is waiting on the phone, a large number of prescriptions
need to be filled in the next hour, and you have not eaten lunch so
you are starving. You may feel that this is not a convenient time to
talk to others, such as the mother in the above example.
A possible solution might be
• to give the mother basic information to get the therapy started.
• Another strategy is to have written information that can reinforce a
short message during busy situations.
• “highlighting” related information within the written information to
emphasize key points before the patient leaves the pharmacy.
• Messages become helpful to others only when they are accurately
received and understood.
• If messages are distorted or are incorrect, they actually may be
harmful to patient care and interpersonal relationships.
• Failure to communicate may lead to negative patient outcomes.
• Barriers, may lead to distortion of messages and misunderstandings
between you and others.
• you must be assertive about your need to communicate with others,
but at the same time be aware of their needs as well.
• In any situation, you should assess nonverbal messages from health
care providers or patients for assurances that communication is well
timed (Do they appear to be listening to you? Are they
comprehending what you are saying?). At the same time, you must
be aware of situations where people are trying to talk with you, but
you are not listening appropriately.
REVIEW CASE STUDY 4.1
A pediatrician phoned two different antibiotic prescriptions into a
pharmacy—one for Brian Bentley and one for Brandon Bentley.
Unfortunately, the pharmacy assistant did not recognize that two
different names were given and did not realize that they were twins.
She subsequently typed both prescriptions for Brian (Brandon sounded
like Brian to her). The father picked up both prescriptions and gave
them both to Brian. Unfortunately, the parents did not discover the
error until the next day. They immediately called the pharmacy to
address the issue. Both the assistant and pharmacist on duty
apologized to the Bentleys; fortunately, Brian was not injured by taking
a few doses of both antibiotics.
1. Name three things that help facilitate communication in this
2. Describe three things that help facilitate communication in this
ambulatory care clinic.
1. What is the first step in removing environmental and personal
barriers to communication?
2. What are at least three patient barriers that inhibit
3. How can the current nature of pharmacy practice inhibit good