The document discusses guidelines for effective communication between pharmacists and patients, including explaining drug usage, storage, adherence, and costs in an empathetic, ethical manner. It provides examples of communicating with patients about hypertension medication, inhaler usage, seizure medication, and oral contraceptives. The goal is to motivate patients and improve compliance through clear, patient-centered explanations.

1. Communication with patients:
Pharmacology competency
PH 5.1,5.2.5.3 and 5.4
Dr. Uma Advani (06-09-2021)
Associate Professor Pharmacology
SMS Medical College, Jaipur.

2. Competency: Communicate with the
patient with empathy and ethics on all
aspects of drug use.
PH 5.1
Level: Show How
Suggested teaching learning method:
small group discussion

3. Learning Objectives:
• To understand the importance of effective
communication with the patient.
• Communicate effectively regarding the proper
use of a drug to improve patient compliance.
• Communicate with patient in a non-
judgmental ,empathetic & respectable
manner.

4. Definition…
Communication is the process of sharing information
or messages for the purpose of common
understanding.
Effective communication with patients on various
aspects is important
‘Patient –centered care’ recommended also by WHO
Following features are important in communication
in medical profession:
Sympathy – it is an effort to understand another
person’s feelings or behavior with kindness and
compassion.

5. Definitions…
Empathy: Empathy is the ability to feel other people's
emotions, coupled with the ability to imagine what
someone else might be thinking or feeling, suffering by
ability to imagine oneself in another’s situation.
Ethics: Ethics is the study of morality – careful and
systematic analysis of moral decisions and behaviors and
practicing those decisions in day today life.
Medical ethics is application of fundamental moral
principles of ethics that apply values and judgments to the
practice of clinical medicine and in scientific research.

6. Principle of Medical Ethics:
• Beneficence: A physician must act in the best
interest of the patient
• Non maleficence: Physician must not harm a
patient through careless, malice or dislike or even
through treatment indeed to help the patient
• Autonomy: This principle is focused on the
patient's independence or liberty
• Justice: Justice refers to fairness with respect to
the distribution of medical resources without
considering their economical , social or any other
status.

7. What is purpose of doctor-patient communication?
• Creating good inter-personal relationship:
The doctor must show empathy, respect,
genuineness and warmth.
• Exchanging information:
The doctor should seek information about the
clinical problem from the patient by being a good
listener and then giving information.
• Making treatment related decision:
He/she should provide information about the
disease, drugs, life-style and dietary changes etc.

8. Doctor -patient interaction:
Non-verbal communication
• Offering seat, touching the patient, nodding head, eye to
eye contact
Verbal communication
• Patient complaints
• Prescriber’s questioning about complaints: length, severity
• Prescriber’s explanation about diagnosis/ diseases
• Prescriber’s explanation to patient’s question
• Prescriber’s explanation about treatment particularly drugs

9. Coding of ideas :
1. Language (verbal, written)
2. Para-language (tone, pitch, accent of voice)
3. Non-verbal or body language (face, eye, other
gesture, body positioning, appearance)
Approx.% of meaning conveyed by the three codes:
1. Language-7%
2. Para-language-38%
3. Non verbal or body language-55%

10. Active listening
• Listening is a communication skill every doctor
should cultivate.
• It is the foundation of all communication and
relationship skills.
• A doctor must:
• Commit time to listen without interruption
• Absorb what patient want to convey
• Be open-minded, sensitive, empathetic
• Be able to concentrate without distractions (mobile/
laptop)…. or interruptions

11. Explanations on the following:
• Name of drug: generic name & brand name
• Therapeutic effects, side effects
• How to take the drug, when to stop
• Patient’s question about treatment
• How to prevent the disease / exacerbation
• Other information about diet/exercise
Effective communication results into accurate
diagnosis, more effective treatment or medical
intervention, more speedy recovery & better
realization of quality of life

12. Steps to Good communication skills with patient
• Initial greeting (friendly & helpful), building rapport with
the patient
• Offer Seat make comfortable
• Body posture -non threatening (warmth in questioning
style)
• Maintain eye contact, listen complaints actively ,sensitively
• Interruption and facilitation, when needed use of silence at
times
• Discuss personal and psychosocial issues of relevance
• Explain treatment available/given, directions for follow up
with clarity of expression
• End of interview with solving doubts to satisfy patient .

13. Avoid / Don’ts of communication
– Cynical or pessimistic talk
– Misleading false hope
– Creating guilt complex
– Losing temper

14. GATHER - in family practice
• G = Greet patient in a friendly way
• A = Ask about complaints
• T = Tell them about methods available
• H = Help the patient to decide
• E = Explain use
• R = Plan return visit

15. PH 5.2
Demonstrate & Communicate effectively with
the patient regarding optimal use of prescribed
drug/ delivery devices & storage of medicines

16. Learning Objectives:
• Communicate effectively with the patient
regarding drug use to improve patient
compliance.
• Communicate effectively with the patient
regarding use of device to improve efficacy of
drug.
• Communicate effectively with the patient
regarding appropriate storage of drugs to
prevent complications or adverse effects.

17. • Proper storage of medicines in pharmacy
premises, at patient’s home or in hospital
pharmacy is necessary.
• Pharmaceutical products require controlled
storage and transit conditions in order to
ensure that their quality is not compromised.
• Proper environmental conditions (i.e.,
temperature, light, and humidity) must be
maintained to maintain the potency, efficacy
and quality of drugs and vaccines, and prevent
their degradation.
storage of medicines…

18. All drugs should be stored according to the
conditions described on the label :
• Store in cool and dry place, protect from heat
and light, protect from direct sun light and
keep in dry place at a temperature not
exceeding 30 º C.
• Keep the bottle tightly closed.
• Various storage conditions may be required,
for example:
storage of medicines…

19. • Freezer: Temperature is maintained
thermostatically between : 25ºC and -10ºC
• Cold: Any temperature not exceeding 8ºC.
Temperature can be maintained in a
refrigerator between 2ºC and 8ºC.
• Certain medicines like insulin, antibiotic
liquids, injections, eye drops and some
creams must be stored between 2ºC and 8ºC.
storage of medicines…

20. PH5.3
Communicate effectively with the patient to
motivate regarding adherence to prescribed
drugs in chronic diseases.

21. Drug Adherence:
• Medication adherence is defined by the
W.H.O. as "the degree to which the person's
behavior corresponds with the agreed
recommendations from a health care
provider."

22. Guidelines for ensuring adherence to drug treatment:
It is essential to provide step by step guidance on how
to use/ administer different medical devices/dosage
forms.
Information should be provided in a simple language,
that the patient/caretaker can understand.
Make sure the patient has understood the instructions.
Written instructions too may be provided in patient’s
vernacular language

23. Drug adherence….
– Whenever possible, involve patients in decision
making regarding their treatment so that they
have a sense of ownership in the treatment plan.
– Address key information about the drugs (what,
why, when, how, and how long)
– Check adherence on follow up visits….by various
means can ask to bring empty blisters of
medicine to cheque..intake of tablets…etc…

24. Drug adherence….
– Inform the common side effects and those that
patient should necessarily know.
– Provide medication calendars or schedules that
specify the time to take medications, medicine
related information sheets or specific packaging
such as pill boxes indicating the time of dose
– Motivate & Monitor adherence on follow up
visits

25. PH 5.4
• Explain to the patient the differences in cost
of treatment for a given disease and patient
compliance.
• Communicate effectively regarding cost of
drug therapy to promote non-maleficence as a
guiding principle in patient care.

26. Cost of drug therapy
• Overall expenses is also an important factor to be
considered in drug therapy to prevent non-adherence
to the treatment and an adverse outcome..
• Consumer of drug is patient & unlike other product he
has no choice and is dependent on the Doctor.
• Thus duty of Doctor is most important in this regard.
• The prescribed treatment should be affordable to the
patient , the no maleficence direct physicians to ‘do no
harm’ to patient .
• The pertinent ethical issue is whether the benefits
outweigh the burdens.

27. Guidelines for cost effective prescribing:
– Drug should be prescribed by generic name, since
generic drugs are usually cheaper than branded
drugs.
– Only requisite medicines should be prescribed,
overprescribing should be avoided.
– Non pharmacological treatment, if recommended,
should be advised before initiating drug treatment.
– Unnecessary use of injectable drugs and laboratory
tests that add to indirect costs should be avoided.
– Total cost of treatment should be evaluated (should
be economical)prior to choosing a particular
treatment, from various available alternatives.

28. A case of 50 year old male patient with mild
hypertension(138/88 mm of Hg) who is prescribed Tab.
HYDROCHLOROTHIAZIDE 12.5 mg.
Assignment 1

29. Brief about disease:
You have been diagnosed with hypertension, a
condition where your blood pressure remains
high.
If left untreated, it can lead to heart disease,
brain disease or kidney problems.
You will have to take the medication life long as
hypertension requires long term treatment and
stopping the treatment will result in
complications.

30. Case of mild hypertension….
• Medicine: I am prescribing you a tablet called
hydrochlorothiazide 25 mg, which will excrete
excess water and sodium from your body and
will keep your blood pressure under control.
• You might notice that you urinate more
frequently. It is normal.
• Take one tablet of hydrochlorothiazide 25 mg
every day, once in the morning.

31. Case of mild hypertension….
• Reduce the amount of salt intake up to 2 grams per
day in your food.
• Avoid pickles, papads or noodles.
• Have a diet rich in green vegetables, fruits,
legumes, nuts, whole grains, fish, polyunsaturated
fatty acids.
• Minimize consumption of processed meat, refined
carbohydrates, and sweetened beverages.
• Do regular exercise mild to moderate intensity.

32. Case of mild hypertension….
• If you notice any muscle cramps or excessive fatigue or
dyspnea, Do report immediately.
• Maintain a diary recording of your blood pressure either at
home or in the nearest health care facility for the next
month.
• Avoid smoking and alcohol consumption.
• Have adequate sleep.
• Do not take this medicine after 4 PM as it will be disturb
your sleep.
• Revisit after one month with Kidney Function Test reports.

33. Assignment 2
Perform a role-play of a doctor instructing an adult
asthmatic patient on proper use of inhaler.

34. Instructing an asthmatic patient on proper use of inhaler….
• Brief about the disease : You have been diagnosed to
have acute asthma attack which is producing breathing
difficulty due to mild to severe airway narrowing in
your lungs.
• It might be due to allergy and hypersensitivity reactions
to common allergens in food , environment and even by
some drugs.
• To treat this condition, I have prescribed you a drug
called Salbutamol as a metered dose inhaler (MDI)
which will give drug directly into the lungs and will give
fast relief.
• Salbutamol reverses the airway narrowing and helps you
to breathe at ease. Hence it is very important to take
this drug whenever you are having an attack

35. instructing an asthmatic patient on proper use of inhaler….
• Details of device-This device has a mouthpiece , drug
canister and piston. This piston is pressed to deliver the
pre measured amount of salbutamol drug.
• You should hold the MDI vertically. Now gently shake
the MDI for 3-4 times. Now breathe out forcefully to
empty the lungs.
• It will help to inhale more drug . Keep the mouthpiece
of MDI between the upper and lower front teeth and
seal with lips.
• Press the canister once while taking the breath. You
should hold the breath for at least 10 seconds (10-45
seconds) to provide enough time for the drug to be
absorbed and act.

36. instructing an asthmatic patient on proper use of inhaler….
• Wait for 5 minutes and if you feel you are not
improving then repeat the dose.
• Sometimes you may develop fine tremors,
elevated heart rate. These are usually
harmless and will subside in due course.
• DO:
• You should call emergency service at the third
doses if you are still not better and meanwhile
trying the fourth dose.

37. Instructing an asthmatic patient on proper use of inhaler….
• Clean the MDI frequently and dry it before its next usage.
• As soon as you feel better after an attack, do gargling of the
throat with plain water. It will help to remove the drug
deposited in the throat and prevent unwanted side effects.
• Please always have an additional MDI with you in case one is
exhausted .
• You can periodically check the remaining medicine in the
canister by shaking, viewing the dose counter or using
calendar methods.
• Ask the patient for any query and also to demonstrate the
usage of MDI when possible.
Revisit after 2 week

38. Assignment 3
Communicate medicine for prevention and
give important instructions for a 10 year old
patient diagnosed with generalized tonic clonic
seizure

39. Brief about disease
• Your ward has been diagnosed with a common
neurological disorder called generalized tonic-clonic
seizure (GTCS).
• The symptoms are caused by abnormal bursts of
electrical activity in your brain.
• It may be idiopathic or many factors including genetics,
history of head injury may lead to it.
• I am prescribing you a tablet/ syrup called sodium
valproate that works by stabilizing the electrical activity
of your brain and it will prevent the seizures from
reoccurring or reduce the frequency of seizures .

40. Sodium valproate for generalized tonic clonic seizures…
• This medicine will continue for at least five years
or three years after last attack so compliance is
important in treatment of epilepsy.
• Do not stop the drug even if you do not have
seizures for a long time.
• Stopping the drug suddenly can aggravate
seizures.
• Do not change the brand of the medicine on your
own.
• As it can cause variations in drug levels leading to
enhanced toxicity or reduced effectiveness.

41. Sodium valproate for generalized tonic clonic seizures…
• This prescribed medicine sodium valproate 50 mg
has to be taken three times a day every day after
food.
• Try to take your doses of valproate at the same
time each day.
• This will help you to avoid missing any doses.
• If you forget to take a dose, take it as soon as you
remember unless it is nearly time for your next
dose, in which case leave out the missed dose.
• Do not take two doses together to make up for a
missed dose.

42. Sodium valproate for generalized tonic clonic seizures…
• Common side-effects are loss of appetite, vomiting,
heartburn, drowsiness, loss of balance and shakiness.
• Long-term use of valproate may cause weight gain and
metabolic adverse effects.
• You should immediately report if you experience
abdominal pain, dark urine or jaundice which are
suggestive of liver problems.
• Maintain a healthy lifestyle. Eat a balanced diet, and do
regular exercise.
• Review after 2 months with Liver Function Test reports.
• Ask queries.

43. Assignment 4
Communicate with a 25 year old newly
married woman regarding the use of oral
contraceptive pills

44. Brief about contraception methods
• Common contraception methods available for
immediate use are physical methods like
condoms and creams for males and vaginal
creams, rings and hormone based emergency
pills for females.
• To get long term protection for months to years,
hormone based pills or implants are preferred.
• I am prescribing these birth control pills as a
method of contraception since you are planning
to avoid pregnancy for one year.

45. use of oral contraceptive pills…
• This is pack of 28 pills with 21 the hormone pills
and seven are iron pills.
• You must start taking first these hormone pills
from 5th day of your menstrual cycle as shown by
arrow in the tablet strip. Take one pill everyday
after meals preferably at the same time .
• Last 7 pills are hormone free pills, during this
time usually you will get breakthrough cyclical
normal bleeding.

46. use of oral contraceptive pills…
• Suppose, if you miss a pill one day, then take the
missed pill as soon as you remember or take the
missed pill along with the next dose.
• Even if not start the new strip from 8th day
onwards .
• You can continue the same as long as if you wish
to avoid conception.
• It is important that you take these pills every day
without fail to provide effective contraception.

47. use of oral contraceptive pills…
• However, if two or more pills are missed, then take
only the most recently missed pill and continue
from the next dose in the usual time.
• In such situations, you need to use back-up
contraception (e.g., condoms) or avoid intercourse
until hormonal pills have been taken for 7
consecutive days.
• In addition to birth control, this will also reduce
blood loss during periods.
• Taking pills will not prevent sexually transmitted
infection.

48. use of oral contraceptive pills…
• You may experience nausea, breast tenderness,
headache, intermittent bleeding in the initial
period. This will settle after continued use of pills
for sometime.
• There is also a lesser chance of developing serious
side effects like blood clots in veins, hypertension
and cervical cancer on long term use
• Whenever you want to conceive you can stop this
pill and fertility will return in subsequent 2-3
months.
• Can ask any query.

49. Demonstrate to counsel effectively regarding the proper use of a drug to a
patient using Role play method or actual scenario and tally it with checklist
question Response Marks
1 Greeted the patient Yes / No 1/0
2 Offered the seat Yes/ No 1/0
3 Favorable non verbal expressions Yes / No 1/0
4 Appropriate para language (tone, accent) Yes / No 1/0
5 Asked for complaints Yes / No 1/0
6 Patient listening Yes / No 1/0
7 Interrupted or asked questions to patient Relevant for clarity/
irrelevant
1/-1
8 Eye contact during encounter Yes / No 1/0
9 Addressed patient by name or appropriately Yes / No 1/0
10 Sensitive while asking habits or personal
history
Yes / No 1/0
11 Cynical talk or inappropriate comments Yes / No -1/0
12 Explained disease and treatment Yes / No 2/0
13 Proper instructions Yes / No 1/0
14 Allowed and replied to queries Yes / No 2/0

50. Assessment of Assignments by Grading of skills
• Poor performance (Below Expectations) < 5
• Fair performance ( Meets Expectations) 5-10
• Good performance(Exceeds Expectations)11-15
According to performance : Remark by the faculty: can
repeat for student with below expectations
--Thank you--