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    Pharmacy training: More than just "filling precriptions"


    Ken Baker
    One of the courses I teach undergraduates as an adjunct professor at Midwestern University's Glendale, Ariz., campus is "Patient Safety and Continuous Quality Improvement." Before class recently, a student was telling me and some of her peers about an encounter she'd had the day before with an "older" gentleman who lived near her apartment building.

    When she told him she was studying pharmacy in college and still had a couple of years in school before she graduated, he asked her, "Why does a pharmacist have to go to college so long just to fill prescriptions?" She gave a good answer, but she was notably irritated by the question. "Don't they know what we can do?" she asked.

    The class that day centered on choosing techniques and best practices that could be made a part of daily practice to reduce the risk of a mechanical prescription error reaching the patient. One of those best practices, which almost everyone agrees can prevent many medication errors, is effective patient counseling.

    We were to talk in class that day about show-and-tell counseling, whereby the pharmacist opens the prescription bag, shows the patient the medication, and asks the patient the counseling questions developed by the Indian Health Service decades ago.

    My students already know what those questions are. They are taught to every student in every pharmacy school in the United States, because they are still the most effective and most efficient way to educate patients in the use of their medication.

    The first question — "What did your doctor tell you this medication is for?" — lets the pharmacist learn what the patient already knows about why the drug has been prescribed. It also causes the patient to visually link the dosage form with the patient's medical need for it. From the risk manager's point of view, it provides a check on a possible error by physician or pharmacist. Similarly, the second and third questions — "How did your doctor tell you to take this medication?" and "What side effects did your doctor tell you might experience?" — are designed to educate the patient. What we were going to talk about that day was how they can be used to protect the patient and the pharmacy from mechanical errors and intellectual claims.

    That day in class, we discussed the old man's question and discussed counseling from another point of view. Perhaps, we decided, there is another, equally important purpose for counseling. We talked about the old man's question from his point of view. When he enters a pharmacy, what does he see a pharmacist doing? Does he see anything that shows his pharmacist's education or knowledge?

    When he visits his physician, he is likely to be impressed by the physician's skill and knowledge. In the hospital, he sees nurses who appear to be doing something special, and while he may not know why, it looks as if knowledge is required. He may not understand what his lawyer is talking about, but it sure sounds smart. Even his plumber shows skills that seem impressive.

    I asked the students to consider from the old man's perspective what he sees from his pharmacist that would prompt the question he asked. This old man may not be alone in his perception of what we do, or don't do. So when does a pharmacist have the opportunity to demonstrate to the everyday patient the special knowledge, experience, and skill that he or she possesses?

    The answer is: during counseling. It is during good counseling that pharmacists can show their special knowledge.

    By counseling, I do not mean crisp perfunctory comments, such as "Take two a day — it may cause drowsiness." I mean the art of effective communication. I mean counseling delivered with empathy and with a smile. I mean show-and-tell, with open-ended questions to determine what the patient already knows, so that the pharmacist can fill in the blanks. I mean "pharmacists care" patient education, the type of counseling you don't do to look good, but do to help a patient get well.

    You may not undertake this type of counseling with every patient, every time. But you can practice it selectively, with patients at particular risk, such as the elderly or those taking several medications. Selective educational opportunities may be required when a drug the patient is using requires special attention (e.g., the NTI — narrow therapeutic index — drugs, such as warfarin) or needs to be taken with special care. Counseling can reduce the risk of medication errors and can assist the patient make the most beneficial use of medication.

    Good counseling has other benefits. This is the one time a pharmacist will normally have a face-to-face opportunity to show a patient firsthand why all those years of education were necessary. When that old man comes into your pharmacy to get his prescription, show him how important a pharmacist can be to him.

    KEN BAKER is a pharmacist and attorney who consults in the areas of pharmacy error reduction and risk management. Contact him at
    .

    Kenneth R. Baker, BS Pharm, JD
    These articles are not intended as legal advice and should not be used as such. When a legal question arises, the pharmacist should ...

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