Pharmacist-Physician Communication

1. Pharmacist-Physician Communication

2. Background: • Athens Primary Care – Pharmacy Care Clinic

4. Objectives • Understand the importance of pharmacist-physician communication in achieving patient outcomes. • Identify the key attributes and variables that impact this communication process. • Apply basic communication skills to communications with physicians. • Understand the one thing you should never do when communicating with a physician.

5. Why? • To make sure patients get the best care possible • Effective collaboration between doctors and pharmacists is essential to patient care (1) • Poor care has been linked to poor inter-professional communication (2) (1) Nijjer S, Gill J and Nijjer S. Effective Collaboration between doctors and pharmacists, Hospital Pharmacist 2008;15:179-182. (2) Astrom K, Duggan C, Bates I. Developing a way to improve communication between healthcare professionals in secondary care. Pharmacy Education 2007;7:279-85.

6. Your role as a pharmacist: • Work toward achieving desired patient outcomes via the Pharmacy Care Process (3) • Collect and use patient information • Identify patient drug related problems • Develop solutions to these problems • Select and recommend therapies • Follow up to assess outcomes • With this, the role of the pharmacist as simply the “drug expert” now expanding to include responsibility for patient outcomes (3) See e.g., numerous publications based on original work by Doug Helpler and Linda Strand.

7. This represents some degree of change in certain practice settings. • Changing traditional roles, responsibilities • Past: • Pharmacist subservient to the physician • Present & Future: • Pharmacy care process and greater impact on care has changed this traditional model • Peer model more appropriate as pharmacists and doctors take on complimentary roles

8. But: • New role for pharmacists has been met with some resistance – mainly from older physicians. • Respond with: • Tools from the tool box which make you an excellent communicator: • All basic communication rules, strategies, tactics (tool box items) apply in communicating with doctors. • The impact of the level of the relationship with the doctor is critical in developing a communication strategy, aka. rapport. • Tact and diplomacy are two new tools.

9. Remember: • Doctors are people too! • All aspects of communication apply: • Non-verbals • Barriers • Two-way flow of information • Always the potential for a challenging situation – PAR • Toolbox?

10. Physician Pharmacist Collaborative Relationship (4) Professional Professional Exploration Professional Commitment Awareness Awareness and Trial Relationship to Collaborative Expansion Working Relationship Participant Characteristics Context Characteristics Exchange Characteristics (4) Zillich AJ, McDonough RP, Carter BL, Doucette WR. Influential characteristics of physician/pharmacist collaborative relationships. Annals of Pharmacotherapy 2004;38:764-70

11. Keys to effective communication with physicians.(4) • Essential attributes of practitioner communication: • Proximity • Time • Clinical knowledge • Mutual professional practice interests • Professional equality • The variables impacting effective collaboration • Personal Variables • Exchange characteristics (can we get along?) • Practice environment (context) (4) Zillich AJ, McDonough RP, Carter BL, Doucette WR. Influential characteristics of physician/pharmacist collaborative relationships. Annals of Pharmacotherapy 2004;38:764-70

12. A process for communicating. • Introduction • Dr. Smith, I am Lucinda Jones and I am the pharmacist monitoring Jason Holcomb’s warfarin level. • Sharing of details: • I need to update you on his recent INR and blood level of warfarin. • Plans or interventions: • I suggest we decrease the dose to .5mg QD and recheck in 2-3 days.

13. And, the one thing you should never do… • Physicians are problem oriented. That is how they are trained. • They want the information they need and only that information, whether it be oral or written communication. • So: never tell a physician something they already know, unless you preface it with that qualification: • “As you know, Ms. Smiths INR was elevated this morning…” • Remain focused on information and actions.

14. Example: • Less desirable: • Dr. Smith, I saw Mr. Jones last week and it has been 7 months since his last digoxin level. I think we should get a digoxin blood level soon as possible. • More desirable: • Dr. Smith, this is Tommy Johnson the pharmacist monitoring Mr. Jones medication therapy. I saw Mr. Jones last week at the pharmacy and he complained of palpitations. After checking our records I noted it has been 7 months since he has had a digoxin blood level. Based on his symptoms, I’d recommend repeating this test to see if he is still in the therapeutic range to rule out the med as a possible cause of his palpitations.

15. A final thought: • Simply communicating, or exchanging information with a physician does not mean there was a collaborative working relationship. Pharmacy or medical care outcomes need to be improved, in other words, we need to accomplish something for our patients.