Counseling – when listening is more imporant than talking

Being a full time temp/floater.. only working for temp services… I get the opportunity to see how many other RPH’s really practice and how they have trained their staff to interact with patients.  I have seen – although not working at the time – staff that has been trained to check the “decline counseling” on the electronic signature… and not a word to the patient.  I try to change techs that ask the patient “do you have any questions for the RPH”… to “do you have any questions about your medication(s)”. I don’t need some smart ass to get me to come to the register to get asked “Do you know what the Pick-4 numbers for today are going to be ?”

Of course, many of the people that have serious questions are “seniors” and on multiple meds.. I  have noticed that since I now have naturally gray hair… what’s left of it… seems to give me a one up on counseling other seniors… maybe they figure that I can easily relate.. or figure that I have been around the block as many times as they have.. and may have picked up some knowledge in all that time… more than those “young whipper snappers”

I had two very interest interactions today.. I was working at a BIG BOX store… for some lucky reason… it was a slow day and my “tech” was a freshly minted PharmD… who will be taking the NABPEX in a couple of weeks… so I pretty much stood back and monitored what was going on…

First patient… not even sure if she was a Rx customer for this store… Her reason for stopping was to ask the question if/how much Aleve would affect her blood sugar.. She told me that her doc just put her on Metformin. I found out.. that she had attended some sort of training session for newly dxed DM-II.. She was somewhere between reluctant and obstinate in not doing blood sugar testings – “it hurts”… was her reason. Her only concern was low blood sugar… she was either told, not listening or not paying attention when someone told her about the long term consequences of high blood sugar. No one had told her about using her forearm for testing..  I must have spent 15 minutes trying to get her to understand the consequences of just having a concern of low blood sugar… and trying to get her to understand what she really needed to do… to see where her blood sugar is… and how it will vary… you know the drill…

Second patient… a chronic pain patient… had just had some spinal injections and was – for the time being – doing pretty well… in talking to her… she had – IMO – a unrealistic concern of “addiction” to hydrocodone… before the spinal injections.. she was taking a couple of HCD/APAP per day… to “help me get thru the day” … when I asked her where her pain level was “getting by” .. her answer was 7-8.. which is UNACCEPTABLE…  again another 15 minutes talking to a patient about misconceptions about their medications and or managing their disease states.

Unfortunately, as a “floater” … I will never know .. if I made a difference.. asking open ended questions… listening… about what is being said and what is not being said by the patient… gave me the insight… to do more than rattle off … “take this on a empty stomach”…”take all till gone”… etc…etc…etc…

this was a slow day.. but just imagine… if each of us… took the time.. for one-two patients a day… what a long term difference we could make.. in so many people’s lives.. you will get patients that will “trust” and “listen” to you in the future… These are the same people… as your volume increases and staff gets cut.. that you can pull them aside.. and tell them that you would like to give them the best service possible.. but.. you would like to ask them to call their refills in 24-48 hrs before they intended to pick them up.. so that you can keep their wait time to a minimum…

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