In her third article on patient-centred care, Reena Barai explains how both she and a patient benefitted from a different consultation technique.

One of my regular patients came in recently for a MUR.
I had done MURs on this patient in previous years and, to be honest, all the MURs had the same storyline. He was a poorly controlled type 2 diabetic, overweight and he drank too much alcohol, so I spent every MUR ‘telling’ him to take his medication, ‘telling’ him to lose weight and ‘telling’ him to cut down on his drinking.

Because I had always done what I had always done, I would always get the same reaction. Had any of my MURs with this man made any difference to his outcomes? Probably not.

Year-on-year, his diabetes control got worse, he gained weight and he drank more. This year when I called him in I used a very different consultation technique. I started off by being really honest with him and told him how I felt we were still in the same position with regards to his health as we had been in previous years.

He was initially taken aback by my approach, but eventually he agreed with me. I then asked him what it means to him to be diabetic. He didn’t think being diabetic was an important health issue for him, which rather took me by surprise. I went on to ask him what his fears were about being diabetic – and that was when he really opened up.

We talked about how he did not want to go on insulin as he drove for a living and didn’t want to ever risk losing his licence. I asked him if he knew why people went on insulin and it was almost like a light-bulb moment for him. Suddenly he realised that if he didn’t start taking his oral medications and didn’t change his lifestyle, he would be on insulin sooner rather than later.

The best consultation models focus on ways that achieve partnership working with the patient. My intention with my series of questions was to take into account my patient’s ideas, concerns and expectations (the acronym ‘ICE’). By using this technique I was able to create a shared agenda with the patient.

If I hadn’t used ICE to start off the MUR, I wouldn’t have achieved the results I did. My patient has since lost weight, drastically cut down on his alcohol intake and has a better HbA1c level.

Shared agenda

By creating this shared agenda, I was able to empower my patient to take responsibility for his own health. For pharmacists this really should be our ultimate goal in every consultation.

I often think about this patient as I honestly wouldn’t have changed the way I conduct my consultations if it wasn’t for the work I have been doing through the CPPE. I urge all of you to pick up the blue CPPE Consultation Skills for Pharmacy Practice book that was sent out to you last year and start reading it.

Even better, book onto one of the many CPPE workshops running in your area on consultation skills. You can also visit the website for more information on how to improve your skills.

All too easy...

As an independent contractor myself I know it is all too easy to always do what you have always done. Sometimes it is because of the comfort zone we create for ourselves, but often it is because we know no better as we work on our own and don’t have the benefit of peer support or feedback. Once you have read through the CPPE resources make sure you undertake the e-assessment.

This includes watching videos of consultations and then rating them based on how well they meet the various standards. The videos are a good way to see how others may word things when they consult with patients and I found them a very good tool for reflecting on my own consultations. I’ll end with one of my favourite quotes:

“Whatever got you where you are today is no longer sufficient.” For me, this sums up the situation perfectly. We all have to make changes to the way we consult with patients in order to have a real impact on them and their health outcomes.