There are two very important lessons to learn with prescribing and the interaction with patients:
“Say no quickly and yes slowly”
“Think of the answer and then think about the question”
If you have no intention of prescribing a medicine, where there is no suitable, endorsed or recommended treatment, then say ‘no’ quickly. This offers little room for discussion, but opens up the question ‘so what can I do’. You can then fill the gap with things that the patient can do to relieve symptoms, including the purchase of medicines and remedies over the counter, self-help or self-care. Don’t be tempted to offer a reason why you are not going to prescribe – just try not to open this line of conversation or you may lose and be persuaded to prescribe something that is not appropriate.
If you have the intention of prescribing a medicine, then say ‘yes’ slowly. This is the first stage of the medication experience, and is very important in getting things off to a good start. You need to open up a dialogue to enable you to deal with issues important to the patient’s medication experience at the earliest opportunity.
I appreciate that the system is set up to make a diagnosis and give a medicine, but a patient’s mind may not work this way.
Have you considered the question ‘would you like me to prescribe something that might help?’ In my experience many patients would prefer not to take a medicine and this is often followed by a reply such as ‘so what options do I have’ that allows you to explore alternatives. It may be an open door to explore life-style changes that may either help the condition and/or reduce the need for a medicine in the first place.
Obviously this opens up further opportunities for discussion:
- What will the medicine mean for me? Some medicines may reduce or release specific symptoms and others may reduce the likelihood of a further complication. There are outcome charts with smiley and sad faces that may help.
- What will it do to me? It is very important to explain what a patient might feel when the medicine is in their body – how will they know when it is working.
- How long will I need to be taking it for? Medicines that are quickly curative or deal with specific symptoms may be easier to accept than medicines that have to be taken long term (see previous blog).
- What flexibility do I have? Remember that patients will take control and you may want to discuss flexibilities and in this way they drive their own compliance. I know that dexterity, vision and memory can cause problems, but they can be overcome by the community pharmacist.
You cannot achieve perfect compliance in a patient that doesn’t want to take the medicine the way that you advise.
This may represent a great start at the point where the medicine is introduced, but note the stages of medication experience and make sure that your wider team, including the community pharmacist are available when the patient asks further questions.
Where there are significant life-style or self-management issues, consider which patient support programs might be available. Ask the CCG to explore self-management programs delivered by charities and supervised through community pharmacy.