Patients are a Pandora’s Box

I often listen to people talking about providing information to patients and questions to ask. A lot of the time my heart sinks at the closed and direct nature of the questions. No frills and preamble – just straight to the point – ‘do you take your medicines as prescribed’.

With 2 milliseconds of thinking time the answer is invariably ‘yes’. Not even the infamous ‘yes, but’ that can so often support a further discussion, bud a hurried and immediate knee-jerk yes, because that is the ‘right answer’.

In my experience, many patients are a Pandora’s box and this is when a pharmacist’s joy begins. At one stage of my career I might have stood aghast at what people actually say – surely people don’t think like that – how on earth have you come to that conclusion – just why!

I am older and a little wiser now. I understand now that people may start on a completely different planet from me, have widely different beliefs and interpret words and phrases completely differently from their intention. My chin seldom hits the desk, my face is more controlled and I quite often add ‘hmm that’s interesting’. It is this variation that makes every contact different, interesting, exasperating and worthwhile.

Last week I found someone who injects their insulin in bed, because they were told to ‘inject at 90 degrees’ and another that injected the last dose in the shoulder because she was told to ‘rotate sites’. The latter patient had been to clinic at least three times, been asked if she was rotating injection sites and undoubtedly said ‘yes’ each time.

So I have learnt three very important lessons:

  • Precede a question with a statement showing a little empathy and understanding to build rapport, set the scene and allow a level of orientation and thinking time.
  • Try to use open exploratory questions. Perhaps questions that require an emotional response, for example ‘how do you feel about….’.
  • Repeat the question or a simple variation of the question, until I feel that I have exposed enough layers of thinking to get close to the fundamental underlying belief, perception or understanding. I have seen this called the 5 whys and deep diving.

It is never about persuading people to do as they are told, but exposing belief, supporting understanding and enabling the patient to make an appropriate decision for them.

And if you get to the bottom of this – agree that cognition precedes behaviour – and read it again.


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