Practice Insight: Registrant-Patient Communication

Communication Breakdown Impacts Pharmacy Care

A patient received a telephone call from their regular pharmacy advising them their prescription would not be filled and they should find another pharmacy. In speaking with the patient, the registrant indicated they did not want to fill the patient’s prescription because they were rude during a previous visit to the pharmacy. Without determining the patient’s wishes, the registrant also informed the physician’s office that the patient’s prescription should be sent to a different pharmacy.

Months prior, during a visit to the pharmacy close to closing time, the patient suggested prescriptions could be filled in ten minutes and should be made available for pick up the same day rather than the following morning. After the registrant filled and dispensed the patient’s prescription prior to the pharmacy closing, they suggested the patient may receive faster service at a smaller, less busy pharmacy and it may be best for them to take their prescriptions elsewhere in the future.

As the patient’s regular pharmacy is the most convenient and they needed their medication the same day, the patient was not comfortable filling their prescription at a different pharmacy.

Outcome of the Inquiries, Complaints and Reports Committee

A panel of the Inquiries, Complaints and Reports Committee noted their concern that the registrant contacted the patient’s physician to ask that the prescription be sent to another pharmacy without having ascertained the patient’s wishes about where to fill their prescription. The panel pointed out that making assumptions about a patient’s preferences is contrary to a pharmacist’s obligations to act in the patient’s best interest and facilitate continuity of care.

Patients have the right of self-determination and should be encouraged to participate in decisions about their health. The panel was of the opinion that the registrant did not utilize effective communication skills to understand and assess the patient’s needs and preferences.

Further, the panel was concerned that the registrant took it upon themselves to terminate the pharmacist/patient relationship based on an interaction with the patient that had taken place months prior. The panel directed the registrant to the College’s guideline on Ending the Pharmacist Patient Relationship, which states that “the patient relationship cannot be terminated without good reason, proper notice, and an opportunity given to the patient to obtain another pharmacist’s/pharmacy’s services before discontinuation.” The panel noted that the guideline provides details on how to communicate the decision to terminate the pharmacist-patient relationship, and pointed out that the well-being of the patient must always be the registrant’s first priority.

The panel felt that the registrant may have been triggered by the patient’s comment that it only takes ten minutes to fill a prescription. The panel advised the registrant to maintain their professional composure at all times and to prioritize providing excellent patient care rather than taking personal offence to comments made by their patients. The registrant was reminded that it is incumbent upon them to ensure their patients receive optimal pharmacy care under all circumstances.

Learnings for Registrants

Registrants are to follow all College policies and guidelines, including the College’s guideline on Ending the Pharmacist Patient Relationship.

The panel provided advice/recommendations to assist the registrant in how they may be more thoughtful in their practice when communicating with patients. The panel took the opportunity to advise the registrant of specific obligations under the NAPRA Model Standards of Practice and particularly advised the registrant on the standards of collaboration and professionalism and ethics:

Collaboration

Pharmacists communicate effectively.

Pharmacists regardless of the role they are fulfilling:
16. use effective verbal, non-verbal, listening and written communication skills

Professionalism and Ethics

Pharmacists demonstrate professionalism and apply ethical principles in their daily work.

Pharmacists, when providing patient care:
5. demonstrate a caring, empathetic, professional attitude
7. maintain the patient’s best interest as the core of all activities
9. educate and enable patients to make informed choices, involving them in decision-making

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Practice Insight: Registrant-Patient Communication – 4 Key Takeaways
1. Nearly 44 percent of formal complaints received by the College in 2021 include communication as a primary or contributing concern.
2. Clear communication is essential for providing appropriate and comprehensive patient care.
3. Patients have the right to self-determination and should be encouraged to participate in decisions about their health.
4. Pharmacists have obligations under the NAPRA Model Standards of Practice, including using effective verbal, non-verbal, listening and written communication skills.