Fall Semester 2008
Lecture 5
Barriers to communication Labiba Khalil El-Khordagui, PhD 1
Professor of Pharmaceutics Faculty of Pharmacy, University of Alexandria
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Professional Communication Elective Course
Identified Learning Objectives To identify the main types of barriers that hinder communication Environmental or physical barriers Personal barriers (from pharmacist perspective) Patient barriers Perceptions and prejudice Administrative and financial barriers Time barriers
To identify means to overcome communication barriers
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Overview Within the communication process, numerous barriers exist that could potentially disturb or even eliminate personal interaction. The potential number of barriers in any pharmacy practice setting is so large that proper communication may not take place. Removal of these barriers involves a two-step process: 1- Recognizing that the barriers exist 2- Take appropriate action to overcome them
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Barriers may disturb interpersonal communication
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B
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S=sender
R=recipient
B=barrier
Main types of communication barriers I.
Environmental or physical barriers
II.
Personal pharmacist barriers
III. Personal patient barriers IV. Perceptions and prejudice V.
Administrative and financial barriers
VI. Time and timing barriers
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l- Environmental Barriers Distractions related to the environment often interfere with the communication process.
Environmental barriers may be rather obvious or more subtle.
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Examples of environmental barriers in pharmacy practice 1- The height of the prescription counter separating the patient from the pharmacist 2- Crowded noisy prescription areas 3- Lack of privacy in counseling area
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1- The height of the prescription counter separating the patient from the pharmacist Prescription counters exist for 3 main reasons: 1- To identify the location of the pharmacist 2- To allow the pharmacist to look over the area periodically 3- To provide a private and safe working area for the pharmacist
High prescription counters as communication barriers Patients may not see the pharmacist Patients cannot talk to the pharmacist they almost don’t see, which gives the impression that the pharmacist does not want to talk to them Pharmacist standing over the counter may give the impression of superiority and make eye contact less than optimal
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Partitions may negatively affect pharmacist-patient communication
2- Crowded noisy prescription area This inhibits effective one-to-one communication • Many pharmacies tend to have a lot of background noise, such as people talking and cash registers ringing. These noises interfere with the pharmacist ability to communicate with the patient. • Frequent phone answered by pharmacist 10
calls the
A crowded noisy consultation area interfere with the pharmacist ability to communicate with the patient
Pharmacies with separate consultation and prescription areas enhances effective communication 11
3- Lack of privacy • Privacy does not necessarily mean having a private room, but both the patient and pharmacist must feel that privacy exists. • The presence of a clerk, technician or other people who stand between the patient and pharmacist reduces privacy. A quiet and private patient counseling corner improves communication and decision making 12
How to overcome environmental barriers in the prescription area? The first step, find out which barriers exist in your practice setting by check for the following: –Is the pharmacist visible? –Is it easy to get the pharmacist’s attention? –Does it appear that the pharmacist wants to talk to patients? –Is the prescription area conductive to private conversation? –Do you have to speak to the pharmacist through a third person? –Is there a lot of background noise or other distractions? Make sure that: – Mechanisms that allow patients to have ready access to the pharmacist do exist – a suitable area for counseling patients to allow meaningful patient-pharmacist dialogue is available – A comfortable waiting area is available 13
ll- Personal barriers (from the pharmacist perspective) Many personal characteristics of the pharmacist can lead to ineffective communication. 1) Lack of confidence in good communication skills Many people feel that communication is something you are born with and do not need to be learned. People must realize that communication skills can be learned and developed by practice and reinforcement. People must also realize that there is no one who can communicate perfectly all the time 14
2) The degree of personal shyness. Individuals with high shyness levels tend to avoid interpersonal communication in most situations including interactions in pharmacy practice. Overcoming these barriers is a more complex process than overcoming other types of barriers. It requires more time, effort, training, and many times, professional assistance. However, some techniques, such as systematic desensitization, may be successful 15
3- Preoccupation ► Sometimes, the pharmacist may be more
preoccupied with his internal feelings and thoughts or even more involved in an internal conversation within himself while talking with patients and others than listening to them ► It is essential to develop an awareness of this because it can inhibit your ability to listen effectively and make proper decisions 16
4- Problem and emotion transfer from others Another personal barrier involves the tendency to transfer problems to another person, especially, patient to pharmacist. If the sender (a patient, a colleague or boss) is troubled, angry or worried, you can facilitate communication by easing his emotional state but not taking responsibility for his problem and associated feelings. As the health care professional, you must attempt to remain empathic but not get so involved that you carry the emotional burden of those (especially patients) with whom you interact 17
5- Cross-cultural factors These arise when people from different cultures interact. Examples include: Different language (an interpreter may be helpful) Different perception of eye contact in different cultures Different definitions of illness Perceptions of what to do when ill Common health-related habits and customs Differences in health-seeking behavior 18
A trained interpreter facilitates communication between a patient who speaks a different language, and the health care provider. 19
6- The fear of being in a situation that is sensitive or difficult to handle. These personal fears or anxieties of making mistakes put tremendous pressure on us to “say the right thing” and may prevent us from talking with others. Usually, if the anxiety is confronted and overcome, the actual situation turns much better than expected Examples: • Fear of presenting information or public talking • Not knowing exactly what to say to a cancer patient when he expresses fear of dying • When talking to your boss about a personal problem 20
7- Perception of the value of patient interaction Pharmacists may believe that patients neither expect nor want to talk with them Pharmacists must change their perceptions in order to value patient interaction and be eager to adopt new counseling practices Unlike environmental barriers, removal of these barriers involves personal introspection (EFواIJر واLMFN اOPF) and analysis of one’s motivation and desire to communicate.
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lll- Patient Barriers If patients perceive pharmacists as not being knowledgeable, they will not ask them questions or listen to their advice. Some patients sense that health care providers are not concerned about them as individuals but rather as cases or disease states. Patient may believe that their condition is minor and does not require further discussion after the physician visit In contrast, patients may be anxious about their condition and fear to talk about it with anyone Patients may feel that label instructions are enough and they do not need to discuss the prescribed medications with the pharmacist 22
Patient may have health problems that affect communication, e.g. deafness, speech difficulties, sight problems, etc To overcome the patient barrier, pharmacists need to convince patients to change some of their inappropriate perceptions (by showing competence and self-confidence) and that they need to learn about their condition and medications for achieving better therapeutic outcomes and improving their quality of life. 23
lV- Perception ( )إدراكand prejudice (UVWX YMZ) These can be significant barriers although we deny it We base feelings and actions on our perceptions Obvious prejudices include race, religion, and gender. Pharmacists showing explicit prejudices act not only illegally but also unethically Differences in social class. It is difficult to be sympathetic with someone smelly, untidy or rude. You must act truly professionally toward these patients A study indicated that pharmacists acted differently in two study scenarios concerning an old untidy man and a young woman patients, where prejudice was clearly demonstrated towards the old untidy man 24
V- Administrative and Financial Barriers Several factors dealing with the administrative or financial aspects of pharmacy practice serve as barriers to communication. Examples • Pharmacists are not paid directly for educating or communicating with patients. Research indicates that benefit to cost ratio of patient counseling and education is worth rewarding. • Policies that discourage pharmacist-patient interaction such as high counters, glass or even bar partitions. • Staff shortage, work overload and difficulty simultaneous dispensing and counseling activities 25
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Vl- Time and timing barriers Lack of time and choosing an inappropriate timing to talk may lead to communication failure. The timing of the interaction is critical as either or both communicators may not be ready to communicate at a given time. Examples • A women with two sick children coming out of the physician office after waiting for 3 hours is most probably not in the best frame of mind to sit and have a meaningful conversation with the pharmacist about medications • The pharmacist may be hurried by a large number of prescriptions
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Time barrier may be overcome by using a variety of strategies such as: • Use of printed patient educational material • Highlighting important information with a highlighting pen • Use of nonverbal messages for reassurance
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Summary Interpersonal communication, because of its complexity and human involvement, is a fragile process. Messages become helpful to the patient only when they are accurately received and understood. If messages are distorted or incorrect, then they actually may be harmful to the patient and may prevent an effective and meaningful patient outcome. Barriers, such as the ones discussed, may lead to this distortion. It is important to first recognize potential barriers and then develop a strategy to minimize or remove them. 28
