A View from a Room

Glenn Rodrigues used to complain about lack of privacy. He remembers his typical consultation being uncomfortable, with the patient simultaneously trying to listen to him and drown out the distraction of other patients waiting their turn. For the patient, it was like ordering a meal from a fast food joint, but with the discourse being about drugs and personal health issues, not burgers and fries. But he came to accept the awkwardness of the semi-public conversations he had with his patients as part of the job. Until July 2011, that is. At that time, his community pharmacy went through renovations, which included the construction of an extra room. Rodrigues says most pharmacists use these types of rooms for storage, but he felt that he wanted to use it for his patients. He now uses the private room for every single consultation. “It's been a game-changer for me in terms of how consistently it improves the interactions I'm having with patients,” he says. “When we're counselling at the counter, it becomes a challenge to get people to open up because of the lack of privacy.” Rodrigues, who graduated from the college of pharmacy at Dalhousie University in 1999 and has been working in community pharmacy ever since, says his consultations take a little bit more time, but he feels it's completely worth it for a number of reasons. “We need to use the private consultation room to optimize patient care, improve the public perception of the value of pharmacy, improve the perception of this pharmacy, improve job satisfaction of the pharmacist and solidify the role of the pharmacist.” Optimizing patient care and “solidifying customer relations” are probably the most significant benefits of using the private room, says Rodrigues, who also coordinates one of the skills labs at the college of pharmacy at Dalhousie University. He says consulting at the counter can be challenging, since people have a hard time opening up and don't want strangers to know about their medications. “You can see it in some people. They're anxious about whether or not the pharmacist is going to start talking about their medication at the counter. People are concerned about the privacy of their information, since privacy is a big thing in our society.” But the private room allows the patient to overcome this fear, as Rodrigues finds that people tend to talk about things they never would have at the counter. “What's really struck me is that there are a lot of things going on in our patients' lives, and it's the recognition that we're not getting to know them at that level of detail that's inspiring us to do this more than anything.” Once in the consultation room, Rodrigues asks patients about why they're seeing their doctor, the symptoms they have, how long they've had them, what other medications they've tried, and so on. This interaction leads to vastly improved patient-centred care, he says. “There's greater opportunity because we're dealing with a much more significant body of information with the people we are serving.” This process also leads to stronger relationships with patients, says Bonnie Parsons, who works with Rodrigues at their Sobeys pharmacy, located in a small but growing suburb just outside Halifax. When a pharmacist dedicates more time to understanding what's going on in a patient's life — which the private room enables Parsons to do — the patient feels more comfortable talking about their issues, and the pharmacist has so much more to document, says Parsons, who graduated from the school of pharmacy at Memorial University in Newfoundland in 1993. “Even if we see somebody outside of the pharmacy setting, we can ask and monitor how they're doing. It may be a small thing, but our desire to get to know our patients better and having the opportunity to facilitate that is really what makes a difference here.” Rodrigues stresses that the pharmacist also benefits from the private consultation room. Both he and Parsons agree that the job ends up being much more rewarding. They point out that some pharmacists can fall into a rut and get frustrated with dispensing day in and day out, never finding enough time to conduct clinical interactions. Having in-depth conversations with the patients in the private consultation room changes the whole dynamic of the profession, Rodrigues says. “It's not the therapeutics or drug plans that are the interesting part of the job. It's always been the people who are the interesting part.” At a time when pharmacies are facing financial challenges and increasing pressure to do more work with less staff, Rodrigues says he's happy to be going against the grain by taking more time with his patients. “How many businesses fire employees who have great relationships with their customers and improve the quality of their lives? Even if it isn't for my own job security, using the room improves my job satisfaction.” Rodrigues adds that the private consultation room also improves the public's perception of the pharmacy and re-establishes the pharmacist's role within it, as talking to the patient in the private room has the “feel of a clinical consultation.” “It gives a much better image for the type of service we're providing … and helps establish what my role and value is at the pharmacy. Sometimes [patients will] bring up new information and questions because they are looking at the pharmacist in a different way.” Rodrigues explains that patients sometimes even seem surprised at the comprehensive attention he is giving them. Many patients double-check his name tag or business card, and he is more likely to receive thanks and a handshake for his service. They no longer care as much about the pharmacy's fees, average wait-times or distance away from home, and he's no longer simply checking drug identification numbers and making sure the right pills are in the right bottle. Their expectations of him and the pharmacy radically change, he says. “We need pharmacists in pharmacies acting as clinicians, because not only does it improve the level of care,” he says, “it also reflects well on pharmacy itself as a business because we are providing a higher-quality service.” Rodrigues knows many pharmacists want to make their job more clinical, and it all starts with the interactions, he says. “What I really try to look for, in the everyday interactions that we have, is how do we make those more clinical? I find that particularly rewarding and I really hope people will start to value us as clinicians as a result.” TIPS FOR PHARMACISTS If you have a private area where you can speak with your patients, make sure it's in good condition and ready to use. “A lot of pharmacies use the room for storage. Clean it up so you can at least start using it occasionally,” Rodrigues says. “Do you mind that we go in here so we're not interrupted?” Bring up the idea of going into the private consultation room with the patient by asking this question. Most patients will not have a problem with it, Rodrigues says. Start slowly — hold consultations every now and then. The private consultations will start to have an impact on you and your patients, and momentum will build out of that. Over time, “people will start to recognize how much value it is to move [the conversation] from the counter to the private room,” Rodrigues says. Identify situations when you really should be talking to the patient privately, and start by always moving these conversation into the room. “For the most part, the pharmacist is going to do the consultation in any case,” Rodrigues says. “You can easily move that conversation to the private counselling room, and see how it's changed the dynamic in terms of how it's affecting your patient and how it's affecting you. But even when you don't think privacy will be relevant, the patient will hold back something that's relevant because they're in an open area. So I think the more that we can use a private room, the better.” The feedback Rodrigues and Parsons have received regarding the private consultation room has been overwhelmingly positive. Some patients even end up telling their physician about the positive interaction, Parsons says. “They're showing us in a positive light and representing us as someone that other health care providers can call upon.” But Rodrigues says even though people enjoy the new private interaction, some people can get frustrated with the slightly increased wait times. “One of the things I really think is important is the experience after the wait. There are physicians who make you wait well after your appointment time, but you wouldn't dare switch doctors because you value the care they provide.” Rodrigues hopes to see the community pharmacist move from beyond someone people “like and trust” to a valued clinician. “If we do that, we will have much greater success in terms of expanding our scope of practice, connecting with other health care providers and making our job much more rewarding.” The standard use of a private consultation room would be a major catalyst for this change, he says. “We have to change patients' perceptions of what they were missing out on. The biggest thing we can do to advocate for the profession is to let people understand what the experience of going into a community pharmacy should be about, and that it really can be an opportunity to improve the quality of their life through a meaningful consultation with the pharmacist.”

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