What, IYO, is a good consultation?

[powertoold]

I only have 120 hours of experience in a retail pharmacy and have seen 6-7 different pharmacists give consultations. I find that many of these consultations are inadequate. In fact, I have yet to see a "good" consultation. Often, there's little or no consideration as to whether the PT understood any of what was said. Even when there's little work to do, the pharmacists only do 10-20 second consultations.

Having done almost 20 consultations myself, I realize that it's difficult to give a good and concise consultation. Most of the time, I just read the directions on the label and then go through the auxiliary information, which is also what the pharmacists do. When I do this, I always finish with a sense of dissatisfaction for 3 reasons. First, my drug knowledge is inadequate, so it's difficult for me to thoroughly review the medication with the PT. Second, I know the patient will forget 70% of what I said when they walk out the door. Third, I rarely have any back-and-forth with the patient.

I learned the 3 prime question method in school, but I haven't used it yet. Many experienced pharmacists tell me it isn't viable in the real world. Sooo this all leads to my question, has anyone seen / heard of a "good" real world consultation? Is it possible to do one even when you're sort of busy, etc? If so, what questions are asked, what information is given, how is patient understanding affirmed?

Thanks!

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[kbv]

I only have 120 hours of experience in a retail pharmacy and have seen 6-7 different pharmacists give consultations. I find that many of these consultations are inadequate. In fact, I have yet to see a "good" consultation. Often, there's little or no consideration as to whether the PT understood any of what was said. Even when there's little work to do, the pharmacists only do 10-20 second consultations.

Having done almost 20 consultations myself, I realize that it's difficult to give a good and concise consultation. Most of the time, I just read the directions on the label and then go through the auxiliary information, which is also what the pharmacists do. When I do this, I always finish with a sense of dissatisfaction for 3 reasons. First, my drug knowledge is inadequate, so it's difficult for me to thoroughly review the medication with the PT. Second, I know the patient will forget 70% of what I said when they walk out the door. Third, I rarely have any back-and-forth with the patient.

I learned the 3 prime question method in school, but I haven't used it yet. Many experienced pharmacists tell me it isn't viable in the real world. Sooo this all leads to my question, has anyone seen / heard of a "good" real world consultation? Is it possible to do one even when you're sort of busy, etc? If so, what questions are asked, what information is given, how is patient understanding affirmed?

Thanks!

Are you a pharmacy student? (Your title said otherwise.)

Which PY are you in now? (If you were a pharmacy student.)

It's a wonder how on earth your PIC let you do what you did even though like you said "I only have 120 hours of experience in a retail pharmacy..."

How did "I only have 120 hours of experience in a retail pharmacy" help you decide "I find that many of these consultations are inadequate. In fact, I have yet to see a "good" consultation. Often, there's little or no consideration as to whether the PT understood any of what was said."?

Who are you to judge the pharmacist when you said " I realize that it's difficult to give a good and concise consultation. Most of the time, I just read the directions on the label and then go through the auxiliary information, which is also what the pharmacists do."?

"my drug knowledge is inadequate, so it's difficult for me to thoroughly review the medication with the PT" Wow, come back when you're licensed to practice.

I know the patient will forget 70% of what I said when they walk out the door. How? I'm curious.

I rarely have any back-and-forth with the patient. Why? "120 hours" plus "~20 consultations"?

Many experienced pharmacists tell me it isn't viable in the real world . True.

Is it possible to do one even when you're sort of busy, etc? Yes, nothing is impossible.

If so, what questions are asked, what information is given, how is patient understanding affirmed? Why? Don't bite off more than you can chew.

 

[powertoold]

It's a wonder how on earth your PIC let you do what you did even though like you said "I only have 120 hours of experience in a retail pharmacy..."

I'm not sure why the PIC lets me do consultations, but I'm usually asked to do them, and the pharmacists often don't even know what drug I'm consulting on.

How did "I only have 120 hours of experience in a retail pharmacy" help you decide "I find that many of these consultations are inadequate. In fact, I have yet to see a "good" consultation. Often, there's little or no consideration as to whether the PT understood any of what was said."?

Who are you to judge the pharmacist when you said " I realize that it's difficult to give a good and concise consultation. Most of the time, I just read the directions on the label and then go through the auxiliary information, which is also what the pharmacists do."?

Consulting is like teaching. I have some experience in tutoring and know when an adequate amount of patient understanding is achieved. Even if I didn't have experience in tutoring, I don't see how one can't evaluate a consultation without experience. A 10-20 second consultation where the pharmacist is basically just reading off the labels can't be considered "good." It doesn't take a rocket scientist to figure this out.

I know the patient will forget 70% of what I said when they walk out the door. How? I'm curious.

Because I forget 70%+ of my lecture material soon after I hear it for the first time...

Is it possible to do one even when you're sort of busy, etc? Yes, nothing is impossible.

Great answer, but it doesn't help this thread in any way.

If so, what questions are asked, what information is given, how is patient understanding affirmed? Why? Don't bite off more than you can chew.

Okay, thanks for figuring out that I'm an idiot. Yes, I admit I'm an idiot. Unfortunately, your great detective work hasn't helped me or anyone else in any way. Would you mind giving your perspective on a "good" consultation rather than talking about me and my qualifications?

You must be having a bad day or something... lol

 

[Ackj]

I'm not sure why the PIC lets me do consultations, but I'm usually asked to do them, and the pharmacists often don't even know what drug I'm consulting on.

It seems that Wegmans interns are doing that. Today was my first day back to classes, so we're talking about our first summer internships. All of the wegmans folks basically said "yeah, they just kind of threw me into it, i didn't know what the were even, they just said 'go counsel' "

 

[Old Timer]

A good consultation involves a dialog, not a monologue.

Why are you taking this medication?
Did the doctor tell you how to take this medication?

That's how you start. The conversation can go anywhere based on the answers to my opening questions.

If they bring in an Rx for Atenolol 50 mg qd. And they say

ME: Why are you taking this medication?
Patient: chest pain

ME: Did the doctor tell you how to take the Atenolol?
Patient: Once a day at bedtime.

Now we can have a small discussion about NTG, beta blockers masking the signs of hypoglycemia if they are a diabetic. Speak about not stopping suddenly.

You can't give a mini lecture. I generally only warn people about common side effects and ask them to read the print out so they know what to look out for.

You also have to dumb down your presentation to the level of your audience. My preceptor always said he graduated with honors. When he graduated the dean it was an honor to get rid of him. But what he had and why people loved him was the ability to pithily explain complex things. When I was a student, I was asked how beta blockers work. He watched me struggle to explain it and then he told the person "it regulates your heart beat." For the high school educated 85 y/o woman it was a simple explanation and all she needed.

So, a good consultation is:

• A dialog
• Brief
• In terms the patient can understand.

 

[Sparda29]

At school, we're taught that these consultations are supposed to last 5-10 minutes. That is the ideal world, and is probably possible at Dr.M's pharmacy and other independents.

But in retail chains, not gonna happen.

 

[Its Z]

thats because youre not an effective communicator! lmao.

I only have 120 hours of experience in a retail pharmacy and have seen 6-7 different pharmacists give consultations. I find that many of these consultations are inadequate. In fact, I have yet to see a "good" consultation. Often, there's little or no consideration as to whether the PT understood any of what was said. Even when there's little work to do, the pharmacists only do 10-20 second consultations.

Having done almost 20 consultations myself, I realize that it's difficult to give a good and concise consultation. Most of the time, I just read the directions on the label and then go through the auxiliary information, which is also what the pharmacists do. When I do this, I always finish with a sense of dissatisfaction for 3 reasons. First, my drug knowledge is inadequate, so it's difficult for me to thoroughly review the medication with the PT. Second, I know the patient will forget 70% of what I said when they walk out the door. Third, I rarely have any back-and-forth with the patient.

I learned the 3 prime question method in school, but I haven't used it yet. Many experienced pharmacists tell me it isn't viable in the real world. Sooo this all leads to my question, has anyone seen / heard of a "good" real world consultation? Is it possible to do one even when you're sort of busy, etc? If so, what questions are asked, what information is given, how is patient understanding affirmed?

Thanks!

 

[Old Timer]

Agreed, but avoid closed ended questions like "Did the doctor...". Rather, use "How did the doctor tell you how to take this?" and "What did the doctor tell to you expect (side effects) with this medication?". I know I usually shut down and take nothing in if I am simply responding "yes" or "no"...

Ask for them to repeat it back to you just to assess understanding. The way I see it, if you tell them: how to take the medication (when, how often, etc.), what it is being used to treat, and 1-2 key side effects... AND they can repeat these back to me, that is about as ideal as it can get in today's retail...

So how long have you been a pharmacist? How many consultations have you done that do not include academy award winning performances by a classmate?

First, there is no significant difference between:

Did the doctor tell you how to take this medication?

and

How did the doctor tell you how to take this?
​

Because you are not asking the question in isolation. If they say yes, they usually fllow that with how they are taking the medication. If not, then you ask how they are supposed to take it and if they say no, you explain how to take it. A consultation has a life of it's own, depending of the drug, the condition being treated, the duration of therapy.

Next, I am sick I come to the store and now I have to pass a friggin quiz in order to go home. Are you out of your mind? I would shove that script so far up you @SS that you would have to open your mouth to get it out. What happens if I can't answer your questions? I have to stay at consultation until I get them all right? You have to learn to read people. You can tell when you have reached someone and when you haven't. Remember they have a label, a monograph and possibly a med guide. You are there to reinforce and advise them of the key things they need to focus on with the particular medication.

Don't read them the directions, side effects and storage information and then give them an oral examination to see what they learned.