Developing professional relationships

Background

Pharmacists and pharmacy technicians are often the first point of contact for many patients seeking health care because of accessibility and convenience. Before providing care, it is crucial that pharmacists and pharmacy technicians establish and maintain professional relationships with patients. This leads to increased trust and sharing of information with patients and helps health professionals provide accurate and transparent care.

Person-centered care is foundational to pharmacy practice, and building strong professional relationships is essential to achieving it. Within a pharmacy environment, nurturing and maintaining the connection you have with patients enables effective communication, collaboration, and transparency. This connection allows you to provide better patient care.

Advice

1. Who is allowed to form professional relationships with patients?
   1. Only pharmacists and pharmacy technicians can form professional relationships with patients within their scopes of practice. They have the necessary training and are accountable to professional standards.
   2. Unregulated employees (pharmacy assistants) can be an integral part of the pharmacy team but cannot form professional relationships with patients or be delegated this responsibility on behalf of a regulated member. Pharmacy assistants can form customer service relationships, but only regulated members form professional relationships with patients to provide health care. For example, a pharmacy assistant may gather and record information into the patient record such as name and birth date, but this must be reviewed and validated by a regulated member.
2. General advice when maintaining professional relationships.
   1. Communication is key.
      1. As outlined in Domain 3 of the Standards of Practice for Pharmacists and Pharmacy Technicians (SPPPT), communication is a cornerstone of maintaining healthy professional relationships with patients, and in providing evidence-based patient care. Take the time to explain the reasoning behind providing clinical services and always include the patient in decision-making processes to build trust.
      2. Practise active listening by asking open-ended questions and give the patient time to respond. Reflect what you hear back to them to confirm your understanding and to demonstrate empathy and attentiveness.
   2. Person-centred care.
      1. Domain 1 of the SPPPT highlights the importance of recognizing and respecting a patient’s cultural values and unique circumstances. Focus on the patient as an individual and consider the principles of equity, diversity, inclusion and accessibility when establishing a professional relationship. Consider language barriers, cognitive or sensory impairments, and cultural or social factors that may affect the professional relationship.
      2. Part of maintaining the professional relationship is ensuring you create space for patients to ask questions and actively participate in their own care. Shared decision-making builds trust, strengthens care relationships, and leads to better health outcomes.
      3. Indigenous patient care. Domain 1 establishes that a regulated member’s duty is to recognize that systemic bias affects Indigenous peoples in Alberta, and to practise in a way that seeks to eliminate their own bias. Educating yourself on Indigenous healing practices and how they can be incorporated in patient care helps build trust and goes a long way in establishing and maintaining a healthy professional relationship with Indigenous patients.
3. Addressing barriers to maintaining professional relationships.
   1. Quotas. As per Standard 2.1.2 of the Standards for the Operations of Licensed Pharmacies (SOLP), proprietors are prohibited from imposing quotas that may compromise the professional independence, judgement, integrity, or ability of regulated members, licensees, or other regulated health professionals to comply with the legislative framework that governs their practice. Quotas can undermine the development of professional relationships by shifting the focus away from the patient and toward performance metrics. Building and maintaining professional relationships requires time, trust, and clinical judgement, all of which can be undermined in an environment driven by quotas. For example, signing off on care plans without speaking to the patient in order to meet clinical performance metrics weakens the professional relationship building that comes with communicating with their patient. Regulated members are reminded that, as per the standards and Code of Ethics, your first duty is always to the patient.
   2. Language barriers.
      1. Alberta is a diverse province, and pharmacists provide care to patients with many different cultural and linguistic backgrounds. Language differences can create challenges in understanding when you communicate with patients. In these situations, it is important to recognize that there are resources that can help you ensure your message is clear. Taking extra steps to address communication barriers strengthens and maintains the professional relationship and supports patient wellbeing and safety.
      2. Language translation services and ASL interpreters are available provincially via 211 Alberta. Within the pharmacy, staff who speak other languages may help bridge the communication gap.
      3. Recognize the health literacy of individuals and adapt your communication style so patients understand by using clear and appropriate language.
4. Professional relationships in a virtual environment.
   1. Compared to in-person care, virtual care is subject to various challenges and communication barriers. Virtual environments, including the telephone, may limit or eliminate non-verbal cues including body language, eye contact, and tone changes. These factors are important in establishing trust, empathy, and mutual understanding which support the professional relationship.
   2. Patients have varying degrees of digital literacy and limitations in visual or auditory clarity can impact the quality of patient engagement. Acknowledge the limitations of virtual care and take steps to continually confirm patient understanding throughout the interaction. Paraphrase key points, summarize the discussion, and use open-ended questions to confirm understanding (e.g., “Can you explain to me how you will take this medication?”) When possible, supplement virtual communication by providing recommendations verbally and in writing.
   3. When forming professional relationships virtually with patients, be intentional about rapport building. Take the time needed to understand the patient’s goals, preferences, and comfort level with virtual care. This is an important part of building trust that is often overlooked or missed in a virtual setting. Use active listening and verbal affirmations (e.g., “I understand,” “that makes sense”) to replace non-verbal signals like nods and open body language.
   4. Structure the interaction by providing a clear introduction and outlining the purpose of the interaction. Mark transitions in the discussion with verbal “signposts” (e.g., “We’ve reviewed your medication history, now let’s talk about this new prescription.”). Ensure you summarize the key points, confirm the next steps, and always invite the patient to ask questions throughout. This helps patients follow along more easily in the absence of visual cues.
   5. When using the telephone, compensate for the lack of visual connection by ensuring you and the patient are in a private space with minimal background noise. Pay close attention to the patient’s tone and listen for any pauses or hesitations. These are cues that might indicate confusion or concern.

Conclusion

Regardless of the setting, forming and maintaining professional relationships is the cornerstone of person-centered care and should be at the forefront of your mind as a regulated member when providing care to your patients.

Further reading

ACP resources

• Standards of Practice for Pharmacists and Pharmacy Technicians
• Standards for the Operation of Licensed Pharmacies
• Understanding Professionalism
• Standards of Practice for Virtual Care
• Guidelines for pharmacists and pharmacy technicians – Requests to transfer patient care
• Collaboration is mandatory – The Link, March 31, 2021

External resources

• 4 Reasons Why Building the Pharmacist-Patient Relationship Is So Important – EnlivenHealth
• Chukwuka Obioma Opara, Gbenga Emmanuel Odubayo, and Kauna Usman. “Effective and Efficient Pharmacist-Patient (Client) Relationship (Managing Different Patient Personalities).” Research & Reviews: Journal of Medical and Health Sciences. Volume 8, Issue 1 (2019).