Making your voice heard

white coat professional shouting into megaphone

Pharmacists need to stand up for themselves and their patients, writes Carlene McMaugh… but how?

Assertiveness is defined as having confidence in your statements or beliefs, or defending, upholding or insisting on a belief or fact.

When we look at the knowledge and experience pharmacists have, we can see opportunities to utilise assertiveness in many different facets such as interactions with doctors, but also with patients and other groups.

This has been a recent and ongoing focus due to tragic events where people have died or experienced significant injury when a pharmacist has not been assertive enough in addressing an identified safety issue.

When I think of reasons to be assertive I can think of none better than to protect or save a life; to prevent complications, adverse events or harm. I believe that it is our duty of care as healthcare professionals. We have other complementary responsibilities such as having timely alternatives and solutions to the issues we raise, as well as being responsible and aware of the manner in which information is delivered to achieve a desirable result.

Barriers to this responsibility such as the recipient’s ego, defensiveness, retaliation or disregard should not be a reason to avoid having a conversation that is in the best interest of your patients.

Keeping in mind the motive and the manner in which the intervention is delivered and thinking of how you approach potentially difficult conversations is key to effectively communicating the issues that need to be addressed.

Are you hesitant, do you mumble, are you unsure of yourself, are you more focussed on not upsetting the recipient rather than finding a reasonable solution? All of these can come across in your delivery.

Think about the last intervention you made and how the conversation went and ask yourself or your colleagues: could i have done anything better, and how could I be more productive next time?

I would like to give you a scenario to consider… a prescription from a doctor that is being used off label, for the first time, via an unusual route and you would like to confirm this with the prescriber. Following on from the advice from Jarrod McMaugh whereby you present your case, plan reasonable alternatives, and consider possible interactions or problems; this is a good way to start to ensure that you have a constructive conversation.

I would like to add to this as pharmacist prescriber interactions are not the only interactions where pharmacists have to utilise assertiveness. The examples I would like you to consider are as follows:

  1. The other pharmacy down the road lets me have all my repeats.
  2. A patient requests prochlorperazine because they were recommended by another pharmacist who did not have it in stock for nausea associated with vertigo
  3. The patient has an owing that they have not received a script for and have come back in to your pharmacy requesting another owing.

In these situations, the patient may argue that they want their scripts back or that they will not visit your pharmacy if you do not meet their demands… these are some scenarios that may not be too foreign to you and represent another opportunity where assertiveness should be utilised.

I recently had a student working a the pharmacy I work at on a three-week placement from university. So far she had worked in a pharmacy on  weekends and gone to university for three years; she was entirely unprepared for the patient who came in requesting all of their repeats of their prescription at once.

They believed the pharmacist down the road would do that for them and the patient would take their scripts if this was not completed as per their request.

I discussed the situation with the student and how unfortunately these situations do happen. Sometimes too often. The student had to realise that there could be a difference between what the patient wants, what is in the patients best interest and what you are able to do within the law and ethics, and how these are not all possible to achieve

This student also learned how to prepare herself by being aware of how to express your considerations and how sometimes doing the right thing does mean that patients may not be happy with you, even if getting their way is not in their best interests.

The situation whereby you are faced with losing a patient or doing what is not reasonable to keep them is not ideal, although we have all faced it. This is a situation that can happen regularly and we may talk to our colleagues after it happens, but it is not talked about as widely, despite contributing to workplace and individual stress.

Being assertive with patients to protect them, honour the prescriber’s intent, honour Medicare requirements and honouring product indications is something i want you to consider: how do you balance it?

I wonder if there is enough advice on how to handle these situations with consistency throughout the profession and how everyone handles these situations so that patients are protected as these are difficult conversations. The patent may not get what they want, when they want it as a results and the situation may end up with a patient making threats or indeed leaving your pharmacy.

Questions to ask yourself:

  • Would you recommend nauseatil or similar outside of indications?
  • Would you allow a patient to have six repeats at a time if they threaten to leave your pharmacy?
  • What is your limit and where are your boundaries?

Assertiveness with other healthcare professionals is important, assertiveness with patients is important, assertiveness with other groups is important.

Other groups can include medical representatives who in my experience may want your time only to find out who is prescribing their product or their competitors and how many.

There is so much more a pharmacist  and a medical representative can gain from the right conversation with each other, instead of just finding out what you offer with regards to prescribing information.

I urge you to think about how to be assertive as a pharmacist.

I am asking you to do some self-reflection.

What are your priorities? When will you be assertive (or less assertive) with patients, other healthcare professionals and other groups.

The discussion is as much about being assertive as it is about when not to be assertive and how to do this in the best manner. What happens if you do bend the rules for a patients and it becomes a continued expectation? How can you be more assertive to ensure that time, energy and resources are used to their best ability?

Assertiveness is not a way to describe an opinionated, difficult, rude or dismissive person. It is a way to protect yourself and your patients by confidently stating a fact or belief or asserting something such as defending, upholding or insisting on a belief or fact that serves to protect the patient and work within the law and ethics.

It is the manner in which you a deliver a message, the solutions you provide when you cannot honour a request and the way you look back on situations to examine if they could be done better next time with all of your interactions.

Where could you be more assertive, less assertive or more strategically assertive?

Carlene McMaugh has worked in the healthcare field for over 20 years in varied roles and as a pharmacist for ten years including three years working as a pharmacist in the UK. She currently works in Capital Chemist Coburg and in the pharmaceutical industry.

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