Patient Communication Flashcards

A patient with limited English proficiency presents with a prescription for warfarin. The patient's adult child offers to interpret. Which is the MOST appropriate action by the pharmacist?

Answer: Use a professional medical interpreter service, explaining to the family member that confidentiality and accuracy require it

While family members may seem convenient, they introduce risks of omission, distortion, or breached confidentiality—particularly critical for high-alert medications like warfarin where dosing nuances and INR monitoring instructions are complex. Professional medical interpreter services (in-person or telephone) ensure accuracy, impartiality, and protect patient privacy under Canadian privacy legislation (PIPEDA/provincial equivalents). The family member should not be dismissed unkindly but the professional interpreter is the standard of care.

During a medication review, a patient with moderate hearing loss repeatedly nods and says 'yes' but gives incorrect answers when asked to repeat back instructions. The pharmacist suspects the patient did not understand. Which communication strategy is MOST effective at this point?

Answer: Use the teach-back method with written key points, facing the patient to allow lip-reading, and confirm comprehension step-by-step

Simply increasing volume can distort speech sounds for hearing aid users and does not confirm understanding. Teach-back (asking the patient to explain back in their own words) is the gold-standard technique to verify comprehension, not just compliance cues like nodding. Facing the patient allows lip-reading and visual cues, and coupling verbal explanation with written key points accommodates multiple sensory channels. Referral to a physician is inappropriate for medication counselling within pharmacy scope.

A pharmacist is counselling a patient newly initiated on bupropion for smoking cessation. The patient discloses they have a history of an eating disorder that was 'resolved years ago.' The pharmacist notices this is NOT documented in the patient profile. What is the MOST appropriate next step?

Answer: Counsel the patient that bupropion is contraindicated in current or past eating disorders regardless of resolution, document the disclosure, and contact the prescriber to discuss an alternative

Bupropion carries a Health Canada black-box contraindication for patients with a current OR past history of bulimia or anorexia nervosa due to increased seizure risk—'resolved' status does not eliminate this contraindication. The pharmacist has a professional and legal obligation to act on this clinical disclosure immediately: document the history in the profile, explain the contraindication to the patient without stigmatizing language, and contact the prescriber to recommend an alternative (e.g., varenicline or NRT). Passing to the next shift abdicates professional responsibility.

A pharmacist is counselling an elderly patient on a newly prescribed cholinesterase inhibitor for mild Alzheimer's disease. The patient's caregiver insists the pharmacist speak only to them and not involve the patient 'because they won't understand.' The patient appears oriented and is making eye contact. What should the pharmacist do?

Answer: Counsel both the patient and caregiver together, directing primary communication to the patient and supplementing with caregiver-directed information as appropriate

A patient with mild Alzheimer's retains decision-making capacity in the early stages and has the right to participate in their own care (autonomy). Excluding a present, apparently competent patient violates their dignity and provincial health consent legislation. The pharmacist should include the patient as the primary communicant—using clear, simple language—while also equipping the caregiver with the supplemental information they need for safe medication management. Excluding the caregiver entirely (option C) is also inappropriate given the caregiver's practical role in adherence support.

A patient picks up their third consecutive refill of a proton pump inhibitor prescribed for GERD. While reviewing the profile, the pharmacist notices no physician follow-up in over 14 months and the patient mentions ongoing heartburn despite adherence. Under the PEBC's framework for patient-centred care, the MOST appropriate pharmacist response is:

Answer: Conduct a structured medication review, explore lifestyle and adherence factors, assess alarm symptoms (dysphagia, weight loss, bleeding), and recommend urgent physician referral if alarm symptoms are present—or routine follow-up if absent

Persistent GERD despite PPI adherence warrants investigation for alarm symptoms (dysphagia, odynophagia, unintended weight loss, GI bleeding, vomiting) that could indicate Barrett's esophagus or malignancy—these require urgent physician referral. Absent alarm symptoms, a structured review of lifestyle factors, dosing timing, adherence, and potential drug interactions should precede any recommendation. Simply refilling (A) misses a clinical safety net. Refusing outright (B) is paternalistic and could harm the patient. Autonomously dose-escalating (D) without ruling out serious pathology is outside safe practice.

A pharmacist is using motivational interviewing (MI) to address medication non-adherence in a patient with uncontrolled hypertension. The patient states: 'I know I should take my pills, but I just don't think they're making any difference.' Which pharmacist response BEST reflects advanced MI technique?

Answer: 'It sounds like you're frustrated that you're putting in the effort but not seeing the results you hoped for. What would 'making a difference' look like to you?'

Advanced MI uses complex reflections and open-ended questions to explore the patient's own values and meaning—not to convince or educate. Option B reflects the patient's emotional ambivalence ('frustrated'), validates their perspective without judgment, and uses an open-ended question ('What would making a difference look like?') to elicit the patient's own definition of success—a core MI strategy that surfaces intrinsic motivation. Option A is confrontational (the 'righting reflex'). Option C provides unsolicited education (information-pushing), which can trigger reactance. Option D is a closed-ended challenge that bypasses the patient's underlying ambivalence.