Every pharmacist and pharmacy technician has been there. The patient on the other side of the pharmacy counter has steam blowing out of his ears because you just told him there is a problem with the prescription. The customer is now questioning your intelligence, your integrity, your professionalism, and maybe even your parentage. Loudly.
Maybe a patient is having a tearful fit in the middle of your pharmacy. You had to tell her that the copay has tripled or that insurance will no longer cover the only medication that works well.
Then there is the patient who is a continuing source of aggravation. Month in and month out, she complains that you are overcharging, moans about your poor service, and is generally a “pain in the ass.”
Or—in an even worse scenario—after you refuse to fill a questionable script for oxycodone, the customer says he may come back with his gun.
Patient/customer relations has never been more challenging for pharmacists and pharmacy staff. Problem patients—or those with problems—have always made their way into pharmacies. Pharmacists have to deal with them and, when possible, defuse the situation.
In an online survey conducted by Drug Topics, pharmacists were asked whether they feel that they were adequately trained to deal with “difficult” customers. Of the 95 respondents, roughly one-third answered no, a third answered yes, and another third mostly said that this kind of training came on the job.
The survey also asked where pharmacists received training in how to work with customers. Of the 55 who responded to the question, 18 said they learned on the job from other pharmacists, 34 said they learned from outside the pharmacy (such as in previous non-pharmacy jobs), and only 2 said they received training in pharmacy school.
In decades past, schools of pharmacy may not have covered customer/patient relations in their curricula. Now, it is an important part of what a pharmacist’s education should be, said Robert S. Beardsley, RPh, PhD, Professor of Pharmaceutical Health Services Research at the School of Pharmacy University of Maryland in Baltimore.
Customer and patient relations may be addressed in a variety of ways in pharmacy education, Beardsley said. It can start with lectures. Then experienced pharmacists and patients will talk with students. It also includes role-playing activities, where pharmacists are confronted with different situations.
The skills needed to work well with patients evolve from professionalism, Beardsley said. “We need to keep this in the forefront of everyone’s thinking,” He added. “If pharmacists are not professional, we are not going to be supported as a profession.”
Although the training may be similar in most schools of pharmacy, it may not always be labeled as “customer relations,” said Lakesha M. Butler, PharmD, BCPS, Clinical Associate Professor in Pharmacy Practice at Southern Illinois University Edwardsville (SIUE). “Throughout the curriculum, we talk about things pertaining to customer relations, but we don’t title it or think of it as customer relations,” she said. “I certainly think that we should.”
Communication with patients is specifically discussed, Butler noted. A lab allows students to role play with students from SIUE’s theater department, who portray angry, confused, or calm customers, Butler added. Students can then watch their performance on video. “They see what they could have done differently, said differently, or said in a way that ensures the patient is understanding,” she said. “This is a case of the students having to learn ‘How can I try to put out this fire? How can I calm this patient down?’”
Such training was not always provided in pharmacy schools. “I got none whatsoever,” said Pete Kreckel, RPh, who has been a community pharmacist for 36 years and who now works at Thompson Pharmacy in Altoona, PA. He learned on the job and now trains pharmacy students when they work at his store during their residencies. Such skills have to be learned by doing, he noted. It is not something that a pharmacy student can be adequately trained to do, “but I think it is something that can be developed.”
Up next: How to deal or defuse
Learning to deal or defuse
The first thing Kreckel tells his new pharmacy students is to stand in the patient’s shoes. People come to the pharmacy when they are sick, he said. “And because you are the most accessible health-care professional, you are probably going to feel the brunt of their frustration with the physicians, frustration with their insurance company, and maybe even the frustration with the parking attendant who gave them a ticket.”
Financial issues also crop up for a patient in the pharmacy. They don’t see the fees going to the doctor because most of it may be paid by an insurance company, Kreckel added. “The money a doctor takes from a patient is their insurance money, [money] that they never see. I am taking money out of their wallet.”
Understanding where the patient is coming from is the start of reaching out to them. If you encounter a patient who is angry or emotional, acknowledge his or her emotions, Butler said. “Make sure that you speak with empathy. Put yourself in their shoes and let them know that you genuinely want to help solve the problem and come up with a solution together.” Finding common ground can help you and the patient create a solution, she added.
Active listening is also important, she said. “The patient has to see that you are engaged. You are not pointing the finger. You are wanting to find out the full story.”
The phrase Kreckel uses for dealing with a patient’s problem is “Let’s take this apart.” When a patient is discussing a problem, he repeats his concerns, to make sure he has heard it clearly, and to allow the patient to hear his own request, and then explains the possible solutions.
Show patience, Kreckel said. “Watch your body language. Do not roll your eyes.”
Ask open-ended questions, said Beardsley. Build on where the patient is.
In a confrontation with a patient, keep from personalizing it, said Butler. “A lot of time, when someone comes at you, you are thinking that [it is] a personal attack or criticism. Any time you think it is a personal attack, you are going to immediately get defensive.”
Is the customer always right?
Dealing with a problem customer can mean that he or she takes the complaint up to the store manager or beyond. Sometimes pharmacy management or those higher up the corporate ladder will try to appease a customer who insists he has been wronged, simply because “the customer is always right,” Kreckel pointed out. “The customer can’t always be right.” That idea might work in a hardware store, but it is not true in a pharmacy, he said. “I, by my very nature as a pharmacist, have to have a higher level of training to sell my product than that person walking in the store.”
Managers should support their pharmacists, said Kreckel. If management thinks enough of a pharmacist to decide to hire him or her, they should back the pharmacist when a disagreement comes up “Sometimes district managers and people up the food chain have to have enough confidence in their decision, and they have to stand and support their employees and not the customers.”
Up next: When the customer just won't listen
Telling the patient when (and where) they can go
Some patients simply cannot be made happy, Kreckel pointed out. These are the regular customers who complain and find problems each time they come in. “You can’t fix some of these people.” With some continually complaining patients, Kreckel tells his staff that he is the only one who should deal with them. He described himself as having a thick skin and an ability to deal with difficult people.
But there have been two or three times when Kreckel has told a customer to take their business elsewhere, he said. “I am kind of a tough guy, but when she becomes so much more difficult and abusive or slanders my name or reputation, she is gone.”
A customer who is persistently demanding and rude may need to be told to go elsewhere, said Butler. “Just politely let him or her know that we are certainly trying to do all that we can, but if you would feel more comfortable going elsewhere, I think that might be a better option, just for the both of us,” she said. “I’ve often said, “I am going to give you respect and I expect the same from you.’”
A pharmacist can tell a patient to bring their prescriptions elsewhere, as long as the patient is not abandoned, said Karl G. Williams, Professor and Associate Dean at the Wegmans School of Pharmacy at St. John Fisher College in Rochester, NY. He is a spokesperson for the American Pharmacists Association.
The concept of patient abandonment is especially important because of the nature of chronic disease and the need to take medications consistently. “While we can’t abandon patients, we don’t have to be a door mat for the patient, either,” Williams said. A pharmacist can fire the patient if the patient’s behavior is interfering with the therapeutic relationship, but the patient has to have some place to go for their prescriptions, he noted.
But before that happens, the pharmacist should be trying to engage in a constructive dialog with the patient that is aimed at stopping verbally abusive behavior, Williams said. “Conflict resolutions skills are crucial and can really turn the situation around.” Sometimes warning a person that their behavior is not acceptable can act as a wake-up call, he added.
What if there is no improvement? “If it is manageable, if you can still care for that patient even with the odd or sometimes abusive behavior, you probably should.”
Up next: Should you ever call 911?
When to call the police
But what should you do when the patient is threatening or becomes violent?
“If there is a real, recognizable threat, you can act,” said Williams. If a patient makes threats or if someone has thrown things or knocked over displays, you should call the police, he said. “You describe the circumstances and allow the professionals to act, to advise you about what to do, and then make a judgement about that.”
“Trust your instinct. Anytime you feel you are in danger it is best to remove yourself from the situation. If you need to call for some assistance, do it,” said Butler.
The continuing opioid epidemic may be an emerging source of difficulty with some patients, Williams noted. As more restrictions are put on the number of opioid pills that can be prescribed, people who are addicted may start acting out more often when they are denied prescriptions or refills, he said.
The difficult patient will probably always be part of the practice of pharmacy. “If you are seeing lots of patients every day, you are going to get folks in all sorts of emotional states and who exhibit all sorts of neurotic behavior,” Williams said. “You have to have skills to reckon with that. Or you are not going be successful and you are going to hate your practice.”
But being able to deal with and defuse problem situations can offer its own rewards. “If you are successful, if you can turn the patient around ... that can be very satisfying. It can be a very rewarding feeling to know that I haven’t been a door mat, but I have been successful with this patient.”