1. Barriers to Communication

2. Overview
Within the communication process, numerous barriers exist that may disrupt or even eliminate interpersonal interaction. Given the large number of potential barriers that exist in pharmacy practice settings, it is a wonder that any communication takes place at all. Some barriers are rather obvious, while others are more subtle. The key is to identify when barriers exist and then develop strategies that minimize them.

3. Introduction
As indicated before, the communication process involves five essential elements: the sender, the message, the receiver, feedback, and barriers. Deficiencies in any of these essential elements may cause a breakdown in communication. The message must be clearly sent by the sender and received accurately by the receiver. Feedback that verifies understanding must be related in a clear, unambiguous manner.

4. The fifth element, barriers, is often overlooked
The fifth element, barriers, is often overlooked. Unfortunately, many things seem to get in the way when you try to communicate with someone else. Some issues are rather obvious, while others are not. Some are easily removed, while others are more complex and require multiple strategies to minimize their impact.

5. Minimizing communication barriers typically requires a two-stage process:
first, you must be aware that they exist.
Second, you need to take appropriate action to overcome them.
To become a more effective communicator, it is essential that you realize when you are not communicating effectively with another person and then try to analyze why effective communication is not taking place.

6. Environmental Barriers
The environment in which communication takes place is critical in pharmacy practice, and distractions within the environment often interfere with this process. One of the most barriers in most community practice settings is the height of the prescription counter separating patients from pharmacy personnel.

7. These prescription counters exist for three primary reasons:
(1) they provide an opportunity for patients to identify where the pharmacy is located;
(2) they provide an opportunity for pharmacy staff to look over the store area periodically; and
(3) they provide a private area in which the staff can work.

8. Unfortunately, in some situations, patients cannot see pharmacy personnel behind these strategically placed partitions or counters. It is difficult for patients to talk with individuals they cannot even see. These counters may intimidate some patients and inhibit communication because the pharmacist is standing over them. This type of environment may also give patients the impression that the pharmacist does not want to talk to them.

9. Many pharmacies provide areas where the counter is lower to facilitate pharmacist–patient interaction. Ideally, you and the patient should both be at eye level to enhance verbal and nonverbal communication. This will also help counteract patient perceptions that you are not approachable.

11. Potential Environmental Barriers
The next time you enter a community pharmacy, check for the following:
• Is the pharmacist visible?
• Is it easy to get the pharmacist’s attention?
• Does it appear that the pharmacist wants to talk to patients?
• Is the prescription area conducive to private conversation?
• Do you have to speak to the pharmacist through a third party?
• Is there a lot of background noise or are there other distractions?

13. Personal Barriers Pharmacist-Related Personal Barriers
Patient-Related Personal Barriers

14. Pharmacist-Related Personal Barriers
• Low self-confidence
• Shyness
• Dysfunctional internal monologue
• Lack of objectivity
• Cultural differences
• Discomfort in sensitive situations
• Negative perceptions about the value of patient interaction

15. Patient-Related Personal Barriers
Patient perceptions of pharmacists are critical in establishing communication rapport. If patients perceive you as not being knowledgeable or trustworthy, they will tend not to ask questions or listen to the advice being offered.

16. Another patient perception that hinders communication is their belief that the health care system is impersonal. Some patients sense that health care providers are not concerned about them as individuals but rather as cases or disease states.

17. Patient perceptions of their medical conditions may also inhibit communication. Some may believe that their condition is a relatively minor one requiring no further discussion with you. Thus, they may not seek out information from you, or they may rebuff your attempts to counsel them. In contrast, some patients may be overly anxious about their condition and therefore will avoid talking about it because they feel so vulnerable.

18. Some patients may feel that their physicians would have told them everything about their condition and their medication. Therefore, there is no need to talk with you. In addition, many patients think that all the important information is stated on the prescription label.

19. Administrative Barriers
Several factors dealing with the administrative aspects of pharmacy practice serve as barriers to communication. For example, most community practitioners are not paid directly for educating or communicating with patients. Counseling services are not included as part of pharmacies’ business plans. Therefore, many pharmacy managers perceive the task of talking with patients as an expensive service and not a high priority. Unfortunately, pharmacies often make policies that discourage pharmacist– patient interaction.

20. Time Barriers
The timing of the interaction is critical, since both parties must be ready to communicate at a given time. For example, a woman who just came from a physician’s office after waiting for three hours with two sick children may not be interested in talking with you or anyone else. The most important thing on her mind is to go home, get her kids to bed, and then relax. She is probably not in the best frame of mind to sit down and have a meaningful conversation about her children’s medications.

21. By the same token, you may not be in the best frame of mind to interact with this mother. You may be dealing with multiple issues: a physician is waiting on the phone, a large number of prescriptions need to be filled in the next hour, and you need to go to the rest room. You may feel that this is not a convenient time to talk to the mother.

22. In addition to the communication barriers discussed, some communication habits can interfere with your ability to listen well. Trying to do two things at once makes it evident that patients do not have your full attention. Planning ahead to what you will say next interferes with actively trying to understand the meaning of patients’ communication. Jumping to conclusions before patients have completed their messages can lead to only hearing parts of messages—often pieces that fit into preconceived ideas you have. Focusing only on content, judging the person or the message as it is being conveyed, faking interest, communicating in stereotyped ways—all cause us to miss much of the meaning in the messages people send us.