2. Objectives Show ability in using open ended questions, reflective responses, nonverbal communication, active listening and verify understanding. identify functional, environmental, psychological barriers and avoid them

3. Introduction There are many errors that occur in the medical community from drug in adherence, miss use of medications, incomplete information that affects patients and the outcomes of their medical plans.

4. Many studies have concluded that poor communication between medical staff and patients is a main reason for these results and found that the pharmacist is the most accessible professional to both patients and medical staff, so as pharmacists we should take advantage of this and gain a new role in the medical field. We should always pay attention to the fact "What we say is not always under stood exactly as we intended "and this is what we are going to study here.

5. what are the benefits of interacting for patients and other health professionals? - Benefits of counseling patients 1. Reduce medication miss use. 2. Reduce noncompliance. 3. reduce adverse drug reactions 4. Reassuring the patient that the drug is safe and effective. 5. Referring non drug related situations for assistance. 6. Assistance with self care. 7. Improve patient satisfaction.

6. - Benefits of consultation to pharmacists: 1. legal protection by lack of information to patients 2. Increase job satisfaction. 3. Attracts customers and aim in market competition. 4. Reduce job stress by gaining trust from people surrounding them. 5. Increase profit by paying for counseling and reduce loss from unfilled prescriptions. 6. Maintain professional status in the health care team.

7. Interactive communication skills Communication is the transfer of meaningful information from one person to another; it involves a sender transmitting an idea, information, or feeling to a receiver Interactive communication is a process that makes a dialogue easier and more understood by providing more than one chance to accurately interpret meaning and response appropriately.

8. Two models exist a medical model of communication in which the patient is only listening not talking and the other is the helping model where the patient talks and the pharmacist helps him or her to explore the problem and possible solution so there is a discussion here with more information exchanged to the benefit of patients.

9. Elements of interactive communication 1. Open ended questions. 2. Awareness of non verbal language. 3. Active listening. 4. Reflective response. 5. Verification of understanding.

10. Open ended questions Are questions that starts with who, what, where, when, how and why and not answered simply by yes or no. Their purpose is to make the patient talk more and give information about his wellbeing and medication satisfaction and adherence. It is not wrong to ask close ended questions (yes, no questions), it may be necessary to use it when you want the patient to focus on an idea.

11. Non verbal cues (body language): Almost 55-95% of our communication is non verbal like facial expressions, body posture, and tone of voice, eye contact and gestures. Proper use of this can make a big difference into making a successful communication with any person but when body language is not consistent with verbal language people believe non verbal one. But be careful to cultural or age groups there are variations in interpretation of non verbal cues.

12. Good non verbal cues Smiling and friendly facial expression. Varied eye contact keeps assuring him that he has you attention but don’t stare. Professional appearance. Relaxed, warm, and comfortable gestures. Attentive body posture (slightly lean forward). Keep good personal space 18-48 inch. Varied voice tone and rate to keep others interested but avoid shouting.

13. Bad /distracting nonverbal cues Lack of eye contact, he may feel you are not interested. Too near to the patient he may feel discomfort. Unfavorable voice tone. Weight shifting to one side may indicate lack of interest. Untidy work place.

14. Active listening It is very important to listen as much as to speak. In pharmacy there is usually no time or space or crowded place which may let the patient feel his complain is not important and further pushes him away form the pharmacist.

15. Here are something we do that reduce our ability to listen effectively 1. Doing two or more things at once. Get ride of distractions 2. Jumping to conclusions before the others finish talking. You can’t listen if you talk 3. Communication stereotypes so react to the information not the person. 4. Faking interest in what is being discussed - so use good eye contact to keep you concentrated. 5. Judging people based on their appearance or condition – so focus on information nonverbal cues.

16. You can use the following to enhance listening paraphrasing, clarifying, Summarizing, Feed back.

17. Reflective responses It shows to the sender that you understand him both the talking and the feeling. This allows you to be empathic without agreeing. Like: So you believe……….. I gather that……. You seem to be saying…… You appear to be feeling…… Looks like you are…….. So you are not judging, advising, questioning or confusing that person here and accept his feeling and concerns.

18. Verification of understanding This prevents misunderstanding and is the check point for the dialogue. Here you ask the patient to tell you what the message was so you can confirm that it was what you intended You can use open ended question to verify the massage but be careful not to let him feel that you are putting him in a quiz or make him angry in that you think he is stupid. So practice and practice.

19. Psychological barriers This is the hardest form since it deals with the humans directly so to be effective you must have a high level of confidence which may be affected by anxiety due to past experiences belief or because you don’t know what to expect. It depends on how you see your self, A dispensing pharmacist or care provider and this will motivate you to go further.

20. Communication is not an all or nothing experience and it is not some thing that you can’t learn, eventually by practice and trying good skills can be attained. Patient may come to you in fear, anger, or confusion due to the diagnosis they have or all of these together so as a pharmacist you should deal with this person effectively with good communication skills, you may use reflective responses in dealing with this type of patients.

21. You may face barriers with coworkers or other health care professionals and dealing with them by telephone, and lack of communication will make these barriers bigger. Recommendations for interaction with coworkers and other health care professionals: 1- provide high level of services answer questions at the right time alert them when interactions or misuse of medications suggest alternatives for the medication monitor treatment and give feed back provide documentation of the pharmacist care

22. 2- promote pharmacy services 3- listen and empathize with peers 4- be assertive 5- resolve conflict give information that is of benefit avoid criticism be flexible Use feed back to verify understanding.

23. 6- enhance telephone communications: be prepared begin with friendly greeting avoid distractions Check for understanding.

24. And to assure good relationships between pharmacy personnel: put rules mistakes should be admitted all should participate in planning and decision making avoid comparisons and favoritism use praise and criticism express kindness Appropriate feeling should be expressed.

25. Environmental barriers In the pharmacy there are many physical barriers between patient and pharmacist like The loud noises Too many people The counter Pharmacist in a place not seen Pharmacist is higher than the patient Glass Low level of privacy

26. These contribute to low communication and some times the patient avoids talking and wants to go home. In these circumstances the pharmacist should make every attempt to reduce the barriers like willing to take the patient to an area that is less noisy and provide him with privacy and remove any physical barriers that may hinder communication. The presence of a waiting area will give patients a place to rest and reduce the crowdedness near the dispensing counter thus more space and privacy and time to talk to the patient.

27. Functional barriers These refer to the patient's characteristics such as vision and hearing impairments, language differences, low literacy, and comprehension difficulties. Form these you can do the following: 1- Reduced vision Different bottles sizes or vials Variety of dosage form Large typing

28. 2- Reduced hearing: Counsel where less noise. Talk slowly and clearly. Flash cards and brochures. Sign language. 3- Language differences Computer software's that provide translation. Pictograms Interpreter (friend or a relative).

29. 4- Low literacy: Encourage to call with questions. Provide instructions orally. Pictograms to reinforce oral instruction.

30. Thanks