I pick up the pharmacy phone and start dialing to make one of those “dreaded adherence calls.”
As the phone is dialing, I peruse my patient’s profile for some notes only to find one that says, “Patient hates adherence outreach calls, DO NOT CALL.”
This feels like I’m about to open Pandora’s box.
Opening Pandora’s Box
Oxford Dictionary calls “a process that generates many complicated problems as the result of unwise interference in something” as a Pandora’s box.
And that’s exactly what these phone calls feel like:
I guess the last conversation(s) didn’t go so well.
But I was curious.
What could have happened?
Since the beginning of my pharmacy journey, I’ve heard countless tales of patients despising and berating pharmacy teams for calling so much.
We’re supposed to call at least 3 times, leaving voicemails along the way.
On top of the regularly scheduled text messages and automated calls they receive.
No one would blame me if I hung up the phone right now.
The patient specifically requested no adherence calls.
But my white coat called out to me.
“Don’t cop out.”
Avoiding an awkward or painful phone call only serves one thing: my ego.
I don’t know the whole story.
On the screen, it tells me there may be medication optimization potential.
It also tells me exactly what to say to my patient.
I will ignore both for now.
After what seemed like 10 minutes of ringing, she picks up and immediately says,
“I TOLD YOU GUYS ALREADY, I DON’T NEED MY MEDICINE AUTO-FILLED.”
So I introduce myself formally, even though she thinks she already knows who I am.
“I really don’t appreciate you calling me at all times of the day; when I need my medicine, I will call!” She’s completely exasperated after her 2nd sentence.
I’m listening to the words, but I pay more attention to the emotions behind them.
In those first 2 sentences, I learned so much about my patient.
1. She’s frail and frustrated
2. She thinks we only call to automatically fill her medicine
3. She wants to take care of herself
The Power of Rapport
Most people would opt to find a solution when presented with a problem.
But my patient’s primary concern was not a clinical one; it was a human problem, a misunderstanding.
So, I pull up my stool, and sit down in front of my computer.
That way, I can’t see the distracting chaos in front of the pharmacy counter.
My team can fend off the hordes for now.
“Mrs. Jane Doe, I can sense your frustration, especially if you think I am calling only to automatically fill your medicine. That’s not why I’m calling you.”
She responds with surprise, but still mostly upset.
“To be honest, I’m calling because I don’t remember the last time I had counseled or discussed your medicine with you.
As your pharmacist, I’m embarrassed by this, and I want to know if you have a few minutes to talk about your healthcare and medication?”
I know she wants autonomy and doesn’t want anyone doing anything for her.
I can work with that.
My grandma is the same way: a very strong, independent woman in her 80’s.
My tone of voice must have agreed with the words I was saying because she replied agreeably.
Permission to be a pharmacist granted.
Time to replace the humanitarian hat with the clinical hat.
Wear The White Coat
I scanned her medicine profile, inferred disease states, checked pick up dates, looked for gaps in therapy, missing immunizations, and reviewed any other patient notes.
Took me 15 seconds.
I would approach her carefully to make sure we were on the same page.
If I infringed on her autonomy, it could create distrust and slow down this process.
So, I revisited my pharmacy student basics:
“How are you doing on…”
“When was the last time you…”
“What do you think about…”
I let her do most of the talking so I could learn the most about my patient.
The computer screen may show me a list of medications and diagnoses, but her answers are a gold mine right now.
They’re the missing pieces I need to ensure she has the very best health outcomes.
With each concern she had, I made sure to make a recommendation, and to explain the clinical thinking behind it.
I would ask, “What do you think?” Or “Why do you think that happens?” Just in case I missed something.
I took her very, very seriously.
My forehead was probably scrunched the entire time.
Towards the end of the call, I summarized the main things we had talked about.
From what started as an “adherence call,” we touched on
1) A1c, blood sugar testing frequency, insulin timing, lifestyle changes
2) blood pressure monitoring, side effects and goals
3) Nerve pain, leg cramps, and OTC solutions
4) GERD, lifestyle changes, and more OTC solutions
With each disease state, I measured my effectiveness as a clinician by the amount of engagement and questions she had for me.
After all, once I hang up the phone, how do I know if I really made a difference in her healthcare?
Many pharmacy students (and some practitioners) I see making these calls expect that their recommendations are accepted wholeheartedly and followed religiously.
In reality, human nature overrides laws and best practices.
People do what they want and feel like, even at their own demise.
I’ve learned that the best way to treat patients and ensure the best outcomes is by connecting with them first and becoming influenced BY them.
Start with curiosity, and acknowledge that we don’t know everything.
Involve the patient in their own healthcare.
Treat them like fully capable, independent people who know what they’re doing, and maybe they will surprise you.
The only way I can take care of tens of thousands of patients is by inspiring them to care about their health and subsequently empowering them with the tools to do it.
What started off as fleeting terror for opening a Pandora’s box, my adherence call ended as a 15 minute phone conversation that reminded me why I became a pharmacist in the first place.
The first line of the Oath of the Pharmacist:
I will consider the welfare of humanity and relief of suffering my primary concerns.
At the end of the call, she was so grateful and asked for my name.
She was looking forward to the next time we would speak.
I happily deleted that “Do Not Call” note in her profile.