The most critical element is that the pharmacist is accessible in their pharmacy at all times. This also means ensuring face-to-face communication. Therefore, the responsibility of pharmacists compounding magistral preparations is far more significant. Remember that, from the dispensing of the magistral medication prescribed by the physician to the end of the treatment period, the patient is as much your responsibility as they are the physician’s. Magistral medication requires proper presentation, explanation, and follow-up.
Studies show that when the relationship between the pharmacist and the patient is positive and sincere, it becomes much easier for patients to cope with their illnesses and achieve far better adherence to the treatment process. Numerous studies have demonstrated that a large proportion of patients are dissatisfied with their interactions with healthcare personnel. Although the source of this dissatisfaction is rarely due to the incompetence of healthcare professionals, it is most often due to ineffective communication with patients. Achieving a successful outcome in patient treatment with magistral medication depends precisely on the existence and quality of this communication. Most of the time, because patients are unfamiliar with this type of dosage form, they hesitate to ask questions and do not fully understand what is being explained to them. As patient-pharmacist communication increases during the dispensing of magistral medications, patients can cope more easily with potential treatment risks, and the desired success in therapy can be achieved more readily. The whole world regards communication as the key to success in healthcare. As Cipolle et al. stated, “Care Means Communication, Quality Care Means Quality Communication”.
Studies and reports show that pharmacists need training to become effective counselors. Communication skills can be developed through training and practice. As the world moves toward patient-centered care, magistral medication represents the most accurate and meaningful form of this therapy. Assisting our physicians and supporting our patients regarding magistral medications is our most crucial duty. To this end, it is essential for pharmacists to develop their communication skills, especially in the field of magistral preparations.
However, it must always be kept in mind that communication is not a one-way process. Particularly in patient-pharmacist communication, patients must also take an active role in this process alongside the pharmacist. Otherwise, communication will fail. Our patients must also participate in treatment decisions and feel a sense of responsibility. Many pharmacists in the United States have adopted a counseling method developed by the Indian Health Service. Whether it is a magistral preparation or a manufactured drug, effective communication is achieved through this method.
In light of these explanations, what path should we follow? Let us look at that now: We have prepared our magistral medication prescribed by the physician and are about to dispense it to our patient; how do we transform this situation, which may be a first for the patient, into something positive and beneficial through the power of communication?
1. First of all, introduce yourself to your patient.
2. Identify the patient or the person representing the patient.
3. Explain the purpose and importance of the counseling.
4. Ask the patient what the doctor explained regarding what is being treated, and determine the current patient profile (allergies, etc., if any).
5. Ask if they have any concerns regarding the magistral medication.
6. Explain the treatment process and administration (dosage, usage, etc.).
7. Tailor the administration schedule of the magistral medication to the patient’s daily routine.
8. Explain how long the treatment will last.
9. Explain the side effects of the magistral medication, any drug-drug, drug-food, or drug-disease interactions if applicable, and how to manage them, taking into account pregnancy and lactation status.
10. Inform them on what to do in case of a missed dose or overdose.
11. In addition to verbal advice, provide written information, brochures, etc. regarding beneficial and harmful activities (such as sports, diet, and similar situations).
12. Perform patient follow-up. Very few healthcare providers follow up on treatment services. In magistral medications, following up with patient consent is very important.
Use appropriate language when explaining all this. Do not go into unnecessarily confusing medical terminology and similar technical details. Use simple, clear language. There will certainly be time for brief conversation during the explanation, but it should be kept short and merely serve to ease the atmosphere.
When providing information on the use of magistral medication, consider the patient’s educational background, physical disabilities, or mental disorders, if any.
Communication with physicians regarding magistral medications:
The primary reason a pharmacist calls a physician, with few exceptions, is that something is wrong or there is a problem that needs to be resolved. Therefore, because the conversation usually begins with a problem, it often starts negatively or awkwardly, which may lead to defensive behavior from either the physician or the pharmacist. However, a knowledgeable and attentive pharmacist succeeds in turning these negatives into positives.
Proper and accurate magistral drug therapy requires collaboration. A relationship where egos are set aside (although you cannot control someone else’s ego, you can certainly control your own) is essential.
The focus of such a conversation with a physician should be helping the patient and resolving or eliminating drug-related problems. The relationship should be built on mutual respect. Such a situation can be frustrating for both parties if the pharmacist is not properly prepared. Before contacting a physician regarding magistral medications, the following points should be kept in mind:
1. Have the facts, recommendations, and rationales regarding the magistral medication readily available. These facts may include not only information about the drug or disease, but also the patient’s specific condition. If possible, ensure your literature knowledge and technical details are complete and accurate. Never cite questionable or ambiguous information to the physician. Be confident in what you are talking about; do not waste a busy physician’s time. Be concise and to the point. After introducing yourself (e.g., Hello, I am Mehmet Güler from Sağlık Pharmacy) and stating the patient’s name (e.g., Remziye Korkmaz), clearly explain the problem.
2. SOAP (Subjective-Objective Information-Assessment-Plan) approach can be used because this is a method physicians are familiar with from their medical education.
3. Keep an alternative recommendation in mind in case your initial suggestion is not accepted.
The goal should be to focus on problems and issues. The purpose of the conversation should not be that the magistral prescription is inappropriate, but rather solving the patient’s problem. Do not try to play doctor or guess what the doctor will say. We must demonstrate that the issue is not about being right, but about the patient’s treatment.
Prepare yourself mentally and emotionally for various outcomes. What will you say when faced with resistance, anger, a combative, intimidating, or dismissive approach? To what extent can you continue? Recognize that such situations may occur. Be prepared to speak with a nurse or office receptionist for the telephone call. You may need to be persistent to speak with the doctor. Carefully consider under what circumstances you must speak directly with the physician. If you encounter any resistance, stay focused on the problem. If the doctor does not like your suggestion or alternative regarding the magistral medication, do not prolong the argument. If the patient is likely to be harmed by this inappropriate magistral preparation and the doctor rejects your recommendation, conscientiously inform the doctor that you cannot dispense this medication because it may harm the patient. Also explain to the patient simply what has occurred. Even if your suggestion is correct, do not lead the patient to think that the doctor provided poor care. Take care not to jeopardize the patient-physician relationship.
Word Choice:
Do I refer to our patients more as “my patient” or “the patient”? When discussing a patient’s issue, do I say the patient’s problem or our patient’s problems? “I” and “we” are more direct than “your” and “their” pronouns. Using the terms “my” and “our” involves the pharmacist rather than detaching them from the situation. It conveys that you take responsibility and care about your patient. It makes your patient feel supported.
Distance-Duration-Environment:
The distance between you and the patient, as well as the environment, plays a major role in communication. The distance should be enough to create a personal space between the pharmacist and the patient (around 1 meter, although not applicable during the pandemic). When dispensing magistral medication to our patients, the cleanliness of the environment, being visually neat and orderly, and health-related visuals instill trust and comfort. The environment should encourage the patient to express themselves comfortably. Having a dedicated area or corner, even if small, where the pharmacist and patient can speak without interruption is of distinct importance for communication. We call these elements parts of non-verbal communication.
When explaining magistral medications, our patients may have special circumstances. The patient may be elderly, or may have physical disabilities (such as visual impairment) or mental health issues. The power of communication provides patient benefit, and this benefit is a right for every patient. Generally, our time sensitivity is very high, and we are not used to waiting more than five minutes. With a few exceptions (waiting at good restaurants or in a doctor’s waiting room), people generally get tense and irritated. Even when it comes to magistral medication, they grow impatient. Mitigating this negative aspect of waiting is in our hands. An approach such as “I will dispense your medication as quickly as possible; I have one more patient ahead of you, and I want to ensure my patients receive their medications accurately and completely” often yields good results. Eye contact with your patient is also very important; direct eye contact demonstrates care and attentiveness. Therefore, maintaining eye contact while communicating with your patients is essential.
In conclusion;
The most significant difference between a magistral preparation and a commercially manufactured drug is that it is personalized. In addition, another important difference is the absence of a package insert. As pharmacists, we embody the role of a living package insert for magistral preparations. With this awareness, we must develop, inform, and educate ourselves about the magistral medications we dispense.
Pharm. Zeki Erdinç ÜLKER
References: 1. Simge ÇAĞIRICI, Selen YEĞENOĞLU
Hacettepe University Faculty of Pharmacy, Pharmacy Management
2. Communication Skills for Pharmacists 2009 Jobson Medical Information LLC
American Pharmacists Association
3. Rovers JP., Curie JD., Hagel HP et al. A Practical Guide to Pharmaceutical Care
1998:91
4. NHS Wales. In your care, your medicines
5. Wiener M, Mehrabian A. Language Within Language: Immediacy, a Channel in Verbal Communication. New York: Appleton-Century-Crofts; 1968.
