Writing a New Prescription

Pharmacy students learn communication may be the drug patients need most

Pharmacy student Jaimee Blanchard, right, says her visits with 98-year old Hortense Sperling have taught to appreciate the needs of the elderly.

At first blush, the matching of pharmacy student Jaimee Blanchard, 20, and retired teacher Hortense Sperling, 98, may seem unusual. But UW School of Pharmacy administrators are convinced such a pairing will make Blanchard a better pharmacist.

Blanchard is learning a lot about life — and getting a fair view of her future dealings with patients — during weekly visits to Sperling’s small apartment, where she helps with vacuuming, cleaning cupboards and rearranging dolls collected over a long life.

The required new “experiential clerkship” connects students with people in the community who may have special social, medical or physical challenges. The course is designed to improve students’ communication skills and increase their awareness of different needs patients may have.

For Blanchard, spending a few hours a week with Sperling has been an eye-opening experience. “I see she really appreciates what I do for her,” says the young Marshfield native, who hopes to concentrate in pediatric medicine when she begins her pharmacy career. “I was also surprised to learn I enjoy working with older people.”

As communication and interaction with patients becomes increasingly important to pharmacists in their daily practices, pharmacy educators around the country are revising their curricula to reflect this and other changes. Building on groundbreaking research conducted here, the UW School of Pharmacy instituted the first in a series of planned curriculum changes this fall in its new professional degree program, the Doctor of Pharmacy, or PharmD.

“Pharmacists today are responsible for much more than compounding and dispensing drugs,” said Melvin Weinswig, dean of the school. “They help members of the health-care team choose appropriate drugs, monitor medications’ effects and communicate extensively with patients.”

The new PharmD replaces a five-year bachelor of science degree, for years the national standard in training pharmacists. Now the education begins with two years of college-level science and liberal-arts courses, followed by a four-year professional program. Subjects examined in the new curriculum range from basic sciences to drug action and delivery systems, from quality assurance to pharmacist-patient interaction.

The curriculum shift focusing on interaction has been driven in large part by the fact that more and more people today are turning to their pharmacists for medical advice. The communication flows both ways: since 1976, Wisconsin pharmacists have been required by law to counsel patients about the use of prescription drugs and potential side effects. A similar federal law has been in effect since 1993. Dispensing advice is important in many ways, says Joseph Wiederholt, professor of pharmacy administration.

“As patients become better informed, they can manage their medication schedules better, which means drugs should work more effectively and patients will ultimately feel more satisfied with their health care,” he says. “Improved communication also helps reduce adverse drug reactions, keeping people out of hospitals and holding down health-care costs.”

Wiederholt’s research team, and others at the school, looks at patient-pharmacist communication from all angles. They’ve found that some pharmacists may be reluctant to delve into too many details because they fear patients may become overwhelmed or alarmed. They’ve discovered that the physical set-up of the pharmacy and time available to consult may inhibit or enhance communication.

Patient knowledge and behavior is equally important, the researchers have found. “Pharmacists take their cues from their clients and spend more time with those who initiate conversations,” says Betty Chewning, assistant professor of pharmacy administration. “We’ve observed that when we teach people what pharmacists can do for them, they expect more of them.”

Chewning heads a School of Pharmacy task force committed to integrating communication into all levels of the new curriculum, such as the Psychosocial Aspects of Pharmacy class she presents to first-year students; simulated laboratory situations; a third-year class on communication, education and behavioral interventions; pharmacist shadowing experiences; and internships in which students serve as assistant pharmacists. The task force wants to guarantee that students become comfortable and proficient at entering into a dialogue with patients, learning what patients know and filling informational gaps that may exist.

“We want to ensure that at every point in the curriculum involving patient contact we build on communications principles and concepts presented in the preceding course,” she says.

Next summer the school hopes to begin presenting workshops in communications theory and practice for the nearly 300 institutional and community pharmacists scattered throughout the state who serve as preceptors to the school’s pharmacy interns.