What is the most useful feedback to provide to a pharmacy resident to avoid misunderstandings with patients, after a resident failed to address a patient's immediate need for a new prescription for insulin (novolog/humalog) pens during an encounter?

Feedback for Pharmacy Resident on Patient Communication

The resident should negotiate agendas with patients at the start of each encounter. This feedback would be most useful to help the pharmacy resident avoid similar misunderstandings with other patients in the future 1.

Why Agenda-Setting is Critical

The scenario demonstrates a classic communication breakdown where the resident provided excellent education and used appropriate health literacy techniques, but completely missed the patient's primary concern - needing a new prescription for insulin pens. This misalignment between the resident's and patient's priorities resulted in:

1. Wasted time for both parties
2. Patient frustration
3. Failure to address the patient's actual need
4. Potential risk to the patient's diabetes management

Evidence-Based Approach to Agenda-Setting

The American Society of Clinical Oncology's consensus guideline on patient-clinician communication strongly recommends that clinicians should "collaboratively set an agenda with the patient after inquiring what the patient and family wish to address and explaining what the clinician wishes to address" 1.

Key strategies for effective agenda-setting include:

• Using open-ended questions to encourage patients to share what is important to them
• Asking "What else?" to ensure all concerns are captured 1
• Avoiding interrupting patients when they are expressing their concerns 1, 2

Research shows that when patients are given the opportunity to speak without interruption, they typically express about three concerns per office visit and take only about 32 seconds to complete their list of concerns 1.

Implementation in Pharmacy Practice

For pharmacy residents, a structured approach to agenda-setting should include:

1. Begin with an open-ended question: "What would you like to discuss today?" or "What brings you in today?"
2. Allow the patient to fully express concerns: Research shows clinicians often interrupt patients after just 11 seconds 2
3. Prioritize concerns together: "I'd like to discuss your diabetes management, but I understand you need a new prescription for insulin pens. Let's address that first."
4. Confirm the agenda: "So today we'll get you a new prescription for insulin pens, and then review insulin technique if we have time. Does that sound right?"

Common Pitfalls to Avoid

1. Assuming the patient's needs: The resident assumed education was needed when the patient actually needed a prescription
2. Focusing solely on the clinical agenda: While diabetes education is important, the immediate need for medication should take priority
3. Not checking for understanding of the visit purpose: The resident could have asked "What are you hoping to get from our visit today?"

Impact on Patient Outcomes

Proper agenda-setting directly impacts morbidity and mortality by ensuring:

• Patients receive needed medications without interruption (in this case, insulin pens)
• Critical patient concerns aren't missed
• Patient adherence improves through addressing their priorities
• Patient satisfaction increases, leading to better engagement in care 1

The American College of Physicians emphasizes that patients should be "active partners in all aspects of their care" 1, which begins with understanding and addressing their priorities.

By implementing effective agenda-setting at the beginning of each patient encounter, pharmacy residents can ensure they address patients' most pressing needs while still accomplishing clinical goals, ultimately improving patient outcomes and satisfaction.