Communication is essential for the success of any relationship including medical teams. There is a clear emphasis on the importance of knowing what to recommend but not enough on how to make those recommendations to the team. Let’s fix that and focus on making effective recommendations to improve team relations.
Even with well-seasoned pharmacists, there can be frustration when recommendations are not accepted.
I urge you to not fall into that trap; it is helpful to no one.
Instead let’s focus on what we can adjust in our practice and perspective to improve patient outcomes through specific recommendations tailored to each situation.
Know Your Role
I have so much respect for physicians. They take on the responsibility of the whole patient: every organ, every drug, the social issues, insurance issues…all of it. They are the captains of the ship. We are part of the crew.
As pharmacists we are focused on the drugs. The provider must consider our recommendations against all those other issues and make a decision. They must do the same for recommendations from other specialists as well. We provide evidenced based recommendations; they make the decisions.
When I consider the immense liability that physicians assume, it calms any frustrations I may feel when a recommendation is not accepted. There may be factors that are not apparent from my perspective.
With that said, the reason for rejection could also be the approach. Let us consider 3 ways to refine your presentation of interventions and potentially improve the acceptance of recommendations.
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Be Helpful, Provide Value
You will never fail in any aspect of life if you show up ready to be helpful and add value. Knowledge does not inherently provide these qualities; you must pursue them. Don’t wait to be called on, find ways to contribute to the discussion. This is how you build trust and show competency.
Here are 3 ways to proactively engage the team and improve your rate of acceptance.
- Recommend high quality resources that supports their current discussions. This can be an infographic, a website or you can offer to put together a handout for the team that can serve as a quick reference. Provide something that is specific to your facility and of course relevant to their practice.
- Offer to present on an atypical disease state that the team is working on. You can present while they have lunch in their office or breakroom. It does not have to be formal.
- Offer pharmacy services as appropriate:
“I can take care of the warfarin dosing“
” I can show you how to order a pharmacy consult for almost anything you need help with“
You want to figure out very specific areas the team will come to rely on your recommendations. For instance, always be ready to provide days of therapy for antibiotics. Always review cultures and sensitivity, always renally dose medications. Over time, with consistent performance in those areas, the team will see you as an invaluable part of the team because of these very clear expectations.
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Ask Questions
Ask questions, even when you know the answer. Asking a question is one of the main ways that I offer up recommendations. Even if I am certain that a specific intervention is appropriate, I bring it up as a point of curiosity rather than a request. This questioning approach leads to more productive recommendations.
Dr Jacobs, would this be a situation where de-escalation to nafcillin would work since the culture results show MSSA?
With this question, I made the recommendation, provided the reasoning and the solution. But I also gave the provider bandwidth to engage in discussion versus:
We should switch the patient to nafcillin since its MSSA.
The discussion generated from asking questions helps to build relationships and places the decision-making power where it needs to be, in the hands of the physician.
State Your Intent Before Giving a Defense
Mr. Roger’s medication history shows that he has never taken narcotics in the past. Right now, he’s on oxycodone 10mg PO every 4 hours scheduled with 4mg morphine every 2 hours as needed for pain from his broken femur. Today is day 10. Do we need to scale back his opioids in preparation for discharge?
While all the information provided is helpful it leaves everyone wondering where this train of thought is leading. Instead, place the recommendation up front so that the details provided can be interpreted with respect to that recommendation.
The recommendation here could also have been to assess bowel movements and add stimulants or about the risk of respiratory depression. The teams mind could be going in many different directions. Here’s what I would say instead:
Do we need to scale back on Mr. Roger’s pain medications in preparation for discharge? Today is day 10 post op for a broken femur. He is on oxycodone 10mg PO every 4 hours scheduled with 4mg morphine every 2 hours as needed for pain.
With this approach everyone is on the same train of thought and heading in the same direction. This small change in presentation of your recommendations will improve your rate of acceptance.
Rounding vs. Calling
There is a distinct difference in approach when you are rounding with the team versus when you are calling a provider. Rounding is conducive to back-and-forth discussions. It has a benefit of body language, eye to eye contact and everyone there is keyed in on the same patient at the same time.
Some of the strategies we’ve already discussed would not fare well when calling a provider to make a recommendation.
When you call a provider there is no telling what they are currently engaged in. They could be with another patient, at home with family, dropping their kids off to school (they have lives too!). They may not have convenient access to the patient chart.
When calling a provider, I recommend a more straightforward approach. Be concise as possible. Immediately state your recommendation clearly:
- who you are
- the patient you’re calling about
- the concern
- the recommendation
Dr Jacob’s, this is Marsha from pharmacy. I am calling about Mr Combs in 946. I have the order for insulin lispro ACHS. This patient is NPO, can we change that to Q4H?
Unlike rounding, here I am providing enough relevant information for a yes or no answer. If a change in therapy is going to be made, always emphasize who will change the order. I always offer to initiate the change, again, because I have no idea what they are up to.
What you say and how you say it matters when interacting with the medical team. Take some time to evaluate your approach. If you don’t have an approach, build one! The strategies for effective recommendations provided here are a great way to start.
If you’ve found this unit helpful, we would love to hear from you! Share some of your strategies for landing your recommendations in the comments!
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The information on this website is intended to be used solely for educational and informational purposes. While the content may be about specific medical and health care issues, it is not a substitute for or replacement of personalized medical advice and is not intended to be used as the sole basis for making individualized medical or health-related decisions.
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