Page 117 - 633 102 Professional English for Pharmacists E-Course book

**Instead of focusing on the patient having done something wrong (not filling his
prescription for 3 weeks), the pharmacist takes the opportunity to praise an action
(checking blood glucose four times daily). Note that the action, rather than the person, is
praised.

Mr. Anderson: Thanks (smiling briefly). Well, he said, my A1c was too high, and starting
anything other than insulin would not be effective in reducing my risks of complications.

Pharmacist: Oh, yes. We have in our records your last A1c was 10.0%. You told me before
that you and Dr. Purdy discussed that it would be a good goal to get your A1c less than
7.0%.

**The focus is on the patient's goal, setting up the ability for the pharmacist to show
that the patient's action (not starting insulin) is not congruent with his goal. This creates
discrepancy.

Mr. Anderson: Yes, that's right (lowering his eyes toward the floor).

Pharmacist: Well, can I talk to you about increasing the doses of your oral medications as
opposed to starting insulin?

**The pharmacist respects the patient's autonomy by asking permission to give him
more information before “filling in the gaps.”

Mr. Anderson: Sure.

Pharmacist: You are currently taking the highest doses of your oral diabetes medications.
They are helping, but because your A1c is at 10.0%, you would need to get it down by at
least 3 more percentage points to reach your goal. There isn't any other medication that
can be taken by mouth that can do that for you. So, the next step toward reducing your
risk of complications from diabetes would be to start insulin.

**The reasoning behind starting insulin rather than increasing the dose of his oral
medication is explained. Also, this is stated in a way that relates the action of taking insulin
with achieving his goal. This reinforces the benefits (increasing the “pros”) while providing
the opportunity for the patient to make his own decision, preserving autonomy.

Mr. Anderson: I guess so (looking down again). The next step toward my grave.

Pharmacist: Oh, Mr. Anderson, you sound concerned. Tell me more.

Mr. Anderson: Well, my mom had diabetes years ago. We buried her 3 months after she
started taking insulin. Starting insulin in my family is … a death sentence.

114 633 102 Professional English for Pharmacists