Lesson from Blood Clots: Training Pharmacists to Build Patient Trust by Healing the Spirit and Individualizing Care Practices

By: Riley O’Donnell, Student Pharmacist

“No one cares how much you know until they know how much you care

-Theodore Roosevelt

As the ultrasound technician started the scan, she asked the usual question, “What happened to you?” It was my first follow-up scan after a diagnosis of May-Thurner’s Syndrome, lower extremity deep venous thrombosis (DVT), pulmonary embolism (PE), and a mechanical thrombectomy that removed a thrombosis the length of my femur. Her shocked eyes as I explained my story resonated with the disbelief I had when the doctor first told me the diagnosis.

What would you say to me as a member of my healthcare team? How would you convey a sense of compassion so that I would feel certain you had my best interest in mind? The ability to establish a trusted healthcare professional-patient relationship is something pharmacy programs across the country strive to incorporate within the skill set of student pharmacists. ACPE Standards 2.1 and 2.3 outline goals for “[providing] patient-centered care as the medication expert” and “[improving] the health and wellness” of those we serve.1 However, in order to center our efforts on the patient and improve both their clinical outcomes and their well-being, we must go even deeper to integrate practices that humanize our care.

Treating the spirit is an important method in which a healthcare professional can strengthen patients’ trust.

In my situation, I valued my surgeon’s approval to allow my mother to pray over me in the operating room prior to beginning the thrombectomy. Not only did he allow this prayer, but the entire surgical team stepped in to ask for God’s protection. This simple act set the tone for the peace I felt going into my procedure.

The pharmacy curriculum must emphasize the importance of authentically respecting patient beliefs, especially their spirituality, which can actually impact their clinical outcomes.2 Out of 141 final year student pharmacists who responded to a 2015 survey with questions about spirituality in pharmacy practice, only 12% were familiar with how to conduct a spiritual assessment, while 57% would be willing to pray with a patient if it was requested.3 The willingness to honor patients’ spiritual needs must be supplemented with exposure to these topics in the curriculum through multiple methods:

  • Elective courses on spirituality
  • Faculty sharing spiritual patient experiences with students
  • Shadowing chaplain services during experiential activities
  • Topic discussions with nurses and other healthcare professionals on palliative care units

Trust can be further strengthened by tailoring treatment to fit the individual and providing patient-specific care.

When I was prescribed a new dose for my oral anticoagulant, I was never properly educated to take my medication with a fatty meal to improve absorption. I discovered this counseling point while attending my anticoagulation elective course in pharmacy school. I also did not know patients are at the highest risk for venous thromboembolism recurrence within the first 6-12 months following an incident, with 30% of patients experiencing a recurrence within 10 years.4 I was in need of the right information to take my medicine in a way that would help reduce my clotting risk. We must train pharmacists to effectively engage patients in order to fill in any knowledge gaps and empower each individual based on their specific needs.

Dr. Shannon Miller at the University of Florida College of Pharmacy provides an approach to help students practice these skills by using a method of communication known as “the six thinking hats”.5 This strategy of dialogue allows students to view the same topic from different points of view and mandates that they adhere to a certain hat (e.g. “white” must respond with only facts, “red” with emotion and feeling, “green” with creativity and possibility).5 Exercises like these aid students in their adaptation of relationship building with a patient. In this way, students can build exposure in sensing how patients might perceive their own health scenario. By learning which hat is appropriate in a given situation, we learn how to provide the right clinical information in a person-specific rather than formulaic manner, which will show patients that we care about them while caring for them.

Conclusion

We are called to act in our role as healthcare professionals to establish a relationship with patients that fully treats them in all aspects of their health and well-being. We accomplish this by incorporating methods to heal the mind, body, and spirit. We also work to individualize our efforts so that patients can receive a quality of care that meets their person-specific needs. While we see improvements, we must continue to innovate pharmacy curricula in order to provide students with a deeper understanding of true person-centered care.

Acknowledgements:

I would like to thank the following University of Florida faculty members: Dr. Miller for her constant enthusiasm and encouragement in my writing, and Dr. St. Onge and Dr. Curtis for their added support. I would also like to thank my mother Robin O’Donnell for living through my patient case scenario with me and advocating for my health.

References:

1. Accreditation Council for Pharmacy Education. Accreditation Standards and Key Elements for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree.. Accessed August 1, 2019.

2. Beach MC, Inui T. Relationship-centered Care. A Constructive Reframing. J Gen Intern Med. 2006;21(S1):S3-S8.

3. Purnell MC, Johnson MS, Jones R, et al. Spirituality and Religiosity of Pharmacy Students. Am J Pharm Educ. 2019;83(1):Article 6795.

4. Heit JA. The Epidemiology of Venous Thromboembolism in the Community. Arterioscler Thromb Vasc Biol., 2008;28(3):370-372.

5. Six Thinking Hats. Six Thinking Hats. The deBono Group, LLC.. Accessed on August 6, 2019.


Riley is a third-year student pharmacist at the University of Florida College of Pharmacy Orlando campus. Her interests include anticoagulation management, community practice, and ambulatory care. In her free time she enjoys discovering the best coffee shop in Orlando and traveling to Gainesville to see her favorite Gators play during football season.


Pulses is a scholarly blog supported by Currents in Pharmacy Teaching & Learning

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