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HelixTalk Episode #116 - Taking Your Patient Counseling Skills to the Next Level: Clinical Pearls and Pitfalls to Avoid

Date posted: July 21, 2020, 6:00 am

In this episode, we partner with Dr. Danielle Candelario and Dr. Sneha Srivastava, clinical skills faculty at our college, to discuss tips, tricks, and common pitfalls to avoid when performing medication counseling.


Key Concepts

  1. Patients have a wide variety of health literacy -- you should start your counseling sessions assuming that patients have lower health literacy until you're able to individualize your session as your conversation progresses.
  2. Don't say "Don't operate heavy machinery when taking this medication" -- consider phrasing like “Avoid doing things that require mental concentration, such as driving, until you see how this medication affects you” instead.
  3. When discussing drug adverse effects, don't forget to include information on how to manage these ADRs.
  4. Counseling sessions should be educational and link known concepts; avoid being overly basic, factual, and "listy" without providing context to patients.
  5. Avoid counseling on monitoring parameters that cannot be monitored (“Monitor for hyperkalemia, QTc prolongation, arrhythmias, …”).
  6. Patient counseling sessions should be individualized -- ask questions, get to know your patient, and customize what you discuss based on the patient's individual needs.  Engaging the patient is key!
  7. When counseling for opioids, don't say “Monitor for difficulty breathing or shortness of breath”.  Patients who are so sedated that they have a depressed respiratory drive will not be alert enough to recognize their own respiratory distress.
  8. Not all prescribers are men or doctors -- don't assume!
  9. Focus your adverse effect counseling on ADRs that actually happen.  Avoid catch-all ADRs like headache, nausea, and diarrhea unless the medication actually causes these problems.  For more information, see HelixTalk Episode #70 - Does rosuvastatin REALLY cause 42 adverse drug reactions? Identifying true ADRs to improve your patient counseling.
  10. Don't forget to mention drug disposal information, especially for opioids and other controlled substances.
  11. At the end of a counseling session, don't "quiz" the patient or ask them to reiterate the entire counseling session.  Verification of patient understanding can be done without putting the patient on the spot.
  12. End your counseling session with an open-ended "What questions do you have" question.  Avoid "Do you have any questions" (closed-ended) or worst of all, "You don't have any questions, do you?".  Keep the dialog open and inviting!