Fall Semester 2008

Lecture 5

Barriers to
communication
Labiba Khalil El-Khordagui, PhD
1

Professor of Pharmaceutics
Faculty of Pharmacy, University of Alexandria

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Professional Communication
Elective Course

Identified Learning Objectives

To identify the main types of barriers that
hinder communication
Environmental or physical barriers
Personal barriers (from pharmacist perspective)
Patient barriers
Perceptions and prejudice
Administrative and financial barriers
Time barriers

To identify means to overcome communication

barriers

Overview
Within the communication process, numerous
barriers exist that could potentially disturb or even
eliminate personal interaction. The potential number
of barriers in any pharmacy practice setting is so
large that proper communication may not take place.
Removal of these barriers involves a two-step
process:
1- Recognizing that the barriers exist
2- Take appropriate action to overcome them

Barriers may disturb interpersonal

communication

S=sender

R=recipient

B=barrier

Main types of communication

barriers
I.

Environmental or physical barriers

II.

Personal pharmacist barriers

III. Personal patient barriers

IV. Perceptions and prejudice
V.

Administrative and financial barriers

VI. Time and timing barriers

l- Environmental Barriers
Distractions related to the environment
often interfere with the communication
process.

Environmental barriers may be rather

obvious or more subtle.

Examples of environmental barriers in

pharmacy practice
1- The height of the prescription counter
separating the patient from the pharmacist
2- Crowded noisy prescription areas
3- Lack of privacy in counseling area

1- The height of the prescription counter separating the

patient from the pharmacist
Prescription counters exist for 3 main reasons:
1- To identify the location of the pharmacist
2- To allow the pharmacist to look over the area periodically
3- To provide a private and safe working area for the pharmacist

High prescription counters as communication barriers

Patients may not see the pharmacist

Patients cannot talk to the pharmacist they almost dont see,
which gives the impression that the pharmacist does not want to
talk to them

Pharmacist standing over the counter may give the impression
of superiority and make eye contact less than optimal

Partitions may negatively affect

pharmacist-patient communication

2- Crowded noisy prescription area

This inhibits effective one-to-one communication
Many pharmacies tend to
have a lot of background
noise, such as people
talking
and
cash
registers ringing. These
noises interfere with the
pharmacist
ability
to
communicate with the
patient.
Frequent phone
answered
by
pharmacist
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calls
the

A crowded noisy consultation area

interfere with the pharmacist ability
to communicate with the patient

Pharmacies with separate consultation and prescription

areas enhances effective communication
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3- Lack of privacy
Privacy does not necessarily
mean having a private room,
but both the patient and
pharmacist must feel that
privacy exists.
The presence of a clerk,
technician or other people
who stand between the
patient
and
pharmacist
reduces privacy.
A quiet and private patient
counseling corner improves
communication and decision
making
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How to overcome environmental barriers in the

prescription area?
The first step, find out which barriers exist in your practice setting
by check for the following:
Is the pharmacist visible?
Is it easy to get the pharmacists attention?
Does it appear that the pharmacist wants to talk to patients?
Is the prescription area conductive to private conversation?
Do you have to speak to the pharmacist through a third person?
Is there a lot of background noise or other distractions?
Make sure that:
Mechanisms that allow patients to have ready access to the
pharmacist do exist
a suitable area for counseling patients to allow meaningful
patient-pharmacist dialogue is available
A comfortable waiting area is available
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ll- Personal barriers

(from the pharmacist perspective)
Many personal characteristics of the pharmacist can
lead to ineffective communication.
1) Lack of confidence in good communication skills
Many people feel that communication is something
you are born with and do not need to be learned.
People must realize that communication skills can be
learned and developed by practice and reinforcement.
People must also realize that there is no one who can
communicate perfectly all the time
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2) The degree of personal shyness.

Individuals with high shyness levels tend to avoid
interpersonal communication in most situations
including interactions in pharmacy practice.
Overcoming these barriers is a more complex
process than overcoming other types of barriers.
It requires more time, effort, training, and many
times, professional assistance. However, some
techniques, such as systematic desensitization,
may be successful
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3- Preoccupation
Sometimes, the pharmacist may be more

preoccupied with his internal feelings and

thoughts or even more involved in an
internal conversation within himself while
talking with patients and others than
listening to them
It is essential to develop an awareness of
this because it can inhibit your ability to
listen effectively and make proper decisions
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4- Problem and emotion transfer from others

Another personal barrier involves the tendency to
transfer problems to another person, especially,
patient to pharmacist.
If the sender (a patient, a colleague or boss) is
troubled, angry or worried, you can facilitate
communication by easing his emotional state but
not taking responsibility for his problem and
associated feelings.
As the health care professional, you must attempt
to remain empathic but not get so involved that
you carry the emotional burden of those
(especially patients) with whom you interact
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5- Cross-cultural factors
These arise when people from different cultures interact.
Examples include:
Different language (an interpreter may be helpful)
Different perception of eye contact in different cultures
Different definitions of illness
Perceptions of what to do when ill
Common health-related habits and customs
Differences in health-seeking behavior
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A trained interpreter facilitates communication between a

patient who speaks a different language, and the health care
provider.
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6- The fear of being in a situation that is

sensitive or difficult to handle.
These personal fears or anxieties of making mistakes
put tremendous pressure on us to say the right thing
and may prevent us from talking with others. Usually,
if the anxiety is confronted and overcome, the actual
situation turns much better than expected
Examples:
Fear of presenting information or public talking
Not knowing exactly what to say to a cancer patient
when he expresses fear of dying
When talking to your boss about a personal problem
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7- Perception of the value of patient interaction

Pharmacists may believe that patients neither expect
nor want to talk with them
Pharmacists must change their perceptions in order
to value patient interaction and be eager to adopt
new counseling practices
Unlike environmental barriers, removal of these
barriers
involves
personal
introspection
(EFIJ LMFN OPF) and analysis of ones motivation
and desire to communicate.

21

lll- Patient Barriers

If patients perceive pharmacists as not being
knowledgeable, they will not ask them questions or
listen to their advice.
Some patients sense that health care providers are
not concerned about them as individuals but rather as
cases or disease states.
Patient may believe that their condition is minor and
does not require further discussion after the
physician visit
In contrast, patients may be anxious about their
condition and fear to talk about it with anyone
Patients may feel that label instructions are enough
and they do not need to discuss the prescribed
medications with the pharmacist
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Patient may have health problems that

affect communication, e.g. deafness,
speech difficulties, sight problems, etc
To
overcome
the
patient
barrier,
pharmacists need to convince patients to
change some of their inappropriate
perceptions (by showing competence and
self-confidence) and that they need to learn
about their condition and medications for
achieving better therapeutic outcomes and
improving their quality of life.
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lV- Perception ( )and prejudice (UVWX YMZ)

These can be significant barriers although we deny it
We base feelings and actions on our perceptions
Obvious prejudices include race, religion, and
gender. Pharmacists showing explicit prejudices act
not only illegally but also unethically
Differences in social class. It is difficult to be
sympathetic with someone smelly, untidy or rude.
You must act truly professionally toward these
patients
A study indicated that pharmacists acted differently
in two study scenarios concerning an old untidy man
and a young woman patients, where prejudice was
clearly demonstrated towards the old untidy man
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V- Administrative and Financial Barriers

Several factors dealing with the administrative or
financial aspects of pharmacy practice serve as
barriers to communication.
Examples
Pharmacists are not paid directly for educating or
communicating with patients. Research indicates that
benefit to cost ratio of patient counseling and
education is worth rewarding.
Policies that discourage pharmacist-patient interaction
such as high counters, glass or even bar partitions.
Staff shortage, work overload and difficulty
simultaneous dispensing and counseling activities
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of

Vl- Time and timing barriers

Lack of time and choosing an inappropriate timing to talk may
lead to communication failure. The timing of the interaction is
critical as either or both communicators may not be ready to
communicate at a given time.
Examples
A women with two sick children coming out of the physician
office after waiting for 3 hours is most probably not in the
best frame of mind to sit and have a meaningful
conversation with the pharmacist about medications
The pharmacist may be hurried by a large number of
prescriptions

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Time barrier may be overcome by using a

variety of strategies such as:
Use of printed patient educational material
Highlighting important information with a
highlighting pen
Use of nonverbal messages for reassurance

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Summary
Interpersonal communication, because of its
complexity and human involvement, is a fragile
process. Messages become helpful to the patient
only when they are accurately received and
understood.
If messages are distorted or incorrect, then they
actually may be harmful to the patient and may
prevent an effective and meaningful patient
outcome.
Barriers, such as the ones discussed, may lead to
this distortion. It is important to first recognize
potential barriers and then develop a strategy to
minimize or remove them.
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