Counseling or Consulting?

Without question, medicine can be one of the most time-crunched professions, and the practice of pharmacy is no exception. Multiple customers can arrive simultaneously for hours, each wanting personalized service, some of whom don’t feel well, and staffing is always a concern and a struggle. This fast-paced environment seems at odds with the typical image of counseling many of us have: sitting quietly with a client, identifying the key issues, and spending time talking about them.

This image comes historically from the mass media, where counselors are portrayed as Sigmund Freud clones, complete with beards, pipes and thick glasses. Pharmacy counseling obviously cannot look like this. Instead, the interactions will usually be brief and concise, with few wasted words. This does not mean, however, that these interactions need to be terse, uncaring and dismissive. The practice of pharmacy is becoming more reliant on interactions with patients, evolving into a point-of-care service rather than more of a subcontracted product delivery service. As this change takes shape, the pharmacist will be asked to interact with the patient more meaningfully and frequently.

As medications have become more plentiful and frequently used in society, the need to inform patients has become more critical. For some time now, pharmacists have been asked to take the time to speak with patients about their medications, making sure that the drug is understood, how it should be used, and other important facts. Historically, this behavior has been called “counseling.” However, it may be time to consider the pharmacist as more of a “consultant.” The word “counseling” carries connotations that don’t capture what actually happens when pharmacists speak with patients. While the difference may seem semantic, I would argue that the difference can be important for a number of reasons.

Organizational psychologists like me are trained in critical consulting skills that can be used successfully in pharmacy counseling sessions. The goal of this brief series of contributions is to make this case to you. To do so, the first step is to make sure we are “seeing the world” in the same way. In a later contribution, I will offer some practical ideas and tactics that are adaptable to the pharmacy counseling environment.

So what is counseling? The counselor is usually more of a listener that lets the client talk things out. The counselor must provide a safe environment for this behavior, but assumes that the answers to the client’s problems are the client’s. It is not the counselor’s job to tell the client what to do. Some counselors go to the opposite extreme, handing out advice like prescriptions and taking total control of the interaction. Regardless, the counselor is seen as “the boss” and the provider of prescriptive held, and the client is the passive participant.

So what is consulting? The consultant is an expert that gives clients the opportunity to discuss issues in equality and from their own perspectives. The consultant will ultimately suggest a course of action based on expertise and the information that the client provides. This approach allows critical information and support from the pharmacist to be delivered while keeping the decision-making authority with the patient. Research in psychology suggests that asking for help puts us in a vulnerable and humble position; few enjoy admitting that we need another person to do something that we can’t do on our own. The pharmacist must give advice and counsel without making the patient feel badly that he had to ask for it. The consultant model of helping is perfect for this task.

We can’t waste words or time when it comes to helping patients, but we also want to actually be helpful. Simply asking whether they have any questions or providing a lengthy pamphlet on the medication is not very helpful. Every patient you serve may be able to benefit from a quick conversation, if only to let the patient share a fear or a concern. Make a promise in your practice to be helpful to patients, not just available.