Thoughts on difficult conversations

Below is a case study taken from a pain review during the PROMPPT research programme’s phase of in-practice testing. It highlights some of the difficulties you may face during when delivering pain reviews and how these may make you feel.

80 year old female, taking Severadol TDS for many years. Patient wasn’t happy on the medication but was guarded during the consultation, not revealing her ‘agenda’ and didn’t seem to want to make any changes.

The clinical pharmacist described it as ‘the hardest of the batch’. They couldn’t find a way in to talk about her pain or talk about making changes to her opioids. They seemed to ‘hit a brick wall’ with explaining that some of the symptoms she was experiencing could be opioid side effects.

The outcome of the consultation was a referral to physiotherapy, which the patient had been offered but refused in the past and a prescription for voltarol gel, which she was already buying OTC. It left the clinical pharmacist feeling like they had not made a significant change for the patient.

Have a think about how you would feel during and after this consultation.

  • Have you had similar experiences in the past?
  • How would you cope with a difficult consultation like this?
  • What strategies have you used in the past? Were they successful?

Now have a read of a few quotes from clinical pharmacists who undertook PROMPPT reviews during the in-practice testing.

“And it is sometimes emotionally draining because a lot of these patients do have complicated lives and will also suffer from mood disorders, depressive type illnesses as well so there’ll be a whole catalogue.”

“Sometimes it can be a bit difficult because you’re raising questions that no one has ever asked before. Sometimes it can be an awkward and difficult conversation, especially when you’re trying to promote your own role as a clinical pharmacist…”

“I think if they had a consultation like this, they’d probably feel like they’ve been dragged through a hedge backwards.”

Can you relate to any of these?

Have a think about how this makes you feel for the pain reviews you will be undertaking. It’s important to think about the difficulties you could face and ensure you are prepared for them.

PROMPPT Trainer, Dr Sarah Harrisson, talks about her experience of having difficult conversations with patients consulting with pain in the video below and shares some of her tips for navigating these experiences.