Conversations about opioids can be difficult for patients and health-care professionals alike. Pain medicines can be the primary strategy patients use to live with persistent pain and making changes to this may bring about some difficult conversations during PROMPPT appointments. We’re hoping that the skills you have learnt in the PROMPPT training will have equipped you with the capacity to engage effectively with these types of conversations.
However, your own wellbeing is important and this lesson gets you thinking about some of the reasons why these conversations may be difficult and the techniques you already use to cope with these. It will also give you some tips and resources to help you manage your own self-care.
Watch the video by Dr Tim Williams about his experiences of consultations with patients living with pain as a non-specialist health care professional.
Thoughts about difficult conversations
Below is a case study taken from a PROMPPT review during in-practice testing. It highlights some of the difficulties you may face during PROMPPT consultations 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 PROMPPT reviews you will be undertaking. It’s important to think about the difficulties you could face and ensure you are prepared for them.
Continue to work through the rest of the lesson by watching the video below, in which, PROMPPT Trainer, Dr Sarah Harrisson talks about her experience of having difficult conversations with patients consulting with pain.
A hidden impact
The patient from the earlier case study was followed up by the same clinical pharmacist 4 weeks later… she had completely stopped the opioids and was coping really well with the pain. She said she just needed someone to point out to her that the itching and falls she was experiencing could be due to the opioids!
How would you feel if you had achieved this outcome with the patient from the case study?
This case study highlights how even when consultations are difficult and it feels like you’ve not achieved anything for the patient there can be a hidden, positive impact.
Some final thoughts and tips from clinical pharmacists
“I tend to do a mixture of appointments… I find it difficult to do whole pain for the whole afternoon… so I’ll cover pain or cover post MI patients…you have to have your own self awareness of your own emotional state as well”
“I think as pharmacists, we need to come together, we need to network together. Its very hard, its very challenging”
“So it’s about experience, it’s about having that peer support, so network of pharmacists doing similar consultations and kind of learning together. Yeah and its about having the medic and the nurse support just saying, go on, keep going, does that make sense?”
“(If) I think I need some help here or some guidance, I will sit down with the Lead GP… and have a good discussion about it…”
Difficult conversations can be taxing on your mental health and wellbeing. The charity Pharmacist Support hosts a number of resources and fact sheets that may be relevant to you. To find out more about the support services they provide for pharmacists click here and to find out about the Wardley Wellbeing Hub click here.
Take me to: Pain Management Skills Quiz