Royal Pharmaceutical Society

Saving lives through consultation skills

Written by Amul Mistry, Pharmacist Manager, Well Lees – Mellor Street Pharmacy

Recently a patient tried to visit the local GP surgery seeking medical advice, but on arrival found it was closed, so turned to our local community pharmacy for advice and support.

The patient arrived asking to speak to the pharmacist so I asked her how I could help, and she described she was experiencing pains in her chest that started after going out for a walk that morning, and the pains had not gone away.

I invited the patient into our consultation room, and immediately thought about the training I had completed on consultation skills provided by the RPS. I thought about how I would apply the Calgary-Cambridge model or LICEF. I initially asked the patient to tell me more about her chest pain. She described that the pain was in her chest and radiating into her back. With this information I asked her if she had any ideas or concerns regarding the pain and while she had no family history of cardiac problems, she was concerned it may be cardiac related.

I asked the patient if I could take her pulse and blood pressure, and she agreed. Both of which were normal. I then used the SOCRATES method to help proceed with my consultation in a structured way.

I was clear about the site of the pain and the time it started, I asked the patient to describe her pain in more detail using open questions, she described it as a “dull pain”, I probed further and asked if it felt like a weight or crushing pain, which she replied “no”. I then asked the patient if she felt the pain was radiating into her arms or upper jaw – she confirmed it was just in her chest and back.

I kept observing the patient and her body language throughout the consultation, which remained normal. I asked if she felt nauseous or clammy, again she said “no”. I then asked if anything such as standing or sitting alleviated the symptoms, again she replied “no”. I asked the patient if the pain had got worse, she explained the pain was “persistent, not getting worse but it still was not going away”, I then asked how severe she thought the pain was on scale from 1-10, she said it was “about 5-6”.

I did not want to alarm the patient, but I said as a precaution I was going to call an ambulance, I sat with her until the paramedics arrived, they conducted an ECG which was normal. The following day I was informed that the patient was having a Myocardial Infarction (MI) and was fitted with a stent the same day.

On reflection, the training I received on consultation skills by the RPS helped me apply what I had learnt. During the consultation I found myself applying different elements of each model, the training helped me to  take my time and come to a different diagnosis. The training encouraged me to take time to listen to the patient and her concerns. Even though the patient did not display any of the classic symptoms of a MI, something was telling me that something was not quite right!

As a community pharmacist I felt that I already had good consultation skills, however this patient intervention gave me the opportunity to really apply my learnings. I can say that the consultation skills training has changed my daily practice for the better, helping deliver better patient outcomes and putting patients at the heart of my daily care.

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