“You want that patient to be a partner.” Dr. Paul Ranelli on patient communication

Whether you’re a patient or a health care worker, learn how to encourage partnership through communication, thanks to Pharmacist Dr. Paul Ranelli. This is one of the many interviews you can find in our archives! Check them out at h-cpartners.com/podcasts. 

Partnering with patients. It’s a phrase we’ve all heard before, and it might sound like some feel-good cliche, but it is real. It has real benefits. And it takes real work to do it well. In this episode, Dr. Paul Ranelli shows how he uses specific ways of communicating with patients to encourage this partnership.

Hi everybody, I’m Dr. Anne Marie Liebel, and this is 10 Minutes to Better Patient Communication from Health Communication Partners. Since 2017, HCP has been helping organizations like yours reach their engagement, experience, and satisfaction goals with our next-level, inclusive solutions. If you’re in industry, healthcare, or government and want to improve the efficiency and effectiveness of your quality improvement activities, I can help. Visit healthcommunicationpartners.com and click on contact, or you can find me on LinkedIn.

You might know we just celebrated the 7th anniversary of this series, and again I want to thank you. This community continues to grow. Most shows don’t make it this long. Those who do, many of them plateau, and we haven’t. We keep growing, and that’s because of you, and I do not take this for granted. Thank you for finding us. Thank you for listening. Thank you for sharing.

And with seven years of the show to go through, I was thinking some newer listeners might not have heard some of our amazing guest interviews, especially those in the early part of the series. So I’m going to be better about bringing these up so you can hear them if you’re newer to the show, or revisit them if you heard them years ago, to see how they sound to you now.

But I was just thinking about whose interview, which of these great interviews should I share first, when I got an email from Dr. Paul Ranelli. Dr. Ranelli is now Professor Emeritus of Social Pharmacy at University of Minnesota, and he’s been on our show more than once. I’m going to share one of his interviews for three reasons.

One of them was that email. This gives me a chance to share some podcast love with another series, because Paul was telling me he’s recently been on another podcast series. It’s called The Clinic and the Person, and it is a medical humanities series. I’m gonna give the link to the show that Paul was on. It’s just outstanding, and really I’m excited to know about this series, too, and I’m excited to share it with you.

The second reason is the kind of listener feedback I got about Dr. Ranelli. One of our listeners said, “He has compassion in his voice. You can hear it. And he’s so interesting. He’s the real deal,” and I couldn’t agree more.

And my third reason is it’s always good to be reminded of how patients are experts on their own lives. So here’s Dr. Paul Ranelli.

Paul: Thank you and thank you for having me. Glad to be back!

Anne Marie: I'm so glad you're here. You were my first interview and I'm going to go ahead and put the link to that show in for anybody who hasn't heard it. Please do go listen to it. And Dr. Ranelli in that first interview, you spoke about information giving and information-gathering. I wonder if you could give our listeners kind of a quick reminder of what you meant by that?

P: Sure. Glad to. Those are my simpleton or fancy words for what a pharmacist does a lot. With their medications that they're giving to a patient, is giving information about that drug or about that medicine to the person who's going to be using it. So that's the information giving. That seems pretty standard. The information-gathering is something I try to emphasize, and that's getting information from the patient, is gathering information to help you be a better Giver of information. So what information does that patient have about their medication-taking experiences with this drug, with another drug, with this disease state, with this illness? So I try to divide those in my teaching, with the Gathering it, what you got from get from your patient, and then giving what you give about the drug.

AM: Thanks for that, because I think that was the feedback that I got from your interview was so strong and so positive. And the thing that people remarked on the most was this idea that of the information-gathering from the patient. Like people, once you said it, made sense, but people hadn't thought about themselves as valuable sources of information for the pharmacist. I wonder if you can tell us a little bit more about that idea of the patient as a holder of valuable information.

Sure, well they're very valuable to that relationship. I consider them an expert. We may be experts in our clinical and drug knowledge with all the schooling that we get. But that patient is an expert in their life. And an expert in how they take their medicines, or what experiences that they've had. And they have a great deal to offer to us. So I try to use that as a way to, if you think that there may be an information power differential, “well this is the almighty pharmacist with all this drug information and I'm this lowly patient that doesn't know anything.” Well, that's balderdash! They aren't an empty vessel. They have data to give to us or information that they can share. You may think, they may think it's mundane, but it's not. It's their experiences that they are bringing to the medication taking experience. It's the idea of concordance. You want that patient to be a partner. And you are giving them the confidence to be a great partner. That I want to hear from you.

And you're you're anticipating my next question. And that's, I ask all of my guests, what's the problem or the issue in patient communication that you're addressing or that you're facing? And I just heard you name three or four different kind of problems and issues that get raised in patient communication. The idea of being on the same team together. The idea of a patient having enough confidence in their knowledge to take good care of themselves and to see themselves as a partner. The building of the relationship. The trust issue. I mean, the concordance, you brought that up. There so many issues or problems in patient communication that you are addressing in thinking about the patient as a holder of equal information. The power differential! There you go! There's another one! So, how have you been encouraging this approach with your students?

We do a lot of role-playing in class. And I use techniques of sometimes deconstructing. I sometimes use a technique of deconstructing a patient record, where the students only get the drugs that someone's taking, not any background information. So then they have to make a history from the different kinds of pharmaceuticals that the person is taking. And it could go in many different directions, there's not one right answer. That's the point, there is not one right answer. But it's interesting to see how many different histories you can develop backwards, deconstructing just from the drug list.

Wow that's really powerful. I've never heard of something like that before, but it makes sense just I mean from my outsider perspective. Recently you've been working with some more arts-based pedagogy as well. You had a pretty exciting project this past semester. Do you want to tell us about it?

Sure, I'd love to.  We had, the last few years of my work as an academic and my teaching in pharmacy school I've been working on how to bring the Arts Theater, Visual Arts, let's say into the classroom, but also as a way of teaching. As a pedagogy. A way of explaining this medication use process with the public, with other health professionals, with students. To have a way to make this richer, these stories that people have about their medication taking experience. To make them richer. So this Spring, I've been working with a course with two theater professors at the University of Minnesota where I work. They're at the Theater Department and I'm in College of Pharmacy. So the three of us got our heads together and had a course called Pharmakon: Performing Science. And so the students who signed up for the class, had to the function of the class was to produce a play at the end about medication taking experiences. And they had to bring their own experiences to the class. And then we had them read some old Greek tragedies. I presented some Pharmacy history to them, discussing how drugs developed, and how important the gods were, way long ago about medicine, then science came in. So they produced, with their own medication experiences, and all the history and sociology of medication taking, they produced a play that was for a class exercise that was put on at the end of the class for a couple hours.

So remarkable so many layers here that that we could talk about: the drama pedagogy. The fact that you're again centering the patient. Asking people to share their own experiences. You and the other professors layering in your knowledge as ways of thinking about those experiences. Getting students to interrogate those experiences. And then sharing that with an audience!

Paul: Right

Anne Marie: Who gets to think about, oh! Wow, what does this have to do with the way I think about medication? And pharmacy?

P: Yep.

AM: And Pharmacists? And that you know you brought in religion and science. There's so much richness here. And I think there's, if there is anything that I can link to for our listeners to have a chance to see some of this. It is okay if I do that?

P: Yes, yes.

AM: Super!

P: That's' great

AM: Because I got to watch it, I got to see it live

P: That's right, yes

AM: So let me let me finish with it with the question that I that I finish all of my interviews: what advice can you give to people, whether pharmacists or patients, considering what we've talked about today, in terms of seeing the patient as an expert.

P: So the patient I'd like to you to be kind of assertive, and say, Yes I want to speak to the pharmacist about my medicine. And also have a question or two in the back of your mind if the pharmacist stumbles a little bit. Is there something I should be asking that I'm not asking? You know that's always a great question to have. Is there something I'm missing? You as the patient helping that conversation along, if the pharmacist is a little bit shy. So from the pharmacist perspective, I would like them to come out from behind the glass and be more assertive, and not even wait for someone to say yes I'd like to talk to you” but say “well what can I help you with about this drug? I would like to hear from you about your experience with it, or what you talked with the physician about with it. So that's kind of the way I approach this from the student's perspective, and that's how I would like pharmacist and patients to plan that visit.

Thank you. Thank you for this, Doctor Paul Ranelli. Thank you for coming back to the show, thank you for sharing this with us today.

Oh you're welcome, my pleasure.

Thank you again to Dr. Paul Ranelli for returning to the show. Be sure to check out the student-produced video on Pharmakon, I’ve got link in the show notes. Support this series and your own learning with our digital educational products. Available right now on HealthCommunicationPartners.com. This has been 10 Minutes to Better Patient Communication from Health Communication Partners. Audio engineering and music by Joe Liebel. I'm Dr. Anne Marie Liebel, thanks for listening.

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