Achieving patient centeredness in pharmacy practice: openness and the pharmacist's natural attitude.

Objective: To present the benefits of openness for achieving patient centeredness by pharmacists, provide patient narratives from two qualitative research studies that demonstrated how patients have experienced pharmacists' traditional approach, and describe a tool with six component strategies for pharmacists to use in direct patient care.

Design: (1) Ethnographic study and (2) hermeneutic phenomenological study.

Setting: (1) Pharmaceutical care practices and (2) university.

Participants: (1) Patients, practitioners, and student pharmacists, and (2) university faculty and staff taking long-term medications for chronic diseases.

Interventions: (1) Participant observation, in-depth interviews, focus groups, and analysis of documents, and (2) unstructured, in-depth interviews.

Main Outcome Measures: (1) Observations and participant comments and (2) patient comments.

Results: Pharmacists' primary reliance on pharmacology and pharmacotherapy--without consideration of the patient as an individual--can devalue patients' personal understanding of their own situation and negatively affect care. This "natural attitude" of pharmacists, created through their preparation and education, involves their understanding of medications, focus on the product, use of counseling as the major approach with patients, and emphasis on medication adherence as a goal. Pharmacists as professionals must recognize how their natural attitude negatively affects care and work to become more patient-centered practitioners by the development of skills such as openness. Pharmacists can achieve openness by applying six strategies with patients (listen, acknowledge, wonder) and themselves and professional colleagues (recognize, question, reflect).

Conclusion: Patients want to be heard and seen as individuals with unique experiences and responses to medications. If pharmacists are intent on working with patients to ensure that their medication-related needs are met, they should grasp what it means to be patient-centered, and the six strategies for achieving openness should be applied in the daily practice of pharmacy.