Imagine that a patient has come into the pharmacy to pick up their medication. As you hand it over the counter, you carefully explain the dosage, when to take the tablets and what side effects to look out for. You encourage the patient to ask any questions they may have, before sending them on their way – comfortable in the belief that you’ve done the best you can to ensure they understand why they need the medication and when to take it.

Now imagine the same scenario, with a different patient. Only this time, neither of you speak the same language.

As any good pharmacist knows, effective communication skills are the key to providing good healthcare. But explaining complex medicine regimes or potential side effects to patients can be complicated at the best of times, and when there’s no common language between you and the patient, things can become even more difficult.

But the world is shrinking and, as communities become more diverse, pharmacists and their teams are having to find new and innovative ways to overcome the language barriers they encounter. So, in this global age, how should you interact with patients with whom you don’t share a common tongue?

Patient safety issues

Being unable to communicate with patients in their own language can cause serious problems, says National Pharmacy Association (NPA) chief pharmacist Leyla Hannbeck. “These can include patients misunderstanding the advice or instructions for how to use their medicines.” There’s a lot at stake: including poor adherence and a risk to the patient’s safety, she points out.

For these reasons, being unable to explain a patient’s medication in words they can comprehend makes pharmacists feel understandably uncomfortable, even if they rest on the assumption that a patient will be able to seek a translation elsewhere.

These concerns are familiar to pharmacist Murtada Alsaif, who co-founded Written Medicine – a company that provides software to print bilingual medicines labels (see Case study). Mr Alsaif originally experienced problems communicating with patients while working as a locum, and says: “It doesn’t rest easy with you – you’ll still be thinking about it [when you go home]”.

One of the biggest issues with language barriers is that it’s impossible to find out how many of your patients are making mistakes with their medication, Mr Alsaif says.

For some pharmacists, hitting a language barrier is a regular occurrence. Martin Bennett, who owns Wicker Pharmacy in Sheffield, has noticed an increase in the number of languages spoken by the patients he has helped over the years. “[At] one time, if you came from just out of the area, you came from Barnsley. But now patients can turn up from anywhere in the world,” he says. “And most days, they do.”

Mr Bennett has communicated with patients from all over the world, including a Russian patient who was looking for mastectomy products for his wife. “That was interesting, trying to find her the right size,” he recalls.

Over time, it has become “more difficult” to communicate with every patient who comes into the pharmacy because of the sheer amount of dialects that are spoken, he says.

Even with the best of intentions it can be difficult to provide translations for everyone, so his team has to fall back on trying to explain instructions and advice the best they can, in English. He says he finds that “most things” can be overcome by patience and goodwill, and admits he has resorted to “gesturing” as a last resort.

 

Seeking help

But being able to explain patients’ medicines to them in their own language is clearly preferable. This is a familiar scenario for Ash Soni, contractor and chair of south London’s local professional network for pharmacy. His two pharmacies in the area serve a diverse population, with large Polish and Somali communities, and many refugees located nearby. Naturally, pharmacies situated in these kinds of diverse communities are more likely to encounter language barriers, and Mr Soni estimates that his teams serve non English-speaking patients “several times a week”.

For this reason, Mr Soni says he has actively recruited staff who speak some of the local non-English languages.

“We’ve generally been able to get by,” he says. However, on occasion he has resorted to asking the patients’ children – who have often learnt English at school – for a translation. “It’s very risky, but in some cases it’s the only solution that you have,” he says. “You always turn [to the patient] and say, ‘If you’re not sure, please can you find someone else who may be able to help?’”

It’s easy to assume that pharmacists will only encounter communication barriers with patients who do not speak the same language. But as Mr Soni points out, some English-speaking patients may have “very poor” literacy skills. This means that, although they may be able to understand the instructions you tell them, they may not be able to read them once they are written down.

Similarly, pharmacists who have moved to parts of the UK where they didn’t grow up may have trouble understanding the local dialect. Mr Bennett says he recognises that certain Yorkshire phrases may be difficult for some of his team to understand, so he provides his pre-registration students with a leaflet explaining local expressions.

Possible solutions

In areas with a large bilingual population, it may also be useful to consider displaying materials in your pharmacy that are written in both languages. For example, health bodies including Public Health Wales, Community Pharmacy Wales (CPW) and local Welsh health boards have worked together to create bilingual display materials for pharmacies.

In parts of the country where Welsh is a daily language, this often means that members of the pharmacy team will speak the language as a result, CPW points out. Mr Alsaif stresses that pharmacists with “any sense” will take the same approach in other parts of the UK if they live in areas where many patients do not speak English.

Mr Alsaif’s co-director at Written Medicine, former dispenser and pharmacy manager Ghalib Khan, recommends every pharmacist takes this a step further and learns a few useful words or phrases in a local ethnic language themselves, as a way to drive patient loyalty. Mr Alsaif agrees. “At the very least, it makes a huge impact when you’re trying to build a rapport with your patients,” he says.

However, this isn’t always possible, and visual cues can be a useful fall-back option if all else fails (see box, below). Mr Bennett and Mr Soni both recommend using visual prompts and illustrations to help patients understand how they should be taking their medication. These could include pictures of the sun rising to indicate taking medication in the morning, for example.

If you must carry out the conversation in English, Mr Alsaif suggests making sentences as easy to understand as possible. Asking closed questions can help, because there is less scope for misunderstanding if your questions have simple yes or no answers, he says.

Pharmacists’ roles are becoming increasingly clinical, meaning that communication skills are more important than ever. And as communities across the UK become even more diverse, it’s clear that language barriers between patients and pharmacists are one obstacle that won’t go away any time soon.

While there is no easy way to overcome this linguistic divide, all of the suggestions mentioned above serve as useful examples of simple ways that pharmacists can communicate better with non-English speaking customers.

By being practical, sensitive and recognising the needs of their patients, pharmacists can make sure that everyone has access to effective healthcare, whatever language they speak.