Key points to cover

Example phrases

 Greet Mr Shah and tell him why you have called him back:

• To talk about the blood tests
• Ask him what he was expecting
• Introduce the idea of a new drug for him to take

“….this would mean that I would give you an extra tablet a day to reduce the cholesterol in your blood…how does that sound to you?

 Active listening to Mrs Shah’s concern:

• Ask him what he knows and thinks about taking these drugs
• Encourage him to tell reveal his concerns about drug treatment (benefits / drawbacks)

 Pick up on any cues he drops:

• The poor health in his family
• The side effects he currently experiences
• Taking drugs with no obvious benefit when he has no heart symptoms

“You mentioned your brothers…what worries you about all this?”

“You said the tablets you are taking aren’t doing you much good…why do you say that?”

“You asked how the tablets will affect you. Why do you think they are going to give you any problems?”

 Demonstrate empathy

• Put yourself in Mr Shah’s place
• Understand his problems/embarrassments with the side effects
• Understand his view on taking a drug when he has no symptoms
• Understand his despondency following the loss of his brothers

“I can sense this is difficult for you to talk about, but it is important you tell me these things…”

 “I can see how it might seem strange to take tablets which are supposed to be for your good when you don’t feel much better with them"

 Explain in simple terms and with clarity:

• The action of the drug and how it is of benefit to him.
• Why drugs might benefit him, despite him not feeling any better.
• Why the drug might benefit him despite his brothers not doing so well.
• Be balanced, by mentioning any drawbacks of treatment.

 “Some drugs, like these are preventatives, they stop or slow down a condition at a very early stage before you even know it is going on inside you. You would only feel the benefit of the drug if you actually stopped it and nature took its course…”

“It does seem difficult to believe that this will help you, when your brothers didn’t get much help from similar drugs…but I don’t know exactly what drugs they were on and for how long, they might have started them too late for a preventative affect to be useful and they may well have lived their lives differently to you, in term of how they ate or exercised…”

 Check Mr Shah’s understanding of the points you have made and the value of taking a new drug.

 “After what we have discussed, do you see why I am keen for you to take this extra pill?”

Give Mr Shah some options:

• Opportunity to see a dietician in the interim
• Opportunity to discuss things with his wife present

• Offer to review his other drugs in light of his side effects

 Work with Mr Shah to make his own decision with your help:

• Explain the decision is his
• Be non-coercive.

• Give him time to make the decision

“Any decision to start a new drug is ultimately your choice. I am not here to pressure you into something. I just want to give you all the facts I can so that you can make what I believe to be the best choice for you.”

“You don’t have to rush into any decision right now. I want you to have the time to think about things. In the mean time I have some information I can give you to read at home, but you can also make contact with other patients in your situation if you’d like”

 Offer Mr Shah some further information:

• Leaflets e.g. British Heart Foundation (in many languages)
• To get in contact with a any patient led groups

 Ask if there are any further questions and close (by scheduling a follow-up if appropriate).