The prime questions in authentic patient's consultations: a call for additional research on current and new paradigms

Although the 3 prime questions ("What did your doctor tell you the medication is for?" "How did your doctor tell you to take the medication?," and "What did your doctor tell you to expect?") have been recommended as a way to implement an interactive approach to patient's counseling in pharmacy, research examining how these questions are actually used in practice is relatively sparse. Qualitative approaches might assist to inform pertinent questions that might challenge prevailing paradigms. This commentary calls for a close look at how novice pharmacists in training manage these questions in real-life patient's consultations. These examples are aimed to provide preliminary observations about (1) how the prime questions in their original and modified forms are treated by pharmacists in training and patients, and (2) the interactional functions that the prime questions and similar questions may serve. Preliminary observations based on a conversation analysis of these examples show that the open-ended nature of the original prime questions sometimes leads to interactional problems such as delays in patients' responses and pharmacists' revision of the questions. Modified question formats that involve the use of specific knowledge expected to be possessed by a pharmacist, such as declarative questions and Q-word questions with concrete information, may lead to smoother interaction. Finally, questions about the purpose of the therapy may also be used to create opportunities to express empathy toward the patient or to shift the zone of expertise to the doctor. These initial findings suggest a more context sensitive and adaptive approach to communication in pharmacy.