The concept of 'health excellence' is a useful one: an approach that allows healthcare professionals to better understand how the person actually perceives their condition and how, together, you can create more successful health outcomes. Now that we spend more time delivering services from the pharmacy consultation room, we have the opportunity to work towards health excellence with our clients. This process facilitates changes in attitudes and behaviours and will help to bring about positive outcomes.

The aim is that the individuals themselves create a set of specific health goals that mean something to them, rather than simply be given some by the healthcare professional. While this is a different model from what we are used to, remember that people are in charge of their minds and therefore their results.

Let's consider medicines use reviews as an example of a patient interaction. Say, for example, that someone is showing poor compliance. Simply providing directions to the patient about how to use their medicines will not bring about a change in their attitudes. They may agree with you that they need to change their behaviour, but will reject your attempt to change their beliefs, probably by the time they leave your pharmacy. Have you succeeded in developing 'health excellence' in this example or have you simply completed another MUR?

It is more useful to use terms such as 'individual' or 'client' rather than patient. Working with a group of pre-registration pharmacists, we recently invited in individuals classified as having a chronic illness. We wanted to demonstrate the effect of rapport on a healthcare setting. One person, recently diagnosed with Type 2 diabetes, wanted first to clarify that he had diabetes, not a chronic illness, and second that he was nobody's patient, i.e. he did not want to 'belong' to anyone.

We could have dismissed this information very quickly. But has this individual's belief about his condition and status as a 'patient' absolutely influenced his attitude towards the management of his symptoms and medication? We could not progress with a successful consultation and ultimately bring about a change in behaviour without understanding his viewpoint.