When Doctors and Pharmacists Miscommunicate, Patients Pay the Price, Thai Study Finds

In the intricate machinery of a modern hospital, few relationships matter more to patient safety than the one between physicians and pharmacists. Doctors prescribe; pharmacists dispense, verify, and counsel. Yet the handoffs between these two professions are far from frictionless, and when communication breaks down, the consequences land squarely on the people the system is meant to serve. A new study from Thailand’s Ministry of Public Health general hospitals has now put hard data behind that intuition, mapping where and how communication conflicts arise between the two professions and, crucially, which channels of communication seem to keep those conflicts in check.

The research, published in BMC Health Services Research by Cheerana Yomchot of Mahidol University’s Faculty of Social Sciences and Humanities, took a deliberately dual approach. Using a mixed-methods design with a convergent parallel structure, the study gathered qualitative insights through in-depth interviews with five experienced pharmacists, each with more than a decade of hospital practice, selected through purposive sampling. In parallel, it distributed self-administered questionnaires to 460 pharmacists working in general hospitals across the Ministry of Public Health system. Of those, 232 pharmacists responded, a response rate of 50.4 percent, and 200 completed questionnaires made it into the final analysis. The design allowed the author to compare what pharmacists say about communication conflict in their own words with what the numbers reveal when the same phenomenon is measured at scale.

The conceptual heart of the study lies in a distinction that communication scientists have long drawn between the types and the methods of professional interaction. The research examined four communication types: formal, informal, one-way, and two-way. Formal communication follows institutional channels, such as official memoranda and scheduled meetings, while informal communication encompasses the hallway conversations and quick consultations that fill the gaps between official procedures. One-way communication transmits information in a single direction, from sender to receiver, with no built-in opportunity for clarification or feedback. Two-way communication, by contrast, creates a loop: the receiver can question, confirm, and correct, turning a message into a dialogue. The study also catalogued six communication methods used in Thai general hospitals: face-to-face interaction, telephone calls, progress notes, meetings, official and unofficial documents, and electronic media.

Why does this taxonomy matter for patients? Because each channel carries different risks of misunderstanding. A one-way message, such as a note appended to a chart, cannot be interrogated in real time. If a physician’s instruction is ambiguous, or if a pharmacist spots a potential drug interaction that the prescriber did not anticipate, a one-way channel offers no mechanism for immediate resolution. Two-way, face-to-face communication, in principle, allows both parties to negotiate meaning on the spot, catching errors before they reach the patient. The Thai study tested whether these theoretical differences show up in the lived experience of hospital pharmacists, and the results suggest they do.

The headline finding is, in one sense, reassuring. Both the qualitative and quantitative strands of the study converged on the conclusion that communication conflicts affecting patient benefits occur at a low level overall. The in-depth interviews placed the conflict at a low-to-moderate level, while the survey of 200 pharmacists recorded an overall low level of conflict. In other words, the system is not in crisis. Physicians and pharmacists in Thailand’s public general hospitals largely manage to coordinate their work without the kind of corrosive disputes that would routinely endanger patients. That convergence between the interview data and the survey data strengthens confidence in the result, since two independent methods of measurement pointed in the same direction.

But the more consequential finding concerns the distribution of that conflict across communication channels. When Yomchot analysed conflict by communication type and method, a clear pattern emerged: conflict was minimal when pharmacists and physicians used two-way communication, and it was lowest of all when that two-way exchange happened face to face. The implication is striking in its simplicity. The oldest and least technologically sophisticated form of hospital communication, two professionals talking to each other in person, remains the most reliable buffer against the misunderstandings that can compromise patient care. Every step away from that direct dialogue, whether toward written notes, documents, or one-way transmissions, appears to open more room for conflict to creep in.

The mechanism behind this pattern is well understood in the literature on health communication. Face-to-face dialogue carries a rich bandwidth of information: tone of voice, facial expression, immediate feedback, and the ability to repair a misunderstanding the moment it appears. Written and one-way channels strip most of that away, leaving the receiver to infer intent from text alone. In a hospital setting, where prescriptions, dosage adjustments, and medication reconciliations often involve ambiguity, that loss of bandwidth can be costly. A pharmacist who receives a terse progress note may hesitate to question it, or may misread its intent, whereas the same pharmacist in a direct conversation could raise the concern, hear the physician’s reasoning, and reach a shared understanding within minutes.

The study’s impact statements make the stakes explicit. Communication, the author notes, is crucial to the collaboration of multidisciplinary teams, and conflict in physician-pharmacist communication can lead to adverse outcomes for patients. The remedy proposed is not merely exhortation but structural: the types and methods of communication need to be adjusted to accommodate the various limitations and obstacles that hospital staff face in their daily work. That framing matters, because it shifts responsibility from individuals to institutions. A pharmacist who avoids confronting a physician may not be timid so much as rational, responding to an organizational culture or a workflow design that makes direct dialogue inconvenient, time-consuming, or hierarchically awkward.

That is precisely where the study’s policy recommendation comes in. Yomchot concludes that organizational policies need to be revised in order to effectively manage and minimize communication conflicts between pharmacists and physicians, with the aim of improving patient care coordination and increasing patient benefits. In practice, this could mean designing hospital workflows that protect time for direct consultation, building two-way feedback loops into electronic systems, and ensuring that formal channels do not crowd out the informal, dialogic exchanges where many clinical misunderstandings are resolved. The author also emphasizes that organizational policy planning is necessary to manage and prevent communication conflict in the future, rather than leaving the problem to be handled ad hoc by individual professionals.

The research was conducted in accordance with the Declaration of Helsinki, with ethical approval from Mahidol University Central Institutional Review Board and written informed consent from all participants, and it received no external funding. Its limitations are those inherent to its design: the qualitative strand rests on five experienced voices, and the survey captured half of the pharmacists invited, with 200 usable responses. Yet the convergent design, in which interviews and questionnaires independently pointed to the same conclusion, gives the findings a robustness that neither method alone could provide. For hospital administrators far beyond Thailand, the message travels well. As multidisciplinary care teams grow more complex and digital tools mediate more of professional life, the study is a reminder that the highest-fidelity communication channel in medicine may still be a conversation, and that health systems ignore the humble face-to-face dialogue at their patients’ peril.

Subject of Research: Physician-pharmacist communication conflict and its impact on patient benefits in Thai general hospitals

Article Title: Pharmacists’ perspectives on conflicts in physician-pharmacist communication that impact the benefits of patients in general hospitals, Ministry of Public Health, Thailand

Article References: Yomchot, C. (2026). Pharmacists’ perspectives on conflicts in physician-pharmacist communication that impact the benefits of patients in general hospitals, Ministry of Public Health, Thailand. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15703-8

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15703-8

Keywords: physician-pharmacist communication, communication conflict, patient safety, Thailand, general hospitals, health services research, two-way communication, face-to-face communication, multidisciplinary teams, hospital policy, pharmacists, health communication