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Background: Patients commonly ask pharmacists for the over-the-counter medications when they get different ailments. Assessment of how a pharmacist evaluates a patient's signs and symptoms and his or her approach to treating the patient using over-the-counter medications were the main goals of this study. Methods: In this cross-sectional study, the scenarios on cough, diarrhea and Obesity were selected from questionnaires that had been responded by 61 pharmacists. The scenarios were then designed by determining important questions including the key question using appropriate references and the opinions of a panel of experts. Subsequently, a list of all pharmacies in Isfahan (Iran) was obtained and 210 pharmacies were randomly selected. Final analysis was made on 151 visits to 127 community pharmacies. Performance of pharmacists, i.e. the number and type of questions used to come up with a recommendation and the appropriateness of the decision, was assessed both strictly and leniently. Moreover, the length of time spent for counseling and influence of gender and ownership of pharmacists were analyzed. Findings: The mean counseling time was 130.2 ± 86.1 and 98.6 ± 72.4 seconds for female and male pharmacists, respectively (P = 0.01). The key questions for cough, diarrhea, and Obesity scenarios were asked by 29 (55%), 45 (87%), and 0 (0%) of pharmacists, respectively. The questions led to 25 (47%), 10 (19%), and 8 (17%) appropriate recommendations according to a lenient evaluation. Conclusion: Despite asking the key questions, the majority of pharmacists do not make appropriate recommendations for cough, diarrhea, and especially Obesity. Incorporating relevant courses in the pharmacy curricula and devoting continuing education seminars to over-the-counter medication usage are suggested to improve pharmacists' performance. [ABSTRACT FROM AUTHOR]