Patient education: How to encourage your patients to make good healthcare decisions
Several of the top ten leading causes of death in the United States — such as heart disease, stroke and diabetes — are connected to unhealthy lifestyles.1
Patients who've educated themselves about their own wellness tend to have better health outcomes, but in today's environment — with primary care providers' limited time to see patients — the time for educating patients about preventative lifestyle measures is often cut short. These conversations can be critical, however, as patient education and better care are closely connected to one another.
So how can you educate your patients and improve their health literacy? Read on for tips on helping your patients make good healthcare decisions.
1 | Recognize that patient education is a part of patient care
Gone are the days when patients followed directions without asking too many questions.
Now, patients and their families or supportive circles are often considered part of the team, and their buy-in to a treatment plan is essential. To get that buy-in, they need to understand what is going on, according to Alex G. Little, MD, a retired thoracic surgeon and now a clinical professor of surgery at the University of Alabama.
Dr. Little encouraged his patients to bring their spouses or partners to their appointments. One important reason was that patients may not comprehend information as well when they are worried or under stress. Although the partners experience stress, too, they are usually able to hear and absorb information better than the patient is. He says it's important to recognize the value of the partners' understanding.
"Many patients would come back eventually and say, 'I didn't really get it, but my wife/husband really helped me through,'" Dr. Little says.
You can use tools to reinforce patient education. Recording the conversation on a cell phone or using pen and paper to note down information allows the patient to review things at home, when they're less stressed or anxious.
In Dr. Little's practice, he often saw a spouse pulling out a notepad and pen. It might be a good idea for physicians to offer writing materials just for this purpose.
2 | Overcome communication barriers when speaking with patients
Patient education is not always a simple matter. Physicians often encounter barriers to effective communication.
"Patients come from different cultures, and they have different backgrounds and languages," explains Sheila Perez-Colon, MD, a pediatric endocrinologist at Kidz Medical Services in South Florida. "If there's a language barrier, I get a translator, making sure he is from the medical field, so we can try to help them understand."
As tempting as it sometimes is, it's important not to rely on family members (especially children) for translations.3 In fact, it is forbidden in many places, even if the families insist on it. If there are no interpreters available to come in person, there are often phone and video options available.
"Sometimes, there are different attitudes and beliefs of what medicine is and what to expect from a doctor, so that could be a challenge," says Dr. Perez-Colon.
In some cultures, the entire family — from children to grandparents — takes part in healthcare decisions. In these situations, a physician may find a group of people, all equally invested, accompanying the patient to appointments.4 Allowing this may increase patient understanding and compliance.
Other barriers to communication may not be as noticeable, such as patients having had a previous negative experience in healthcare, not wanting to take personal responsibility for their illness, lack of motivation, lack of funds or even their environment.
If a patient isn't compliant with their care, it's important to first understand why, and then find ways to mitigate the problem.
3 | Use appropriate language and make sure the patient understands it
Even if patients or their families do speak English well, you may still encounter barriers to their understanding.
For instance, a medical professional may say "myocardial infarction" instead of "heart attack," or the patient is "febrile" instead of "having a high fever." Though these words may roll off a medical expert's tongue, they are unfamiliar to many people, who may prove too shy or intimidated to ask for an explanation. That doesn't mean that you can never use those terms, you just need to introduce them to the patients and explain what they mean. This way, patients learn the medical terminology without feeling overwhelmed.
Asking patients to repeat back the information can help reduce misunderstandings, even when you do use simpler language. This is a strong teaching tool because it can help you catch something that isn't obvious.
"I once had a patient who was getting ready to go [home] after his operation. He asked me why I thought he was going to die," says Dr. Little. When Dr. Little asked the patient why he had that impression, the patient responded, "Well, you kept talking to me about coffins." It turns out that the patient heard "coffin" rather than "coughing," which Dr. Little encouraged him to do after the surgery.
4 | Think about how the information reaches the patient
How you teach patients is just as important as what you teach them. Teaching isn't a one-size-fits-all activity, which means that you need to adjust to each audience and use some creativity.
"There can be nervousness and fear, concern about the diagnosis, what might have to be done, what the risks are," Dr. Little says. "So they frequently aren't really following you."
This is where timing and approach come into it.
Dr. Little explains that he used to exit the office when he finished speaking with patients, leaving them with a resident or nurse, someone with whom the patient may feel more comfortable. "They would go over things again when the patient had settled down a bit," Dr. Little says.
In Dr. Perez-Colon's practice, she needs to teach both her patients and their parents or guardians.
"I usually go as basic as I can. I want them to understand me," Dr. Perez-Colon says. "I usually explain by drawing a picture and showing them what is the normal function of the gland, [for example]."
5 | Help your patients improve their health literacy
The Health Resources & Services Administration defines health literacy as "the degree to which individuals have the capacity to obtain, process and understand basic health information needed to make appropriate health decisions."2
If physicians and other healthcare professionals don't provide the information patients need, they may do without or consult Dr. Internet, with less than desirable results.
Patient education begins from the first visit and continues during every subsequent one, and healthcare providers have an important role in building patient health literacy.
Speaking openly and clearly with the patient or their family during every encounter allows them to build up a body of knowledge so that, if and when you must speak to them later about a specific issue, the language, terminology and topic won't surprise or confuse them.
6 | Mind the newest barrier to care — the internet
The internet has brought information to anyone's fingertips with the click of a mouse or the touch of a screen.
Unfortunately, not all of that information is correct, and some is outright false and dangerous. According to an article published in the BMJ in 2020, there are more than 100,000 medically related sites, but only half have doctors reviewing their content.5
In cases when the family disagrees with the diagnosis or treatment due to inaccurate information, Dr. Perez-Colon tries to counter that by asking them questions and engaging in a conversation to understand their position. She then provides them with the correct information based on scientific facts and research, as well as literature for them to read and better inform themselves.
One issue that's taking up a lot of space online and on social media is vaccinations. There has been a growing "ant-ivax" movement over the past few decades that has become even more of a concern during the COVID-19 pandemic.
When a parent expresses that they don't want their child vaccinated, Dr. Perez-Colon tries to find the reason.
"I then supply them with information to explain why we do it and what to expect," Dr. Perez-Colon says. She's found that if she takes time to learn why they are refusing, they generally turn around and agree to vaccinations.
Follow these tips to encourage effective patient education
The good news is that patient education is not difficult, although it may take some extra work to set things up. Here are some tips that may help improve your patients' health literacy:6
- Ask the patient to "teach back" so you can gauge their level of understanding
- Allow for a follow-up appointment or a phone call so you can answer questions the patient wasn't ready to ask earlier
- Offer written information for the patient to take home
- Provide addresses of websites you trust so patients can learn more on their own
- Incorporate alternative learning strategies like photos, drawings, multimedia and mobile apps
Providing effective patient education to both patients and caregivers allows you to offer better care while staying aligned with your patient's needs. When patients and their families feel part of the team, they are more likely to cooperate with their treatment.
1: https://jamanetwork.com/journals/jama/fullarticle/2778234
2: https://www.hrsa.gov/about/organization/bureaus/ohe/health-literacy/index.html
3: https://www.ama-assn.org/delivering-care/health-equity/7-keys-overcome-linguistic-cultural-barriers-equitable-care
4: https://hhma.org/blog/overcoming-language-cultural-barriers-in-health-care/
5: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1173379/
6: https://www.hcea-info.org/quick-guide
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