Say what doc?

1. Say what doc? • Patient • Education & • Communication Chaim Arias, PGY1

2. Goals • Do we have problems: • Communicating with patients? • Educating our patients? • If so, how do we fix it?

3. Timing is everything

4. Average physician • 4 minutes 17 sec per patient • 20 seconds per relative Timing is everything

5. Timing is everything

6. Disease vs Person • “The main failing of patient-doctor encounters is not a lack of courteous manners, but the moral offence patients experience when existential concerns are ignored.” -BMJ

7. Patient Perception • “The doctors have information on their computers... I don’t know how much... they never tell you.” -BMJ

8. Patient Perception • “Whenever I leave the doctor’s office, I never feel like I get my questions answered. I don’t understand what medicines they give me...” -JD

9. Patient Perception • 3 kids with asthma • Multiple hosptilatizations/ ED visits • Asthma action plan multiple times • Non-compliant -Local

10. At risk population • Low socio-economic status • Language / Linguistic barrier • Low education • Immigrants • Medicaid / Medicare

11. Education

12. -the process of recieving or giving systemic instruction -an enlightening experience New Oxford American Dictionary Education

13. - Respect - Immidiate application - Safe - Engaged - Relavent Adult Learning Theory

14. Adult Learning Theory

15. Communication

16. -the imparting or exchange of information New Oxford American Dictionary Communication

17. Nonverbal

18. Nonverbal • Posture • Gestures • Facial expression • Eyes • Distance • Touch • Vocal intonation • Dress / hygeine

19. Nonverbal

20. Nonverbal • Regardless of physician ethnicity, physicians were more accurate at rating Caucasian faces and vocal tones (nonverbal cues) than S. Asian stimuli • Caucasian patients showed better compliance with treatment

21. Sit down!

22. Sit down!

23. Shared Decision Making

24. Shared Decision Making Adapted from S.Lee, unpublished data, June 2002, as it appeared in “Enhancing Physician-Patient Communication,” American Society of Hematology, 2002: 474-483.

25. Shared Decision Making • Establish a conducive environment

26. Shared Decision Making • Elicit patient preferences for information and decision making • Be direct!

27. Shared Decision Making • Identify the choice at hand

28. Shared Decision Making • Discuss the patient’s values, concerns, expectations • Open ended questions

29. Shared Decision Making • Discuss medical info and confirm understanding • “What is your understanding about your disease and treatment options?”

30. Shared Decision Making • Make your recommendations

31. Shared Decision Making • Negotiate decision in partnership with patient

32. Shared Decision Making • Affirmation and action

33. Providing Info • Avoid medical jargon • Use numbers when available • Write down key statements, graphs, etc. • Present in the “positive”

34. Providing Info • Beware of biases that affect choices • Acts of Commission = regret • Too many choices • Nonlinear probabilities

35. Providing Info • Assess understanding & attention frequently • Post-discussion test

36. Written Material • Less is more • Plain language • Good pictures • Clarity is in the eye of the beholder • Asthetics matter

37. Written Material

38. Written Material

39. Written Material • PatientED.aap.org • MDConsult.com • UpToDate.com • FamilyDoctor.org • Clevland Clinic • NIH.gov “Health Info / Medline” • Lied Clinic handouts

40. Does it help?

41. Does it help? • Reduced pain in WAD in patients s/p written/oral education • DRE rated “mild” vs “moderate - severe” on visual pain scale after proper education • Improved compliance in toddler diet s/p repeated education

42. Bottom Line • Talking to patients Communicating • Talking to patients Educating

43. Sources • “The efficacy of patient education in whiplash associated disorders: a systemic review,” Pain Physician, 2012 Sep-Oct; 15(5)351-61. • “Does clarifying the DRE to the elderly reduce the discomfort in the first execution,” Revisto do Colegio Brasileiro de Cirorgioes, 2011 Nov-Dec; 38 (6):407-11. • “It’s like two worlds apart: an analysis of vulnerable patient handover practices at discharge from hospital.” BMJ Quality Safety, Dec 2012.doi.org/10.1136/bmjqs-2012-001174. • “Four minutes for a patient, twenty seconds for a relative - an observational study at a university hospital” Becker et al. BMC Health Services Research 2010, 10:94.

44. Sources • “Effect of sitting vs. standing on perception of provider time at bedside: a pilot study,” Patient Education and Counseling 86 (2012) 166-171. • “Couteous but not curious: how doctors’ politeness masks their existential neglect. A qualitative study of video-recorded patient consultation.” Journal of Medical Ethics, 2011; 37: 650-654. • “Physician Cross-Cultural Nonverbal Communication Skills, Patient Satistfaction and Health Outcomes in the Physician-Patient Relationship,” International Journal of Family Medicine, Vol 2012, Article ID 376907. • “Enhancing Physician-Patient Communication,” American Society of Hematology, 2002: 474-483.

45. Sources • “Emergency Department Discharge Instructions: Lessons learned through Developing New Patient Education Materials,” Emergency Medicine International, Vol 2012, Article ID 306859, 7 pages • “A Prescription to End Confusion,” Institute of Medicine, National Academy Press, Washington, DC, 2004. • “A cluster randomized controlled trial of a telephone-based parent intervention to increase preschoolers’ fruit and vegatable consumption,” American Journal of Clinical Nutrition 2012; 96: 102-10.