Physiatry Practice Management Resources

Education

Education has taken place when the cognitive, behavioral, and effective needs of the patient are addressed. Research shows that clinicians overestimate the time spent in the education of their patients by nine times! In reality, approximately one minute is actually spent on this crucially important task. Poor education of patients is clearly a product of poor communication skills on the part of the clinician.

To effectively communicate, first assess what the patient already knows and then ask questions to determine what he or she might be wondering. Not all patients will be forthcoming with questions, so be prepared to probe empathetically to discover their most basic concerns and fears. Educating a patient involves providing increased knowledge and understanding while at the same time, decreasing uncertainty and anxiety.

There are several techniques to assist clinicians with patient education. Assess the patient's current knowledge by asking about their understanding of the disease process, and ask the extremely effective question, "What do you think is going on?" Clinicians are often surprised by the valuable information this question elicits from the patient.

Always assume that all patients have the same questions, whether or not they ask them. These include:

• What has happened to me?
• Why has this happened to me?
• What will be done to me?
• Why will they do this rather than that?
• Will it hurt?
• When will you have the answers (test results)?
• When will I have the results?

Remember that education has not taken place until the patient has learned something. Be sure that all questions have been answered. Then ask how the patient understands, not if the patient understands. Also, consider that health terms may have both a clinical and lay meaning. Be clear in describing or defining terms to avoid confusion, making sure that you and the patient are on the same page.

Successful education brings great rewards. The relationship between the patient and the clinician is enhanced and the patient becomes part of the process. The patient will know and understand what is happening, what to expect, and therefore, will be less anxious. You will not bear total and sole responsibility for the implementation of the proposed regimen, and both of you will be partners in a successful treatment plan, creating a high level of mutual satisfaction.

It is a challenge to the health care provider to create a plan of treatment that the patient will accept and to which he or she will adhere. As all practitioners know, patient non-adherence is a tremendous problem. Research shows that several things affect adherence: patient's perception of the illness, efficacy of treatment, and duration of treatment. What is clearly presented is that the relationship between the clinician and the patient is a critical factor in patient adherence.

Before they even enter the clinician's office, most patients have made their own diagnosis—a diagnosis that more often than not, they are looking to confirm. Enlistment requires that a clinician and patient come to an agreement about the problem and prescribed treatment. To ensure collaboration, provide a "possible explanation" and ask how it fits with what the patient has been thinking. Differences in diagnoses need to be reconciled or the patient is likely to follow his or her own.

When enlisting agreement, lay out all the variables for the patient in a simple format, including such things as dosage requirements, description of benefits, and review of possible side effects. Ask for feedback to ensure true collaboration and be prepared to tailor the course of treatment based on the individual's lifestyle, habits and routines. Flexibility is critical to arriving at a plan of action that will best suit the patient's needs and overall health. At the completion of the visit, be sure to close effectively by summarizing the agreed-upon plan and discussing next steps.

Creating a Win-Win Situation

Although patient communication is the most common and easiest-to-improve medical procedure, its significance is often overlooked. Effective communication is key to adopting a patient-centric approach to providing medical care, and to the reduction of adversarial clinician-patient relationships. By incorporating effective communication techniques into daily patient interactions, clinicians can decrease their malpractice risk. More importantly, clinicians can positively and effectively impact patient health outcomes without increasing the length of visit—a win-win situation for both parties, and indeed the goal of health care.