Archive for February, 2009

Patient Interview not Going Well? Start Again!

February 23, 2009

doctorexplaining

Your interviewing a patient and things are not going well.  The patient
does not seem to be following or even worse seems upset.  Dr. Lony C.
Castro, a professor and chairwoman of the Obstetrics and Gynecology
Department at Western University of Health Sciences, suggests starting the
interview again.

Dr. Castro wrote an article for the Los Angeles Times in which she talked
about the benefits of a “second take” (Dr. Castro is in LA so she can use
movie jargon!).  She discussed an experience she had with an
end-of-the-day patient at a time when she was hoping to wrap up on time
and get home.  Her patient meeting did not go well and she thought, “If
only I
could start over.”  Then she decided to do just that — she asked the
patient if we could start again.  She began the interview again and it was
very successful.

Tips to make the first encounter the best:

Stop for a moment and mentally prepare.  Before you knock at your next
patient’s door, take a deep breath and mentally prepare for the visit.
If you are distracted with other patient issues or your own personal
issues, it is time to put those aside and focus on this particular patient.

Explain medical information to patients in an understandable way.
Rushing through complicated medical details can confuse patients.  They
will end up feeling frustrated.  If you don’t think you have time to
explain, think about how much time will be spent if the patient doesn’t
understand and has to call you back or make a return visit.

Body language and nonverbals.  Make sure yours are patient friendly —
good eye contact, facing the patient and never keeping your hand on a
doorknob!  Also, look at the patient’s cues — do they seem puzzled,
anxious or distracted?

If you need to start over:

After obtaining the patient’s permission, Dr. Castro physically left the
examination room and began the interview from the very start.  This second
try worked and the patient was very satisfied with the meeting.

You do not necessarily need to leave the room.  You can simply state, for
example, “I know this is a lot of information.  Let’s start again, if that
is acceptable to you.”

Work on making the first encounter the best possible meeting.  However, if
you need to start again, that is fine too.

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  To book one of his high-content communication skills programs, visit or call: http://www.CommunicatingWithPatients.com or call 1-800-677-3256

Effectively opening a patient interview: create comfort from the start

February 9, 2009

patientshakinghands

The first few seconds of meeting a patient are critical to establishing rapport, helping the patient feel at ease and setting the tone of the interview. 

Wash your hands both before AND after seeing each patient.  Many healthcare professionals prefer to wash their hands in front of the patient so the patient does not have to worry that they will pick up the previous patient’s germs.

 

These are guidelines to beginning an interview with patient:

Take a Deep Breath. During a busy day, you will develop a fast pace and your patients may pick up on that in your actions and voice.  Taking a quick deep breath will relax you and prepare you for your next patient.

 

Knock at the Door. After a tap on the door announcing your presence, wait for the patient’s response.  Do not just immediately open the door.  Most clinicians knock and immediately walk in, however it is best to knock and wait until you hear a response and then enter.  This only takes a few seconds.

 

Patient’s Name

* When first entering the room, use the patient’s name.  This will immediately give your interaction a personal touch.  From the start, people will feel more at ease and open to discussion. (Use the patient’s name first, then yours.  We want the patient to feel special and using their name first will create this environment.  Using your name first creates an authoritative feel to the interaction.  If you are meeting a patient for the first time, state your role. For example, “Hello Mrs. Smith.  I am your nurse, Barbara Jones.”)

* Begin with a more formal approach with new or older patients.  For example, walk in and say, “Hello Mr. Smith …”  Address them this way, unless they request otherwise.

* If you are seeing the patient for the first time and are unsure of the pronunciation, ask!  To avoid the patient awkwardly telling you, “My last name is actually pronounced …”  On the patients’s chart, it would be a good idea to phonetically write their name.  For example, my last name is “Leigh.” People often mispronounce it as “Lay.”  In my chart, it can be noted, “Last name pronounced ‘Lee.’”  This is not only for your reference, but anyone else who reviews the chart.

* Be sure names are updated, as in the case of marriages / divorces or step children.  To avoid any awkward moments — asking about “life changes.” You may want to say, “We are updating our records, have their been any name changes?”

.

Shake hands, if you feel this is appropriate for the patient. According to a recent article in the Archives of Internal Medicine, most patients want physicians to shake their hands when they first meet.  The article dealt with physicians, however the shaking hands gesture would most likely apply to other healthcare professionals.

 

Acknowledge others in the room, such as a family member or friend.  Be sure to get their names. Shake their hands if appropriate.  This acknowledgment is very important since you want to create a positive image with these family members as they will play key roles in the patient’s compliance.

 

Start with an open ended question.  This includes the question, “What brings you here today?”  Let the patient talk for at least a minute before asking questions.

 

By following these suggestions, patients will feel comfortable and ready share medical information.  An effective start translates into an effective interview!

 

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  To book one of his high-content communication skills programs, visit or call:
http://www.CommunicatingWithPatients.com or call 1-800-677-3256
 
 
 
 
 
 
 
 
 

 

Teaching Patients about their Medications: The Keys to Decreasing Non-Compliance

February 6, 2009

patienttakingmedication1

According to the National Council for Patient Information and Education,

about 50% of the 2 – 3 billion prescriptions filled each year are not taken

correctly.  According to the Agency for Healthcare Research and Quality,

educating patients before they leave the hospital reduces readmissions,

emergency department visits and saves money.  Medication non-compliance is

a very serious problem, however

by following a series of guidelines we can help reduce the severity of

this issue.

The following are tips to help patients understand their medications:

Confirm that the patient understands the reason for the medication.  Before

beginning

a discussion of the medication (s), the patient first must have an

understanding

of the reason for the medication.  For example, if a patient has been

diagnosed with diabetes, they must first have a basic understanding of

their disease.

The basics.  Be sure you review the following information with the

patient: brand / generic name, function, how / when / length of time the

medication is taken, possible side effects, foods / liquids / activities

to avoid while

on the medication, refills (if necessary) and medication storage.

Ask about the use of herbal remedies, over-the-counter medications,

vitamins and mineral supplements.  We should

already know about any other prescription medications that patients are

taking,

but we must also inquire about non-prescription medications, for these

could interact with prescription medications.

Financial issues.  Many people don’t take medications because of economic

hardships.  We must be very sensitive to this issue and inquire in a

careful manner.  For example, we must never say, “Can you afford this new

medication?”  Most people would be too embarrassed to admit they can’t.  As

an option, try a question like this, “This medication will be an

additional expense, how does it fit into your finances?”

Make it easy for the patient to take the medication.  Think of a plan

that would work for the patient.  If the medication is taken in the

evening, suggest they keep the prescription near their toothbrush as a

reminder (assuming they brush their teeth before bed!).  If they have

other medications and use a weekly pill tray, have them add the new pills

to the tray.

Dosage issues.  In some cases, dosages have to be adjusted after beginning

the medication.  It is important patients are told of this BEFORE they

leave.  For example, if a patient is taking a preventive medication for

migraines, but still has headaches, they may think you gave them the wrong

medication and you are not helping them with their medical issue.

Literature about the medication.  For non-hospitalized patients, many

pharmacies provide literature about medications when the prescription is

picked up.  However, we can’t assume

this fact.  For commonly prescribed medications, having a page about basic

medication facts would be very helpful.  Use a highlighter or pen to note

critical prescription facts for the patient.

Check with the patient to verify understanding of the medication.  In one of my “Communicating with Patients” workshops,

a participant stated, “I would say to a  patient, ‘I have given you all

the medication facts, now repeat them back to me.'”  That type of comment

puts people on the spot. (If I heard that comment I would think to myself,

“Uh

oh, I didn’t know there was going to be a test!”)  A better comment would

be, “I have given you a lot of information, let’s review your

understanding of the prescription.”  Then ask patients to review his/her

understanding of what you discussed.

Have family members or caregivers be part of the team.  Explain the

medication to other people so they can help with administration and

provide reminders.

Identify patients at risk for non-compliance. These patients may need a

referral to an agency to help with administration.  Also, contact the

pharmacist to design a drug administration schedule that can be easily

followed.

For more information regarding educating patients about their medications,

visit the National Council on Patient Information and Education website:

http://www.talkaboutrx.org/ (The organization motto is, “Educate before

you medicate.”)

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare

Communication.  To book one of his high-content communication skills

programs, visit or call:

http://www.CommunicatingWithPatients.com or call 1-800-677-3256

Educating Your Patients: 10 Top Teaching Tips

February 2, 2009

teachingpatients

Healthcare professionals spend a great deal of time educating their
patients about illnesses and medical procedures.  Unfortunately, several
studies shave shown that
this is traditionally a weak area and patients may walk away experiencing
confusion, and subsequently, anxiety.

In today’s hectic healthcare environment, time constraints are the norm.
We often feel rushed with little time to educate our patients.  Taking the
time
to learn appropriate educational techniques ultimately saves a lot of time
down the road.  If we don’t explain it properly the first time, then
patients will call back, which takes an even larger amount of time taken
away from an already busy schedule.

Partner with your patient.  Do not think in terms of telling your patients
what do you.  Offer suggestions and choices and then together come up with
the best possible solution.  The healthcare professional-patient
relationship has moved from paternalistic to partnership.

Avoid medical jargon.  Unless your patient is also a healthcare
professional, speak plain English.  For example, use the term “kidney” not
“renal.”  Think about the roots of medical terms to help explain
conditions.  For example, cardiomyopathy literally means “heart muscle
disease” (cardio = heart, myo = muscle, pathy = disease).  Telling a
patient they have cardiomyopathy might sound completely foreign to them.
However, telling a patient there is a problem with the heart muscle sounds
much more understandable.

Offer explanations during examinations.  Let the patients know what you
are doing.  For example, you can say, “Now I am checking your lungs.”
This will help the patient feel more at ease as opposed to being silent.
During the silence they may think to themselves, “He spent a long time
examining my back, maybe there is something wrong?”

Use analogies and metaphors.  These can be very helpful to explain medical
concepts.  For example, when explaining a colon resection, an analogy of
a garden hose can be used.  We can say to a patient, “We need to remove a
section of your colon.  Imagine a garden hose, we remove a section and
then reattach.”

Explain statistics using people not percentages.  Saying 9 out of 10
patients do well is better than saying ninety percent of
cases.  People can relate to the word patients, but not as much to the
word “cases.”  Percentages sound distant and scientific, while patients /
people are more friendly and warm.

Sketch a diagram.  In your office always have paper for drawing simple
diagrams.  Be sure the pad of paper has your medical practice / center
contact information written on it.  These hand-drawn sketches are
very effective and patients feel special that you did this just for them.
Of course, pre-printed charts and graphs and also effective.

Utilize Plastic models.  These items are very helpful in explaining medical
procedures or tests.  They provide  a strong visual element to help
patients understand complicated medical anatomy and physiology.  When, I
was undergoing chemotherapy, I had problems with the constant needle
sticks.  I
was told of the benefits of a Bard® Port; a device implanted under the
skin for
chemotherapy infusions.  My oncology nurses brought out a model to explain
where the port would be implanted.  I decided on getting a port, which
made chemotherapy a much more pleasant experience!

Avoid stress-inducing words; replace with gentler terms.  Instead of using
the words “deformity” or “abnormality,” use the term “finding.”  “When we
have this finding” sounds less anxiety-provoking than saying, “An
abnormality was seen …”

In terms of looking at our lives, we all want positive experiences.  We
all want to achieve remarkable things.  However, in healthcare we want
just the opposite!  We want our test results to be negative and
unremarkable.  We have to be sure that our patients clearly understand
what these two terms really mean!

Use brochures.  Provide written information the patient can take home.
However, before giving written materials to patients be sure to
carefully review the information.  Are the materials written in plain
English?  Are there helpful visuals in the materials?  Just before giving
the brochure to the patient, briefly review key sections with them.  Keep
a pen or highlighter nearby; you may want to mark certain parts of the
brochure.

Supply Resources.  Provide information to help the patient understand and
cope with the medical challenge they are currently facing.  Think about
organizations that can be of assistance, such as a local chapter of a
non-profit group.  Also, think about websites to refer patients.

Through effective educational techniques we can help patients better
understand their medical issues.  This will lead to more satisfied
patients and improved compliance.

 

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare
Communication.  To book one of his high-content communication skills programs, visit or call:
http://www.CommunicatingWithPatients.com or call 1-800-677-3256