Posts Tagged ‘Education’

Teach Back as an Effective Patient Education Tool

June 26, 2014

PatientTeachBack

by Edward Leigh, MA

A patient tells you they understand everything you said about their treatment plan.  You feel good about this patient visit and are ready to close the meeting.  The patient stated they understood, but did they really?

Problem with “Do you understand?” question

There are serious issues associated with the question, “Do you understand?”  Just because the patient says, “Yes,” does not mean they truly understand.  How can you be sure they understand? Use the powerful “teach back” method.

Teach back is a powerful communication tool to assess a patient’s understanding. After the professional shares new medical information with the patient, the patient is asked to “teach back” what they just heard, verbally or in the form of a demonstration. This allows the professional to correct misunderstandings and provide additional information, if necessary. (In some cases, the patient’s caregiver may be the person “teaching back” the information.)

Factors to consider

If the teach back strategy is not properly set up it could actually backfire leading to a worse patient experience.

Patients may feel you are questioning their intellectual abilities. I have interviewed thousands of patients regarding their experiences with healthcare professionals.  For example, I asked one patient if she was familiar with teach back. She stated she was not familiar with the strategy. She also asked, “Is that for people with learning disabilities?” Upon further discussion, she said if a healthcare professional asked her to repeat back what she heard, she would feel that they think of her as dumb. This example illustrates that the set up to the discussion is critical.  It is vital that patients know the strategy is useful for everyone.

This strategy is not a like a pop quiz you had in school. Don’t simply tell a patient, “Repeat back what I just said!”  This comment will put them on the spot and cause anxiety.  They will feel like a school kid who was just told to clear their desk for an unannounced pop quiz.

To avoid these potential issues, ask the patient certain types of questions. View sample questions in the next section.

Sample of open-ended questions to assess understanding

There are many ways to assess patient understanding via teach back. The questions below provide a friendly and comfortable manner to assess understanding.

Focus on “I” Language. It is important to remember teach back is a way to test our abilities at explaining. In other words, we are actually testing ourselves, not the patients. Using “I” language takes the stress off the patient.

  • “I want to be sure I explained everything clearly. Can you explain it back to me so I can be sure I did?”
  • “Please show me how you will use the device, so I can be sure I have given you clear instructions.”

Focus on how they would tell other people in their lives.

  • “How would you describe your health condition to a friend?”
  • “When you get home and your spouse asks about your treatment plan – what will say?”

Possible reasons for patients not being able to teach back

If the patient is not able to repeat back their medical situation this may be an indication the professional needs to rework their teaching approaches. There could be several factors reducing the ability of a patient to teach back.

Excessive use of medical jargon. If patients do not understand what professionals are saying, they will not be able to repeat back what was said to them. Use everyday language.  For example, do not say, “NPO after midnight.” Rather, state, “Do not eat or drink anything after midnight.”

Too much information presented too quickly.  The “chunk & check” strategy is a tool to avoid this scenario. Provide a “chunk” of information and then “check” with the patient for understanding.

Patient anxiety.  Regardless of how skilled the professional is at explaining to the patient their medical situation, if the patient is very tense, the material will not be absorbed.  In this case, use empathy. Mention that you understand their feelings of anxiety.  You may want to engage in brief deep breathing exercises with the patient to help them feel calmer so they are better able to take in the information.  The exhale should be longer to achieve maximum relaxation. For example, inhale on a count of four and exhale on a count of six. A few deep breathes goes a long way!

If the patient was not able to repeat back, do not repeat – re-phrase.

Benefits of teach back

Improves outcomes. According to the Joint Commission, research indicates that the teach back technique is effective, not just for improving patients’ understanding, but also for improving outcomes. For example, patients with diabetes whose physicians assess their comprehension and recall with the teach back technique have significantly better diabetes control than patients whose physicians do not use the technique. (Schillinger D, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163:83-90.)

Can ultimately save time. Professionals often feel they have no time for the teach back method.  It actually does not take very long to assess a patient’s understanding.  Think of how much time it will take if the patient has to call back or visit again.

Enhances patient safety. If a patient does not understand their medical issue, they are at risk. A patient’s medical situation is not nice-to-know information, it is need-to-know information!

Unity Point Health, Des Moines University and other organizations collaborated to develop an excellent Teach Back Toolkit.  Click on the link for more information on this very helpful toolkit.

http://www.teachbacktraining.org/

After giving it – be sure they get it!

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication. The Center focuses on increasing patient satisfaction, improving compliance and decreasing the risk of medical errors. The Center offers high-impact training, consulting and one-on-one coaching. Edward Leigh’s new book, Engaging Your Patients, is due out in late 2014.  http://www.CommunicatingWithPatients.com or 1-800-677-3256

Effective Use of PowerPoint in Medical Presentations

February 12, 2014

PowerPointPic

by Edward Leigh, MA

During the morning break from an all-day physician workshop, a participant approached me (while smiling) and stated, “I’m angry at you!”  He then went on to say, “I come to these seminars and always sit in the back. I open up my laptop to get work done, but you made me listen. You made me work. This is the best seminar I have attended in I don’t know how long.”  I am not sharing this story so I could simply tell you how wonderful I am at presenting programs. Rather, I am sharing the story to reveal a significant problem in medical education. The red flag here is the dependence on PowerPoint as a teaching tool. Effective learning must be an active engaging process that stimulates the learners’ minds, not a passive process of simply looking at slides.

Before you create your first slide – answer this question.  What’s your point?  What are the goals of your session?  When I coach people on their presentation skills, I always ask this question, “A month from now, what  two to three points do you want people remember from your presentation?  I am talking about the big picture take home points.” People struggle with this question often telling me they have dozens of points.  Think about your big overall goals and build your slides from that information.

PowerPoint is ONE component of a dynamic presentation. In addition to the slides, we must have a great opening, powerful close, audience involvement and THE key attribute – enthusiasm! This is your subject and you must show your passion! PowerPoint is an aide to us, we are not an aide to it. The slides are part of our program, but they should never become THE program. You and your knowledge base are the stars of the show.  In the very unexpected event of the PowerPoint not working, could you still present your program and engage the audience?

Avoid all-text slide presentations. This scenario creates an uninspiring presentation that leads to audience boredom.  Incorporate photos and charts to make the program come alive.  Periodically, add graphic elements between text slides to keep the audience interested in your presentation. A medical student told me he attended a presentation by a visiting professor, who spoke in a monotone voice and had text-only slides. When the professor was done speaking, the audience didn’t clap at first because they didn’t realize he completed his presentation! When an audience is so tuned out they don’t realize a presentation is over, that’s really bad news!

6 x 6 rule.  No more than six lines per slide.  No more than six words per line.  It is important to think in terms of “less is more.”  Each slide should contain ONE main idea.  I have attended medical presentations in which the slides were so busy and complicated most audience members were completely baffled, which led to a lot of frustration.  When coaching people on their presentation skills, the biggest issue I find is information overload.

No one learns when they are sleeping. Providing the slides to audience members and then simply reading the slides verbatim is not only a poor educational tool, it is also incredibly tedious. While attending typical medical programs, I often look around at the audience. I see few people truly engaged. Many people looking are at their smart phones, reading something else, quietly talking to a neighbor, or worse, sleeping. Since the audience can read, the presenter is not necessary. The audience members could read the slides on their own. To be truly effective, speakers must bring something more to the presentation.

Moving from passive to active audience members.  Yes, you can engage audience members with PowerPoint!  This can be done in a variety of ways. Put a question on a slide and ask the audience to briefly discuss the question with a neighbor. Then ask for responses. Show a picture and ask the audience, “What is going on here?”  These very quick engagement tools perk up the audience! Go from dull to dazzling! When I incorporate questions in my slides, I do not put the answer in the written slides. They have to attend the session and listen to get the answer!

Be consistent with fonts, colors and backgrounds.  You want the audience to focus on your content, not your ever-changing visuals.  Also, the addition of animation and sound adds variety, but should not be used excessively. They key to an excellent presentation is balance. Also, be sure there is a significant contrast between the text color and the background color. For example, dark text on a dark background is very hard to read.

Use a text size of at least 24 point.  I prefer a font size of 28 to 32 for text and 36 to 44 for titles. Try this readability test; put your slides on the screen and stand in the back of the room in which you will be presenting. Can you read the slides? I have been to many presentations in which the speakers say, “I know you can’t read this, but …” If the audience can’t read it, don’t show it.

Arrive at the program venue early to check the slides.  It is important to arrive to a presentation location early for many reasons, including checking the AV equipment. Before the audience members arrive, check to be sure your slides are working properly.  Unfortunately, I have seen many presentations start with this statement, “Does anyone know how to work this?” As a backup, even if I email my slides to the meeting planner, I always carry the slides with me on a flash drive. It is also a good idea to arrive early to meet audience members; this is helpful to gain insight as to their needs / questions.  Through my pre-program chats, I have also received excellent ideas that I incorporated into the session. Audience members love this recognition! For example, I have stated, “Just before the program, I spoke to Steve who mentioned a great idea to help patients …” I have Steve waive his hand so the audience could acknowledge his great idea.

Separation of handout from slides. I speak at hundreds of medical conferences, and I am usually the only presenter that separates the slides from the handout. The handout is given to participants; the handout has all the information well organized into sections. The slides are highlights of key points, including graphics.  There are also surprise questions and mini quizzes. The audience is constantly engaged.  Granted, it takes more work to present in this manner.  However, it is time well spent since I know people are engaged and learning. We do what’s best for our audiences, not what’s easiest for us.

Make PowerPoint work for you to create memorable presentations. You are brilliant, you are the expert – that is the reason you are making the presentation. The spotlight should be on you and your vast knowledge, not the slides.

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication. The Center focuses on increasing patient satisfaction, improving compliance and decreasing the risk of medical errors. The Center offers high-impact training, consulting and one-on-one coaching. Edward Leigh’s new book, Engaging Your Patients, is due out in the Spring of 2014. http://www.CommunicatingWithPatients.com or 1-800-677-3256

Virginia Tech Carilion School of Medicine Assesses Students Communication Skills Before Admitting

October 13, 2011

By Edward Leigh, MA

Have great grades?  Excel in science?  Thinking of medical school?  Think again!  Medical schools are now realizing that excellent academics are not enough to become a great doctor.  Communication skills and the ability to work in teams are vital.

Virginia Tech Carilion, located in Roanoke, Virginia, is one of the newest US medical schools (the school opened in August 2010).  Their medical school admission interviews go beyond the typical questions, “Why do you want to be a doctor?” The medical school has added a communication component to their admission interview process.  Great grades alone will not prepare prospective students for this part of the interview process; great “people skills” are needed.

Communication skills are more than “bedside manner.”  These skills also directly impact patient safety. According to the Joint Commission, “An estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off.”

This is how the medical school interview process incorporates communication skills:
• Candidates stand with their backs to doors.
• A bell rings and they turn around and read a sheet of paper taped to a door. The paper will have a scenario that requires communication and teamwork skills. (The school requests that the actual scenarios be kept secret.)
• After two minutes, the bell rings again and the candidate enters the room to discuss the ethical issue with an interviewer.
• The candidate has eight minutes to discuss that room’s issue. The interviewer scores each candidate with a number and sometimes a brief note.
• The process is then repeated several times.

The school administrators created questions that determine how well candidates think on their feet and their ability to work in teams. The interviews closely assess how well they respond when someone disagrees with them.  This is a critical skill in working with teams.

According to the school, “Candidates who jump to improper conclusions, fail to listen or are overly opinionated fare poorly because such behavior undermines teams. Those who respond appropriately to the emotional tenor of the interviewer or ask for more information do well in the new admissions process because such tendencies are helpful not only with colleagues but also with patients.”

“We are trying to weed out the students who look great on paper but haven’t developed the people or communication skills we think are important,” said Dr. Stephen Workman, associate dean for admissions and administration at Virginia Tech Carilion.

Dr. Harold Reiter, a professor at McMaster University in Hamilton, Ontario, developed the system. He states, “Candidate scores on multiple mini interviews have proved highly predictive of scores on medical licensing exams three to five years later that test doctors’ decision-making, patient interactions and cultural competency.”

The emphasis on communication and teamwork does not end with the medical school interviews.  Medical students at Virginia Tech Carilion are required to take team-based classes.  The school also requires students to become involved in community projects.

The mini interviews help shift the discussion away from personal narratives (that are usually rehearsed) to focus on the student’s problem solving abilities.

For more information about Virginia Tech Carilion’s innovative medical school application process, please contact Dr. Stephen Workman at SMWorkman@carilionclinic.org

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. The Center offers high-impact training, consulting and one-on-one coaching. Edward Leigh’s newest book is Engaging Your Patients (due out in early 2012).
http://www.CommunicatingWithPatients.com or 1-800-677-3256

How to Plan a Successful Patient Satisfaction Fair

June 14, 2011

Wheeling Hospital held their first annual patient satisfaction fair to educate employees on current process improvement projects related to enhancing patient care. The fair was developed to encourage interdepartmental communication as it relates to patient-centered care. The medical center felt it was very important that each department knew the activities of other departments to enhance teamwork.

Heidi Porter, the Director of Quality Management, shared tips on how your medical center can plan its own patient satisfaction fair.

Educate employees on patient satisfaction.  Plan educational events to help employees improve the patient experience.  Wheeling Hospital had several educational opportunities for employees. The hospital emphasized the focus on patient satisfaction is not just for “bottom line” reasons. Yes, based on changes in healthcare, reimbursement does tie into patient satisfaction scores (e.g., HCAHPS). However, it is important to emphasize to employees this focus on patient satisfaction is related to delivering outstanding care and improving patient safety.

Form a Patient Satisfaction Committee. Wheeling Hospital formed a patient satisfaction committee that meets monthly to focus on improving the patient experience.  One of their projects is the fair.

Be sure every department has a display / booth. Each one of Wheeling Hospital’s thirty departments were asked to create a display and discuss their patient satisfaction initiatives. For example, the radiology department discussed using contrast material that tasted better to patients since this was often an issue. The lab discussed scripts to use to be sure patients understand their lab reports.

Involve everyone in each department.  The people staffing the booths were not always directors.  Many front line staff were present, especially since they are the people who have the most direct patient contact.

Have materials at the booth. Nearly every booth had written information on their various projects. This is important so fair attendees have information to review.

Plan ahead.  Wheeling Hospital planned the event well in advance to create a successful event.  Time is needed to make sure all the necessary arrangements are in place.

A patient satisfaction fair is an excellent opportunity for each department to share their projects.  Make plans to have a fair at your medical center.  Heidi Porter has graciously agreed to answer questions about starting your own fair.  Heidi can be reached HPorter@wheelinghospital.org

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!
http://www.CommunicatingWithPatients.com or 1-800-677-3256

My Mother’s Recent Emergency Department Experience: Lessons for Learning

March 7, 2011

My mother, Julia, is part of a clinical trial, which involves monthly infusions.  The clinical trial protocol requires periodic blood work, scans, x-rays, etc.  Last week, the physician leading the clinical trial called me at my office and said that my mother has atrial fibrillation and they will not proceed with the monthly infusion. They also noticed that one of my mother’s legs was red and swollen; they were concerned about a possible blood clot. They suggested calling an ambulance and having my mother taken to the closest Emergency Department (ED). I agreed to this action. They then called the ED to inform them of the atrial fibrillation and possible clot.

I called the ED to mention that my mother is on her way and also told them that before leaving my office I will fax over my mother’s medical history information. I have a two-page summary of my mother’s pertinent medical information (e.g., medications, hospitalizations, allergies, etc.).  I told the ED that my brother and I would be there shortly.

Overall, everyone at the hospital was very friendly. However, there were several parts of the experience that could have been improved. This article is a summary of the issues with suggested changes.

Problems with hand off. When my brother and I arrived at the ED, we went to my mother’s room and the nurse told us that their tests did not find atrial fibrillation and that my mother was going to be discharged now.  I asked about the issue with mom’s leg.  They said, “What issue?” In spite of the fact that the clinical trial physician clearly stated the leg needs to be evaluated for a possible DVT, that information never made it to the ED records.  After discussing the leg issue, my mother was scheduled for an ultrasound.  (As an FYI, the ultrasound revealed no clots.) To avoid these botched communication episodes that could seriously harm patients, professionals should engage in “repeat back.” After the information is shared the receiver must “repeat back” the information to verify accuracy.

No partnership statements.  The relationship between the patient and professional is not about giving orders; it is about forming a partnership. Upon admission to the ED, all patients should be asked, “What would make this an excellent experience for you?” What does great care mean to you?” We need to immediately understand the patients’ needs. If we are to be truly patient centered, we need to understand the needs of the patient.  In order to work as a team, we need to understand the patients’ needs.  Working as partners leads to quality improvement and better clinical outcomes.  Of course, this partnership approach leads to higher patient satisfaction.

Use of medical jargon. The people at the ED did not know I was a healthcare professional. They often used medical jargon that I understood, but what if I was not in the field?  When they scheduled the ultrasound, we were told Mom was being evaluated for a DVT. The abbreviation, DVT, was never explained. This is a serious problem in healthcare — the constant use of medical jargon that patients often do not understand.  This is known as a problem with “health literacy.” (The term literacy could mean problems with reading, however it often refers to the ability to understand the language of medicine.)

No signposting. This is a communication strategy in which people are given an overview of what will take place during their stay.  Streets have posts with signs on them (street names) hence the term “signposting.”  These posts with signs give people direction; that is exactly what we want to do with patients, give them direction.  In other words, tell then what will be coming up in regard to their care. This could as simple as saying, “First we will assign you to a room, run some tests and have you seen by one of our highly-qualified doctors. Based on the results of the tests, we will let you know how long you will be here.”  Patients should also be told that we are here to help you and make your stay as pleasant as possible.  There was one significant fact not revealed to our family that could lead to serious damage with patient satisfaction scores.  After being in the ED for approximately 1 1/2 hours, I asked our nurse, “When do you think my mother will have the ultrasound?” She then smiled as though she was about to laugh!  She said the average time for an ultrasound is 4 1/2 hours, but it could be up to 8 hours! This fact should have immediately been told to us.  (As an FYI, we had the ultrasound done in about 3 hours.)

Lack of hourly rounding.  After my mother was in the ED an hour, I expected someone from the medical center to check in on Mom.  No one came to see how Mom was doing.  Hourly rounding is a critical tool for many reasons.  This process helps prevent potential falls by asking patients if they need anything, such as a trip to the bathroom.  Many patients are seriously injured each year because they have to use the restroom and no one is coming to check on them. They try to get up on their own and sometimes fall.  The rounding also has a psychological benefit in that you are reassuring patients that you are thinking of them and working on their care.

No empathy. Going to an ED is a very stressful experience. During my mother’s time in the ED not one person directly stated an empathic response.  I would have liked to hear at least one person say, “I know it is scary being here. However we are here to help you.”  This comment should often be followed by a partnership statement, such as, “We will work together with you to find out what is going on as soon as we could. We will periodically check on you, but if you ever need anything, please feel free to let us know. We are here for you.”

Directions — don’t just tell, show!  When I arrived at the ED, I asked the person at the front desk what room my Mom was in and they told me. I asked for directions. The directions were very complicated due to ongoing construction. The person at the desk said something to this effect, “Go down this hall, turn right at the first hallway, then make an immediately left, go down the corridor until you get to a desk, then make a slight right, etc. What? Huh?  I then asked, “Could you have someone take me there?”  They agreed. When people ask directions, don’t simply give directions; take them to their requested destination.  This is an excellent customer service tip all hospital staff should incorporate into their work with patients and their family members.

Teach back technique not utilized.  After the ultrasound was completed, we were given discharge instructions.  Being in healthcare, I understood all the directions, however what if I was not in the field? Saying to a patient, “Do you understand?” is not sufficient.  In order to determine if they indeed understand, you must use the communication technique called, “teach back.” Ask the patient to summarize the information you provided. This could be as simple as asking, “Tell me what you will do when you get home.”

In summary, all of the hospital staff members were quite pleasant.  However, there were some very significant problems that could have negatively impacted my mother’s health. Based on a poor hand off, the ED was unaware of the leg issue.  Fortunately, my mother did not have a DVT. But what if she did?  This medical center needs to have staff development training covering communications skills, rounding techniques, educational strategies and customer service. These techniques are more than “bedside manner” tips; rather they are skills to avoid potentially serious medical errors.

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!  http://www.CommunicatingWithPatients.com or 1-800-677-3256

Edward Leigh’s new book, Engaging Your Patients, is due out in June 2011!

MD Anderson Cancer Center Offers Innovative Patient-Professional Communications Program

October 8, 2010

The Interpersonal Communication And Relationship Enhancement (I*CARE) programs are excellent educational tools developed to enhance the communication skills of oncology professionals. The program is part of MD Anderson’s Department of Faculty Development. The program developers strongly believe that “skillful communication is a competency that can be taught and learned.”

The I*CARE program mission: “Most cancer clinicians have not had the opportunity to develop their skills in managing difficult patient encounters such as those where there are strong emotions, stressed families or uncomfortable conversations when transitioning a patient to palliative care or discussing end of life. Oncology providers want to extend their role beyond treating disease to establishing a therapeutic and supportive alliance with the patient and family. Our goal is to assist you in sharpening the skills necessary to manage these challenging encounters.”

I*CARE PROGRAM INITIATIVES

I*CARE Website

The website, http://www.mdanderson.org/icare, contains the MD Anderson Cancer Center’s Video Library of Clinical Communication Skills and is an educational resource for communication skills development. The video library helps with understanding the basic principles of communication and advanced skills such as discussing end-of-life issues and error disclosure by providing specific protocols that can be used and illustrating them with video re-enactments.  Free Continuing Medical Education (CME Ethics credit is available) and Risk Management credits are available to physicians enrolled in The University of Texas Professional Liability Insurance Plan. People may download materials for teaching purposes.

Programs

There are many program options, including fellow & faculty forums, interactive workshops, train-the trainer sessions, conferences and the quarterly Achieving Communication Excellence (ACE) lecture series.  One program, “On Being An Oncologist,” features actors William Hurt and Megan Cole who assume the personas of various doctors. Using dialogue gathered by physician focus groups, they share their feelings about the stress of caring for patients with life-threatening illness; the time pressures; the challenge of breaking bad news; the need to keep hope alive; the balancing of sympathy and empathy and keeping personal boundaries, as well as dealing with both the patient’s and their own emotional reactions.  A workbook with reflective exercises can be downloaded for both teaching and learning purposes.  In the Spring of 2011, there will be a new program launched for patients and families to learn how to communicate their needs to their medical team, and specific information on the cultural aspects of communicating with patients. 
One-on-one Coaching

Trainers observe healthcare professionals with patients and feedback is provided.

Research Opportunities

There are many ongoing research projects such as assessing aspects of the patient / oncologist relationship through audio taping clinical encounters and the impact of empathic statements on a patient’s emotional state.
These outstanding initiatives are making a big impact in helping oncology professionals successfully connect with patients on an interpersonal level.

Walter F. Baile, M.D., is the I*CARE Program Director and Cathy Kirkwood,
M.P.H., is the I*CARE Project Director. For more information about I*CARE, visit: http://www.mdanderson.org/icare

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!
http://www.CommunicatingWithPatients.com or 1-800-677-3256

Medical Students Learn what it is like to be a Resident in a Long-term Care Facility … by becoming a Resident! The Learning by Living© Project

September 29, 2010

Empathy in healthcare is all about understanding what it is like to be “in the shoes of “ a patient / resident.  Medical students at the University of New England College of Osteopathic Medicine learn what it is like to be a resident in a long-term care facility by becoming a resident!

The Learning by Living© Project is the brainchild of Dr. Marilyn R. Gugliucci, Director of Geriatric Education and Research at the College of Osteopathic Medicine.  In this innovative program, medical students are “admitted” into a long-term care facilities to “live the life” of a resident for two weeks.  Each student comes with a diagnosis and appropriate treatments. For example, if the student is admitted in a wheelchair, the student must stay in the wheelchair for every activity, including changing clothes and bathing.

Prior to the development of this project, students learned about long-term care via traditional methods (e.g., lectures and brief visits).  

In 2005, the first medical student was “admitted” into a Maine long-term care facility to live the life of a resident. Each summer since then, Dr Gugliucci has admitted students into long-term care facilities.  The students do not return home at the end of the day; the students live in the facility on a 24/7 basis.

Dr. Gugliucci maintains constant contact with students portraying an adult daughter of the student acting as a resident.  The students carefully document their experiences. The long-term care facilities provide a bed and meals at no cost.

The program has a 100% success rate!  Follow-up data reveal that students practice medicine differently because of their experience of living in a long-term care facility.  According to Dr. Gugliucci, students gain the following by having this experience:

  • Importance of physical touch, voice inflection, and word cadence when working with patients.
  • Enhancement of communication by being at eye level with the patient, whether they are in a bed, a wheelchair, or on a treatment table.
  • Communication with authenticity and sincerity, emphasizing the importance of being comfortable sharing with patients.
  • Connection with and treating the person rather than the diseases or frailties of the patient.

Currently, the University of New England College of Osteopathic Medicine is the only medical school in the country admitting students into long-term care facilities for extended periods to live the life of a resident. The plan is make this a nationwide project. The project is also applicable to nurses and other health profession students.

The Learning by Living© Project is being filmed for a documentary, due out in June 2011.

For more information about the Learning by Living© Project, please contact Dr. Marilyn R. Gugliucci at mgugliucci@une.edu

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!
http://www.CommunicatingWithPatients.com or 1-800-677-3256

 

My Mother’s Recent Hospitalization Experiences: The Good, the Bad and the Ugly!

November 18, 2009

About a month ago, my mother was crossing the street with her friend. Just as she stepped on the sidewalk she started feeling faint and began to feel sick.  An ambulance was immediately contacted and my mother was taken to the ER.  My mother’s friend accompanied her to the hospital — she called us from the hospital and told us to come right over.

My brother and I entered the hospital’s ER to find my Mom awake and alert. An ER nurse told us that my mother’s EKG was abnormal and that she had a condition known as Atrial Fibrillation and would need to take the medication, Coumadin.

A few hours later, my mother was admitted to the hospital.  The physician on the unit determined the underlying medical issue, dehydration.  We thought my mother was drinking enough fluids — obviously not.  My mother was in the hospital for four days.  Upon proper hydration, she was feeling fine and looking forward to returning home.

These are my observations regarding my mother’s recent hospitalization.  I base the observations on my PIE Model of Patient Communication.
P  Psychosocial (providing emotional support)
I  Interviewing (getting information)
E  Educating (giving information)

Psychosocial Dimension

Everyone was very friendly and kind.  I found the healthcare professionals to be very caring and treated my mother quite well.  However, what I did not find was any direct empathic responses.  I was waiting for someone to make a statement such as, “I know this must be difficult for you.”  Every medical center and practice always mention that empathy is an important component of their work.  In reality, empathy is rarely displayed.  This is due to the fact that healthcare professionals are not educated on how to convey empathy.

Interviewing Dimension

The questioning techniques employed were sufficient to gather information from my mother and I.  There was the usual issue of asking too many closed questions in succession and not allowing the patient sufficient time to discuss their medical issues.

The biggest issue was closing the interview with this question, “Do you have any questions?”  That is a closed question.  To encourage patients to ask questions, we should rephrase the question as an open question, “What questions do you have?”

Educational Dimension

Brace yourself and fasten your seat belt!  This was by far the weakest area.  Upon discharge, the unit nurse reviewed the discharge instructions, which were disjointed at best.  There were so many issues, I almost did not know where to begin my evaluation.  These are the problem areas and suggestions for improvement:

Excessive use of medical jargon:  The discharge instructions used the terms presyncope and mixed hyperlipidemia.  I am in the healthcare field and know what the terms mean, but what if I wasn’t in the field and didn’t know what the words meant?  Use patient-friendly language.

Ultimate diagnosis not mentioned. My mother initially fainted, but was ultimately diagnosed with dehydration by the attending physician.  Dehydration was never mentioned in the discharge report. This is a perfect of example of how poor handoffs lead to medical errors. At the time of discharge, I asked about the dehydration and how much fluid my mother should consume.  The nurse said, “About 3-4 glasses a day, I guess.” (Having a solid healthcare background, I researched the topic and developed a daily fluid intake plan for my mother.)
Vague comments. The discharge form states, “Will order Influenza vaccine.” Was it ever administered to my mother?  I called the hospital and was first sent to the Medical Records Department — they had no idea.  The Medical Records Department sent me to the unit, who also had no idea.  The unit nurse did say this, “Your Mom most likely did get the flu shot.  We usually give it to people 50 or over.”  Why didn’t the report state, “Patient was given a flu shot?”

No educational materials / resources.  In spite of the fact my mother was diagnosed with dehydration, no information was provided.  A brochure, website or organization to contact would have been helpful.

Overall, the healthcare professionals who took care of my mother were kind and skilled at their jobs.  There were some issues with the interviewing questions and empathic responding, however the biggest concern was the poor patient education component.  If patients do not comprehend their medical situation, they are at risk.

I signed the form for my mother (I have Power of Attorney).  By signing the form, I indicated I understand the discharge papers.  I actually did understand them — I have been in healthcare over 20 years.  My biggest concern is that most people will sign the form stating they understand, but they really do not.

Hospitals need to do a better job at educating patients.

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

When Patients Want Antibiotics They Don’t Need: Offer Explanations, not Prescriptions

August 31, 2009

AntibioticsNotForColds

A patient with an upper respiratory infection comes to see you.  After performing a history and physical, you determine the patient has a viral infection.  You are concerned the patient will insist on a prescription for antibiotics.  Below are the steps to handle this patient concern.
 
Show Empathy
 
Think about how sick you felt with a respiratory illness.  They can be a miserable experience.  Here is an example of a statement you can say to a patient, “I understand you are not feeling well.  I want to assure you that I want to help you.”
 
Explain Difference between Viruses and Bacteria
 
For patients, viruses and bacteria are all “bugs.”  They do not perceive a great deal of difference between these organisms.  We need to explain to them the difference and then discuss how antibiotics are effective for bacteria, but not viruses, such as the virus causing the common cold.
 
You can mention to patients, “Most adults, on average, get two to three colds a year; and children can have eight to twelve colds a year. Most colds last about one week. But it’s not unusual for symptoms to continue for as long as two to three weeks.”
 
Describe Dangers of Antibiotics
 
Side Effects. Mention how antibiotics can be have unpleasant side effects. Say, “I do not want to give you a drug that will not help and possibly make you feel even sicker.” Describe potential antibiotic side effects including: upset stomach, diarrhea, rashes, and (rarely) serious allergic reactions (even with antibiotics that they may have used safely in the past).
 
Resistance. In addition, explain how overuse use of antibiotics can result in resistance to them.  For example, you can say, “Using unnecessary antibiotics can cause some bacteria to become resistant to the antibiotic. This increases your chances of having bacterial infections later that can’t be treated by antibiotics. This is called ‘antibiotic resistance.’”
 
Potential Patient Issues
 
Concern over Green or Yellow Mucus. A patient may state they are having green or yellow mucus and fearful that means their illness is serious.  We need to combine empathy with our explanation. You can state, “I could understand your fear.  We used to think that green or yellow mucus indicated a bacterial infection. However, today, we know this is not true. A viral infection can cause green or yellow mucus.”
 
Previous (Unnecessary) Antibiotic Prescription. Explain to patients that if they were given antibiotics in the past for colds that antibiotics often get credit that your body’s own immune system really deserves. Review issues of antibiotic side effects and resistance.  Also, mention newer knowledge of antibiotics.
 
Emphasize the use of self-care measures (such as fluids) and nonprescription medications.
 
It is important to remember, patient satisfaction is generally linked to communicating effectively not writing prescriptions.
 
The CDC has an excellent brochure for patients, “Cold or Flu. Antibiotics Don’t Work for You.”  Here is the link:
http://www.cdc.gov/GetSmart/campaign-materials/print-materials/Brochure-general-color.pdf

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

New “Readability Toolkit” Helps Develop Understandable Patients Forms and Educational Materials

July 9, 2009

PatientFormsClipboard

The Group Health Center for Health Studies recently created an excellent report, the “Readability Toolkit.”  The Toolkit is designed to show research teams how to create consent forms and other participant materials in plain language.  Overall, the Toolkit has excellent information to create patient-friendly forms and educational literature.

The Toolkit contains these sections:

What You Should Know Before Using this Toolkit – Background information on health literacy, plain language, and why both are important in the research context.

The Principles of Plain Language – An explanation of the components of plain language, as well as concrete strategies that support plain language writing.

How to Determine Reading Level – Information and advice about using readability formulas to rate the approximate reading level of your materials.

Quick Reference Guide for Improving Readability – An at-a-glance summary of plain language principles and strategies, plus other formatting, editing, and proofreading tips.

Editing Checklist for Participant Materials – A companion to the Quick Reference Guide that guides users through a systematic process to improve readability, identify unclear concepts, and eliminate proofreading errors.

Resources for Informed Consent Documents – Readability advice and resources specifically for consent forms, including a list of common pitfalls, links to helpful consent templates and guidelines, and a selection of easy-to-read template language for common consent topics, such as randomization and voluntary participation.

Resources for HIPAA Authorization Documents – Links to helpful HIPAA templates and guidelines, along with a brief selection of easy-to-read HIPAA language.

Alternative wording suggestions – A list of plain language alternatives for hundreds of words typically used in medical and research settings and links to online resources that define medical and research jargon.

Examples of improved readability– Before and after “snapshots” of plain language revisions to original text taken from actual participant materials.

Examples of improved formatting – Techniques for improving readability through
formatting changes are illustrated with three before and after examples: an advance letter, a consent form, and a study information sheet. While the focus is on improved formatting, all three examples also illustrate other plain language techniques.

Repository of readability resources and references – A clearinghouse of Web-based resources focused on health literacy, readability, plain language, and informed consent, plus a short bibliography of articles related to literacy and readability in health research.

Download the complimentary Toolkit here:  http://www.centerforhealthstudies.org/capabilities/readability/ghchs_readability_toolkit.pdf

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