Physicians & patients as teachers and learners
In preparing a module on health literacy for a physician audience, I had the opportunity to review some papers on principles of patient-centered care.
Patient-centered care is based on the idea that patients are active participants in developing a health strategy for themselves. This means that both physicians and patients have responsibilities in communicating information and concerns.
This video by Don Berwick (also a physician) is a great introduction to why patient-centered care should be the core of healthcare provider-patient interactions.
Physicians as teachers and learners
The American Medical Association recommends 6 steps for improving doctor-patient communication:
- Slow down, slow down, slow down
- Create a shame-free environment, encouraging questions
- Limit the amount of information provided (keep it action-oriented— “this is what you need to do”)
- Use plain, nonmedical language
- Show or draw pictures
- Use the teach-back method or show-me technique
It’s worth noting that plain language is NOT about dumbing things down. It’s a way of speaking and writing that helps people:
- Discover what they need
- Understand what they find, and
- Act appropriately on that understanding
More about the use of plain language can be found in this health literacy primer:
- A LiveBinder Health Literacy Primer
The teach-back method is a way of assessing whether a patient understands information. Instead of asking “Do you have any questions,” the doctor asks questions like:
- I want to be sure I explained everything clearly. Can you please explain it back to me so I can be sure I did?
- What will you tell your wife (husband/partner/child/etc) about the changes we made to your medications today?
- We’ve gone over a lot of information today about how you might change your diet. In your own words, please review what we talked about. How will you make it work at home?
(North Carolina Program on Health Literacy, n.d.)
The teach-back method should be practiced in chunks, checking each time new information is presented. Here the doctor takes time to be a learner rather than a teacher, to find out whether his or her communications have been effective.
(Schillinger et al., 2004)
For doctors who find the directive of “slowing down” in opposition to the reality of a 15-17 minute office visit, it’s worth considering the potential practice benefits of patient-centered care.
- Improved medical outcomes (e.g., Stewart, 1995; Kinmonth et al., 1998; Berkman, Dewalt, Pignone, Sheriden, & Lohr, 2004; Schillinger et al., 2004)
- Patients more likely to follow a treatment plan
- Better communication between staff and patients
- Increased patient loyalty
- Fewer malpractice lawsuits (Eastaugh, 2004)
Patients as teachers and learners
In probing questions of health literacy and physician-patient communications, it’s tempting to cast patients always in the role of recipients of information, but as we’ve seen from the patient-centered care model and findings from using the teach-back model, this role should be rethought. Certainly, as patients (regardless of our level of expertise), we all have much to learn. We are not experts in medical science; yet we are certainly experts in our experiences and our personal values. We are experts in what matters to us and in the circumstances that will cause us to embrace one treatment strategy/lifestyle change and reject another. These are issues which we must teach our physicians, even as we learn from them.
Berkman, N.D, Dewalt, D, Pignone, M.P., Sheriden, ., & Lohr, K.N. U.S. Department of Health and Human Services, The Agency for Healthcare Research and Quality. (2004). Literacy and health outcomes (AHRQ Publication No. 04-E007-2). Washington, DC: Government Printing Office. Retrieved from http://www.ahrq.gov/downloads/pub/evidence/pdf/literacy/literacy.pdf
Eastaugh, S.R. (2004). Reducing litigation costs through better patient communication. Physician Executive, 30(3),36-38.
Kinmonth, A.L., Woodcock, A., Griffin, S., Spiegal, N., Campbell, M.J. (1998). The Diabetes Care From Diagnosis Research Team. Randomised
controlled trial of patient centred care of diabetes in general
practice: impact on current wellbeing and future disease risk. British Medical Journal, 317(7167), 1202-1208.
North Carolina Program on Health Literacy. (n.d.) The teach back method. Retrieved from http://www.nchealthliteracy.org/toolkit/tool5.pdf
Schillinger, D., Piette, J., Grumbach, K., Wang, F., Wilson, C., Daher, C., Leong-Grotz, K., Castro, C., & Bindman, A. (2003). Closing the loop: physician communication with diabetic patients who have low health literacy. Archives Internal Medicine, 163 (1), 83-90.
Stewart MA. (1995). Effective physician-patient communication and health outcomes: a review. Canadian Medical Association Journal, 152(9),1423-1433.
Weiss, B.D. (2007). Health literacy and patient safety: help patients understand. A Manual for Clinicians, 2nd ed. Chicago, IL: American Medical Association Foundation and American Medical Association.