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OB/GYN Editorial February 2004
Wanted: Effective Patient Education
Ronald T. Burkman, MD
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The challenges for practicing physicians certainly are immense.
The effects of the liability crisis, changes in the nature and
expectations of the workforce, and “landmark” studies
such as the Women’s Health Initiative (WHI) have had profound
influences on the practice of medicine. Such challenges, or perhaps
opportunities, are endless as new technologies and discoveries
occur almost daily. Further, most of the changes are far more public
such that patients present at our offices with newspaper articles
or Internet printouts seeking our advice. It is not that we haven’t
always had change, but rather change is occurring at a much more
rapid and open pace than in the past.
Handling this glut of new information in a way that incorporates
it into our practices is an increasing challenge. Although drugs
and technology have had their place in advancing the health of
women, it is also clear that life-style issues are of great importance
to one’s health. Thus, as gynecologists and other primary
care physicians, we are called upon to address diet, tobacco and
alcohol use, exercise, supplements and complementary medicine,
as well as emerging issues such as the WHI and new Pap smear criteria.
Similarly in obstetrics, one also addresses many of these same
issues but to this we add exposures that may affect fetal health
and, in particular, the rapidly growing field of prenatal diagnosis.
Most of us would agree that there is little time in the day given
the pressure of managed care to accomplish such tasks. Further,
each of these areas of counseling brings to bear different knowledge
bases and even skill sets. For example, is the message on a given
topic area consistent? Is it accurate? Does it address the individual
needs of a patient? And finally, is it effective? In my view, this
latter point has not had the attention it deserves. As counseling
aids, we often have a plethora of written handouts from a variety
of sources that provide significant information on a given topic.
Religiously, after our usually brief oral presentation, we provide
them to patients and ask them to read them over carefully. But
do most patients use the information or is it tossed in a trashcan
when they leave our office? It is well known that the learning
styles of today’s generations “X” and “Y” are
different. They are much more attuned to visual images than written
words, yet few of our materials take this into account. Certainly,
the decline of traditional newspapers in most cities would support
my contention that the written word is taking a backseat to the
visual imagery of television. In addition, many of our patients
lack the educational background or reading skill to understand
much of the material presented to them. Even if these hurdles can
be overcome, it is unclear to what extent most patients can retain
the information to the degree necessary to allow them to make some
type of informed choice or be motivated to change their life-style.
Finally, since we are called upon to discuss and counsel on a variety
of topics regularly during the workweek, it is unlikely that one
can guarantee consistency and accuracy or individualization each
time an issue is discussed.
One possible approach is to adapt current informational technology
to meet patient education needs and couple the technology with
evidence-based research which examines adult learning styles in
the current health care environment. We need to establish which
types of presentation approaches on complex health issues will
effectively meet the needs of the majority of our patients. Based
on such research, we then need to develop educational programs
on important topics, incorporating the research findings into the
program design. Ideally, such counseling should be interactive
and computer based through CD-ROM or Internet-based programs. There
should be some type of post-test mechanism after the learning session
that documents how much the “trainee” has learned.
Such programs could be individualized for patients with special
needs by providing different pathways in the program based on interactive
responses. It is my belief that because of the rapid growth of
information of great relevance to patients, we will increasingly
shortchange the counseling needs of our patients or rely heavily
on potentially ineffective approaches, such as handouts, because
of the time constraints of the practice environment. The initial
costs of developing new programs and incorporating them widely
into our practices may be high, but the potential dividends for
the health of our patients will be substantial.
Ronald T. Burkman, MD
Associate Advisory
Board Member
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