Health Matters

Many benefits to better patient education seen

Conway McLean, DPM, Journal columnist

Joan’s eyesight is failing, or certainly has worsened over the years. Reading the paper has become impossible while large print books have saved her favorite activity. Prescriptions have also become troublesome. She started out taking the wrong dose of her new blood pressure medicine since she couldn’t read the label and had never been instructed in how to use it. The result: Joan had a cardiac event and had to be admitted to the hospital.

David was a middle-aged man, newly-diagnosed diabetic, and moderately overweight. He worked in a car repair shop performing hard, physical labor on concrete. This job was tough on the feet. He had always had calluses so he wasn’t terribly worried when he saw some drainage on his sock. After all, he had no pain whatsoever. Neither his doctor nor the nurses had told him about the numbness that can develop with diabetes. The drainage was due to a thick callus which had become an ulcer, leading to infection and hospitalization. But the infection was caught too late, and amputation became necessary.

These are but two of numerous examples of a failure to provide adequate patient education. Patient education can be defined as the process of influencing patient behavior and producing beneficial changes in knowledge, attitudes, and skills necessary to maintain or improve health. The consequences of inadequate education are many, from greater health care expenditures to increased morbidity and mortality (illness and death). In some of these critical situations, insufficient information is often provided, like how to take a new medicine, or how to best care for and live with a newly diagnosed disease.

Studies indeed reveal a lack of effective patient and family education in American health care. The clear and obvious trend in health consumer education is to turn to other sources to learn about some pain or newly-prescribed medication. A majority of Americans, 66%, have used the Internet to search for information about a prescription drug. Most have asked their physician to prescribe or discontinue a specific medication based solely on information found on the internet.

As mentioned, diabetes is a disease that demands substantial and potentially life-saving education. People don’t inherently know that when they have diabetes (or are even pre-diabetes), some of the nerves in their feet stop working. This is vital information since they can have some problem develop, some skin injury for example, but not have pain. If someone with this very common disease doesn’t know about the absence of pain in the face of a potentially dangerous situation, they generally assume it isn’t serious……since it doesn’t hurt. As the cliche goes, “what you don’t know can hurt you.”

Were one to look behind the scenes of many clinics and health centers, you would see a harried, fast-paced environment, where time is of the essence. Often, physicians employed by corporations have a quota for the number of patients they see. Rarely is sufficient time allowed for education, a time consuming process. Patients understand more of the educational materials extended when given slowly and clearly.

A factor in this equation is the level of literacy of the average patient. Determining your patient’s health literacy, their ability to understand complex medical conditions, is a critical part of effective health care. Any health care provider using medical terminology of any sort will not be understood. Many patients state their physician did not explain their condition in words they could comprehend. Multi-faceted

To provide effective education, some effort must be expended to discuss some complex medical issue……..without using technical terms. For optimal comprehension, these materials should be written at a sixth-grade reading level, preferably including pictures or illustrations. And naturally, patients prefer medical information written in clear and concise language.

A more effective step in efforts to better educate people would be for physicians to do a better job of pointing their patients in the right direction. Provide specific websites that have accurate information. Give them written material at the time of the visit. Or inform them of good links so they can read on their own.

This lack of patient education is something of a national crisis, leading as it does to increased illness, readmittance to the hospital, and significantly adding to American health care expenditures. Asking health care providers to slow down, to make that extra effort to provide relevant information, is a wonderful idea but of little impact in the grand scheme of things.

Better, more effective patient education promotes patient-centered care and increases compliance, how well the patient adheres to prescribed medications and treatments. American health care outcomes would be better if physicians spent more time with patients but that is unlikely to change without instituting a completely different health care system. For individual members of our society to realize the benefits of physician health education, there is a need for real engagement between patients and their physician.

The challenge of educating the American health care consumer is multifaceted, especially when you consider the complexity of many diseases. In addition, nearly half of American adults have limited health care literacy. A patient’s misunderstanding of a condition and its care can result in non-compliance to their physician’s recommendations, significantly and adversely affecting outcomes. But improved patient education leads to a more efficient and cost-effective healthcare delivery system. Educating patients ensures continuity of care and reduces complications related to their illness.

The more clearly a disease is understood, the more likely it is that an individual will be comfortable with their care and adhere to necessary regimens. It is important to understand some of the basics about your condition. Ask questions if you don’t, or at least get some written materials to help you. Be proactive; be your own health advocate. You’ll feel better if you do, and likely be healthier in the long run.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula. Dr. McLean’s practice, Superior Foot and Ankle Centers, has offices in Marquette and Escanaba, and now the Keweenaw following the recent addition of an office in L’Anse. McLean has lectured internationally, and written dozens of articles on wound care, surgery, and diabetic foot medicine. He is board certified in surgery, wound care, and lower extremity biomechanics.


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