Patient Education in Our Offices

Few concepts are more fundamental to medical practice than patient education. Just ask most medical school applicants: They will know that the Latin origin of “doctor,” docere, means “to teach.” It has been shown that family physicians include health education in 9 out of 10 office visits, and education and health advice occupies nearly one fifth of the preciously brief time spent with patients during a typical visit.¹ For many physicians the definition of patient education is the transmission of facts through a handout, videotape, or Web site, perhaps coupled with a mini-lecture. Education does not always mean learning, and expanded knowledge does not always lead to behavior change, which is the target outcome of much patient education. Expanded patient knowledge, while certainly critical, is only a piece of a complex process. Making patient education effective and practical is a challenge. The cost and time constraints so prevalent in family practice demand that physicians invest in activities, resources, and strategies supported by reasonable evidence. Yet access to the growing evidence about patient education is often not available in the mainstream family practice literature, or it is not valued by its readers. Many physicians remain unfamiliar, for example, with the helpful “Stages of Change” model² that can guide and improve interventions through an understanding of the patient’s readiness to undertake a change. We are pleased, therefore, to see 2 articles with practical suggestions on the use of patient education materials in this month’s Journal.^3,4 These researchers went beyond hypothetical thinking and observed the actual use of educational materials in family practice. The studies, using different research methodologies and settings, suggest the same major finding: The physician has a primary role in the effective use of written materials.

Quality versus quantity

The investigation by McVea and colleagues³ challenges those physicians who gather extensive patient education libraries. Through extensive direct observation of what happens in practices, the researchers found that those physicians who kept and used a small collection of handouts were by far the most likely to use them. Even with the availability of extensive, well-organized collections within the practice, stockpiled materials were mostly unused. The effort by so many practices to gather, sort, index, computerize, and expand their patient education materials may be a waste of time and money. Patients in the study by McVea and coworkers were infrequently seen taking patient education materials themselves despite the availability of this information. Why? Perhaps patient education material carries more value when given to a patient by the physician. In their study, Terry and Healey⁴ confirm that it makes a difference when patients receive health information directly from their physicians. These investigators found a higher satisfaction level among the patients who received a self-care book directly from their provider than when it was received through the mail. Even with the abundance of accessible health information on the Internet, in bookstore megachains, and in family practice offices, the physician still has a key role in patient education.

Influencing patient behavior

The provision of patient education materials help sensure that patients have sufficient information to make informed decisions regarding their care. Patient education materials also contribute to higher patient satisfaction, which is a prerequisite for better adherence to physician recommendations. Evidence suggests that effective patient education processes are centered on a satisfying physician-patient interaction. Whether it is called patient-centered medicine,⁵ participatory decision making,⁶ or patient education, the central elements seem the same. The complex and usually longitudinal process of influencing patient behavior starts with a relationship based on trust, caring, and concern. Together, physician and patient explore barriers to change, and negotiate achievable goals supplemented with well-timed use of knowledge-oriented patient education, gentle nudging, and facilitative actions that support the patient’s stage of change. The simple act of handing a patient self-care material improves the physician-patient relationship and may open the door for more effective interaction. Physician-patient communication is a very practical and inexpensive tool in the physician’s tool kit.⁷ It is still unclear, however, whether the value is in giving relevant health material or just in giving patients something (anything) that leads to their increased satisfaction.

As both of these studies indicate, there is much yet to be understood about the best use of educational materials and their ultimate benefit to a patient’s health. Both studies, with their emphasis on written materials, should be considered in the context of the growing body of information on adult literacy and health literacy. When 20% of US citizens are at the lowest reading levels and an additional 20% struggle with written communications in some settings,⁸ physicians need to be aware that a single teaching methodology may not work for all or even most patients. Patient education designed to help with decision making, particularly about ambiguous issues like prostate cancer screening, becomes even more complex when considering literacy and comprehension levels.