The Illusion of Patient Education

The Illusion of Patient Education


Perhaps the greatest fallacy about patient education is the notion that it has occurred. Many offices will assault new patients with patient orientation lectures, videos, brochures, anatomical models, wall posters; everything short of a Vulcan Mind Meld. When asked whether these technologies work, many doctors can only judge their success by how many patients seemingly reject their patient education overtures!

Having been involved in chiropractic patient education, I've reached several conclusions that might assist you in making your patient education efforts more effective and accountable.

Certainly, there is a segment of the population uninterested in the importance of proper spinal biomechanics, the ramifications of poor posture, loss of spinal curves, subluxations or human physiology. Yet, that shouldn't dissuade you from your responsibility to help change the way other patients think about their health and the chiropractic role in it. The long-term practice benefits of effective patient education may be difficult to measure and it may not produce the instant gratification we all seek. However, better compliance, improved retention and the increased ability to describe and defend chiropractic are the most likely and obvious outcomes resulting from appropriate patient education. Besides excellent clinical results, there may be no better way to grow your practice from within.

In the same way you can operate your automobile without knowing how your automatic transmission works, so too, can patients operate their own bodies. However, drivers who understand how their transmissions, anti-lock brakes, turbo and other features of their cars work are more likely to find that their cars last longer and need repairs less often. So too, with one's own personal health.

Patient education also improves the healing response. A study at a Minneapolis hospital that was mentioned in Tom Peter's book, Thriving On Chaos, demonstrated this among two groups of cardiac patients. One group was pretty much kept in the dark about the procedures. The other was given detailed explanations about the operation, how it would be performed, post-surgical expectations, etc. The "educated" patients recovered twice as quickly. Apparently, without appropriate patient education the mind/body connection is overlooked.

Here are some of the conclusions I've reached after talking to thousands of doctors and meeting hundreds of patients at focus group luncheons:

Conclusion #1

Patients do what they do--because they think the way they think.

Patients may be unaware or uninterested in the thought processes that cause them to make certain decisions about their health. But, the decisions and disciplines that cause some people to ignore their seat belts (even though it's the law), regularly neglect to floss their teeth (even though the materials are affordable and readily accessible) and overlook countless other health measures is based on a belief system. People who don't prioritize their health are hard for many doctors to comprehend. It is probably the high value you place on health that attracted you to a career in health care in the first place! If you want to change a patient's behavior, you will need to change the way they think. And even then, there is no guarantee.

Action step: Make sure you examine each patient's mouth. How they treat their teeth and gums is probably a good indication of how they will treat their spine. If they don't value their health the way you do, don't take their rejection personally. Do what you can to enlarge their vision and pay particular attention to those who do value their health. Ask your patients, "What do you hope to do better or enjoy more when you regain your health?" Find out what they value. Relate, attach or explain the significance of chiropractic in the context of something they want or value.

Conclusion #2

Doctors ignore the context in which their patient education is received.

After a new patient has settled into your new patient protocol, has filled out your paperwork, has seen a video and who knows what, it's easy to forget the important "pre-existing complaint" that patients bring with them: a Newtonian, mechanistic model of their bodies that has been heavily influenced by a lifetime of symptom-treating. Changing this outlook is highly unlikely with a 12 minute tap dance in front of the X-ray view box and some snappy tableside chatter in the adjusting room. You may claim you don't treat symptoms and profess that you address the "cause" of their problem, yet the philosophical distinction falls on deaf ears. True, you may be their last resort before surgery or a lifetime of muscle relaxers, but most patients want you to "fix them" (and hurry up already!) with about as much involvement on their part as getting their hair cut or their oil changed. Ignoring the context of your patient education efforts, regardless of what it is, almost assures that your efforts will be ineffective or irrelevant.

Action step: One way to understand the suitability of the "soil" of the patient education "seeds" you wish to plant is to ask better questions. When they describe their particular health complaint asks, "Why do you think that is?" When patients mention they're doing better, ask, "Why do you think that is?" When patients observe a lack of progress, ask, "Why do you think that is?" Look for ways to uncover their theories about how their body functions and what might be involved. You'll be surprised by the "old wives tales" and twisted logic that actually govern their health behavior.

Conclusion #3

Most alleged patient education occurs at the report of findings.

Second to the consultation, the single-most important communication occurs at the report of findings. Besides adjusting technique, there may be no other aspect of practice in which there is so much dogma. One-day reports, two-day reports, three-day reports, group reports, holding X-rays hostage, spouse-must-be-present reports and no report at all blur the purpose of a report of findings: report your findings. Which can be done in about a minute. Making it meaningful to the patient is the hard part.

While you're waxing eloquently about the loss of curves, degenerative changes and soft tissue changes, patients are worring about the cost of care, how they're going to get to your office three times a week and afraid they've traded a dependency on pain pills for a dependency on chiropractic adjustments!

Action step: Answer the four questions patient's want answered, 1. What's wrong?, 2. Can chiropractic help?, 3. How long will it take?, and 4. How much will it cost? Besides the patient education necessary for them to understand your answers to these four questions, make sure some type of education occurs on subsequent visits to your office. Don't be fooled by their polite eye contact.

Conclusion #4

Most patient education consists of nothing more than "data dumps."

Whether you start with the patient's presenting complaint, point out postural deficiencies or explain the colorful history of chiropractic, most patient education is a one-sided affair. Data is delivered with the speed of a semi-automatic assault rifle. Re-exam dates, hip height differences in millimeters, hypolordotic curves, phases of degeneration and treatment recommendations are sandwiched between deductible amounts, a request to bring in their kids and a slam at their previous doctor. Patients are often numbed by the data and are on their own to convert it into usable, meaningful information.

Action step: Ask patients questions along the way to insure their understanding. Like airline pilots who repeat the directions given them by the air traffic controller, follow up your education efforts with questions that can reveal the patient's understanding. Avoid the X-ray view box monologue. Use the nervous system's afferent/efferent model to create a feedback loop to monitor your patient's assimilation.

Conclusion #5

Most patient education depends upon the spoken word.

The most expensive, inconsistent and least likely to be remembered communication media is the spoken word. Yet, most doctors close the heavy door of their report rooms, assume a somber carriage and plunge into a "fireside chat" with scripted precision. You can almost see the doctor's words entering a patient's ear and emerging out the other. Sensing you're on a roll, or merely out of respect, many patients avoid interrupting you. Pausing only long enough to inhale, the verbal assault continues until the staff taps on the door indicating things are backing up in the reception room.

Action step: We are visual creatures. Most of us remember pictures, colors and images much longer than the spoken word. Besides being easier to remember, pictures have less ambiguity. Sure, use X-rays and surface EMG printouts, but collect other images that can add impact to your patient communications. Look for metaphorical representations of the points you want to make. Find a picture of braces on teeth and point to it ("Even with the constant pressure from braces, how long does it take to reposition teeth?" Or how about, "What do you suppose would happen if they took braces off too soon?") Fill your office with pictures, drawings, illustrations, models and other visual devices. Pictures are worth a thousand words--or more!

Conclusion #6

Most efforts are the identical, regardless of the patient's preferred communication channel.

Some patients make decisions based on facts, others on feelings. Some are visually oriented. Others respond to touch. Some respond to testimonials, others to the bottom line. And, while a strong case can be made for the value of a systematized approach, without adapting the message to each patient, this one-size-fits-all approach is doomed. The fact is, most doctors are led to communicate with their patients using approaches that they would respond to.

Action step: Ask patients on your new patient admitting paperwork how they remember important things in their life? How do they make decisions, by facts or feelings? Learning the best ways to explain chiropractic is just as important as asking questions about their presenting health complaint.

The Conclusion

We all remember the professors who were using 15-year old notes and who were clearly not enjoying their jobs as teachers. The material was not to blame, it was a lack of creativity and a lost sense of purpose that turned countless lectures and whole semesters into a bizarre form of punishment. All too many patients are meeting these teachers as doctors, who make chiropractic either too technical or take on a "healthier than thou" attitude and never truly connect with patients. To these patients, chiropractic care is merely an esoteric, low-tech version of aspirin.

Effective chiropractic patient education is essential. Imagine, that instead of merely 100 years of great results we could claim 100 years of truly educated patients! Then, when your patients were asked to spell the word "relief" their answer would be quite different.

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