This week, I’ll start with a scary story.
The clock is ticking. The spotlight is on you. You’re the person everyone wants a part of. And you’re in the middle of educating a patient on a crucial topic.
But it’s going nowhere. Crickets.
“The strategy I’ve been recommending for years was not working.”
“I was getting blank stares.”
These are actual quotes from providers who’ve spoken with me about a nerve-wracking, high-stakes, and not uncommon situation: patient education that’s going nowhere.
You need to be able to shift and adapt. What can you do in that moment, to continue educating, and still build and keep good relationships with patients?
When you only have so much time, and so much complexity to work with, you need to be strategic with your language. And you need to be able to do this on the fly.
Let’s acknowledge up front that medicine, the body, and health care are complex. Education and communication are complex. There will not be some magic pill, but I’ll help you with moves you can make in the moment to pivot and change the direction of your patient education when you sense it’s not working.
You’re trying to communicate information in such a way that patients can act on it, or at least take it into consideration. You want to inform them, and help them grasp their decision-making power and ideally lead healthier lives.
How you spend this short time when you and your patient are together has been shown to have an impact on numerous health outcomes, patient satisfaction, and patient engagement.
Hey, no pressure.
You may have seen signs that your educational interventions aren’t having the desired effect:
- Those blank stares.
- Polite nods and smiles.
- More than usual phone calls after the fact.
- Patients repeat your words, rather than use their own.
You’re not alone. Some of the practitioners who talk to me about this are in academic medicine. It is part of their jobs to focus on teaching and learning, and they still find it difficult.
If you can tell it’s failing, you’re already successful
You may have had some communication skills training in med school, but that does not always translate well to the exigencies of everyday practice. So you may have been learning-by-doing when it comes to patient encounters. You’ve been keeping up on the research.
And now, you’re reading this because
- you’ve noticed some time when your patient education is not going well, and
- you’ve determined not to push on through, but to modify in the moment.
I want to applaud you on both points.
We all know people who wouldn’t notice if a patient education was tanking. Who wouldn’t know a disengaged audience if they saw one.
And we also know those who might notice if a lesson was crashing, but would keep on marching and charge through anyway.
That’s not why you’re here, and that’s not where we’re headed.
Focus on what you can control
An intervention can crash for any number of reasons.
Education is an interaction. So, some of the reasons a lesson screeches to a halt have to do with your patient. Maybe he’s having a bad day. Maybe his mind is elsewhere. Maybe he has no idea what you’re talking about. This is an everyday reality of education.
So let’s focus on what’s under your control.
Start by thinking about what you’d planned to do when educating this patient. Whether or not you ever wrote it down.
Planning your patient education is a funny thing. In essence, you take:
- what you know about the topic,
- what you know about your patient,
- what you know about the situation,
and make your best guess at how to bring it all together.
When it comes to planning, maybe you don’t think about it too much anymore. Maybe you do it the way you’ve always done it. Maybe you copy someone else’s successful approach. Maybe you consult a colleague. Maybe you are keeping current and working hard to use the latest validated approach.
Regardless, planning stops when the educating begins. The rubber hits the road. What you thought you were going to say and do may–or may not–bear much resemblance to what you actually say and do.
From that point on, it’s up to you to notice how things are going.
If it is feeling forced, stop. If it is feeling like you’re getting nowhere, stop. And pivot.
How to pivot
I spend time addressing planning for one reason:
One of the easiest pivoting moves to make is to ditch your plan.
There is no one-size- fits-all in terms of a intervention technique that always works. Thinking on your feet and departing from the script is a valuable skill set. Fidelity is important in randomized control trials, but it only goes so far in education.
So let go of your plan and remember your goal. Your goal is for the patient to understand something well enough to be able to act on it.
So what do you do instead?
Acknowledge it is not working.
Acknowledge this out loud. To your patient. Try, “I’m not saying this the right way” (or some variation that feels natural to you).
Let them know you sense that you’re not getting through, but that you want to. This works, because although patients want you to have expert information, they also want you to be human. You are making assumptions in order to prepare to teach them, and it might be some of those assumptions are off-base.
Stop talking, and ask questions that get your patient talking instead.
Try: “I was explaining X because it’s part of Y. But I’m not being as clear as I want to. Have you heard about X? Have you been through X before?”
Or, frame your questions in terms of what you’ve said in the past with other patients: “Sometimes people want to know about X, sometimes they ask about Y. What do you wish you knew about those topics?”
As the educator, it can be difficult to stop. You may be tempted to do the opposite, and just pile on words, in the hopes you’ll get through. Don’t put that kind of pressure on yourself. People learn in different ways.
Ask your patient to contribute.
Turn the floor over. Let your patient tell you what they know and can do, in whatever language comes naturally to them.
This works because an informed, active patient is not just the passive recipient of information. Though they may trust your influence, they are also holders of information, and potential collaborators with you. Let them tell you what they know, what they need, and how you can work together.
Pivoting is an advanced maneuver
You know your stuff. You give great care. You don’t just rappel in and do some doctoring and then zip back out again.
Education is part of what you do. You take this part of your role seriously. And so do I. You and I both believe in the importance of patient education in health care.
I am, in part, inviting you to recognize and support the educator in you.
In patient education, it can feel like there’s pressure to implement with fidelity. To do ‘what works.’ And to do the same thing every time. But you’d be wasting your time, and your patient’s, if the learning doesn’t occur.
Please continue reflecting and making decisions on which aspects of your patient education need to be changed, and how. Consider finding some colleagues who’d be willing to join in the fun. And of course, write me. I’m a fan.
If you are interested in taking your language use seriously, why not start with your metaphors? This workshop shows you how to break down the metaphors you use, understand their cognitive and affective aspects, and evaluate them in use. On demand, right on this site.