Sometimes, patient teaching just doesn’t go well. You’re doing what you can, but you can tell you’re not getting through.
There is hope! In this episode, you’ll learn
- why you want to separate your plan from your goals
- how to pivot in the moment
- three steps that will shift a patient education that’s not going well.
Hi This is 10 minutes to better patient communication. I’m Dr. Anne Marie Liebel.
In this series, I take one communication question or issue that doctors have raised, dig deeper into with some research, then give you a strategy that you can use in your practice today. And I do it all in about 10 minutes.
It’s not Halloween, but this week, I’m starting 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. You’re frustrated and trying to get through, but you can tell: it’s not working. What do you do?
Providers have asked me different versions of an important question: how do I shift gears during patient education when I notice I’m not getting through?
One said, “The strategy I’ve been recommending for years was not working.”
Another recalled with a shiver, “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 of 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?
Let’s acknowledge up front that medicine, the body, and health care are complex. Education and communication are complex, too. There’s not gonna 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.
Now let’s think about patient education for a moment.
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.
When it goes well, great. Everyone’s happy. But what about those other times?
You may have seen signs that your educational interventions aren’t having the desired effect:
Those blank stares. Maybe some Polite nods and smiles. More than usual phone calls later on. Patients repeat your words, rather than using their own.
If you’ve noticed any of these, 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. Even the best educators can fall flat every once in a while.
You may have had some education and communication skills training in med school. But that does not always translate well to the exigencies of everyday practice. And now, you’re listening to 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. Because If you can tell your patient education is failing, you’re already succeeding.
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 their patient teaching was crashing, but would keep on going and plow through anyway.
That’s not why you’re here, and that’s not where we’re headed.
An intervention can crash for any number of reasons.
So let’s focus on the ones under your control. We’re going to talk about two of them: your plan, and your goal.
Start by thinking about what you’d planned to do when educating this patient. 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 like to 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.
The way you ‘do’ patient education is presumably to reach a goal. You’re trying to make something happen here, right?
Whether or not you consciously stopped to think about your goal for this education, think about it now. What are you hoping will happen? What do you want this person to know or do or think or feel because of your patient teaching?
Whatever your goal, your plan is your words, actions and materials that you hope will achieve that goal. Your way of getting there.
But planning stops when the educating begins. The rubber hits the road. From that point on, it’s up to you to notice how things are going. And If it is feeling forced, stop. If it is feeling like you’re getting nowhere, stop.
But How do you pivot?
I spend time talking about planning there 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 an intervention technique that always works. Fidelity is important in randomized control trials, but it only goes so far in education. Thinking on your feet and departing from the script is a valuable skill set.
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 with your goal in mind, you ditch your plan. What do you do instead?
I’ll tell you in Three steps.
- Acknowledge that your plan is not working.
Acknowledge this. Out loud. To your patient.
Try, “I’m not saying this the right way” or “I’m not being as helpful as I want to be right now” (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.
- Stop talking.
Stop talking. This works because when you stop talking your patient has a chance to talk. And if your teaching is tanking believe me you need them to do more talking. 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, you could 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 want to know more about?”
As the educator, it can be difficult to stop. You may be tempted to do just the opposite, and pile on words, in the hopes you’ll get through. Don’t put that kind of pressure on yourself. People learn in different ways. That brings us to step number 3.
- Ask your patient to contribute.
Turn the floor over for a moment. 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.
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.
So I am, in part, inviting you to recognize and support the educator in you.
Pivoting is an advanced maneuver (but you can do it!).
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 when you’re faced with those blank stares, don’t panic and just hurry through. You’d be wasting your time and your patient’s if the learning you were counting on doesn’t happen.
It’s not easy to throw away the plan sometimes. Please Consider finding some colleagues who’d be willing to also ditch the plan once in a while and pivot.
Now, If you’re listening on itunes, it would be a big help if you’d do the rate and review. Leave stars, write something in the box. I read them! On health communication partners dot com, leave a comment and let us know what you think. I’m Dr. Anne Marie Liebel. This has been “10 Minutes to Better Patient Communication”