Last week, I was at the Chronic Disease Prevention Symposium, where I gave a plenary session on health literacy. After my talk, there was time for questions. Eventually, one physician raised his hand.
Taking the microphone, he said he’d appreciated my talk. Then, he asked (as closely as I can recall):
What if we need the patient to have some knowledge–how do we do that knowledge transfer most effectively?
When I heard the question, I was a little embarrassed. I thought I had been talking about patient communication, along with health literacy. For a brief moment on the stage, I second-guessed everything I’d just said.
I was grateful for his articulation of a problem he saw and experienced in the field. One that, I had to admit in that moment, I hadn’t addressed head-on and directly in my talk.
There’s much in this question. More than I got into in my response that day, and more than I’ll get into here (maybe I’ll take it up again in a future piece).
But I’ll tell you how I answered this question, plus a few things I didn’t say.
And I’ll invite you to think about what you are doing, when you are imparting information–or as the physician put it, transferring knowledge–to a patient. (For sake of ease, let’s imagine you, the provider, have written material to hand the patient or client for them to take home.)
1) How you handle information matters
Unlike the next three points, this was not part of my answer to the Symposium attendees. I want to share it with you here because it’s an easy opportunity to have an impact.
Conversationally speaking, the patient encounter is not a level playing field. There is an imbalance to be sure. You know this already, and the research bears it out. Though the patient also has power and can exercise power, the provider holds the most powerful position in many senses.
When we’re the more powerful person in a conversation, this has some implications. For instance, we also have more power to open the conversation, to decide what is appropriate communication and what is not, to close the conversation, and more.
This extends to how we handle physical materials related to the conversation. That is to say, how you physically handle and talk about written materials matters.
Handle a document with seriousness, and people take notice.
Treat it like an afterthought, and people take notice.
These ‘noticings’ have been shown to shape how we, in turn, treat and understand those materials. So highlight or underline important passages, and talk about them or point to them.
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2) Multimodality for the win
I gave a few quick examples of multimodality in my response that day. In literacy terms, “modes” are ways of communicating meaning. Modes include text, image, sound, movement, color, and more. Anything multimodal uses more than one mode. For example, videos are multimodal because they combine images and sound (and sometimes other modes).
One of the most powerful ways you can help patients learn is through mixing your modes. This can be simple. You may already draw pictures when you’re explaining something.
Here’s another easy one. And there’s a bonus: you do it once and it serves multiple people. Find a written text you use frequently–a handout or pamphlet. Read it aloud into the voice recorder on your phone. Et voila! An audio file.
Post the audio file on your website. You might offer to send it to patients’ phones for them to listen to (even while they’re with you), as most music apps will handle other audio files. Again, you only have to do this once, to help many patients or clients.
While we’re on the topic, how long has it been since you looked at the written materials you give to patients?
Make sure they are accompanied by images, and broken up into small paragraphs. Everyone finds this more manageable and memorable.
Keep and update a list of podcasts and videos that explain your subject matter from a patient perspective. Post links to these on your site and/or share them through social media.
Don’t know any? Ask your colleagues! Or post a request on social media, and then share the results.
3) Learning takes time
The clinical encounter is a busy time, for both you and the patient. You are trying to get your message through, while your patient is thinking, feeling, and noticing many other things.
As busy communicators, we may get right down to work by saying what we think is important. What we think people need to hear. Observing educators over many years, I’ve noticed that, when we are under pressure, we might be especially inclined to just try to move things along by saying what we think people need to hear.
We say it, and people hear it, and there we go!
Of course, this isn’t how learning or communication works. Learning takes time. Part of this is because your message is competing for the patient’s attention—competing with a whole array of other thoughts and actions.
It is reasonable to find something that you know will help people, and to keep repeating it. Repeat yourself, in different terms, throughout the encounter. Have multiple people on the team say the same thing, whenever possible.
But sometimes it’s not mere recall that you’re looking for; it’s understanding.
On top of this, patients’ current knowledge, beliefs and assumptions about the issue at hand will shape how they hear you. How they understand you. And how they learn from you. To put it a different way, imagine that your patient is wondering:
What does this mean?
This question may be followed by another:
What does this mean for me?
These are difficult questions to wrap our heads around! So remember, making sense sometimes takes time.
4) We get by with a little help from our friends
Of course learning happens in people’s heads. But it is also social. We learn through interaction with people, texts, videos, and nearly limitless features of our environment.
We frequently learn in interactions with our various social networks. There’s increasing agreement that family and larger social groups are part of what makes up health literacy.
Patients draw on friends and family to understand complex health-related experiences. The same is true for navigating health information in digital environments.
This means that some learning will happen as your patient or client interacts with you and with the material you share. And other learning will happen as they interact with their various social groups.
So make sure there is something your patient can take home and share with others. Find out who your patient talks to most frequently, and/or who in this person’s life they turn to when they need help. And encourage your patient to share the materials with them. The learning continues when they leave you, and that’s a good thing.
I deeply appreciate this provider’s question. It took a moment (and a deep breath) for me to decide what to say in response. And I’m still turning it over in my mind.
That day, I do remember closing my response with something like: “Learning takes time, it takes repetition, and it takes other people.” The higher the stakes, the more I’ll encourage you to keep this in mind.
