A few weeks ago I wrote about 5 steps you could take to improve your patient education. I promised I would dig deeper into that material. That’s what this article is about.
Specifically, we’re taking a closer look at patient knowledge. Let’s start with some data:
Elisabeth is describing her first meeting with her new doctor. She had to tell him about her symptoms, explain her chronic health condition, give background information, and be able to understand what the doctor asked and explained.
Elisabeth: I went with my husband.
Researcher: Right.
Elisabeth: But it was still difficult for the doctor to understand me and I can’t understand the doctor as well.
Researcher: What happened?
Elisabeth: I just try to speak with my hands to explain. I took everything about my diabetes and took some things to show them. I took everything and it was a shock because it was impossible. I said, ‘Well, how can I explain? I don’t know’.
While Elisabeth struggled to explain her diabetes to her new doctor, she also showed him all her notes and records about her condition, which she had brought with her as an additional way of trying to communicate with him. (p. 21-22)
In this excerpt from a lengthy study, Elizabeth wants to share what she knows about her condition with her doctor.
Imagine you’re Elizabeth’s doctor. You want what she has to share. Yet both of you are struggling. 
The case against patient knowledge
There are plenty of pressures against your listening to patients and taking seriously what they say. Time is a big one. Language or culture can be another. Elizabeth speaks English as a second language (though native English speakers in this study also had trouble communicating with physicians).
There’s also history, or the weight of tradition, in clinical medicine. Specifically, the traditional separating of ‘hard’ and ‘soft’ data—where the patient’s knowledge falls in the ‘soft’ category.
Now I’m not getting into how accurate or relevant some patient knowledge is. I’m not drawing a line between knowledge, beliefs, and assumptions.
I’m telling you that eliciting your patients’ background knowledge—whatever it is–is good for both of you.
Patient knowledge is much more than opinions and preferences. Broadly speaking we could say there are three sources of knowledge:
- experiences
- observations
- study
Elizabeth, for example, had knowledge from her experience: her condition and symptoms, in both spoken and written form.
In your patient’s case, it could be their own experience of an illness; their observing a family member or close friend with an illness; and perhaps looking online for information about an illness.
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Eliciting patients’ knowledge—whatever it is, whatever its source–can help you and your patient. Here’s 5 ways how.
1. So you want to be more effective in your patient education?
I’ve heard several providers mention that patient education should to ‘get patients from A to B.’ If that’s the case, consider patient knowledge as an important part of A.
Effective education links the known to the unknown.
So, finding out what your patients know is how you’re going to reach (and teach) them. I’ll explain.
Patients’ current understandings of the issue at hand will shape how they learn from you. This is because we learn quickly when new information is explicitly related to what we already know.
You may have heard of mental schemas, or Vygotsky’s “zone of proximal development” (ZPD). These and other similar theories of learning suggest we learn best when there are explicit connections between what we already know and the new information.
Start with what your patient already knows, and connect it to the unknown (your expertise).
Patients’ knowledge is going to guide their thoughts and actions when they leave you. A study in chronic self-care points out that “The patient’s knowledge and expertise is critical to grounding, integrating and complementing technical-medical/clinical knowledge in everyday chronic self-care.”
Patient knowledge is the basis for their self-care. So find out what your patient’s background knowledge is, and link it to what you need them to know.
2. So you want to be more patient-centered?
You’re well aware of patient-centeredness, a decades-long move from a focus on disease to a focus on the patient as a whole person.
The term patient-centered can mean many things, depending on which model you look at. But all models include a focus on the patient’s perspective or knowledge. Some include the patient’s experience more broadly.
Patient’s knowledge is also important as one of the key characteristics of shared decision-making (SDM): that both parties share information.
However, patients’ contributions are often limited to opinions and preferences. Certainly these are important. But they are not the same as knowledge and experience.
Furthermore, this research review indicates that “much of the SDM literature focuses on what the professional says, with less attention given to what the patient says.”
Of course, there’s a great chance that there are significant differences between your level of knowledge of the problem, and your patient’s. But both of your prior knowledge is important.
3. So you want to have stronger patient relationships?
Learning about a patient’s background knowledge is more than a shrewd strategic move.
As human beings, we want to be heard and understood. Listening closely, and asking thoughtful questions in order to understand someone’s background, is a profound sign of respect.
We seek to be listened to and understood on our own terms. The study involving Elizabeth concluded that “For the patient, whether their own knowledge (whatever its source) is acknowledged or accepted by their health-care provider can be crucial.”
It makes sense that your view on a patient’s condition and care is given authority. But that does not mean patient knowledge is without merit.
In fact, a growing body of studies find that patients’ knowledge itself is an important source of professional learning for practitioners.
4. So you want to be a better communicator?
Here’s a pro tip: if you want to be a better communicator—even to patients who have cultural or linguistic differences from you—listen when your patients explain their background knowledge.
And take some good notes.
Listen for the specific language your patients use to explain things. Capture as accurately as possible:
- interesting turns of phrase
- powerful images
- metaphors you thought were helpful
- unique connections they made
This becomes a bank of language for you to use with other patients. That is, in other patient encounters, you can use the actual phrases your patients used. You may even phrase it that way: “One of my patients said it felt like an ice cold balloon was in her stomach.”
It’s a win/win.
You get some real-life examples of alternatives to medical terminology. You may even deepen your professional knowledge in the meantime.
The patient wins as well. There’s plenty of research on how patients can learn from other patients with the same experiences and similar cultural identities.
You are indirectly helping your patients learn from each other by using—and sharing–their language.
5. Make knowledge sharing easy on both of you
Let’s go back to Elizabeth’s story. She wants to share her knowledge. If you were her physician, how could you make it easy on both of you?
- Ask your patient what they already know about the topics on the agenda.
- Consider some non-didactic and open communication.
- Remember to be authentic in your asking—that includes being aware of your body language and tone of voice.
- Use your professional judgement to hear the value in your patient’s knowledge, whatever its source.
- To go from A to B, start with what your patient knows, and make an explicit connection to what you have to say.
As I’ve indicated, Listening to patients as they explain their knowledge has other benefits for your professional learning.
I invite you to approach patient knowledge with a humble, respectful sense of curiosity. See what you might learn.
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.
