The nurse administrator looked at me and said, “Time. Everything is about time.” This episode is about not wasting time in your patient encounter when it comes to education. You’ll learn one way to save time when you’re educating patients, why it works, and how easy it is to do.
The nurse administrator looked at me and said, “Time. Everything is about time.”
I had asked her about some front-burner issues she was facing in the oncology department. She continued, with a look on her face that was almost apologetic. “The docs want more time with their patients. They want more time.”
Over the course of our conversation, the time that providers spent in patient education became a central topic. I have been thinking (and writing) about patient education as a powerful space. But this conversation led me to think more deeply: what about time? How is time spent in patient education?
In the spirit of helping you make the most of your time with your patient, I’ll pass on one thing that the nurse administrator and I talked about. This one step can keep you from wasting time and also help you be more effective as an educator.
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It’s no secret that time is the ultimate constraint. Everywhere I go, everyone in healthcare wants to talk about time. But when I talk to providers they also say they want to help their patients, through the education they provide. You go to elaborate lengths to educate patients. And you have to do so quickly. But if the education doesn’t connect, it’s a waste of time.
Furthermore, when it comes to education, trial and error is terribly inefficient. We’re talking lots of wasted time and words and materials. And that’s aside from educational outcomes that might not be what anyone had hoped for. So here’s one thing you can do to be more effective: Start where your patient is. First I’ll tell you what I mean by that and why it works. Then I’ll show you how easy it is to do.
When we’re teaching, there’s an understandable tendency for us to start where we are. That is, we often get right down to work by saying what we think is important. 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 works. What’s more, I’ve observed educators over many years, I’ve noticed that we might be even more inclined to start where we are and say what we think people need to hear when we are under pressure. Time pressure, for instance. So don’t do that. Start where your patient is. Starting with your patient is an approach that works for many reasons, but here’s three of them:
Many modern and long-standing learning theories share a core concept: we learn best when new information is related to old information. That is, when the unknown is related the known. We can make these connections ourselves as learners. We also tend to appreciate when educators make connections for us, showing us how what we already know relates to what we are learning. This means you’re starting with what your patient already knows, and connecting it to the unknown (your expertise).
Here’s a second reason why this works. At least in some research circles, patient education tends to be talked about as patients’ “capacity to process and understand” something. I don’t know about you, but my capacity to concentrate on something varies pretty widely, depending on what else is going on around me. The nurse administrator was clearly aware of this challenge, and brought it up specifically, asking: “How can we be effective in the short amount of time we have? And with a patient who’s staring at us, and not hearing what we’re saying?”
It is not hard to imagine how a diagnosis of cancer – or any bad news – can make it difficult for someone to hear anything over the torrent of their own thoughts. You know educating is about more than someone’s years of formal education, or how well they can read a passage. Like the nurse administrator, you know it’s about where someone’s at, emotionally or psychologically. What they’re ready for. And their priorities–both at that moment, and in general.
And here’s a third reason it works to start where your patient’s at: When it comes to learning, it’s also about where we’re at in our lives. We cannot help but hear and read and understand from our own position. That includes where we’re at, right now, in our lives. It’s like hearing an annoying piece of advice, over and over – until suddenly, one day, it makes sense! And it’s no longer annoying, but profound and brilliant! The advice didn’t change; you did. You were in a different spot. So you were hearing it differently.
Here’s another example: Think of your favorite book. Or play, or poem, or your favorite piece of visual art. Think of how your response to it has changed over time. It looks different to you now than when you first encountered it, because you are seeing it differently, hearing it differently, viewing it differently. Your understanding and appreciation of it has changed because you have changed.
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Like you, patients have positions, priorities and values – and like yours, these can change over time. These matter, because patients’ current understandings of the issue at hand, and how it fits with their larger positions, priorities and values, is gonna shape how they hear you. How they understand you. And how they learn from you. This is why in patient education, you can’t start with what you know, and what you need to say. You need to start where your patient is.
So how do you start where your patient is at? It’s pretty easy. Locate them. Consider some non-didactic and open communication approaches. Ask some questions. Like:
Have you run into any of this before? Have you heard of this before? What can you tell me about it? these kinds of questions works because you’re finding out what they already know, believe, or assume about the topic at hand.
What do you think would help you to know right now? This works because you are learning what they are ready for, where they’re at in their thoughts and emotions, even and especially if it’s not where you really wished they would be or thought they should be.
Use a metaphor! But make sure your patient knows what you’re using as the comparison. Make sure it’s something already known to them, by asking first before you launch into your metaphor.
In case you haven’t heard, I’ve written a workshop that helps you dig down and get better at metaphors. Improving Medical Metaphors. Right on health communication partners.com.
You may be getting the sense that this is not going to lead you to a one-size-fits all didactic routine. But don’t worry. It is not endlessly varied, either. If you’re noticing your patients are located all over the map, so to speak, I invite you to think about the trends or patterns you’ve noticed–in where patients are, or even in the ways patients have responded to your education before. Thinking in terms of these trends or clusters, you may find you can develop an approach that works for each of those different clusters or groups. (You may have been doing this already without noticing it, but notice it for crying out loud! And do it intentionally, to save yourself time.) Your time constraints are real, and sometimes outrageous. So take this step to make your education more effective, so you’re not wasting time giving people information that does not reach them where they’re at.
You also might consider looking upstream, with some like-minded colleagues, at the various larger system forces that keep you from spending more time with your patients. Because if you’re like most of the providers I speak with, and the physicians the nurse administrator works with, you want to spend more time with your patients.