Friday, October 21, 2011

Medical Providers, and The Importance of Patient Education

I was seeing one of my end-stage liver disease patients for his first follow-up appointment with me, the other day.  I was going through my usual patient educational information on how to adhere to a low salt, high protein, high potassium diet.  I asked him whether he was staying on this diet as well as asking him whether he was staying on his nutritional supplements (multi-vitamin, Vitamin E and omega 3). Before he could reply, his wife spoke up and said:  “You know the first time he saw you, he came home and told me that you were ‘mean’ and he didn’t want to come back and see you again.  He also told me that you had advised him to start on the nutritional supplements.   So I went out and got them for him.  He told me that he wasn’t going to take them.  I told him a couple of vitamins a day wasn’t going to hurt him, and if they helped like you said they would, then great, maybe he’d start feeling better.  And I’m here to tell you he does.”
I looked at my patient and he told me, “I’m feeling so much better, I finally have some energy and I’m sleeping at night.” 
I replied, “Glad to hear it.”  “How’s your salt intake?” 
As the clinic visit progressed I could tell that he was compiling with his diet, his ascites was gone, although he still had some pedal edema.  His bilirubin was also down, nearing normal.  At the end of the visit I told him he could decrease his diurectics and to come back and see me in a month.
Patient education, that’s what we’re supposed to be all about.  The physicians don’t have time to spend with the patient, explaining things to them, demonstrating how to take care of their cellulitis, or how to stay hydrated when they have a case of diarrhea.  But we should take the time, we’re the ones who can speak to our patients in a language they can understand.  Many times our physicians speak on too high of an intellectual level that they don’t even comprehend how much the patient didn’t understand them. 
I used to work for a hematologist who specialized in leukemia.  He told me repeatedly that the reason he looked upon me as his ‘right hand man’ was that I could translate his scientific jargon into a language the patients could understand.  He honestly didn’t feel as though he could see patients without my help.  He’d talk about cytogenetic changes and chromosomal deletions and the patients would immediately become lost in what he was trying to say.  So I ended up putting together a very visual patient educational portfolio explaining everything about the various forms of leukemia in it.  I would then use this portfolio with every new patient we saw.  Numerous times, as I was going through the 45 minutes teaching session, patients would just start crying.  They would tell me, “no one ever took the time to explain my disease to me like you just did.  Now, I finally understand what’s wrong with my bone marrow.” 
If we’re not educating our patients on how to take care of themselves, how to stop smoking, or how to exercise, decrease their salt intake, whatever it may be, we’re doing them a disservice.    We can’t expect our patients to be compliant with their medical treatment program unless we are able to speak in a language they understand, and show empathy towards their struggle in getting healthy.  They need to know we are on their side. 
Sometimes this involves being tough on our patients, telling them the truth  (whether they like it or not, many times it ends up being the ‘or not’ scenario).   Patients can’t get well until they have faced the truth about themselves.  As with my patient at the beginning of this essay, I had to get tough with him (he saw it as being mean) regarding the fact that alcohol had given him a cirrhotic liver.  I told him he had a choice to make, he could either continue to drink and eventually die of his liver disease, or he could quit drinking and hopefully live.  Thankfully, he chose the latter. 

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