Partitioned Process of Patient Communication

From LiteracyTentWiki

Some weeks ago, one of the problems under discussion was the short time doctors often have to communicate with patients during their visits to the clinic. Also under discussion was the communication skill of health care professionals, especially in relation to patients with limited literacy skills. We would like to share with you the way that one clinic addresses these problems.

This large free clinic recognizes the communication - time problem, and has partitioned the process of patient communication. The examining doctor provides the patient with the most critical information and explains its importance to the patient. The patient returns to the waiting room and then is called for additional discussions with a health care coordinator who has the patient's medical record with the latest comments from the doctor. Communication methods involve teach-back, demos and "what if" questions.

The partitioning seems to be satisfying to patients, but the process does take longer. I do not know of data that compares patient comprehension and compliance for this two step process with the one step "doctor only" instruction.

Partitioning makes sense because the high value doctor's time doesn't need to be used for much of the communication content and feedback. Sure, it would be nice to have the docs do it all, but not in today's economic environment. Some entrepreneur could provide this service so that any clinic could do the partitioning even if they don't have a coordinator to take up the communication tasks delegated by the doc. This work can be out-sourced to teams of skilled, but lower cost health practitioners; here or abroad. (When I call up for computer tech support, I usually wind up talking to someone in India.)

On the communications skills issue, there is extensive research demonstrating that using visuals greatly improves a person's recall, comprehension, and compliance. (See "Use of Visuals..." in Patient Education and Counseling, Spring 2006 issue) Some research shows a 500% improvement in each of these three factors when simple visuals are added to the verbal or written instructions. The research also shows that visuals are of great help to those with limited literacy skills. What would be the cost savings in Medicare and Medicaid if patients improved only 100% in these three factors?

So why aren't visuals a required part of the process of patient education? Even pictographs and stick figures have been shown to be effective. We suspect that one reason may be that most of us shy away from making a sketch or drawing. Cost is not a significant factor because even very simple, black and white, line sketches have been shown to work best. People grasp the idea in less time, and understand it better when visuals are added.

What do you see as the barriers to getting simple pictures established as a standard practice in patient instructions?

best wishes,

Len and Ceci Doak (new address)
Patient Learning Assoc Inc.
806 Sandpiper
Palm Desert, CA. 92260-3431
706 779-1891