Practice Management Book

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Patient Education

Aka: Patient Education, Dispelling Health Misinformation
  1. See Also
    1. Patient Communication
    2. Emergency Department Patient Satisfaction
    3. Motivational Interviewing (Five Rs Technique)
    4. Health Risk Behavior Counseling (Five As Technique)
    5. Breaking Bad News
    6. Discussing Terminal Illness
    7. Expressing Empathy
  2. Approach
    1. Patient Education effectiveness relies on the rapport and trust built from the patient-clinician relationship
    2. Sit down during the patient encounter
    3. Use open ended, non-judgmental questions and employ engaged, active listening
    4. Assist patients with reliable information they may use in making decisions based on their values
      1. Avoid prescriptive and paternalistic approach
    5. Provide information in small parts and reassess for understanding ("chunking")
    6. Employ anonymized patient stories and clinician experiences where appropriate
    7. Discuss both risks and benefits of recommended testing and treatment
  3. Precautions: Health Misinformation and Disinformation
    1. Definitions
      1. Misinformation
        1. False information not delivered with malice
      2. Disinformation
        1. False information delivered as a deliberate attempt at deception
    2. Patient Education remains an important strategy in primary, secondary and tertiary prevention
      1. As clinicians, we bring an added credibilty and patient trust to Patient Education
      2. U.S. medical certification boards and licensing organizations emphasize reliable information
        1. Clinician spread of misinformation counter to standard of care may result in loss of license, certification
    3. Health disinformation and misinformation risks serious outcomes and death
      1. Covid19 misinformation in 2020-2022 resulted in under-Vaccination and mask resistance
        1. Estimated 163,000 excess covid deaths preventable with Vaccination U.S. June to November 2021
        2. https://www.healthsystemtracker.org/brief/covid19-and-other-leading-causes-of-death-in-the-us/
      2. FAD Diets and supplements of the late 1900s-2000s
        1. https://quackwatch.org/
      3. Anti-Vaccination movements (from Smallpox to Measles)
        1. https://www.historyofvaccines.org/content/articles/history-anti-vaccination-movements
      4. Medicine shows of the 1800s (e.g. snake oil)
        1. https://en.wikipedia.org/wiki/Medicine_show
    4. Approach: Follow the 3Cs (see Misinfo Rx Toolkit below)
      1. Compassionate Understanding
        1. Use open ended, non-judgmental questions (e.g. "what concerns you most")
        2. Employ engaged, active listening
        3. Understand the patient's framework (cultural, religious, community morals, values and approved behaviors)
      2. Connection
        1. Empathize with patient's concerns and acknowledge their initiative to seek health information
        2. Acknowledge true statements that the patient made as well as unknowns
        3. Ask permission to share information you feel is important and related to the topic
          1. Identify the most important key falsehoods and the evidence that dispells those ideas
          2. Ask the patient, their feelings and thoughts regarding this new information
          3. Share reliable resources in the form that the patient prefers to get their information
      3. Collaboration
        1. Identify common goals that you and the patient share regarding their own health
        2. Express your support for them to reach these health goals
        3. Express your strongest, most important recommendations
        4. Accept disagreement and the need to continue to readdress at future encounters
    5. Precautions
      1. Avoid engaging with false information sources online
        1. Responding, resharing, commenting, correcting may amplify the misinformation due to search algorithms
      2. Expose internet users to accurate, reliable health information
      3. For those who have an online presence, consistently post accurate and reliable health information
      4. Recognize the power of trust in medical providers to provide accurate medical information
        1. Also be honest and straightforward when evidence is lacking, and expert opinion is the only guidance
    6. Resources
      1. U.S. Surgeon General Statement regarding health misinformation
        1. https://www.hhs.gov/sites/default/files/surgeon-general-misinformation-advisory.pdf
      2. Debunking Misinformation as "Science" (Hemmer, CNN)
        1. https://www.cnn.com/2021/09/28/opinions/covid-history-of-spreading-medical-misinformation-hemmer/index.html
      3. Misinfo Rx Toolkit
        1. https://misinforx.com/
    7. References
      1. Shajahan (2022) Am Fam Physician 106(2):124-5 [PubMed]
  4. Resources
    1. Healthfinder
      1. http://www.healthfinder.gov
    2. Mayo Clinic
      1. http://www.mayoclinic.com/
    3. JAMA Patient Page
      1. https://jamanetwork.com/collections/6258/patient-information
    4. Family Doctor (AAFP)
      1. http://www.familydoctor.org/
    5. Medline Plus
      1. https://medlineplus.gov/healthtopics.html
  5. References
    1. Barnes, Aust and Leaf (2022) Crit Dec Emerg Med 36(1): 21-25

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