Chuck: Welcome to the Patient Educators
Update. A show where we talk about patient education and patient education topics in
a clinical environment. My guest today, as always, is Fran London. Fran is a patient
education specialist for Phoenix Children’s Hospital, and she’s also a noted author, most
recently author of the book “No Time to Teach”. Which was voted Book of the Year by the American
Journal of Nursing in 2010. Hi, Fran.
Fran: Hi, Chuck.
Chuck: How are you?
Chuck: Good, well I understand the weather’s been kind out in Phoenix. You’ve had a break
in the heat.
Fran: We had some rain. Very welcomed.
Chuck: That’s good. We had a little bit in Texas too, although my little town didn’t
get any but all around us we did so that helps the lakes so that’s really good. Well, as
I was doing the show prep this week, I was kind of having trouble coming up with some
ideas so what I did is what I should probably do every week, is I took your book and I thumbed
through it and I stopped at a page and picked out a topic. Here’s where I stopped. You called
the chapter “How to Waste Time Teaching”. For purposes of our discussion today, I’m
going to call it the “Eight Most Common Patient Education Mistakes”. We’re going to go through
these one at a time and get your feedback on these.
You wrote them, so I know you have some thoughts about them and I know you also live
these everyday. In terms of not only your own process of dealing with patients, but
also in the folks that you work with. I’ve seen some of these too so I think we’ll have
a good discussion. The very first one that you talk about is “make assumptions”. Why
is that a mistake?
Fran: That’s the biggest mistake that people
often make. It’s mostly because it’s a conversation stopper. It’s a relationship stopper. The
best example I have of that is when in a patient education situation and you start talking
about birth control, and if you’re not aware that the patient is gay, that might be a conversation
Chuck: I would say so. Yeah, that’s one
of those things that goes under awkward or irrelevant.
Fran: Exactly, exactly, and it really hurts the relationship.
Chuck: Yeah. How do you avoid making assumptions? What should they do?
Chuck: There you go.
Fran: Ask those questions, yeah.
Chuck: Yeah and we did a whole show on
assessment. I don’t remember the number of it right off the bat, but for those that are
watching that want to know more about assessment, they can look in some of their previous shows
that we’ve done. If I recall correctly, assessment was one of the things that most people skip
but ultimately is the thing that saves the most time. Is that correct?
Fran: Exactly. That’s why it ended up on this list again.
Chuck: OK. Excellent. All right. Number two. Teach before you know who you are teaching.
Fran: Which also refers to assessment. The problem there is you need to know what
they know, what they believe, who they are. So that when you present whatever information
you present, you present it appropriate for them.
Chuck: Sure. That makes sense to me. A real life example, my wife’s been a type II
diabetic, but she also takes insulin. She was in the hospital for shoulder surgery,
and the nurse noticed that she was diabetic and started talking to her about her diabetes
and cure for this, that and the other, without asking her any questions and my wife said,
“No, your information is not right. I’ve been to my endocrinologist. I’ve got this. I’ve
got that and this is what I’m supposed to do.” If she had just asked the question, all
that time could have been saved, and kind of after that, my wife just kind of “wah wah
wah”. She didn’t pay attention to her after that. So I think that’s a pretty important
one. Now number three, this is interesting. Because in the book, you just list it, but
there’s no explanation and item number three is “talk talk talk”. What do you mean by that
Fran: Well there’s lots of ways we waste
time when we’re with patients, and some of it is talking about stuff that’s just irrelevant
and has nothing to do with that issue at hand.
Chuck: Yeah and I would tell you that my
wife is a champion at that. She can get a doctor or a nurse off task so easily, by just
saying, “I love your earrings,” or, “Where’d you get that bracelet?” and there you go,
they’ve spent 10 minutes and they’ve got 10 other patients to go see, and we never got
to the topic at hand. So you’ve got to watch out for my wife in that type of situation.
Fran: And most people. I think part of it is just wanting to build the relationship
with the care giver, so that you really can feel like you can trust them.
Chuck: Yeah, yeah. Number four is lecture. Now, one could look and say lecture and”talk
talk talk” are the same, but I don’t think so. What do you mean by “lecture”?
Fran: I’ve had so many doctors do that to me when I was a patient. Just they have
some idea in their head that they want to get into your head and they just lecture about
it. Or if they have an opinion that they think you’re not doing something right, they’ll
just give you a stern lecture.
Chuck: Boy, I’ve got a great example for
that. Back to my wife and her diabetes. We’ve been though quite a few endocrinologists over
the years and we went to one that, he came highly recommended. So we were excited to
go see him, and we took all of her meds that she had and everything. He started off great
by asking a lot of questions and asking about her lifestyle and all this kind of stuff.
Then we had the big ziploc bag full of medicine. We decided to bring them rather than the list
and he was saying, “Well, no, you don’t need this. You don’t need that. This causes this
problem,” and I was enlightened. I thought this was great.
Then he went into a 20-minute diatribe on the evils of big pharma. I was stunned
by that, and we went to see him two more times after that and I told my wife, I said, “I
can’t take this. Every time we go we get a big lecture on the evils of big pharmacy companies,
and it’s just not appropriate or germane to what we’re there for.” So we found a different
guy after that.
Fran: Yeah, I’ve gotten lectures about
the health insurance companies.
Chuck: Oh yeah. Yeah, it’s easy to get
into those discussions. Item number five. Don’t let the learner interrupt you. Now I
can see, that’s a horrible mistake, right?
Chuck: They have a question.
Fran: Yeah. Well, I’ve seen that happen
in lectures, certainly, and definitely within patient education situations. The issue is
really adult learning theory, is that adults don’t learn the same way that children do.
Children learn things that you think they need to know in order to grow up, to function.
Adults, on the other hand, are already functioning. They know how to get through life. They know
how to solve problems. The times when they want to learn are usually when they have a
problem that they are not solving on their own. So they’re ready to learn something new.
If you don’t let them ask questions when they have the questions, you’re missing an opportunity
to actually teach them something; because that’s when they’re ready to learn.
Chuck: Yeah, absolutely and I’ve often heard that referred to as a teachable moment.
Chuck: When the patient is in the ready
and willing to learn mode and that doesn’t often happen sometimes, depending on why they’re
in the hospital. So when you let those teachable moments or learning opportunities go away,
or don’t pay attention to them, that’s a learning opportunity that is totally wasted and sometimes
those are rare.
Fran: That goes hand in hand with lecture.
If you’re lecturing, then you’re not going to stop to let them ask.
Chuck: Yeah. Item number six. Listen in a hurry. What is that?
Fran: Sometimes we go into a patient’s room and have an idea of what it is we want
to talk about. If you’re always thinking about what the next thing you’re going to say is
or where the next topic is going, you’re hurrying, getting through what it is that you want to
talk about. Then you’re not really listening. When they ask a question or when they say
something or make a response of some sort, you’re not there. You’re some place else.
Chuck: Yeah. Sometimes that’s the fault of the system too because there’s so much
pressure put on the nurse to do this and do that, and document this and document that.
They’re thinking ahead of really their next patient, knowing that I’ve got 10 more things
to do before the end of my shift or whatever so got to hurry up and get through that.
Fran: But that’s my point of this list, because if you do these things, if you’re
aware of these things, you could teach more efficiently and more effectively in the time
you have and you’re not wasting so much time. So you may feel like you don’t have much time,
but there are ways to use your time so much better.
Chuck: Makes total sense. Number seven. Ignore or make light of the learner’s concerns.
I’ve never had a doctor make light of anything that either we’ve said or my wife has said.
Ignore is a different thing. But what have you seen there?
Fran: I’ve seem both. I’ve seen both. One situation where you often see making light
of is if a parent is asking about immunizations and is wondering whether or not they should
get their child immunized. Sometimes the health care provider is so convinced immunizations
are absolutely wonderful and perfect and everyone should have them, that they don’t actually
hear what the concerns are that the parent is bringing up.
Chuck: Yeah, yeah. I can see that. We’ve had some spirited family discussions, because
we have grandchildren now. Sometimes the spouses that your children marry don’t have some of
the same views that you do. So there can become some pretty spirited discussions about that.
I can see how if I was in a situation like that and somebody said, “Oh, well, no, I’m
not sure about this,” that I could just blow right through that. Because it doesn’t make
any sense to me.
Chuck: So I could see very easily the ability to ignore that. And that goes back to assessment
and knowing who you’re talking to, doesn’t it? It always goes back to that.
Chuck: Number eight. Teach when the problem
isn’t a lack of information. What do you mean there?
Fran: That happens more often than we realize. One example for sure is with obesity, which
is a big issue coming up now a lot. A lot of people understand nutrition and they understand
what they should be eating and not be eating, and that they should be exercising more. But
the issue is not education. The issue is how do they apply it to their lives.
Chuck: Yeah, yeah. I totally agree with that. Now there was another example that you
gave in the book. It wasn’t near this chapter. It was farther up in the book, but it was
a story about, I think it was a young girl in a wheelchair and she had problems with
skin lesions. Tell us that story because I think it fits here.
Fran: I love that story because it was something that I experienced when I was a
staff nurse early on. So I learned early on how important it was to listen to people and
to ask questions. Basically she was an adolescent with spina bifida, and she was readmitted
frequently with osteomyelitis, just infections that happen, started with skin lesions that
went down to the bone and she needed antibiotics in the hospital, over and over again. We’d
keep teaching her about skin care and her parents about skin care, and somehow they
just kept coming back.
Finally, after one admission, a nurse asked,
“Why do you think this is happening? Why do you think they keep coming back?” And the
girl knew the answer. She knew what the problem was. Basically, in their small house, apartment,
her wheelchair did not fit through the doorways so whenever she got home, she would have to
jump off her wheelchair and crawl around the house to get around. So once we realized that,
we were able to get home care to get her a smaller wheelchair that did fit through her
doorways and the skin problems stopped.
Chuck: Isn’t that amazing?
Fran: So it wasn’t education.
Chuck: It wasn’t education. In this case,
it had everything to do with asking the right question, or going farther than the typical
questions and looking for environmental issues. That’s interesting. But I found that story
particularly interesting when I read it the first time in the book. It’s like, it just
goes to show you that it’s not all about the medicine. It’s about the relationship and
the questions, and asking that one more thing, when you know whatever you’re doing right
now is not solving the problem. There’s something else that’s being missed.
Fran: And when there is an issue like that, it really does help to ask the patient, “Well,
what do you think is going on?” or, “What do you think the problem is?” They might have
insights that you have no idea about.
Chuck: Yeah, sure. Makes total sense. Well
this was good. I enjoyed this conversation. We covered the eight most common patient education
mistakes out there and you can find these in Fran’s book and you can get Fran’s book,
“No Time to Teach” wherever books are sold, at Amazon or Barnes &
Noble. It’s in both electronic form and in paperback, and for hospitals out there, if
you want to get some bulk purchases of these, you can get a 40%
discount by visiting the publisher, Pritchett & Hull, and their web address is p-h.com.
Fran, where can people get in touch with you?
Fran: I’m always on Twitter @notimetotech,
and my website is www.notimetoteach.com.
Chuck: And you publish a blog there frequently.
I’d encourage people to go visit and make some comments, and then if they also prefer
Facebook or Google +, you’re also on those. I think I saw you on Pinterest the other day
too, is that correct?
Fran: Yeah. There aren’t too many patient
education pictures but when they’re are, they’re fun.
Chuck: Yeah. I would agree. I would agree. I’ve seen you there too. Well thanks very
much for your time today. I look forward to talking to you in the next couple of weeks.
I want to let folks know that the Patient Educators Update is brought to you by Synergy
Broadcast Systems. My name is Chuck Jones. I forgot to tell you who I was, but not that
that it’s important but it’s Synergy Broadcast Systems. We make the medical media delivery
system, which is a video on demand based patient education system. So you can provide 24-7
video education materials for your patients, at a price that you might be surprised. It’s
much lower than you think. For more information you can visit our website at Synergybroadcast.com.
Thanks, Fran. I’ll talk to you soon.
Fran: Thanks, Chuck. Bye.