Target your teaching: How patients learn best

Every appointment is an opportunity for teaching and learning, both for the patient and the doctor. However, given today’s real-life constraints, is expecting doctors to teach patients asking for the moon?

“Your first question should not be, ‘What do I want my patient to know?’ but rather, ‘What do I want my patient to be able to do?’ ”
-Aniruddha Malpani, MD, medical director of Malpani Infertility Clinic in Mumbai, India

The trick is to think of your patients as adult learners, and there are 4 principles of adult learning that you need to remember:[s2If !is_user_logged_in()]…

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  • Adults need to feel respected in order for learning to take place
  • They need to want to learn
  • They learn best by active performance
  • They need feedback regarding their progress and need to give it to you on what they will now do at home

Your first question should not be, “What do I want my patient to know?” but rather, “What do I want my patient to be able to do?” Information on its own is sterile—it needs to be put into action to become valuable. Adult learning is self-directed learning, in which learners own the process and determine their own needs, goals, and priorities. You simply serve as a guide.

When communicating health information to your patients, remember this advice to make your messages memorable:

Key Point: You can target the way that you teach patients in specific ways to increase the likelihood that they will remember the health information that you communicate. Some of the ways to make your messages more memorable include: using visuals, offering interactive media, providing specific examples to help patients envision how to integrate a new practice into their existing routine, and ask them what they have learned in this visit.
  • Health topics should address current needs and interests. Rather than give a general overview of a particular health topic, make the message personally relevant and useful for each patient. If information therapy is tailored to the patient’s needs and is based on what the patient needs to do to get well, she is far more likely to remember it. You need to start from where your patients are.
  • Information should be practical and should relate to everyday occurrences. For example, if you want a patient to eat or drink certain foods, be specific and relate the items to the patient’s usual shopping trip and mealtimes (for example: everytime you go shopping, try to purchase a vegetable that you haven’t tasted before). If you want a patient to perform certain exercises, ask about his daily schedule and how he might fit these exercises in (for example: before work if the patient is a busy professional with an active family life).
  • Use context. Patients learn better when new information is related to examples they already understand. If you want patients to take a new medication in the morning, for example, suggest that they take it after they brush their teeth. Providing concrete suggestions will help patients to understand and follow your advice.
  • Allow patients to direct the conversation. Ask patients what issues they would like to discuss, rather than unilaterally presenting what you want them to know. Use open-ended questions such as, “What questions do you have?” rather than simple yes/no questions such as, “Do you have any questions?” that are too easy to simply say “no” to in response. Encourage patients to ask questions, and listen carefully. This is not easy for most busy doctors to do, so it may take some practice. However, this is a very useful approach; you will learn a lot if you allow your patients to teach you.
  • Use “teach-back.” One of the most effective ways to ensure that your patients have understood what you have told them is to request that they “teach” the information back to you after you have explained it. It can be very useful to ask patients to repeat your advice (using their own words) to the person accompanying them. This repetition helps them to retain the information. You will be surprised how easy it is for patients to misinterpret something, even though you think you have done a masterful job of explaining it. This is why there’s no point in asking, “Do you understand?” because they will almost always say “yes,” and you don’t know what they have truly understood unless you double-check. If the patient doesn’t have someone with him or her at the appointment, you can ask: “When you go back home, what are you going to tell your spouse/friend/parent about today’s visit?”
  • Use visuals. A picture is worth a thousand words, especially for health illiterate patients. You don’t need to be an artist; even simple line drawings can help get a complex idea across. Provide alternatives to written text when possible ; for example, anatomic models can be extremely helpful. Combining audio, visual, and experiential learning is an excellent way to facilitate understanding. Also, encourage patients to view additional resources during their visits. Many are happy to learn more about their health while they are in your clinic. You can play patient educational DVDs on your TV screen, which they can watch while they are waiting for you. You can even have them view interactive, multimedia tutorials that you can find online free of charge. You of course should vet these materials before sharing them with patients to ensure that they are accurate and effective patient education tools.
  • Create a Web site. While you may not have enough time to spend with each patient face-to-face, if you provide educational materials and publish them on your Web site, your patients can then review them from home at their leisure.
  • Tell stories to make it personal. If you tell your patient what happened to someone with a problem similar to his, he usually will remember this type of example very vividly. It’s helpful to use a bit of imagination when crafting your stories, to make them even more memorable.
  • Use metaphors. Metaphors help frame an idea in a familiar context. For example, you could use plumbing as a metaphor for the digestive system, or the concept of car maintenance for the importance of regular health screenings.

By targeting your teaching in these ways, you will improve engagement, which in turn will increase the likelihood that the information that you communicate sticks with your patients. Better educated patients are more adherent patients who are partners in their own healthcare.

Aniruddha Malpani, MD Dr. Malpani is medical director of Malpani Infertility Clinic in Mumbai, India, medical director of the HELP-Health Education Library for People, and author of a physician and patient education blog. He is an angel investor in Plus 91, which offers customized Web sites for doctors.


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