better health by designLearn More

Do you use aids to help you explain?

If your job involves explaining complicated ideas- and let’s face it nothing is simple in medicine- do you use models or aids of any kind?

if not, why not? If you do what do you use and how do you know they work? How do you explain sciatica, heart disease, asthma, cancer?

Physicians cannot control all the reasons for patients pursuing legal atonement but they are able to determine the quality of their connection with them, by improving their communication skills and techniques. Law-suits for medical negligence can be lowered or prevented by taking steps to keep patients content, thus making them more compliant to the treatment, adhering to the medical policies and procedures. Tevanov et al 

Picture by MilitaryHealth

Who talks most in your office?

Who’s voice is heard the most in your office? How do you know? Does it matter? How long before you interrupt the other person? What are you thinking while the other person speaks?

The most striking finding of these studies, however, is not the type, the goal, or even the ultimate effect of the interruptions. It is the fact that after asking patients to express their concerns, physicians were able to listen to patients’ stories for a median of only 18 to 23 seconds before interrupting in some fashion. JAMA

Picture by Several Seconds

What do people see on your desk?

Okay so you might not have chosen the wall paper, the carpet or the size of your office but what’s on display on your desk? What impression is created at a glance? Do you look organised? Do you look like you’ve got the time to give your visitors some attention?

There are six reasons to clean off your desk and as Catherine Conlan suggests:

Remember, your workspace speaks for you even when you’re not there.

Picture by Andrew Tarvin

What’s your vibe?

Do the people who seek your help sense that you are distinctive in some way? How? Is there anything remarkable about you? Your blue shirts? Your leather boots? Something that they immediately recognize as your ‘trademark’. According to Dana Lynch image consultant, your style matters for three reasons:

  1. People for impressions of you within a mere 3 seconds!

2. Your style makes you memorable.

3. Your style allows you to express who you are, which ultimately leads to an improved self-image and confidence.

If you are a doctor your patients will likely decide within seconds if they are going to take your advice.

Picture by Ronald Menti

How do you end your meetings?

We know how to start a meeting- we stand up, shake hands, say hello, smile. But what’s the best way to end a meeting? It matters for one reason:

The peak–end rule is a psychological heuristic in which people judge an experience largely based on how they felt at its peak (i.e., its most intense point) and at its end, rather than based on the total sum or average of every moment of the experience. The effect occurs regardless of whether the experience is pleasant or unpleasant. Wikipedia

If you are a doctor this is all the more important because people generally don’t seek a meeting with you because all is well. They may be experiencing all sorts of unpleasant feelings. So how do you end that meeting? How do you know it’s working?

Picture by Peter Lee

How does your skill at communicating manifest in your interactions?

It is assumed that doctors have to be specialists in communication. People will tell doctors things they may not confide in anyone else- much less a total stranger. That is part of the equity in the business of doctoring. So if you are a doctor, how does that manifest in your interactions with the people who seek your help? Is it reflected in your greetings? In your body language? In your eye contact? In the way you phrase your questions? In the way you terminate your meetings?

Picture by Paul Moody

Why don’t people take medical advice?

Significant proportions of people walk out of doctors’ clinics and disregard or fail to act on the opinion offered.  What practitioners can do to help is to review their communication style. As Bungay Stanier has suggested it can’t be assumed that the first thing the person mentions is what is bothering them the most. Bungay Stanier’s suggested questions will reduce the rush to action. A rush that fails to identify the issue that the patient may feel is a greater priority than hypertension or diabetes.

I summarise the issue in this video:

 

Picture by Sergio Patino

What is said to people when drugs are prescribed for life?

Every day doctors suggest that one or other of their patients have to take medication for life. Hypertension, diabetes and certain deficiencies are among the many conditions that may benefit from taking medication longterm. On the other hand, many people reject this advice or take the prescribed drugs only sometimes. Ultimately the decision to accept treatment is for the person with the condition to decide. How can the advice be tailored so that the person is making an informed decision?

BACKGROUND: ‘Concordance’ has been proposed as a new approach towards sub-optimal medication use; however, it is not clear how this may be achieved in practice. AIM: To develop a strategy for understanding sub-optimal medication use and seek concordance during primary care consultations. DESIGN: A developmental qualitative study using a modified action research design. SETTING: Three Scottish general practices. METHOD: Patients using treatment sub-optimally and having poor clinical control were offered extended consultations to explore their situation. Their authority to make treatment decisions was made explicit throughout. Clinicians refined a consultation model during ten ‘Balint-style’ meetings that ran in parallel with the analysis. The analysis included all material from the consultations, meetings, and discussion with patients after the intervention. RESULTS: Three practitioners recorded 59 consultations with 24 adult patients. A six-stage process was developed, first to understand and then to discuss existing medication use. Understanding of medication use was best established using a structured exploration of patients’ beliefs about their illness and medication. Four problematic issues were identified: understanding, acceptance, level of personal control, and motivation. Pragmatic interventions were developed that were tailored to the issues identified. Of the 22 subjects usefully engaged in the process, 14 had improved clinical control or medication use three months after intervention ceased. CONCLUSIONS: A sensitive, structured exploration of patients’ beliefs can elucidate useful insights that explain medication use and expose barriers to change. Identifying and discussing these barriers improved management for some. A model to assist such concordant prescribing is presented. Dowell et al BJGP

I summarise the issue in this video:

https://youtu.be/xFQ2kVOMS64

Picture by Victor

The healthcare experience must change

The person who believes they have a problem must be fully involved in the options offered for treatment if healthcare is to result in the best outcomes. Research and experience suggests that may not always be the case:

OBJECTIVE: To evaluate hospitalized patients’ understanding of their plan of care.

PATIENTS AND METHODS: Interviews of a cross-sectional sample of hospitalized patients and their physicians were conducted from June 6 through June 26, 2008. Patients were asked whether they knew the name of the physician and nurse responsible for their care and specific questions about 6 aspects of the plan of care for the day (primary diagnosis, planned tests, planned procedures, medication changes, physician services consulted, and the expected length of stay). Physicians were interviewed and asked about the plan of care in the same fashion as for the patients. Two board-certified internists reviewed responses and rated patient-physician agreement on each aspect of the plan of care as none, partial, or complete agreement.

RESULTS: Of 250 eligible patients, 241 (96%) agreed to be interviewed. A total of 233 (97%) of 241 physicians completed the interview, although sample sizes vary because of missing data elements. Of 239 patients, 77 (32%) correctly named at least 1 of their hospital physicians, and 143 patients (60%) correctly named their nurses. For each aspect of care, patients and physicians lacked agreement on the plan of care in a large number of instances. Specifically, there was no agreement between patients and physicians on planned tests or procedures for the day in 87 (38%) of 229 instances and in 22 (10%) of 220 instances. Complete agreement on the anticipated length of stay occurred in only 85 (39%) of 218 instances.

CONCLUSION: A substantial portion of hospitalized patients do not understand their plan of care. Patients’ limited understanding of their plan of care may adversely affect their ability to provide informed consent for hospital treatments and to assume their own care after discharge. O’Leary et al

Here is my summary of this topic:

Picture by Bruno Dumont

Triggering better health outcomes

The first piece of data we collect in healthcare is: date of birth. Could it be used to trigger better habits?

50th birthday bashes have overtaken 21st celebrations as 50 now considered the “peak” age to throw a party, sales figures for cards and party paraphernalia show.

Sales of 50th birthday cards have for the first time eclipsed the number of 21st birthday cards sold, according to data from Clintons, the UK’s biggest cards retailer.

With 50th birthdays now leading on the birthday league table and accounting for 16 per cent of all card sales, 21st birthday cards now make up 14.1 per cent of all cards sold. Katie Morley. The Telegraph Oct 2017

I explore the possibilities.

Picture by synx508