Tuesday, April 29, 2008

Why doctors should not educate their patients

I am a big believer in patient education . I feel this empowers patients and allows them to form a partnership with their doctors. All these years, I have advocated that doctors spend time on educating their patients, but I have now had to change my beliefs, and I no longer think doctors should educate their patients.

Let me clarify.

1. Most doctors are not good educators. They use complex medical jargon and are not able to simplify matters, so that that patients often cannot understand what they are saying.

2. Doctors have not been taught how to teach patients , and this is not always an easy skill to acquire.

3. Because doctors can be intimidating , patients are very reluctant to ask questions. This means that even though the doctor feels that he has provided an adequate explanation, the patient often understands very little, and is still full of doubts and queries. After all, good communication is always a two-way process.

4. Often , the doctor may not provide the right information , because of a vested interest or a hidden agenda.

5. Doctors find educating patients very boring and get fed up very quickly of answering the same questions

6. The doctor's time is precious , and could be better utilised in providing clinical care ( making the right diagnosis; and executing the treatment plan. )

So what is the solution ? Just like we have independent trained counselors who can guide patients, we need to have patient educators to educate patients. This does not mean we need to create new jobs or positions. It just means that the clinic should identify one person who likes talking to patients and is good at this . This is often an innate skill( these are "people persons " !) which can be polished with training . This person could be a nurse or a secretary who then takes on the additional responsibility of educating patients. They are likely to do a much better job than the doctor can , for many reasons.

1. They often have more time

2. Patients are much more comfortable talking to them , rather than the doctor; and are much more likely to ask questions

3. They are much more likely to use the local language , when providing explanations. This helps patients to understand complex concepts much more easily

4. Because they spend a lot of time educating patients , constant repetition will ensure they get very good at it. They can use a number of teaching tools and models to help them get their point across

This is a much more cost effective way of educating patients , rather than using the doctor's expensive time !

This model means that doctors will continue to prescribe information therapy. It is just that the information therapy would be dispensed by someone else in the clinic other than the doctor.

In the past , doctors would do all the lab tests themselves. Today , these lab tests are outsourced to a specialised pathology laboratory. Using exactly the same analogy , patient education can be better provided by an individual who has a special interest in this field. This creates a win-win situation, where everyone benefits. More importantly , it also serves to emphasize how highly the doctor regards patient education ! If we have specialists for taking x-rays ( called X-ray technicians), why can't we have specialists for educating patients ?

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