The third article in the series of three related to the FOAM/EM elective is less related to medical student education and is instead focused on patient education and engagement. This is a topic that is growing near and dear to my heart. Why you might ask?
- The emergency department is a confusing place. As a learner I sometimes barely understand what is happening so how can we expect patients to keep track of the madness, let alone remember what happened when they go home. There are a variety of factors making it even more difficult including, pain, fear and frustration.
- Depending on the institution, approximately 1/5 patients seen in the department are admitted. This means that for 4/5 patients we are the beginning, middle and end of their immediate contact with the health care system. There isn’t anybody who will explain what is happening further down the line. We cannot afford to pass the buck.
- Patients using the emergency department may not be receiving regular care elsewhere. We could be the only point of contact for patient education.
- An emergency department visit may be a turning point for patients and their families. You might have a captive audience to speak about important health concerns.
- It is central to the CanMEDs Advocacy competency
- One of the luxuries of being a medical student is time. It is possible to take the extra 3-5 minutes to focus on patient education. It is something that we can do. Patients leave happier and I am happier too.
There are numerous ways, opportunities and types of patient education that are possible in the ED. In this post I will focus on how I have used a few iPad apps and traditional methods to improve such interactions with patients and finish with a few pie in the sky visions of how I hope this field might evolve.
For basically any anatomy drawing that you need DrawMD is the place to start. Instead of chicken scratched diagrams (especially problematic if you are like me and have zero artistic talent), use one of these templates as the foundation for discussion with a patient. I have downloaded the whole set and use them four or five times a shift.
Eye Decide and Spine Decide
These apps are nice for “point of care patient education”. What is a herniated disc? Why do you get pain in your legs with sciatica? What is pink eye? The added in videos are a nice feature.
A patient says, I have a murmur or you hear one on exam. Why not show her (if she wants) what you are talking about. This app lets you build a murmur and play it through the speakers on your phone so that the patient can hear ‘her’ heart too. It can serve as a jumping off point for discussion about her heart condition or it perhaps more importantly it puts their health into something more then words that doctors use.
When patients come in with ongoing conditions and we have worked them up in the ED without being able to track down a cause and we are getting ready to discharge, I have found that taking the time to help them download an app
on their smartphone to track their symptoms moving forward makes the interaction end on a positive note. It might also help colleagues who are seeing the patient as an outpatient later on down the road with diagnosis beyond the acute conditions we focus on in the ED. A few examples are:
Whenever any patient has a skin condition, laceration or infection I encourage them to take a picture of the area with their smartphone. At the same time I discuss what types of complications they should look out for and explain that they would likely see a different doctor when they come back. A picture a day can help the next doctor see the healing (or complication) in ‘real’ time.
The calendar on any phone is an awesome tool. Help patients set reminders to take antibiotics/medication or to phone the family doctor for a follow-up appointment.
See a patient with a fracture? It’s a great time to talk about smoking cessation because tobacco and bone healing don’t go well together. Suggest that they talk to their family doctor or local smoking cessation program but also mention some of these free apps.
Pen and Paper
I am a believer that patients should leave the department with something in hand. This article highlights patients’ knowledge deficits at discharge. A short discharge note is especially important when there is a language or other barrier to verbal communication. As a learner putting pen to paper also makes sure that I don’t miss anything important when I am discussing discharge with the patient. In my note I include:
- the diagnosis (or more often than not a symptom not yet diagnosed) and any important tests
- what to do at home at home
- what medications were changed and why
- when/how they should follow up with a family (or other) doctor and what they should bring with them when they do
- when they might expect to improve and what symptoms should make them return to the department
I try to write in layman’s terms. In certain contexts it might include a link to a good website or youtube video about their condition. For me this still with pen and paper. The emergency departments that I have worked in do not have the infrastructure in place for it to be typed and printed, let alone delivered to patients electronically.
The future of patient education in the ED is limitless. Technological advances will allow us to move beyond the traditional time barrier to provide education to patients. Just ask @MeganRanney, who is doing amazing research into the use of text-messaging for ED patients after they have been in the department.
At registration, next to home phone numbers we will collect patients’ email addresses. This would allow, at the patients’ request and permission, quick discharge notes to be sent directly to their inbox with links to reputable sources of information about their condition and important reminders. I do recognize that there are complex and very important issues related to patient confidentiality but to provide better care we will need to continue to find ways to bring patient education and engagement to the 21st century.
Share your tips for patient education in the ED in the comments section below!
This post was reviewed by Nadim Lalani (@ERMentor).