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Student-based Patient Education in the ED

Student-based Patient Education in the ED

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.

DrawMD

drawMD

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

eyedecide

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.

Sound Builder

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.

sound builder

Diary

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

bristol

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:

Camera

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.

Calendar

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.

Public Health

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

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).

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A fourth year medical student with interest in all things medicine but especially emergency medicine, rural medicine, medical education and social media in health care. While not clerking it out, she is usually running, playing guitar or planning an outdoor adventure.

4 Responses to Student-based Patient Education in the ED

  1. Fantastic post Eve. I have a keen interest for developing effective patient education techniques and am excited to try out some of these tools.

    A question – what kind of responses to you get from colleagues, patients and/or supervisors when you bring out an electronic device such as an iPad or iPhone to use as an education tool? Or even when using an app as a personal resource (such as Epocrates or DxSaurus)? Do you ever encounter issues with people who misinterpret what you’re using the device for?

    • Eve Purdy says:

      Jon, thanks for reading!

      That’s a great question. The key is communication. I always try to let people (patients and supervisors) know what I’m doing and why. Saying, “I’m just going to take a second and look that up” or “let me get a picture up on my iPad so I can give you a better explanation” goes a long ways.

      The other important piece is reading the situation. Some patients are more receptive to technology and when I’m in doubt I just ask. “would you like to learn more, I can show you a few things using my iPad”. Likewise, some supervisors are more tech friendly then others. By paying a bit of attention to how others are behaving around you and what the ‘norms’ of the unit or group you are working with you can’t go wrong. Even if those I am working with aren’t using ipads/smartphones I will but I’ll be extra careful to explain why.

      Hope that helps! Excited to hear about your patient education ideas.

      Eve

  2. Great post Eve. Lots of nice apps.
    But there are some challenges; and a LOT of these are issues around literacy.

    1) If your patient doesn’t read English … Something to consider in this day in age for sure. At times, I find Google Translate is useful (if they read ANOTHER language). But literacy can still be a problem and often its a silent disease. There are still a lot of people who are rue to admit they can’t read well enough to remember your instructions. But you can’t ASSUME everyone can as well.

    2) Health Literacy – the apps with pictures/anatomy rely on some assumption of key anatomic knowledge. Something that might not be present in some pts. You do need to do a fair bit of assessment of health literacy of your patient to truly be able to apply some of your brilliant apps.

    I just wanted to chime in on these topics.

    • Eve Purdy says:

      Teresa,
      Thanks for reading and for the great points! It’s true that for patients who cannot read written instructions may not be the right way to go so I always try to go over them verbally as well. At least if they leave with a written document someone at home or a future health care provider might have some reference.

      @thesgem and I have been speaking about adult health literacy while I’ve been on elective and learned about a few simple ways to evaluate it like the Rapid Estimate of Adult Literacy in Medicine http://www.adultmeducation.com/AssessmentTools_1.html At the end of the day, poor health literacy shouldn’t be a reason to shy away from education but an indication that you need to spend more time and use a variety of words, explanations and tools to get the same point across.
      Nearly every patient encounter is a teaching opportunity and chance to get patients engaged in their own health/wellness.
      I totally agree that for each patient that looks different and requires that we first take the time to understand what each patient’s needs are!

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