January 1996 Bulletin

Patients need more information

The need for patient education is greater now than ever before.

Today's patients have become educated consumers, who are very aware of medical treatments and technologies. They're exposed to the almost daily announcements of medical breakthroughs and new drugs in their newspapers and on the 15-second "health" segments on TV news programs. Their favorite magazines feature articles and health columns on how to prevent disease and disorders, and bookstore shelves bulge with volumes on how to lead a healthier life.

Some patients are very aggressive in their search for information. They collect articles in newspapers and magazines, hunt for authoritative studies in scientific journals, and browse through the Internet. They call and write medical associations to find out if there are endorsements or position statements on procedures.

Other patients are less aggressive; they just want their doctor to help them make major decisions and receive some printed information to help them remember what the orthopaedic surgeon told them.

Focus group sessions conducted for the Academy last fall found that while printed material was important, the one-on-one discussion with the orthopaedic surgeon is the patients' first choice for education and cannot be replaced by any other format.

Patients told the researchers that the discussions reassure them that they are not just a "case." The discussion gives the patient confidence about the procedure and the orthopaedic surgeon.

Orthopaedic surgeons also recognize that patients have become more curious about their health and that it has become more important to "educate" the patient.

The researchers found that orthopaedic surgeons believe an educated patient has better results and a faster, more successful recovery.

Patient satisfaction is becoming an increasingly important measure of outcome. A patient who is informed about treatment options and made the decision to have a particular treatment, and who has realistic expectations about the outcome and possible complications is less likely to be a dissatisfied patient.

The informed patient is more likely to tell the health maintenance organization or insurance company that they are satisfied with the physician's medical treatment and less likely to file a malpractice suit.

Some orthopaedists believe that changes in the health care delivery system will increase the need for more brochures, booklets, and videos. They contend that managed care-employed physicians with heavy case loads or those who are trying to offset eroding incomes by treating more patients will have less time to spend with their patients.

The interviews with 11 orthopaedists conducted for the Academy last fall doesn't bear that out. These orthopaedic surgeons all met with the patients and said they discussed the surgical treatment, complications, risks, and expected outcome.

An orthopaedic surgeon in Texas offered the following typical description:

"I will have a detailed discussion with the patient, bring out some models, describe the procedure, how I expect their course is going to go in the hospital and at home, and then I will review the risks and the benefits of the procedure, and all potential complications I think are pertinent. I then answer any questions they may have and usually for most of the procedures that I do, I have a patient education booklet."

The orthopaedic surgeons who distribute printed material know that the patient won't remember everything he or she has heard or that the brochure will prompt a question and a call back later. The brochure also helps educate the other family members about what the patient will experience in the surgical treatment.

However, not all orthopaedists distributed brochures or booklets. One orthopaedic surgeon explained that "there is nothing that explains exactly the way that I do it." Another preferred to provide his own individualized postoperative instructions for his patients.

A series of interviews with office administrators and nurses last summer by the Academy's department of communications found that many have developed their own printed material which matched the protocols of the physicians more closely than the generic brochures in the marketplace. In some cases, the nurses compiled a list of the most frequently asked questions from patients and created a handout for patients.

The Academy's Committee on Public Education is studying the development of handouts on treatments that can be personalized by orthopaedic practices.

Although some orthopaedic surgeons said they didn't hand out printed material, orthopaedic office managers and patients made it clear in the focus group sessions that they believed that brochures or booklets should always be given to the patient to take home.

The patients said the brochures and booklets should be interesting and comprehensible, not technical; there should be photographs and illustrations; and the print should be large.

Patients are most interested in postoperative information. They want to know how long they'll have to wait before returning to normal activities. They want specific, pertinent information.

Orthopaedic surgeons and patients were less enthusiastic about the use of videotapes for patient education. Some orthopaedists talked about the expense and the need for a room to show the video and patients either were afraid they were going to see an actual surgery or that the video would be too general to explain the particular circumstances of their condition.

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