Last month I had the honour of presenting to my colleagues at our provincial convention in Saskatoon. Much of my presentation centered around health literacy. I reviewed research that highlighted how strikingly little information is retained by patients following their interactions with their doctors (McGuire 1996; Kessels 2003). Even more concerning is that, according to some older research, about 48% of the information that is retained is remembered incorrectly (Anderson et al. 1979)! While these studies are dated, more current studies are pointing in the same direction, suggesting that patients fail to remember even topics of discussion (Richard, Glaser, and Lussier 2017; Sinnadurai et al. 2022).
How do we improve this?
First, we recognize that there is a gap in doctor-patient conversations without judgment. Done!
Second, we address the players involved. You, the patient, and the doctors. We look for shortfalls; then find solutions/ strategies to narrow the gap. Remember, the ultimate goal for both you and your doctor is for you to be well.
My presentation to my colleagues focused on different considerations and strategies we can employ, as doctors, to better communicate with, educate, and engage patients in a meaningful way. Something that I have always been thankful for, (and feel is a particular advantage to naturopathic care), is the time we are able to spend with you, our patients. This time provides you with a number of benefits. You have more time to ask questions and we have time to build a working relationship that makes you more comfortable to be open and explain your concerns and ask questions.
Today, I would like to focus on your side (the patient side) of our conversations. Let’s review a number of items that can help you to get the most out of your interactions with your ND and all of your healthcare providers:
Don’t be afraid to ask questions
Your doctor might use words, phrases, or concepts that you are not familiar with. This is never intended to confuse you. If you don’t understand, ask for clarification.
Every question is welcome! Your doctor’s job is to teach you about your health. To explain your condition, provide options, clarify the information they are providing you and how it applies to you, help you make an informed decision, and finally help you formulate a plan to move forward. The foundation for all of this centers around your understanding so …. ask lots of questions!
Make sure you understand the numbers
Your doctor may give you numbers to help explain your risk of a particular health concern or outcome. It is important that you understand these numbers and how they apply to you specifically. This can be tricky business! Often doctors need a moment to get the statistics straight. So, if you have questions, it is only natural!
One critical piece; to understand is whether the numbers you are being presented with are a) relative, or b) absolute.
Let’s make an example with “Treatment X” and “Condition A”. In this example, let’s say that Treatment X decreases the risk of reoccurrence of Condition A by 50%. This sounds great, right?!? Let’s dig a bit deeper.
This 50% reduction of risk is a “relative risk reduction” meaning that it is relative to the total risk of recurrence. Let’s unpack this a bit more.
If the total risk of the recurrence is 4%, this would mean that this 50% “relative risk reduction" equates to an “absolute risk reduction” of 2% (4% total recurrence rate x 50% reduction).
Both statements; a 50% “relative risk reduction” and a 2% “absolute risk reduction” are true, however, understanding BOTH numbers is important for you to make a fully informed decision about how you wish to proceed with Treatment X.
Continuing with this example, it is also important that you understand what a 4% total recurrence rate means. Another way to say this is 4 out of 100 people would be expected to have a recurrence of Condition A. Said yet another way, 96 out of 100 people would not be expected to see a recurrence of Condition A.
I will say it again, the numbers can be tricky, and it is important that you understand them. Don’t be afraid to ask questions!
Teach your doctor about yourself
Ensure you are clear about your values, preferences, and non-negotiables. Teach your doctor about your fears, concerns, and struggles. Use your own words to describe your concerns, body parts, and symptoms. Tell them how you like to be addressed. Teach them about your culture, traditions, and regular practices. Your doctor may have questions; help them by clarifying. It is important that your doctor understands you in order to provide information, feedback, and a care plan that will work for you. If the information that is presented doesn’t work for you, tell your doctor and work with them to change your care plan to fit your values and needs.
Ensure your doctor understands you
Often, as doctors, we will reflect back to you what you have told us. This is your opportunity to clarify! Don’t be afraid to correct your doctor! In these moments we are deliberately seeking clarity and not your agreement. Help your doctors by providing constructive and honest feedback.
Be ready to problem solve and ask for what you feel you need
Our job, as doctors, is to help you form a care plan that works for YOU! The most perfectly planned and thought-out treatment plan will never be effective if you can’t, won’t, or don’t execute it. Be honest with yourself and your doctor about your capacity to follow through. It is ok if you need to modify the plan. The ultimate goal is to help you achieve your health goals; this cannot be achieved with an unrealistic plan.
Always be open and honest
We all struggle sometimes; this is natural and part of being human. It may be difficult to open up to your doctor about certain topics. Remember that everything you share is confidential and that we are here to help you. The better our understanding of your concerns, the more complete we can be in our work with you. If it is difficult for you to talk about something let us know that this is a sensitive topic for you, this might make it easier.
It is also important to let your doctor know if you have struggled with a plan that you put in place. This is not admitting to failure, but rather, asking for help. Let’s face it any change is hard! It is important that you are honest about your challenges with both yourself and your doctor. We are here to understand your challenges and build a new, more realistic way to help you reach your goals.
Articulate your priorities
Again, the work you do with your doctor is collaborative. It is important that you are able to articulate your health goals and priorities to help guide your healthcare visits. Your doctor will also have some priorities for you based on issues they might see. Your visits together are the times that these priorities come together.
Keep your doctor up to date
This may sound obvious, but things are going to change with your health. Personal situations, priorities, values, etc. In order to help, your doctor needs to be updated on these changes.
You need to be ready
Committing to yourself and your health is going to take work and commitment. Being ready to take this on is paramount to your success. If you are not ready, it is important to recognize this. Sometimes there are simpler options to get you started, however, you may also consider waiting until you are ready.
There is a second way to look at this point. That is being ready for each appointment. There is generally a lot to cover in a short time during your health appointments. Spending a few moments to write down some questions or topics that you would like to discuss with your doctor can be really helpful.
Avoid taking on more than you can handle
It is common to over-commit. This is true of your health as well. I suggest shifting your priority to continued forward momentum, rather than making changes all at once. Move one step at a time and with intention.
Bring a friend
A lot of information is covered in visits. Consider bringing a trusted friend or family member with you. This person can also help to advocate for you and ask additional clarifying questions.
Take Notes
Having a record of what was discussed in your appointments can be very helpful. Most NDs will also provide you with a summary of your appointment in a digital or paper format for you to review. Return to these notes to keep you on track with your goals.
To sum up, collaboration is the key! Just like any relationship, it does take a bit of work. With an open mind, patience, and commitment we can help you achieve your goals. I would like to finish by repeating that the ultimate goal for both you and your doctor is for you to be well.
Work together with your healthcare provider in honour of your highest potential!
References:
Anderson, J. L., Sally Dodman, M. Kopelman, and A. Fleming. 1979. “PATIENT INFORMATION RECALL IN A RHEUMATOLOGY CLINIC.” Rheumatology 18 (1): 18–22. https://doi.org/10.1093/rheumatology/18.1.18.
Kessels, Roy P. C. 2003. “Patients’ Memory for Medical Information.” Journal of the Royal Society of Medicine 96 (5): 219–22. https://doi.org/10.1177/014107680309600504.
McGuire, L. C. 1996. “Remembering What the Doctor Said: Organization and Adults’ Memory for Medical Information.” Experimental Aging Research 22 (4): 403–28. https://doi.org/10.1080/03610739608254020.
Richard, Claude, Emma Glaser, and Marie-Thérèse Lussier. 2017. “Communication and Patient Participation Influencing Patient Recall of Treatment Discussions.” Health Expectations: An International Journal of Public Participation in Health Care and Health Policy 20 (4): 760–70. https://doi.org/10.1111/hex.12515.
Sinnadurai, Siamala, Pawel Sowa, Piotr Jankowski, Zbigniew Gasior, Dariusz A. Kosior, Maciej Haberka, Danuta Czarnecka, et al. 2022. “Recollection of Physician Information about Risk Factor and Lifestyle Changes in Chronic Coronary Syndrome Patients.” International Journal of Environmental Research and Public Health 19 (11): 6416. https://doi.org/10.3390/ijerph19116416.