5 - 1 - Module 5.1- Evaluating our efforts (19 minutes), Health Literacy and Communication for Health Professionals
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[MUSIC][SOUND] The topic of this video isresults, evaluating our efforts.It's important for you to realize thatconveying health messages clearly inplain language, is not only required bysome professions' code of ethics, butit's also a safety issue andhas legal implications, as well.Therefore, it's important to incorporateways to check for understanding, andassess our communication efforts early andoften.Remember that we should alwaysbe focused on measuring howwell we are communicating in order tohelp people understand our message.One way to be more aware, that theremay be a low literacy situation,is to recognize some of the signsthat have been documented.Here are some clues thata person is not a good reader.Their intake forms are incomplete.They frequently miss appointments.They may not be giving ortaking medicines correctly.They are unable to give a coherent,sequential history.They ask very few questions.They hand materials directlyover to a family member.They try avoiding reading tasks.An example might be s,them saying I forgot my glasses today.They don't always rememberwhat they've read.They stop reading as soon as they finda plausible answer to their question.They take information literally.They often look to things other thanprint information to answer a question.An example would be checking the pill forits appearance insteadof reading the label.When you know the literacy levelof your patients, it allows youto evaluate the situation and make gooddecisions in regards to health literacy.The following video segments share howfaculty members check for understanding asit happens in a pharmacy setting andtwo others in clinical settings.>> Well when we're, when pharmacistscounsel medications to sort of helppatients understand our methods we use,we have a, a three prime question format.What did you doctor tell you thismedication was for what did,how did your doctor tell you to take it?And then what did your doctor tellyou to expect from the medications.So, we use those three prime questions tosort of elicit the information the patientalready knows and so we kind ofhave a baseline of where to start.And then we teach on the medications.Hopefully with patient-friendly language.And, then at the end of the counselingsection we'd go back to the primequestions and s, and ask them again, andthis time ask what is the medication for?How are you going to take it and what canyou expect and when should you follow up?So, we use the questions again at the end.Just sort of come back and assess whetherthey've understood what we've told them.Other things we might do, for example, Iwas talking about the geriatric populationand teaching how to inject insulin orteaching how to use a glaucometerin the pharmacy We show the patienthow to do it on ourselves typically.And then we will actually have, beforethe patient leaves we require them toactually perform a finger stick forthe glaucometer oractually perform an injection with,say saline not with the actual insulin.But, that way we can assess, forexample, with insulin, do they knowhow to draw up the actual dose.Did our message get through?And so we, we use sort of those do one andthen have the patient show us what theyknow, so, that'd be another example.Keeping it, keeping it short, I think,to just the three main questions andhaving patients tell uswhat they know versus having, versusjust saying what did we learn about.You're sort of prompting them,what are the main key points that Iwanted you to get andthen seeing if they actually got them.And same thing for, for techniqueslike the glaucometer and insulin.Making sure that they actually know howto do it before they walk out of there.>> Well, probably the most importantis just not making assumptions aboutwhat the patient understands.Or how they interpret something.Because what mean, might meansomething phrased a certain way,means something to you, might meansomething very different to the patient.So ask going back andasking the patient, okay, what, what didI just tell you and what does that mean?Is helpful sothat you understand what part of itis abso, the patient is absorbing.And we also tend to throwway too much information.As we do in lectures,unfortunately frequently.At once, and as you know,it's throwing Jell-O against the wall and,how much of it's going to stick.When, when, being very being simpler andtrying to get one or two points across,is probably the way to go.I'd do it myself sometimes.I'm trying to be, I don't know, polite andnot underestimate intelligence bypatients soI'm trying to get the subtlety across andit's probably not-you know without a lotof time or a lot of training they'reprobably not going to get it soa simpler message would be more useful.Also probably we need to use peopleother than the physician to do more,more of the training with the,the use of other healthcare professionals.The use of, not with the medicalhome concept coming through.It's using other peoplethat have more time.Even now there's for smoking cessation,there's a lot to teachin most smoking cessation well there'sa 1 800 now number 1 8, 1 800 quit now.And they do the counselling [LAUGH] SoI hand them the card,just tell them a few things, andthen ask them to call that numberbecause they have an hour or, or more.They can stay on the phone andtell the pa,and do the training I and,that I don't have time for.So using other sources is important.>> I want to tell you a story thathappened to me when I was a residentin San Francisco.There was a couple that cameto my to my to the office[INAUDIBLE] at the university, andthe, it was a husband and wife.They had, the wife had multiple sclerosis.This is a condition thatattacks the nerves andprogressively until the patient isessentially completely paralyzed.The, the, the wife could only atthat point, only move her eyes, soshe could only blink.And the husband was givenall of the information.And, I felt like I wanted to havea rapport with the patient directly.So, I did ask her to blink once fora yes and blink twice for no.And then I asked her questions makesure that she was comfortable before andafter the treatment, that she agreed tothe treatment that we were going to do.And now thinking back I mean, there wasdefinitely a good choice to do that,where we didn't necessarilygo through the husband.The husband seemed like a nice person,but he was talking a lot forthe, for the wife, andobviously the wife couldn't speak.But it was important for the wife toalso be able to say what she wanted.What I wish I'd done at the time.Unfortunately I only saw her fora few visits andthen I'll,I finished with my residency and moved on.But I would've liked to be able to maybe,instead of, yes, giving her yes and no,also give her in the specific questions,allow her to also have maybean open ended question.Maybe ask her, is there anythingthat you would like to say?And then have her say yes orno, is anything sokind of actually essentially her guidingthe equation rather than me guiding them.So I feel like that I wish I'ddone that you know at that time.Also I wonder you know the,her start was the dental,the dentition was really in bad shape.She had cavities everywhere.And I think about these you knowlaws that protect children andfrom, from abuse, andI wonder you know, is this abuse?Because, the husband said this some,something that you knowwe didn't realise andnow, now that we're bringing her, probablyafter a long time, to the, to the dentist.But it was too late,nobody took care of her teeth.So I thought the dad was probably,I wish there was a law that reallykind of protected these patients.>> As you've just heard, it's veryimportant to incorporate ways to check forunderstanding andassess our communication efforts earlyenough and throughout our practices.Now let's listen to some patientperspectives about their experiences withdifferent types of communication tools.>> When I went in for the skull operation,I came in with my own skull because I'm ina medical library, and we check them out.So I took my skull in, and I saidshow me here what's going to be cut.And we looked at it, andI said okay, that's great.And I said, I looked around the room andI said,well where are your anatomical models?He said, most people don't want to know.>> My next story is about my father.He had heart surgery.A few days after the surgery, severalhis deaf friends came and visited him.They just spent time chatting andcatching up.One person, a lady with papers,came into the room looking around andnot sure what to do.She went ahead and started talkingto my father, but my father is deaf.He looked at her a bit confused.I had to tell her to hold up,and that he was deaf.The woman said oh, and looked surprised.Oh, he's deaf, okay It was clear sheneeded to tell my father something, soone of his deaf friends who could hearjust a little bit volunteered to try andfigure out what she needed to say.The woman started explaining something,butmy father's friend could only catch heart,test, electric, shock, shock, electric.Do you want that?The friend tried her best to listen andinterpret but my dad, of course stared andsaid electric, test, what?My dad said, no, I don't want it.The woman gave him some papers andsaid to read over them and think about it.She left and we were left confused.That friend was not an interpreter sothat was the best we could do.We read the papers and realizedthey were talking about pacemakers!A few days later another person,with an interpreter this time, came in.They explained that they would...
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